Asthma is a chronic inflammatory airway disease characterized by reversible airflow obstruction. It affects 300 million people worldwide and poses a large socioeconomic burden. The disease severity can range from intermittent to persistent daily symptoms. Common triggers include allergens, infections, pollution, and exercise. Diagnosis involves assessing symptoms, lung function testing, and allergy testing. Treatment involves avoidance of triggers, bronchodilators for relief of acute symptoms, and anti-inflammatory controllers like inhaled corticosteroids to prevent symptoms and exacerbations.
These lecture notes were prepared by Dr. Hamdi Turkey- Pulmonologist- Department of internal medicine - Taiz university
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Bronchial Asthma: Definition,Pathophysiology and ManagementMarko Makram
Definition and Pathophysiology of Asthma in addition to classification and recent updates in the management of asthma based on GINA-2019 Guidelines, by Dr. Marco Makram.
These lecture notes were prepared by Dr. Hamdi Turkey- Pulmonologist- Department of internal medicine - Taiz university
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Bronchial Asthma: Definition,Pathophysiology and ManagementMarko Makram
Definition and Pathophysiology of Asthma in addition to classification and recent updates in the management of asthma based on GINA-2019 Guidelines, by Dr. Marco Makram.
BRONCHIAL ASTHMA
ntroduction
Definition
Etiological factors
Pathophysiology
Types of asthma
Clinical manifestation Restlessness Wheezing or crackles Absent or diminished lung sounds Hyper resonance Use of accessory muscles for breathing Tachypnea with hyperventilation
Clinical manifestation
Diagnostic evaluation
Bronchoprovocation Testing: Testing that is done to identify inhaled allergens; mucous membranes are directly exposed to suspected allergen in increasing amounts. Skin Testing: Done to identify specific allergens. Exercise Challenges: Exercise is used to identify the occurrence of exercise-induced bronchospasm. Radio allergosorbent Test: Blood test used to identify a specific allergen. Chest Radiograph: May show hyper expansion of the airways.
Managemnet
Goal- Promote bronchodilationn Reduce inflammation Remove secretions Prevent ongoing symptoms Prevent asthma attack Maintain normal lung function Avoid triggers
Pharmacological therapy 1. Long term control medication- Inhaled corticosteroid Leukotriene modifiers Long acting beta agonist Methylxanthines Combine inhaler
2 Quick relief medication Short acting beta agonist Anticholinergic Oral or I/V corticosteroid
3 Bronchial thermoplasty- Form severe asthma that does not respond to medication
Non- pharmacological
Oxygen therapy Postural drainage & chest physiotherapy Coughing & deep breathing exercise Avoidance of allergen relaxation technique acupuncture
Prevention
Patients with recurrent asthma should undergo tests to identify the substances that precipitate the symptoms. Possible causes are dust, dust mites, roaches, certain types of cloth, pets, horses, detergents, soaps, certain foods, molds, and pol- lens. If the attacks are seasonal, pollens can be strongly sus- pected. Patients are instructed to avoid the causative agents whenever possible.
Complications Complications of asthma may include status asthmaticus, respiratory failure, pneumonia, and atelectasis. Airway obstruction, particularly during acute asthmatic episodes, often results in hypoxemia, requiring the administration of oxygen and the monitoring of pulse oximetry and arterial blood gases. Fluids are administered, because people with asthma are frequently dehydrated from diaphoresis and in- sensible fluid loss with hyperventilation.
Nursing diagnosis
Impaired gas exchange r/t altered oxygen supply Ineffective airway clearance r/t bronchospasm & obstruction from narrow lumen Ineffective breathing pattern r/t bronchospasm Risk for increasing attack of r
espiratory distress r/t exposure to allergens
BRONCHIAL ASTHMA
ntroduction
Definition
Etiological factors
Pathophysiology
Types of asthma
Clinical manifestation Restlessness Wheezing or crackles Absent or diminished lung sounds Hyper resonance Use of accessory muscles for breathing Tachypnea with hyperventilation
Clinical manifestation
Diagnostic evaluation
Bronchoprovocation Testing: Testing that is done to identify inhaled allergens; mucous membranes are directly exposed to suspected allergen in increasing amounts. Skin Testing: Done to identify specific allergens. Exercise Challenges: Exercise is used to identify the occurrence of exercise-induced bronchospasm. Radio allergosorbent Test: Blood test used to identify a specific allergen. Chest Radiograph: May show hyper expansion of the airways.
Managemnet
Goal- Promote bronchodilationn Reduce inflammation Remove secretions Prevent ongoing symptoms Prevent asthma attack Maintain normal lung function Avoid triggers
Pharmacological therapy 1. Long term control medication- Inhaled corticosteroid Leukotriene modifiers Long acting beta agonist Methylxanthines Combine inhaler
2 Quick relief medication Short acting beta agonist Anticholinergic Oral or I/V corticosteroid
3 Bronchial thermoplasty- Form severe asthma that does not respond to medication
Non- pharmacological
Oxygen therapy Postural drainage & chest physiotherapy Coughing & deep breathing exercise Avoidance of allergen relaxation technique acupuncture
Prevention
Patients with recurrent asthma should undergo tests to identify the substances that precipitate the symptoms. Possible causes are dust, dust mites, roaches, certain types of cloth, pets, horses, detergents, soaps, certain foods, molds, and pol- lens. If the attacks are seasonal, pollens can be strongly sus- pected. Patients are instructed to avoid the causative agents whenever possible.
Complications Complications of asthma may include status asthmaticus, respiratory failure, pneumonia, and atelectasis. Airway obstruction, particularly during acute asthmatic episodes, often results in hypoxemia, requiring the administration of oxygen and the monitoring of pulse oximetry and arterial blood gases. Fluids are administered, because people with asthma are frequently dehydrated from diaphoresis and in- sensible fluid loss with hyperventilation.
Nursing diagnosis
Impaired gas exchange r/t altered oxygen supply Ineffective airway clearance r/t bronchospasm & obstruction from narrow lumen Ineffective breathing pattern r/t bronchospasm Risk for increasing attack of r
espiratory distress r/t exposure to allergens
I am professionally pharmacist. These slides for pharmacy department students based on clinical subject. Very helpful for students who get more benefits.
Asthma is a chronic inflammatory condition associated with airway hyperresponsiveness (an exaggerated airway-narrowing response to specific triggers such as viruses, allergens and exercise).
Physiotherapy can provide relief from symptoms of uncontrolled asthma, including coughing, wheezing, tightness in the chest, shortness of breath and QOL.
Bronchial Asthma - Epidemiology, Pathogenesis and ManagementShashikiran Umakanth
Bronchial asthma is a chronic disease with airway inflammation as a central theme in its pathogenesis. Prevalence of this condition is gradually increasing, especially in developed countries and in countries that are getting "westernized". With early diagnosis, regular monitoring and prompt and rational treatment, most patients with asthma can lead a symptom-free life.
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
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2 Case Reports of Gastric Ultrasound
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
2. DEFINITION
Chronic inflammatory disorder of the airways
Widespread but variable airflow obstruction
that is often reversible either spontaneously
or with treatment
Bronchial hyperresponsiveness to a variety of
stimuli
3. affects 300 million people world-wide
socio-economic impact is enormous,
poor control leads to days lost from
school or work, unscheduled health-care
visits and hospital admissions
4. Adult Asthma Facts
14.5 million workdays lost due to asthma, a 2.3
fold increase from the early 80s to the mid 90s
Adults accounted for over 1.3 million ED visits
and 288,000 hospitalizations due to asthma
One third of asthma related deaths occur in
patients 35-44 years old
Over 50% of asthma related deaths occur in
patients 65 years and older
Morb Mortal Wkly Rep. 2002 March 29; 51:1-13.
5.
6. Atopy
major risk factor for asthma
genetically determined production of
specific IgE antibody
suffer from other atopic diseases,
particularly allergic rhinitis and atopic
dermatitis (eczema)
most common allergens are - house
dust mites, cat and dog fur,
cockroaches, grass and tree pollens
7. Most Patients with Asthma Have Allergic Rhinitis
Approximately 80% of asthmatics
have
allergic rhinitis
Asthma
alone
Allergic rhinitis
alone
Allergic
rhinitis
+
asthma
Adapted from The Workshop Expert Panel. Management of Allergic Rhinitis and its Impact on Asthma (ARIA) Pocket
Guide. A Pocket Guide for Physicians and Nurses. 2001; Bousquet J and the ARIA Workshop Group J Allergy Clin
Immunol 2001;108(5):S147-S334; Sibbald B, Rink E Thorax 1991;46:895-901; Leynaert B et al Am J Respir Crit
Care Med 2000;162:1391-1396.
8. IgE and Asthma in Adults
Asthma
Serum IgE (IU/mL)
Odds ratio
N = 2657
0.32 1 3.2 10 32 100 320 1000 3200
4400
2200
1100
55
22..55
11
Burrows B, et al. New Engl J Med. 1989;320:271-277.
9. Intrinsic Asthma
negative skin tests to common inhalant
allergens and normal serum
concentrations of IgE
later onset of disease (adult-onset
asthma), commonly have concomitant
nasal polyps, and may be aspirin-sensitive
11. AIR POLLUTION
sulfur dioxide, ozone, and diesel
particulates, may trigger asthma
symptoms
Indoor air pollution may be more
important with exposure to nitrogen
oxides from cooking stoves and
exposure to passive cigarette smoke
12. OCCUPATIONAL
EXPOSURE
relatively common and may affect up to
10% of young adults
Chemicals such as toluene
diisocyanate and trimellitic anhydride,
fungal amylase in wheat flour in bakers
suspected when symptoms improve
during weekends and holidays
29. SYMPTOMS
Recurrent episodes of:
Shortness of breath
Wheezing
Chest tightness
Cough, particularly at night and early in the
morning
30. PATTERN OF SYMPTOMS
Perennial, seasonal or both
Continual, episodic or both
Diurnal variations, especially nocturnal
and on awakening early in the morning
32. PHYSICAL EXAM
Normal physical exam - asthma is
under control
Expiratory wheezing with normal or
decreased air movement
Accessory respiratory muscle use
Ominous sign- no wheezing with
decreased air movement
33. Cough may be the dominant symptom
in some patients, and the lack of
wheeze or breathlessness may lead to
a delay in reaching the diagnosis of so-called
‘cough-variant asthma
35. Spirometry: A Simple, Basic
Measurement
Essential to initial evaluation
Helps assess severity of airflow obstruction
Aids in differential diagnosis
Obstructive versus restrictive airway
disease
Reversibility of airflow obstruction
Confirms periodic home PEFR
measurements in selected patients
36. Spirometry in asthma
reduced FEV1, FEV1/FVC ratio, and PEF
Improvement in FEV1>12% with
bronchodilator therapy
Measurements of PEF twice daily may
confirm the diurnal variations in airflow
obstruction – more than 20% is considered
diagnostic
42. Bronchoprovocation
Challenges
methacholine or histamine challenge
calculation of the provocative
concentration that reduces FEV1 by
20% (PC20)
Measures the increased AHR
exercise testing is done to demonstrate
the postexercise bronchoconstriction if
there is anpredominant history of EIA
43. Reasons for Performing
Bronchoprovocation Challenges in
Clinical Practice
To quantify the severity of the airway
hyperresponsiveness(AHR)
Clarify a clinical diagnosis of asthma when a
reasonable degree of doubt exists
To determine the presence of bronchial
hyperresponsiveness in patients with chronic
cough
47. EVALUATION
CBC with differential ( eosinophilia often
seen in asthma, ABPA and CS vasculitis)
Total igE
specific IgE to inhaled allergens
[radioallergosorbent test(RAST)]
CXR
CT of the chest
ABG in status asthmaticus
48. Exhaled NO is now being used as a
noninvasive test to measure
eosinophilic airway inflammation
The typically elevated levels in asthma
are reduced by ICS, so this may be a
test of compliance with therapy
50. Classification of Asthma
sx frequency less than 2 times / week sx frequency 2 times / week or more
Intermittent Asthma Persistent Asthma
MILD
sx frequency >2/days
per week, not daily
FEV1>80%
MODERATE
sx frequency daily
FEV1=60-80%
SEVERE
sx frequency
throughout the day
FEV1<60%
51. Goals of Therapy: Asthma Control
■ Minimal or no chronic symptoms day or night
■ Minimal or no exacerbations
■ No limitations on activities; no school/work
missed
■ Maintain (near) normal pulmonary function
■ Minimal use of short-acting inhaled beta2-
agonist
■ Minimal or no adverse effects from
medications
52. Avoidance of aggravating
factors
particularly important occupational
asthma
relevant to atopic patients where
removing or reducing exposure to
relevant antigens, e.g. a pet animal,
may effect improvement
53. House dust mite exposure may be
minimised by replacing carpets with
floorboards and using mite
impermeable bedding
Measures to reduce fungal exposure
and eliminate cockroaches
Medications known to precipitate or
aggravate asthma should be avoided
55. BRONCHODILATOR
THERAPIES
beta2-adrenergic agonists,
anticholinergics, and theophylline
Short-acting beta2-agonists (SABAs)
such as albuterol and terbutaline – doa
3-6 hrs
Long-acting 2-agonists (LABAs) include
salmeterol and formoterola doa >12
hours
56. CONTROLLER
THERAPIES
Inhaled Corticosteroids - most effective
controllers for asthma
Systemic Corticosteroids
Antileukotrienes - montelukast and
zafirlukast
Cromones - Cromolyn sodium and
nedocromil sodium
Anti-IgE -Omalizumab
Slide 4
Allergic rhinitis and asthma frequently coexist. Most patients with asthma have allergic rhinitis (up to 80%).15-18 Among participants from two French centers in the European Community Respiratory Health Survey (ECRHS), 79% (77/98) of patients with asthma had concurrent rhinitis, and 20% (77/378) with allergic rhinitis had concurrent asthma. Asthma was defined as one or more asthma attacks in the preceding 12 months or positive response to metachloline challenge. Patients were considered to have allergic rhinitis if they responded positively to one or two questions regarding rhinitis symptoms.18
Epidemiologic studies support the suggestion that allergic rhinitis should be suspected as a comorbid condition in most patients with asthma.
IgE is a key component of asthma in most asthma patients, as shown by Burrows and colleagues who investigated the relationship between IgE levels and the risk of developing asthma in adults. As the graph shows, the higher the total serum IgE concentration, the higher were the odds of having asthma.
Burrows et al studied the association of self-reported asthma and serum IgE levels in 2657 subjects in a general population. They found that, regardless of the subjects’ allergy status or age group, the prevalence of asthma was closely related to the serum IgE level (P&lt;0.0001).
The figure in this slide shows the odds ratio of having asthma at seven levels of total IgE concentrations after correction for age, sex, smoking habits, and skin-test index in a logistic analysis. The solid green line represents the risk of asthma. Vertical lines are 95% confidence intervals around the regression for each odds ratio corresponding to a given log IgE level. The log odds ratio of having asthma increases linearly with the serum IgE level.
Burrows B, Martinez FD, Halonen M, Barbee RA, Cline MG. Association of asthma with serum IgE levels and skin-test reactivity to allergens. N Engl J Med. 1989;320:271-277.
The high levels of TH2-type cytokines that are found at sites of allergic inflammation are consistent with a TH2-cell-based aetiology of atopic disease. Furthermore, studies in mouse models of asthma have shown that allergic airway inflammation is dependent on CD4+ T cells and, more specifically, is seen when T-cell receptor-transgenic TH2, but not TH1, cells are adoptively transferred to mice. Finally, the absolute requirement for TH2 cells in directing allergic airway inflammation has been shown by the use of interleukin-4 (IL-4)-deficient mice. In these studies, defective priming of TH2 cells in the absence of IL-4 resulted in a failure to generate allergic inflammatory responses after subsequent airway challenge. Of note, if IL-4 was blocked only during inhaled antigen challenge, airway inflammatory responses were intact, indicating that once TH2-cell priming has occurred, IL-4 is no longer necessary for airway inflammation. This has also been confirmed by studies in which effective TH2-cell sensitization was achieved despite the absence of IL-4. Specifically, we have shown that IL-4-independent TH2-cell responses with high levels of IL-5 and IL-13 production can be generated in IL-4-deficient mice by epicutaneous exposure to soluble protein. In this system, mice showed no deficit in airway eosinophilia or mucus secretion following inhaled antigen challenge. So, the main role of IL-4 in allergic airway inflammation is during the initial priming of TH2-effector cells, whereas IL-5 and IL-13 have been shown, in numerous studies in both mice and humans, to be more directly responsible for the characteristic eosinophil infiltrates and mucus hypersecretion.
IgE binds to high- and low-affinity receptors (FcRI or FcRII) on effector cells. The inflammatory cascade is initiated when IgE bound to effector cells is cross-linked by allergen. This results in the degranulation of effector cells and the release of a comprehensive array of mediators that are linked to the pathophysiology of asthma.
This slide shows autopsy specimens from the small airways of a patient with chronic severe asthma, a patient with acute fatal asthma, and a normal individual. In the healthy individual, the epithelium is not highly folded and the lumen remains open. In contrast, the airway wall of the patient with acute fatal asthma shows marked thickening and is completely occluded by the highly folded epithelium and mucous plug.
Interestingly, the airway of the patient with chronic severe asthma is less acutely constricted, but the airway wall is still much thicker than normal, and the airway is partially obstructed by a cellular plug.