The document discusses several studies on asthma phenotypes and prognosis. One study of over 1300 teenagers found that 81% of asthmatics were also atopic. Another study identified 5 asthma clusters based on characteristics like age of onset, lung function, and medication use. A third study found that remission of childhood asthma in adolescence occurred in 55% of cases and was not affected by anti-inflammatory treatment.
This document discusses tachypnoea (rapid breathing) in well babies. It begins by covering the physiology of breathing in infants, noting that respiratory rate typically decreases over the first year of life. It defines tachypnoea in infants as a respiratory rate over 60 breaths per minute. The document emphasizes that accurately measuring respiratory rate can be challenging, and recommends using a stethoscope and taking the rate over a full minute while recording the baby's state. It also discusses periodic breathing patterns seen in infants.
The document discusses the evaluation and management of difficult or severe asthma. It notes that in evaluating these patients, it is important to first establish an accurate diagnosis of asthma through objective measures like spirometry before and after bronchodilation. Studies have found that a substantial percentage of patients diagnosed with difficult asthma were later found to have an alternative or incorrect diagnosis after thorough evaluation. Assessing and addressing comorbidities, adherence, environmental factors, and phenotypes is also important for optimizing treatment of difficult asthma. Difficult asthma can be divided into cases where underlying problems can be addressed versus true therapy-resistant severe asthma.
Format 2016: how to get asthma control: from PubMed to the tricks of the trade.Envicon Medical Srl
This document discusses strategies for achieving asthma control. It begins by establishing the importance of a partnership between healthcare providers and patients. Effective self-regulation is key, which involves patients observing their condition, making judgments, and reacting appropriately. Motivational interviewing can help patients progress through stages of change. Active listening from providers helps address patients' cognitive and emotional needs. Both verbal and nonverbal communication impact the relationship and treatment outcomes. Involving children in their care can improve satisfaction and adherence.
This document summarizes established and emerging therapies for severe asthma exacerbations in children. It discusses the prevalence and severity of asthma, as well as standard therapies like oxygen, steroids, and beta agonists. It also reviews newer approaches like continuous albuterol, IV terbutaline, heliox, magnesium sulfate, and mechanical ventilation strategies. Highlights various clinical patterns of asthma and approaches to managing mild-moderate vs. severe exacerbations.
The document discusses asthma in children. It states that asthma is the most common chronic disease of childhood and is a leading cause of morbidity. The symptoms of asthma in children include recurrent wheezing, breathlessness, coughing especially at night or in the morning. It then discusses factors that can influence the development and expression of asthma such as genetic and environmental factors like allergens, infections, tobacco smoke, and air pollution. It also outlines some risk factors for asthma in younger children and discusses guidelines for diagnosing asthma in children of different age groups.
Reporte de la intolerancia a los alimentos y síntomas respiratorios en adulto...MEDIAGNOSTIC
This study assessed reported food intolerance and associated respiratory symptoms in young adults in Melbourne, Australia using data from the European Community Respiratory Health Survey (ECRHS) questionnaire. Seventeen percent of respondents reported food intolerance or allergy, with a wide variety of foods cited as causes. Those reporting respiratory symptoms after food ingestion were more likely to be atopic, have used inhaled medications recently, weigh more, and have less exposure to secondhand smoke. However, current asthma was not associated with reported food intolerance. The study highlights the need for improved dietary assessment methods in investigating relationships between diet and health.
Abstract— Bronchial Asthma is a public health problem in childhood. Allergic Rhinitis (AR) is a very common co-morbidity with Bronchial Asthma. So this study was conducted on 250 Primary School Children to find prevalence of Bronchial asthma and Allergic Rhinitis and their association. It was observed from this study that 17.2% of children were having Bronchial asthma and 20.4% were found to have allergic Rhinitis. Co morbidity of Bronchial Asthma with Allergic Rhinitis was observed in 11.6 % of these cases. It was also observed that Bronchial Asthma was observed significantly more in males than females and children of walled city than outer city. So it was concluded form this study that chances of occurring Allergic Rhinitis is significantly more with Bronchial Asthma than the chances of Bronchial Asthma with Allergic Rhinitis
Unbiased BIOmarkers for the PREDiction of respiratory disease outcomebrnbarcelona
The document summarizes the U-BIOPRED study, which aims to use an integrative systems medicine approach to analyze molecular, physiological, and clinical biomarker profiles from over 1,000 asthma patients. The goal is to identify distinct "handprints" or signatures that can predict clinical outcomes, therapeutic responses, and identify novel treatment targets for severe asthma. The study involves collecting multi-dimensional omics data, including genomics, transcriptomics, proteomics, metabolomics, from various sample types like sputum, biopsies, and breath. It is hypothesized that integrating these complex datasets will enable the definition of clinical and biological phenotypes that can improve asthma management.
This document discusses tachypnoea (rapid breathing) in well babies. It begins by covering the physiology of breathing in infants, noting that respiratory rate typically decreases over the first year of life. It defines tachypnoea in infants as a respiratory rate over 60 breaths per minute. The document emphasizes that accurately measuring respiratory rate can be challenging, and recommends using a stethoscope and taking the rate over a full minute while recording the baby's state. It also discusses periodic breathing patterns seen in infants.
The document discusses the evaluation and management of difficult or severe asthma. It notes that in evaluating these patients, it is important to first establish an accurate diagnosis of asthma through objective measures like spirometry before and after bronchodilation. Studies have found that a substantial percentage of patients diagnosed with difficult asthma were later found to have an alternative or incorrect diagnosis after thorough evaluation. Assessing and addressing comorbidities, adherence, environmental factors, and phenotypes is also important for optimizing treatment of difficult asthma. Difficult asthma can be divided into cases where underlying problems can be addressed versus true therapy-resistant severe asthma.
Format 2016: how to get asthma control: from PubMed to the tricks of the trade.Envicon Medical Srl
This document discusses strategies for achieving asthma control. It begins by establishing the importance of a partnership between healthcare providers and patients. Effective self-regulation is key, which involves patients observing their condition, making judgments, and reacting appropriately. Motivational interviewing can help patients progress through stages of change. Active listening from providers helps address patients' cognitive and emotional needs. Both verbal and nonverbal communication impact the relationship and treatment outcomes. Involving children in their care can improve satisfaction and adherence.
This document summarizes established and emerging therapies for severe asthma exacerbations in children. It discusses the prevalence and severity of asthma, as well as standard therapies like oxygen, steroids, and beta agonists. It also reviews newer approaches like continuous albuterol, IV terbutaline, heliox, magnesium sulfate, and mechanical ventilation strategies. Highlights various clinical patterns of asthma and approaches to managing mild-moderate vs. severe exacerbations.
The document discusses asthma in children. It states that asthma is the most common chronic disease of childhood and is a leading cause of morbidity. The symptoms of asthma in children include recurrent wheezing, breathlessness, coughing especially at night or in the morning. It then discusses factors that can influence the development and expression of asthma such as genetic and environmental factors like allergens, infections, tobacco smoke, and air pollution. It also outlines some risk factors for asthma in younger children and discusses guidelines for diagnosing asthma in children of different age groups.
Reporte de la intolerancia a los alimentos y síntomas respiratorios en adulto...MEDIAGNOSTIC
This study assessed reported food intolerance and associated respiratory symptoms in young adults in Melbourne, Australia using data from the European Community Respiratory Health Survey (ECRHS) questionnaire. Seventeen percent of respondents reported food intolerance or allergy, with a wide variety of foods cited as causes. Those reporting respiratory symptoms after food ingestion were more likely to be atopic, have used inhaled medications recently, weigh more, and have less exposure to secondhand smoke. However, current asthma was not associated with reported food intolerance. The study highlights the need for improved dietary assessment methods in investigating relationships between diet and health.
Abstract— Bronchial Asthma is a public health problem in childhood. Allergic Rhinitis (AR) is a very common co-morbidity with Bronchial Asthma. So this study was conducted on 250 Primary School Children to find prevalence of Bronchial asthma and Allergic Rhinitis and their association. It was observed from this study that 17.2% of children were having Bronchial asthma and 20.4% were found to have allergic Rhinitis. Co morbidity of Bronchial Asthma with Allergic Rhinitis was observed in 11.6 % of these cases. It was also observed that Bronchial Asthma was observed significantly more in males than females and children of walled city than outer city. So it was concluded form this study that chances of occurring Allergic Rhinitis is significantly more with Bronchial Asthma than the chances of Bronchial Asthma with Allergic Rhinitis
Unbiased BIOmarkers for the PREDiction of respiratory disease outcomebrnbarcelona
The document summarizes the U-BIOPRED study, which aims to use an integrative systems medicine approach to analyze molecular, physiological, and clinical biomarker profiles from over 1,000 asthma patients. The goal is to identify distinct "handprints" or signatures that can predict clinical outcomes, therapeutic responses, and identify novel treatment targets for severe asthma. The study involves collecting multi-dimensional omics data, including genomics, transcriptomics, proteomics, metabolomics, from various sample types like sputum, biopsies, and breath. It is hypothesized that integrating these complex datasets will enable the definition of clinical and biological phenotypes that can improve asthma management.
Allergen Skin Test Reactivity and Eosinophilia in Adult Bronchial Asthmatic P...MatiaAhmed
1) The document summarizes a study on allergen skin test reactivity and eosinophilia in adult bronchial asthmatic patients.
2) The study found that the maximum number of asthmatic patients had positive skin prick tests for dust mites. Dust mites were found to be a significant allergen followed by house dust and cockroach.
3) The mean eosinophil count was significantly higher in asthmatic adults compared to healthy subjects. However, the association between positive skin prick tests and increased eosinophil counts was not statistically significant.
4) In conclusion, the study found that dust mites, house dust, and cockroaches are common allerg
Severe or difficult-to-treat asthma affects approximately 15% of asthma patients and is characterized by persistent symptoms and exacerbations despite high-dose controller medications. These patients experience greater morbidity and increased healthcare use. Characteristics of severe asthma include irreversible airflow obstruction, neutrophilic inflammation, ongoing mediator release, and reduced association with atopy. Management involves accurate diagnosis, treatment of risk factors and comorbidities, appropriate medication including biologics like omeklizumab, and ongoing patient education and support.
Recent Advances in the Treatment of Childhood Asthma - Robert LemanskeJuan Carlos Ivancevich
Congreso Latinoamericano de Alergia, Asma e Inmunología 2015
Presidente: Alfonso Mario Cepeda Sarabia
Comité Organizador Local: Edgardo Jares, Anahí Yañez, Estrella Asayag
Presidentes Sociedad Latinoamericana de Alergia, Asma e Inmunología, Slaai:
2013-2015: Alfonso Mario Cepeda Sarabia - 2015-2017: Juan Carlos Sisul Alvariza
Buenos Aires, marzo 14-16, 2015
World Allergy Week 2015: AIRWAY ALLERGIES The human and economic burdenJuan Carlos Ivancevich
Welcome! Join us during World Allergy Week 2015 and increase awareness of Airway Allergies - A Human and Economic Burden. There are many ways you can participate, and we hope you will explore this website, returning often, as it will continue to change.
The World Allergy Organization (WAO) is addressing the need for greater awareness and understanding of allergy topics as well as the exchange of ideas and collaboration in order to address treatment and quality-of-life issues related to the care of patients with allergic rhinitis and asthma.
"ABSTRACT
Background. Asthma is a chronic airway inflammation. There is increasing evidence confirming in severe or persistent asthma systemic inflammation can occur. Spillover of inflammatory mediators into the circulation is generally considered to be the source of this systemic inflammation. Obesity is well known to be associated with systemic inflammation too. Both asthma and obesity often occur in the same individual. We examined the independent and synergistic associations of asthma uncontrolled and obesity with systemic inflammation using high-sensitivity C-reactive protein (hs-CRP).
Methods. This was an observational study with cross-sectional approach in 48 asthma subjects with aged 18 – 55 years old without diabetes, cardiovascular disease, hypertension and non smoker. The study was performed in the Hasanuddin Teaching Hospital South Sulawesi Indonesia. Asthma control was assessed using asthma control test (ACT).
Results : Mean of hs-CRP levels were significantly higher in uncontrolled asthma than controlled asthma (4.23 + 3.11 vs 0.92 + 0.61 ; p=0.001). The high hs-CRP levels were most found in uncontrolled asthma patients than controlled asthma. Obese Subject with uncontrolled asthma have higher hs-CRP levels compared to obese subject with controlled asthma (p=0.026). In non obese subject with uncontrolled asthma have also siginificant higher hs-CRP compared to non obese controlled asthma (p=0.005). Hs-CRP level significantly higher in uncontrolled asthma both in obese and non-obese subject. Hs-CRP levels in asthma subject were not influenced by age (p=1.000), gender (p=0.822), family history of asthma (p=0.117), long duration of asthma (p=0.117) and used of steroid. (p=0.358).
Conclusion : Uncontrolled Asthma associated with systemic inflammation both in obese and non obese subject. These findings underline a potensial CVD risk in asthma especially with uncontrolled status.
"
Immunotherapy for asthma, practical use based on updated meta analysisAriyanto Harsono
This document summarizes a meta-analysis on the effects of allergen-specific immunotherapy for asthma. The analysis reviewed 51 randomized controlled trials involving over 2800 participants. It found immunotherapy significantly reduced asthma symptoms, based on symptom scores, with a standardized mean difference of -0.73. It also reduced medication requirements based on medication scores, with a standardized mean difference of -0.57. Additionally, immunotherapy significantly improved allergen-specific bronchial hyperresponsiveness. The analysis confirms the efficacy of immunotherapy in improving these clinically important outcomes for asthma patients.
1) A study of 651 children with pollen-related allergic rhinitis found that component-resolved diagnosis identified a lack of IgE antibodies to major allergens in a significant percentage of patients with skin prick test reactivity, calling into question the appropriateness of immunotherapy for some patients.
2) Without component-resolved diagnosis, immunotherapy would have been prescribed inappropriately in 37% of cases based on skin prick test alone.
3) Component-resolved diagnosis led European and American allergists to change their immunotherapy prescription decisions in 42-48% of cases compared to skin prick testing alone.
Kathryn Maitland describes the challenges faced with oxygen therapy as an emergency intervention in critical illness in African children.
Where Kathryn works, in East Africa, there is no access to intensive care. Caring for critically ill children is all done in the Emergency Department.
70% of the global burden of disease and deaths from pneumonia occurs in Southeast Asia and Sub-Saharan Africa. The WHO has published guidelines as to what classifies as pneumonia, severe pneumonia, and very severe pneumonia.
These classifications rely on clinical signs. However, Kathryn in her research has discovered that these classifications are rarely correlated with the actual underlying disease process.
Clinical signs are non-specific for the diagnosis of pneumonia. Oxygen is recommended for severe and very severe pneumonia.
This has led to calls to prioritise oxygen delivery in African hospitals. However, it has not led to change from a health department or funding viewpoint.
There are also oxygen delivery practicalities to consider. Often there is only one source of oxygen on a ward (if at all) with patients clustered around it.
The production of Oxygen may only happen in a few places.
Poor cylinder quality leads to leaks and therefore, low supply.
Concentrators are useful however they need regular servicing. They also rely on power, and in a region that experiences regular power outages, this can be problematic. When the power goes off, there is no oxygen available.
Kathryn asks – do all children actually need oxygen? There is still however a hidden burden of hypoxia.
Outside of Africa, Kathryn discusses the current state of equipoise on oxygen therapy.
Moreover, oxygen can be harmful if given inappropriately. This leads to concerns more broadly on the harms of oxygen therapy.
Kathryn concludes her talk by looking to the future. She discusses ongoing research and the implications for future practice in resource poor settings, and indeed the world.
The document discusses the use of inhalational devices in asthma care. It describes various aerosol delivery technologies used including metered-dose inhalers, dry powder inhalers, nebulizers, and spacer devices. It emphasizes that the goal of asthma therapy is optimal drug delivery to the lower airways while minimizing deposition in the upper airways. The document provides recommendations for inhaler use and techniques to optimize treatment. It also discusses challenges with various devices and potential solutions through patient education.
Viral respiratory infections are a common trigger for acute asthma episodes. Viruses like rhinovirus can damage the airway and impair its defenses, making it more susceptible to inflammation. Early life wheezing from viruses is a risk factor for developing asthma. The sympathetic nervous system response to asthma involves adrenaline release and bronchodilation, but fails to fully reverse bronchoconstriction. James' symptoms relate to this sympathetic response. Salbutamol acts as a sympathomimetic drug by directly stimulating beta-2 receptors, mimicking the effects of adrenaline to induce bronchodilation. It was administered to James to help reverse bronchoconstriction from the asthma episode.
1. The document discusses Tamaka Swasa (Bronchial Asthma), including its causes, symptoms, diagnosis and management according to Ayurveda and modern medicine.
2. Key causes mentioned include allergens, cold weather, infections, certain foods and drugs. Symptoms include breathlessness, coughing, wheezing and chest tightness.
3. The document provides details on acute versus chronic asthma, as well as when medical attention is needed such as during a severe attack.
To hop 3 thao duoc co tac dung tuong tu corticoidNgoc Dang
This study compared the efficacy and safety of an antiasthma herbal medicine intervention (ASHMI) to prednisone for treating moderate-severe allergic asthma. In a double-blind randomized controlled trial, 91 adult asthma patients received either ASHMI capsules with prednisone placebo or prednisone tablets with ASHMI placebo for 4 weeks. Both treatments significantly improved lung function and reduced symptoms and IgE levels. However, prednisone further reduced TH2 cytokines and cortisol levels while ASHMI increased TH1 cytokines and cortisol levels. No severe side effects occurred with either treatment. The study suggests ASHMI is a safe and effective alternative asthma treatment to prednisone without adverse effects on adrenal
Asthma-COPD Overlap Translating Guidelines into Clinical Pracice - CasesAshraf ElAdawy
This document discusses the diagnosis of a 50-year-old female patient presenting with increased shortness of breath, cough, and wheezing. Spirometry results show obstructive lung disease with partially reversible airflow obstruction. The document examines features that favor a diagnosis of asthma, COPD, or asthma-COPD overlap syndrome (ACOS). It outlines definitions and diagnostic criteria for ACOS proposed by various medical organizations. ACOS is defined as having characteristics of both asthma and COPD, with persistent airflow limitation and a history of smoking. The document concludes the patient's diagnosis requires consideration of ACOS.
This document discusses asthma in children and provides guidelines for diagnosis and management. It notes that most childhood asthma starts in the preschool years and can be classified into different phenotypes based on risk factors and symptoms. The goals of treatment are to control symptoms and prevent exacerbations. Spirometry can help diagnose and monitor asthma in children over 6 years old, while other tools like peak flow meters and exhaled nitric oxide can help in younger children. Treatment involves a stepwise approach starting with reliever medications and adding controller medications like inhaled corticosteroids based on symptom severity and risk of exacerbations. Close monitoring is important to maintain control and reduce medication doses if possible.
Heterogeneity of asthma and difficulty in achieving optimal control are the major challenges in the management of asthma. To help attain the best possible clinical outcomes in patients with asthma, several guidelines provide recommendations for patients who will require a referral to a specialist. Such referrals can help in clearing the uncertainty from the initial diagnosis, provide tailored treatment options to patients with persistent symptoms and offer the patients access to health care providers with expertise in the management of the asthma; thus, specialist referrals have a substantial impact on disease prognosis and the patient’s health status. Hurdles in implementing these recommendations include lack of their dissemination among health care providers and nonadherence to these guidelines; these hurdles considerably limit the implementation of specialist referrals, eventually affecting the rate of referrals. In this review, recommendations for specialist referrals from several key international and national asthma guidelines and other relevant published literature are evaluated. Furthermore, we highlight why referrals are not happening, how this can be improved, and ultimately, what should be done in the specialist setting, based on existing evidence in published literature.
Read the full paper: https://doi.org/10.2147/JAA.S134300
1) Chronic cough in children can be caused by various conditions including asthma, upper airway cough syndrome, gastroesophageal reflux disease, respiratory infections, and foreign body aspiration.
2) A cough is considered chronic if it persists for more than 4 weeks in children or more than 8 weeks in adolescents/adults. Chronic cough can have significant impacts on children's sleep, activities, and family.
3) Pediatric cough is often classified based on time frame (acute, prolonged acute, recurrent, chronic), etiology (specific vs non-specific), or characteristics (moist vs dry). The most common causes of chronic cough vary based on a child's age.
Chronic obstructive pulmonary disease (COPD), a complex progressive disease, is currently the third leading cause of death worldwide. One recommended treatment option is fixed-dose combination therapy of an inhaled corticosteroid (ICS)/long-acting β-agonist. Clinical trials suggest pressurized metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs) show similar efficacy and safety profiles in COPD. Real-world observational studies have shown that combination therapy has significantly greater odds of achieving asthma control when delivered via pMDIs. Our aim was to compare effectiveness, in terms of moderate/severe COPD exacerbations and long-acting muscarinic antagonist (LAMA) prescriptions, for COPD patients initiating fluticasone propionate (FP)/salmeterol xinafoate (SAL) via pMDI versus DPI at two doses of FP (500 and 1,000 μg/d) using a real-life, historical matched cohort study. COPD patients with $2 years continuous practice data, $2 prescriptions for FP/SAL via pMDI/DPI, and no prescription for ICS were selected from the Optimum Patient Care Research Database. Patients were matched 1:1. Rate of moderate/severe COPD exacerbations and odds of LAMA prescription were analyzed using conditional Poisson and logistic regression, respectively. Of 472 patients on 500 µg/d, we observed fewer moderate/severe exacerbations in patients using pMDI (99 [42%]) versus DPI (115 [49%]) (adjusted rate ratio: 0.71; 95% confidence interval: 0.54, 0.93), an important result since the pMDI is not licensed for COPD in the UK, USA, or China. At 1,000 µg/d, we observed lower LAMA prescription for pMDI (adjusted odds ratio: 0.71; 95% confidence interval: 0.55, 0.91), but no difference in exacerbation rates, potentially due to higher dose of ICS overcoming low lung delivery from the DPI.
Read the full paper: https://doi.org/10.2147/COPD.S141409
This document lists publications by Annelies Jacobs from 2000-2007. It is organized by year and includes international peer reviewed articles (a), national peer reviewed articles (c), trade journals (d), and reports/books/abstracts (e). Some key publications include studies on monitoring quality of life in asthma and COPD patients, implementing smoking cessation counseling for COPD patients, and evaluating the accuracy and validity of spirometry testing in general practice.
This document discusses facts and myths about asthma. It begins by stating that asthma is not "all in the mind" but emotional triggers can cause flare-ups. It also notes that while asthma symptoms may become inactive in teenage years for some children, it cannot be outgrown. The document emphasizes that asthma cannot be cured but can be controlled with medical treatment and underscores the seriousness of the condition. It confirms several triggers of asthma attacks and notes that medications used to treat asthma are not habit-forming or addictive. Overall, the document provides information to distinguish true and false statements about the nature, causes, and treatment of asthma.
This document provides information on the diagnosis and management of asthma. It defines asthma as a chronic inflammatory disorder of the airways characterized by reversible airway narrowing and obstruction. The pathophysiology involves airway inflammation, wall thickening, mucus hypersecretion, and bronchial smooth muscle contraction in response to stimuli. Differential diagnoses include other lung diseases, infections, and restrictive lung disorders. Treatment involves inhaled bronchodilators and corticosteroids. Management is stepped up or down based on asthma control and severity.
This document discusses asthma-COPD overlap syndrome (ACOS). It defines asthma and COPD, noting their differences and similarities. Both are chronic inflammatory airway diseases but COPD is characterized by persistent airflow limitation and progressive lung function decline while asthma is often reversible. The document then discusses clinical features that can help distinguish asthma from COPD. It notes that some patients have features of both diseases, termed ACOS. Spirometry, biomarkers, imaging and response to treatment are discussed to help identify ACOS. The inflammatory patterns in asthma and COPD are compared, showing that eosinophilic inflammation is more prominent in asthma while neutrophilic inflammation dominates in COPD.
Allergen Skin Test Reactivity and Eosinophilia in Adult Bronchial Asthmatic P...MatiaAhmed
1) The document summarizes a study on allergen skin test reactivity and eosinophilia in adult bronchial asthmatic patients.
2) The study found that the maximum number of asthmatic patients had positive skin prick tests for dust mites. Dust mites were found to be a significant allergen followed by house dust and cockroach.
3) The mean eosinophil count was significantly higher in asthmatic adults compared to healthy subjects. However, the association between positive skin prick tests and increased eosinophil counts was not statistically significant.
4) In conclusion, the study found that dust mites, house dust, and cockroaches are common allerg
Severe or difficult-to-treat asthma affects approximately 15% of asthma patients and is characterized by persistent symptoms and exacerbations despite high-dose controller medications. These patients experience greater morbidity and increased healthcare use. Characteristics of severe asthma include irreversible airflow obstruction, neutrophilic inflammation, ongoing mediator release, and reduced association with atopy. Management involves accurate diagnosis, treatment of risk factors and comorbidities, appropriate medication including biologics like omeklizumab, and ongoing patient education and support.
Recent Advances in the Treatment of Childhood Asthma - Robert LemanskeJuan Carlos Ivancevich
Congreso Latinoamericano de Alergia, Asma e Inmunología 2015
Presidente: Alfonso Mario Cepeda Sarabia
Comité Organizador Local: Edgardo Jares, Anahí Yañez, Estrella Asayag
Presidentes Sociedad Latinoamericana de Alergia, Asma e Inmunología, Slaai:
2013-2015: Alfonso Mario Cepeda Sarabia - 2015-2017: Juan Carlos Sisul Alvariza
Buenos Aires, marzo 14-16, 2015
World Allergy Week 2015: AIRWAY ALLERGIES The human and economic burdenJuan Carlos Ivancevich
Welcome! Join us during World Allergy Week 2015 and increase awareness of Airway Allergies - A Human and Economic Burden. There are many ways you can participate, and we hope you will explore this website, returning often, as it will continue to change.
The World Allergy Organization (WAO) is addressing the need for greater awareness and understanding of allergy topics as well as the exchange of ideas and collaboration in order to address treatment and quality-of-life issues related to the care of patients with allergic rhinitis and asthma.
"ABSTRACT
Background. Asthma is a chronic airway inflammation. There is increasing evidence confirming in severe or persistent asthma systemic inflammation can occur. Spillover of inflammatory mediators into the circulation is generally considered to be the source of this systemic inflammation. Obesity is well known to be associated with systemic inflammation too. Both asthma and obesity often occur in the same individual. We examined the independent and synergistic associations of asthma uncontrolled and obesity with systemic inflammation using high-sensitivity C-reactive protein (hs-CRP).
Methods. This was an observational study with cross-sectional approach in 48 asthma subjects with aged 18 – 55 years old without diabetes, cardiovascular disease, hypertension and non smoker. The study was performed in the Hasanuddin Teaching Hospital South Sulawesi Indonesia. Asthma control was assessed using asthma control test (ACT).
Results : Mean of hs-CRP levels were significantly higher in uncontrolled asthma than controlled asthma (4.23 + 3.11 vs 0.92 + 0.61 ; p=0.001). The high hs-CRP levels were most found in uncontrolled asthma patients than controlled asthma. Obese Subject with uncontrolled asthma have higher hs-CRP levels compared to obese subject with controlled asthma (p=0.026). In non obese subject with uncontrolled asthma have also siginificant higher hs-CRP compared to non obese controlled asthma (p=0.005). Hs-CRP level significantly higher in uncontrolled asthma both in obese and non-obese subject. Hs-CRP levels in asthma subject were not influenced by age (p=1.000), gender (p=0.822), family history of asthma (p=0.117), long duration of asthma (p=0.117) and used of steroid. (p=0.358).
Conclusion : Uncontrolled Asthma associated with systemic inflammation both in obese and non obese subject. These findings underline a potensial CVD risk in asthma especially with uncontrolled status.
"
Immunotherapy for asthma, practical use based on updated meta analysisAriyanto Harsono
This document summarizes a meta-analysis on the effects of allergen-specific immunotherapy for asthma. The analysis reviewed 51 randomized controlled trials involving over 2800 participants. It found immunotherapy significantly reduced asthma symptoms, based on symptom scores, with a standardized mean difference of -0.73. It also reduced medication requirements based on medication scores, with a standardized mean difference of -0.57. Additionally, immunotherapy significantly improved allergen-specific bronchial hyperresponsiveness. The analysis confirms the efficacy of immunotherapy in improving these clinically important outcomes for asthma patients.
1) A study of 651 children with pollen-related allergic rhinitis found that component-resolved diagnosis identified a lack of IgE antibodies to major allergens in a significant percentage of patients with skin prick test reactivity, calling into question the appropriateness of immunotherapy for some patients.
2) Without component-resolved diagnosis, immunotherapy would have been prescribed inappropriately in 37% of cases based on skin prick test alone.
3) Component-resolved diagnosis led European and American allergists to change their immunotherapy prescription decisions in 42-48% of cases compared to skin prick testing alone.
Kathryn Maitland describes the challenges faced with oxygen therapy as an emergency intervention in critical illness in African children.
Where Kathryn works, in East Africa, there is no access to intensive care. Caring for critically ill children is all done in the Emergency Department.
70% of the global burden of disease and deaths from pneumonia occurs in Southeast Asia and Sub-Saharan Africa. The WHO has published guidelines as to what classifies as pneumonia, severe pneumonia, and very severe pneumonia.
These classifications rely on clinical signs. However, Kathryn in her research has discovered that these classifications are rarely correlated with the actual underlying disease process.
Clinical signs are non-specific for the diagnosis of pneumonia. Oxygen is recommended for severe and very severe pneumonia.
This has led to calls to prioritise oxygen delivery in African hospitals. However, it has not led to change from a health department or funding viewpoint.
There are also oxygen delivery practicalities to consider. Often there is only one source of oxygen on a ward (if at all) with patients clustered around it.
The production of Oxygen may only happen in a few places.
Poor cylinder quality leads to leaks and therefore, low supply.
Concentrators are useful however they need regular servicing. They also rely on power, and in a region that experiences regular power outages, this can be problematic. When the power goes off, there is no oxygen available.
Kathryn asks – do all children actually need oxygen? There is still however a hidden burden of hypoxia.
Outside of Africa, Kathryn discusses the current state of equipoise on oxygen therapy.
Moreover, oxygen can be harmful if given inappropriately. This leads to concerns more broadly on the harms of oxygen therapy.
Kathryn concludes her talk by looking to the future. She discusses ongoing research and the implications for future practice in resource poor settings, and indeed the world.
The document discusses the use of inhalational devices in asthma care. It describes various aerosol delivery technologies used including metered-dose inhalers, dry powder inhalers, nebulizers, and spacer devices. It emphasizes that the goal of asthma therapy is optimal drug delivery to the lower airways while minimizing deposition in the upper airways. The document provides recommendations for inhaler use and techniques to optimize treatment. It also discusses challenges with various devices and potential solutions through patient education.
Viral respiratory infections are a common trigger for acute asthma episodes. Viruses like rhinovirus can damage the airway and impair its defenses, making it more susceptible to inflammation. Early life wheezing from viruses is a risk factor for developing asthma. The sympathetic nervous system response to asthma involves adrenaline release and bronchodilation, but fails to fully reverse bronchoconstriction. James' symptoms relate to this sympathetic response. Salbutamol acts as a sympathomimetic drug by directly stimulating beta-2 receptors, mimicking the effects of adrenaline to induce bronchodilation. It was administered to James to help reverse bronchoconstriction from the asthma episode.
1. The document discusses Tamaka Swasa (Bronchial Asthma), including its causes, symptoms, diagnosis and management according to Ayurveda and modern medicine.
2. Key causes mentioned include allergens, cold weather, infections, certain foods and drugs. Symptoms include breathlessness, coughing, wheezing and chest tightness.
3. The document provides details on acute versus chronic asthma, as well as when medical attention is needed such as during a severe attack.
To hop 3 thao duoc co tac dung tuong tu corticoidNgoc Dang
This study compared the efficacy and safety of an antiasthma herbal medicine intervention (ASHMI) to prednisone for treating moderate-severe allergic asthma. In a double-blind randomized controlled trial, 91 adult asthma patients received either ASHMI capsules with prednisone placebo or prednisone tablets with ASHMI placebo for 4 weeks. Both treatments significantly improved lung function and reduced symptoms and IgE levels. However, prednisone further reduced TH2 cytokines and cortisol levels while ASHMI increased TH1 cytokines and cortisol levels. No severe side effects occurred with either treatment. The study suggests ASHMI is a safe and effective alternative asthma treatment to prednisone without adverse effects on adrenal
Asthma-COPD Overlap Translating Guidelines into Clinical Pracice - CasesAshraf ElAdawy
This document discusses the diagnosis of a 50-year-old female patient presenting with increased shortness of breath, cough, and wheezing. Spirometry results show obstructive lung disease with partially reversible airflow obstruction. The document examines features that favor a diagnosis of asthma, COPD, or asthma-COPD overlap syndrome (ACOS). It outlines definitions and diagnostic criteria for ACOS proposed by various medical organizations. ACOS is defined as having characteristics of both asthma and COPD, with persistent airflow limitation and a history of smoking. The document concludes the patient's diagnosis requires consideration of ACOS.
This document discusses asthma in children and provides guidelines for diagnosis and management. It notes that most childhood asthma starts in the preschool years and can be classified into different phenotypes based on risk factors and symptoms. The goals of treatment are to control symptoms and prevent exacerbations. Spirometry can help diagnose and monitor asthma in children over 6 years old, while other tools like peak flow meters and exhaled nitric oxide can help in younger children. Treatment involves a stepwise approach starting with reliever medications and adding controller medications like inhaled corticosteroids based on symptom severity and risk of exacerbations. Close monitoring is important to maintain control and reduce medication doses if possible.
Heterogeneity of asthma and difficulty in achieving optimal control are the major challenges in the management of asthma. To help attain the best possible clinical outcomes in patients with asthma, several guidelines provide recommendations for patients who will require a referral to a specialist. Such referrals can help in clearing the uncertainty from the initial diagnosis, provide tailored treatment options to patients with persistent symptoms and offer the patients access to health care providers with expertise in the management of the asthma; thus, specialist referrals have a substantial impact on disease prognosis and the patient’s health status. Hurdles in implementing these recommendations include lack of their dissemination among health care providers and nonadherence to these guidelines; these hurdles considerably limit the implementation of specialist referrals, eventually affecting the rate of referrals. In this review, recommendations for specialist referrals from several key international and national asthma guidelines and other relevant published literature are evaluated. Furthermore, we highlight why referrals are not happening, how this can be improved, and ultimately, what should be done in the specialist setting, based on existing evidence in published literature.
Read the full paper: https://doi.org/10.2147/JAA.S134300
1) Chronic cough in children can be caused by various conditions including asthma, upper airway cough syndrome, gastroesophageal reflux disease, respiratory infections, and foreign body aspiration.
2) A cough is considered chronic if it persists for more than 4 weeks in children or more than 8 weeks in adolescents/adults. Chronic cough can have significant impacts on children's sleep, activities, and family.
3) Pediatric cough is often classified based on time frame (acute, prolonged acute, recurrent, chronic), etiology (specific vs non-specific), or characteristics (moist vs dry). The most common causes of chronic cough vary based on a child's age.
Chronic obstructive pulmonary disease (COPD), a complex progressive disease, is currently the third leading cause of death worldwide. One recommended treatment option is fixed-dose combination therapy of an inhaled corticosteroid (ICS)/long-acting β-agonist. Clinical trials suggest pressurized metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs) show similar efficacy and safety profiles in COPD. Real-world observational studies have shown that combination therapy has significantly greater odds of achieving asthma control when delivered via pMDIs. Our aim was to compare effectiveness, in terms of moderate/severe COPD exacerbations and long-acting muscarinic antagonist (LAMA) prescriptions, for COPD patients initiating fluticasone propionate (FP)/salmeterol xinafoate (SAL) via pMDI versus DPI at two doses of FP (500 and 1,000 μg/d) using a real-life, historical matched cohort study. COPD patients with $2 years continuous practice data, $2 prescriptions for FP/SAL via pMDI/DPI, and no prescription for ICS were selected from the Optimum Patient Care Research Database. Patients were matched 1:1. Rate of moderate/severe COPD exacerbations and odds of LAMA prescription were analyzed using conditional Poisson and logistic regression, respectively. Of 472 patients on 500 µg/d, we observed fewer moderate/severe exacerbations in patients using pMDI (99 [42%]) versus DPI (115 [49%]) (adjusted rate ratio: 0.71; 95% confidence interval: 0.54, 0.93), an important result since the pMDI is not licensed for COPD in the UK, USA, or China. At 1,000 µg/d, we observed lower LAMA prescription for pMDI (adjusted odds ratio: 0.71; 95% confidence interval: 0.55, 0.91), but no difference in exacerbation rates, potentially due to higher dose of ICS overcoming low lung delivery from the DPI.
Read the full paper: https://doi.org/10.2147/COPD.S141409
This document lists publications by Annelies Jacobs from 2000-2007. It is organized by year and includes international peer reviewed articles (a), national peer reviewed articles (c), trade journals (d), and reports/books/abstracts (e). Some key publications include studies on monitoring quality of life in asthma and COPD patients, implementing smoking cessation counseling for COPD patients, and evaluating the accuracy and validity of spirometry testing in general practice.
This document discusses facts and myths about asthma. It begins by stating that asthma is not "all in the mind" but emotional triggers can cause flare-ups. It also notes that while asthma symptoms may become inactive in teenage years for some children, it cannot be outgrown. The document emphasizes that asthma cannot be cured but can be controlled with medical treatment and underscores the seriousness of the condition. It confirms several triggers of asthma attacks and notes that medications used to treat asthma are not habit-forming or addictive. Overall, the document provides information to distinguish true and false statements about the nature, causes, and treatment of asthma.
This document provides information on the diagnosis and management of asthma. It defines asthma as a chronic inflammatory disorder of the airways characterized by reversible airway narrowing and obstruction. The pathophysiology involves airway inflammation, wall thickening, mucus hypersecretion, and bronchial smooth muscle contraction in response to stimuli. Differential diagnoses include other lung diseases, infections, and restrictive lung disorders. Treatment involves inhaled bronchodilators and corticosteroids. Management is stepped up or down based on asthma control and severity.
This document discusses asthma-COPD overlap syndrome (ACOS). It defines asthma and COPD, noting their differences and similarities. Both are chronic inflammatory airway diseases but COPD is characterized by persistent airflow limitation and progressive lung function decline while asthma is often reversible. The document then discusses clinical features that can help distinguish asthma from COPD. It notes that some patients have features of both diseases, termed ACOS. Spirometry, biomarkers, imaging and response to treatment are discussed to help identify ACOS. The inflammatory patterns in asthma and COPD are compared, showing that eosinophilic inflammation is more prominent in asthma while neutrophilic inflammation dominates in COPD.
The study examined factors influencing asthma remission from childhood to middle age in a cohort of participants. The key findings were:
1) Weight gain between ages 3-6 was positively associated with higher lung function in adulthood, but only in participants without preschool wheezing.
2) Asthma remission rates decreased with age, with 60% of participants experiencing remission by age 30 but only 30% by age 45.
3) Female sex, later asthma onset, and less severe asthma were associated with higher remission rates.
Homeopathy can effectively treat asthma by addressing the underlying sensitivity and relieving both acute and chronic symptoms. It provides a safe, permanent cure without side effects, especially for children. Asthma causes wheezing, coughing, chest tightness and shortness of breath during attacks, which are often triggered by allergens, irritants, infections or stress. While lifestyle changes and avoiding triggers can help control asthma, homeopathic treatment works by reducing hypersensitivity and managing both acute flare-ups and long-term management.
Bronchial asthma is a clinical syndrome characterized by increased responsiveness of the tracheobronchial tree to various stimuli. The primary physiological manifestation is variable airway obstruction. Pathologically, asthma is defined as a disorder of the airways characterized by chronic inflammation with infiltration of lymphocytes, eosinophils and mast cells. Asthma has many potential triggers including allergens, infections, pollutants, exercise and emotions.
These lecture notes were prepared by Dr. Hamdi Turkey- Pulmonologist- Department of internal medicine - Taiz university
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The document discusses several studies on risk factors for atopy and asthma. It summarizes the following key points:
1) A large international study found significant global variation in asthma prevalence among children aged 6-7 and 13-14, with rates ranging from under 5% to over 20% depending on location.
2) Studies of birth cohorts in the UK found that over 50% of children were diagnosed with at least one allergic condition by age 18, with the most common trajectory being eczema followed by asthma then rhinitis.
3) The prevalence of peanut allergy among children in the UK doubled between 1989-1990 and 2001-2002, suggesting an increasing trend.
4) Children
The document discusses several studies on lung function and spirometry. It provides details on techniques for performing spirometry tests and interpreting the results. It also summarizes some key findings from the studies, including that an FEV1 measurement 2 weeks after hospital discharge for asthma can identify patients at higher risk of subsequent acute asthma attacks, and lower FEV1 levels in smokers correlate with increased risk of lung cancer.
This document discusses asthma, including:
- The definition of asthma as a chronic airway disease characterized by variable airflow obstruction and airway hyperresponsiveness.
- Asthma is a heterogeneous disease influenced by both genetic and environmental factors, and has a complex pathophysiology involving airway inflammation.
- Type 2 inflammation, involving cytokines like IL-4, IL-5, and IL-13, underlies many asthma phenotypes and is a target of new biologic therapies.
This document discusses the management of wheeze and cough in children in primary care. It outlines that wheeze and cough can have different causes depending on factors like age and symptom pattern. It recommends asking parents detailed questions about symptoms and considering immediate referral if concerning signs are present. For ongoing symptoms, the document recommends a trial of asthma treatment to help diagnose the underlying condition. A successful response to treatment suggests asthma while no response warrants reconsidering the diagnosis and potential referral. Regular treatment is suggested for children who experience symptom recurrence after treatment.
Immunotherapy in children SCIT or SLIT. Dra. Desirée Larenas WISC Dec2014 ...Juan Carlos Ivancevich
Symposium: Immunotherapy in Latin America - WISC 2014- Rio de Janeiro
Symposium 5: Latin American Society of Allergy and Immunology (SLAAI) Symposium: Immunotherapy in Latin America Sala 1 & 2 (Sul America)
The study found that in adults presenting with acute asthma exacerbations, the addition of the ketolide telithromycin to standard therapy resulted in greater improvement in asthma symptoms and lung function compared to placebo, especially in those who tested positive for atypical bacterial infections like Chlamydia pneumoniae and Mycoplasma pneumoniae. However, the benefits did not persist beyond 10 days of treatment and telithromycin was associated with more nausea.
Occurrence of COPD in Patients with Respiratory Allergy: A Clinico-Spirometri...DR. SUJOY MUKHERJEE
This study evaluated the occurrence of chronic obstructive pulmonary disease (COPD) in patients with respiratory allergy symptoms. 550 patients aged 18-60 years with chronic respiratory symptoms were divided into two groups - those with symptoms of respiratory allergy like nasal congestion and sneezing (n=260) and those without allergy symptoms (n=290). Both groups underwent spirometric testing and were categorized based on lung function. The study found that 18.97% of the non-allergic group had COPD, compared to only 7.69% of the allergic group, and this difference was statistically significant. Additionally, post-bronchodilator spirometry values were significantly lower in the non-
This document provides information on acute bronchiolitis and wheezing in children under 5 years old. It defines bronchiolitis as an acute viral infection of the small airways. The most common cause is respiratory syncytial virus (RSV). Diagnosis is based on symptoms like cough and wheezing. Risk factors for severe bronchiolitis include apnea, respiratory distress, and cyanosis. Treatment focuses on supportive care and oxygen supplementation. Wheezing in young children can be categorized based on pattern and duration. Factors like prenatal vitamin D, maternal obesity, and acetaminophen use may influence wheezing development. Evaluation of recurrent wheezing may include fractional exhaled nitric oxide,
Updates In Bronchiolitis 23 2 2010 Dr HumaidEM OMSB
This document summarizes recent evidence on the diagnosis and management of bronchiolitis. It defines bronchiolitis and discusses causes such as respiratory syncytial virus (RSV) and human metapneumovirus. Clinical features include fever, cough, wheezing and respiratory distress. Risk factors for severe disease are described. Treatment is generally supportive with oxygen, fluids and respiratory support as needed. Bronchodilators and corticosteroids are not routinely recommended but may be considered in some cases.
Childhood asthma is a chronic inflammatory disease of the lung airways characterized by symptoms like coughing, wheezing and shortness of breath. It affects approximately 14% of children and onset is usually before age 6. Risk factors include family history, allergy, low socioeconomic status, male gender and exposure to environmental tobacco smoke. Diagnosis involves assessing symptoms, lung function testing and ruling out other conditions. Treatment focuses on controlling triggers, using long-term controller medications according to severity, and managing exacerbations with bronchodilators and corticosteroids.
Childhood asthma is a chronic inflammatory disease of the lung airways characterized by symptoms like coughing, wheezing and shortness of breath. It affects approximately 14% of children and onset is usually before age 6. Risk factors include family history, allergy, low socioeconomic status, male gender and exposure to environmental tobacco smoke. Diagnosis involves assessing symptoms, lung function testing and allergy testing. Treatment involves controlling triggers, pharmacotherapy including long-term controllers and quick-relief medications, and managing exacerbations.
Childhood asthma is a chronic inflammatory lung disease characterized by recurrent symptoms, airway narrowing and hyperresponsiveness. It affects 13.5% of children and often begins before age 6. Risk factors include family history, allergy, smoking exposure and male gender. Symptoms include cough, wheeze and difficulty breathing. Diagnosis involves assessing symptoms, lung function testing and allergy testing. Management focuses on controlling triggers, pharmacotherapy including controllers for persistent asthma, and monitoring to prevent exacerbations. The goal is optimal asthma control and minimizing future risk.
Indice Predictor de Asma en edad pediátricaYan Giraldo G
This document describes a study that developed two indices to predict the risk of asthma in young children with recurrent wheezing. The researchers used data from the Tucson Children's Respiratory Study to create a stringent index and a loose index based on combinations of wheezing frequency, family history, eczema, allergic rhinitis, eosinophilia, and wheezing apart from colds. Children who met the criteria for the loose index had 2.6 to 5.5 times higher risk of active asthma between ages 6-13. Those who met the stringent index criteria had 4.3 to 9.8 times higher risk. 59% of children with a positive loose index and 76% of those with a positive
This document presents a debate on whether preschool children experiencing acute wheezing episodes should be treated with oral corticosteroids (OCS). The pro side argues that many preschool children with recurrent wheezing develop atopic disease and sensitization which predicts increased risk of asthma and response to OCS therapy. Studies have shown heterogeneity in design and populations making it difficult to make definitive recommendations against OCS use. The con side argues that most studies have not demonstrated beneficial effects of OCS for acute wheezing in preschool children. Repeated OCS bursts may also be associated with adverse effects. Both sides agree more efficacy trials are needed targeting phenotypes likely to respond to OCS.
- Administered questionnaires
- Performed skin prick tests to common aeroallergens
- Collected blood samples for total IgE & specific IgE
FENO measurement:
- Using NIOX MINO ( Aerocrine AB, Solna, Sweden)
- According to ATS/ERS guidelines
JACI. 2011; 127 ( 5) : 1165-72.e5.
Allergic sensitization:
- Positive SPT ( wheal diameter ≥ 3 mm) to at least one allergen
- Or specific IgE ≥ 0.35 kU/L to at least one allergen
Asthma:
The document discusses asthma and allergic rhinitis (AR). It notes that both are common chronic diseases that affect quality of life and have economic impacts. The prevalence of AR is about twice as high as asthma worldwide. Studies show AR frequently co-exists with asthma, with 40-80% of asthma patients also having AR. They share common triggers, inflammatory processes, and symptoms. Effectively treating AR can help control asthma symptoms and reduce exacerbations. Overall, the document presents asthma and AR as two manifestations of the same overall condition that often overlap and should be treated simultaneously.
This document provides guidelines for the diagnosis and treatment of community-acquired pneumonia (CAP) in adults. It addresses 12 questions regarding best practices for diagnosis and management of CAP in both outpatient and inpatient settings. For each question, the document reviews the relevant evidence and provides treatment recommendations based on that evidence. The recommendations aim to optimize patient outcomes while minimizing unnecessary testing and promoting judicious antibiotic use.
- The risk of anaphylaxis following vaccination is rare, affecting less than 1 in 100,000 people. However, it can occur in any patient.
- A retrospective study found that only 3 of 135 patients who experienced allergic-like events after vaccination were referred for suspected anaphylaxis, suggesting that guidelines may overestimate the risk.
- Most allergic-like events that occur more than 1 hour after vaccination are not likely IgE-mediated reactions and should not be managed as such. Skin testing in these patients can be misleading.
- Allergic rhinitis is a common condition affecting 10-15% of children and 26% of adults in the UK. Topical nasal corticosteroids are the first-line treatment for moderate to severe disease.
- Non-allergic rhinitis is a heterogeneous group of conditions that can present with similar symptoms to allergic rhinitis but without evidence of allergen sensitization. Triggers include medications, hormones, irritants and changes in temperature or humidity. Treatment depends on the underlying cause and may include nasal irrigation, antihistamines, decongestants or anti-inflammatory therapy.
- Low vitamin D levels and reduced expression of the vitamin D receptor on dendritic cells have been associated
This document summarizes several studies on factors related to bronchopulmonary dysplasia (BPD) in preterm infants. One study found that maternal smoking during pregnancy doubled the odds of BPD in infants, and was also associated with prolonged ventilation and late respiratory disease. Another study found that endothelial cell dysfunction in umbilical vein cells was associated with BPD or death in extremely preterm infants. A third study found that infants treated with caffeine in the neonatal period had better lung function at 11 years of age compared to placebo, mediated by caffeine's ability to reduce rates of BPD.
The document presents guidelines from the European Respiratory Society on diagnosing and managing obstructive sleep disordered breathing in children aged 1-23 months. It recommends a stepwise approach beginning with identifying symptoms and risk factors, followed by objective sleep studies to determine severity if indicated. Treatment may include adenotonsillectomy, continuous positive airway pressure, or interventions for specific conditions causing airway obstruction. Management requires a multidisciplinary approach and treatment of all contributing factors to reduce upper airway obstruction during sleep.
This study analyzed the long-term outcomes of 119 children diagnosed prenatally with congenital cystic lung lesions. 43% of children (51/119) underwent surgical management, with most surgeries occurring in the neonatal period or due to concerning CT scan findings. The remaining 57% were managed non-surgically. No cases of malignancy were reported after a minimum 5-year follow-up for all patients, suggesting conservative management may be appropriate for select cases of prenatally diagnosed congenital cystic lung lesions.
The study measured intrathoracic pressures during various abdominal thrust maneuvers used to relieve choking. It found that chair thrusts, where the subject pushes their upper abdomen against a chair back, produced higher pressures than other maneuvers like Heimlich or self-administered thrusts. Both chair thrusts and other maneuvers should be included in basic life support training.
Lower respiratory tract infections before age 3 are associated with reduced lung function at age 10, including lower FEV1, FVC, FEV1/FVC and FEF75. Children with lower respiratory tract infections before age 3 also have an increased risk of physician-diagnosed asthma at age 10 (OR 1.79). While lower respiratory tract infections between ages 3-6 increase the odds of asthma diagnosis at age 10 (OR 3.53), they are not associated with reductions in lung function. Early life respiratory tract infections can influence both later asthma risk and lung development.
This study examined 102 children under 16 years old with chronic prurigo lasting over 6 weeks. Skin prick tests and patch tests were performed for common environmental allergens like dust mites, mosquitoes, and pets. Three clinical patterns were identified: atopic perennial prurigo showed lesions on wrists/ankles and was linked to dust mite sensitivity; summer prurigo showed facial lesions and was linked to mosquito sensitivity; non-summer prurigo showed linear lesions or vesicles and was linked to bedbugs or fleas. Patch tests had higher sensitivity than immediate skin prick tests for dust mites, while delayed skin prick tests at 48 hours had higher sensitivity than patch tests for mosquitoes.
1) Several studies reviewed found that allergen immunotherapy (AIT) can improve symptoms, medication use, and quality of life for patients with allergic asthma and rhinoconjunctivitis.
2) Subcutaneous immunotherapy was more effective than sublingual immunotherapy at improving quality of life and decreasing allergen-specific airway hyperactivity for asthma.
3) The evidence suggests AIT may help prevent new allergen sensitizations, though more high-quality studies are still needed to better determine its efficacy in preventing new sensitizations.
This document discusses drug allergies, specifically severe cutaneous adverse reactions. It summarizes several research articles on topics like optimal drug provocation test dosages, the importance of prolonged provocation testing, oral challenges without skin tests to diagnose beta-lactam hypersensitivity, and how positive skin tests or IgE levels do not reliably predict penicillin allergy on their own but the combination may be a better predictor. It also discusses establishing an inpatient penicillin allergy testing service to help correctly diagnose patients and reduce unnecessary alternative antibiotic use.
- A study examined sensitization to Staphylococcus aureus enterotoxins (SEs) in 868 adolescents. 41.7% were sensitized to at least one food or inhalant allergen, while 26.2% were sensitized to at least one SE.
- SE sensitization was associated with polysensitization to food and inhalant allergens as well as allergic multimorbidity. SE-sensitized adolescents had higher IgE levels to inhalant allergens.
- S. aureus carriage alone was not associated with polysensitization when excluding SE-sensitized adolescents, indicating SE sensitization may be more influential than carriage. Sensitization to SE
The document discusses three studies related to reducing environmental allergens:
1) The Kingston Allergy Birth Cohort study found associations between parental reports of wheeze/cough in children and prenatal cigarette smoke exposure, mold/dampness in the home, and use of air fresheners. Breastfeeding and older siblings were associated with decreased respiratory symptoms.
2) A review of multifaceted and monofaceted interventions found that multifaceted interventions reducing exposure to multiple allergens reduced the likelihood of asthma diagnosis in children under 5 and over 5 compared to usual care. Mono-interventions did not produce statistically significant effects.
3) A study discusses emerging payment approaches for home
What is new in general pediatrics, allergic and respiratory diseasesEnvicon Medical Srl
The document discusses several studies related to general pediatrics, allergic and respiratory diseases from 2017.
One study found that early-term deliveries between 37-38 weeks gestation were associated with increased risk of long-term respiratory morbidity compared to full-term deliveries between 39-40 weeks. Another study showed that preschoolers with bedtimes before 8pm had a lower risk of adolescent obesity than those with later bedtimes. A third study found that high school start times later than 8:30am were associated with improved attendance and graduation rates.
This document discusses the use of vitamin D in preventing and treating non-bone diseases. It begins with an introduction and covers topics like immunomodulation related to allergy, fetal development, and the prevention and modification of diseases like asthma, COPD, allergic rhinitis, atopic dermatitis, and food allergy. It also briefly mentions autoimmunity and other diseases. The document provides information on vitamin D synthesis and metabolism and cites several studies on vitamin D levels in different populations and its effects. It concludes with a discussion of vitamin D's immunomodulatory effects in relation to allergy.
Systemic steroids in preschool children with recurrent wheezing exacerbationsEnvicon Medical Srl
Oral corticosteroids are commonly prescribed for preschool children experiencing wheezing exacerbations, however their efficacy in this age group is unclear. A recent meta-analysis of 11 clinical trials found no significant difference in hospitalization rates between oral corticosteroid and placebo groups overall. However, outpatient studies showed higher hospitalization with corticosteroids, while emergency department studies showed lower rates. Additional corticosteroid courses were less likely with corticosteroid treatment based on two inpatient studies. The efficacy of oral corticosteroids appears to depend on the treatment setting for preschool wheezing exacerbations.
This document discusses fish allergy, including its rising prevalence globally due to increased fish consumption. Fish allergies can be serious and life-threatening, as reactions are often caused by immune-mediated or toxic/parasitic mechanisms. Prevalence rates vary significantly between regions and populations, ranging from 0.2-8% depending on location, fish species exposure, and occupation. The major fish allergen identified is parvalbumin, though other allergens are still being discovered. The review discusses demographics, novel allergens, immunological mechanisms, and approaches for diagnosing and managing fish allergy.
Recurrent aphthous stomatitis (RAS) is the most common oral ulcerative condition, affecting 1 in 5 individuals. It is classified into minor, major, and herpetiform ulcers, with minor ulcers being the most common. The pathogenesis involves an abnormal T-cell mediated immune reaction, though the exact cause is unknown. Certain factors like nutritional deficiencies, infections, genetics, and trauma may contribute to disease development or severity. RAS is diagnosed based on clinical examination and history. Treatment involves managing pain and preventing infections, with some evidence that vitamin B12 supplementation may help resolve ulcers.
The document discusses the role of pediatricians in preventing chronic noncommunicable diseases. It outlines several factors that can impact childhood health and development with long-term consequences, including maternal smoking during pregnancy, preterm birth, maternal obesity, and environmental exposures. Maternal smoking during pregnancy is associated with increased risks of preterm birth, asthma, cardiovascular issues, and neurological and behavioral problems in children. Both undernutrition and overnutrition during pregnancy can also influence the health of offspring and increase risks of chronic diseases later in life. The document emphasizes the importance of pediatricians educating parents about modifiable risk factors and promoting healthy prenatal environments and lifestyles to reduce the future disease burden from noncommunicable diseases.
This document discusses seafood allergies and adverse reactions. It begins with an introduction and overview of seafood classification. It then covers seafood allergy epidemiology and allergens such as parvalbumin. Various studies are summarized that examine parvalbumin content and cross-reactivity between different fish species. The document concludes with notes that heating processes can impact allergens while raw fish collagen in particular can induce sensitization. Not all reported seafood sensitivities constitute a true IgE-mediated allergy.
This document discusses different types of adverse reactions that can occur after eating seafood and may be misdiagnosed as seafood allergy. It describes immune-mediated allergic reactions as well as nonimmunologic reactions that can have similar symptoms. Some examples of non-allergic reactions discussed are reactions to contaminants like parasites, toxins produced by bacteria, or infectious agents. Proper handling and cooking of seafood can help prevent issues caused by contaminants. The diagnosis of a seafood allergy requires consideration of symptoms, allergy testing, and potentially an oral food challenge with the suspected seafood.
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
8. Identification of Asthma Phenotypes Using Cluster Analysis in the Severe Asthma Research Program Moore AJRCCM 2010;181:315 Using three variables (baseline FEV 1 [with a bronchodilator withhold], maximal "Max" FEV 1 after six to eight puffs of albuterol, and age of onset of asthma), subjects can be assigned to the five clusters that range from milder asthma (Cluster 1) to more severe disease (Clusters 4 and 5).
9. Identification of Asthma Phenotypes Using Cluster Analysis in the Severe Asthma Research Program Moore AJRCCM 2010;181:315 50 – 40 – 30 – 20 – 10 – 0 5 – 0 % Sputum: Eosinophils , Neutrophils 1 2 3 4 5 23.3% 33.3% 37.6% 34.7% 48.3% 0.7% 0.7% 1.9% 1.5% 1.2% Cluster
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11. Background: Clinicians have difficulty in diagnosing asthma in preschool children with suggestive symptoms. Objective: We sought to develop a clinical asthma prediction score for preschool children who have asthma-like symptoms for the first time. Predicting the long-term prognosis of children with symptoms suggestive of asthma at preschool age Caudri JACI 2009;124:903
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14. Predicting the long-term prognosis of children with symptoms suggestive of asthma at preschool age Caudri JACI 2009;124:903 MALE SEX 2.5 – 2.0 – 1.5 – 1.0 – 0.5 – 0 1.7 POST-TERM DELIVERY MEDIUM/LOW PARENTAL EDUCATION ECZEMA 3 ≥ 4 2.5 1.5 2.1 1.5 2.3 OR FOR ASTHMA AT AGE 7-8 YEARS WHEEZING FREQUENCY TIMES/Y
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22. 55% Percentages of remitting, periodic, and persistent asthma evaluated in the follow-up phase in CAMP were similar for the budesonide, nedocromil, and placebo–treated groups. Predictors of remitting, periodic, and persistent childhood asthma Covar JACI 2010;125:359
23. 55% Percentages of remitting, periodic, and persistent asthma evaluated in the follow-up phase in CAMP were similar for the budesonide, nedocromil, and placebo–treated groups. Predictors of remitting, periodic, and persistent childhood asthma Covar JACI 2010;125:359 Remission of asthma in adolescence is infrequent and not affected by 4 years of anti-inflammatory controller therapy.
24. FEATURES AT ENTRY INTO CAMP ASSOCIATED WITH REMITTING VERSUS PERSISTENT ASTHMA ( OR ) 3.23 lack of allergen sensitization and less exposure to indoor allergens milder asthma higher FEV 1 1.05 1.39 less BHR 3.5 - 3.0 - 2.5 - 2.0 - 1.5 - 1.0 - 0.5 - 0 2.01 P<0.0001 P=0.03 P=0.03 P<0.02 Predictors of remitting, periodic, and persistent childhood asthma Covar JACI 2010;125:359
25. 55% Distribution of CAMP participants with remitting ( blue ), periodic ( purple ), and persistent ( red ) course by age at the end of the observational phase (N=the number within the bars). The percentage of participants having remitting asthma did not increase with age , although the numbers of older adolescents were low. Predictors of remitting, periodic, and persistent childhood asthma Covar JACI 2010;125:359
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27. Values for the cumulative dose of methacholine at the inflection point of respiratory resistance (Dmin) and the slope of the methacholine respiratory resistance dose-response curve (Sm) in 4 groups. Relationship between bronchial hyperreactivity and asthma remission during adolescence Mochizuki Ann Allergy Asthma Immunol 2009;103:201 Dmin = bronchial sensitivity Sm = speed of bronchial constriction (bronchial reactivity) adolescent asthma adolescent asthma
28. Values for the cumulative dose of methacholine at the inflection point of respiratory resistance (Dmin) and the slope of the methacholine respiratory resistance dose-response curve (Sm) in 4 groups. Adolescents with asthma remission showed no change in Dmin, whereas a significant decrease of Sm was observed (symptom-free but bronchial hyperresponsive asthma). Dmin = bronchial sensitivity Sm = speed of bronchial constriction (bronchial reactivity) adolescent asthma adolescent asthma
29. Values for the cumulative dose of methacholine at the inflection point of respiratory resistance (Dmin) and the slope of the methacholine respiratory resistance dose-response curve (Sm) in 4 groups. Relationship between bronchial hyperreactivity and asthma remission during adolescence Mochizuki Ann Allergy Asthma Immunol 2009;103:201 Sm = speed of bronchial constriction (bronchial reactivity) adolescent asthma
33. OR for FEV 1 /FVC ≤ 70% 1.7 6.3 1 1 7.2 ≥ 3 1.6 ≥ 3 n°FACTORS IN MEN n°FACTORS IN WOMEN 8 – 7 – 6 – 5 – 4 – 3 – 2 – 1 – 0 Early life origins of chronic obstructive pulmonary disease Svanes Thorax 2010;65:14–20
34. OR for FEV 1 /FVC ≤ 70% 1.7 6.3 1 1 7.2 ≥ 3 1.6 ≥ 3 n°FACTORS IN MEN n°FACTORS IN WOMEN 8 – 7 – 6 – 5 – 4 – 3 – 2 – 1 – 0 COPD increased with increasing childhood disadvantage Early life origins of chronic obstructive pulmonary disease Svanes Thorax 2010;65:14–20
35. Associations of chronic obstructive pulmonary disease (COPD)* with (A) individual childhood disadvantage factors and (B) with the number of childhood disadvantage factors. COPD defined as FEV 1 /FVC < 0.70 and FEV 1 < 80% predicted (A) (B) Early life origins of chronic obstructive pulmonary disease Svanes Thorax 2010;65:14–20
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38. Birth weight and risk of asthma in 3-9-year-old twins: exploring the fetal origins hypothesis Kindlund Thorax 2010;65:146 Birth characteristics of subjects with and without asthma in a sample of Danish twin pairs, 3-9 years of age.
39. Birth weight and risk of asthma in 3-9-year-old twins: exploring the fetal origins hypothesis Kindlund Thorax 2010;65:146 Birth characteristics of subjects with and without asthma in a sample of Danish twin pairs, 3-9 years of age. This finding lends support to the “fetal origins hypothesis” suggesting undisclosed prenatal determinants for the risk of asthma.
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42. Non-atopic intrinsic asthma and the 'family tree' of chronic respiratory disease syndromes Holt CEA 2009;39:807 Chronic respiratory inflammatory diseases – a 'family tree' Inset A : Key Inset B : Proposed partial overlap between disease risk genotypes
43. Non-atopic intrinsic asthma and the 'family tree' of chronic respiratory disease syndromes Holt CEA 2009;39:807 Chronic respiratory inflammatory diseases – a 'family tree' Inset A : Key Inset B : Proposed partial overlap between disease risk genotypes Early respiratory tract infections and atopic sensitization during the preschool years are both independently associated with risk for asthma development, but the highest risk for persistent asthma is observed in children who experience both .
44. Non-atopic intrinsic asthma and the 'family tree' of chronic respiratory disease syndromes Holt CEA 2009;39:807 Chronic respiratory inflammatory diseases – a 'family tree' Inset A : Key Inset B : Proposed partial overlap between disease risk genotypes Severe exacerbations of NAA, similar to the situation in AA, are almost invariably triggered by virus infection but requiring a longer time scale to reach a similar clinical end point.
45. Non-atopic intrinsic asthma and the 'family tree' of chronic respiratory disease syndromes Holt CEA 2009;39:807 Chronic respiratory inflammatory diseases – a 'family tree' Inset A : Key Inset B : Proposed partial overlap between disease risk genotypes Inheritance of reduced lung function is a risk factor for severe, early onset COPD.
52. Recurrent wheezing after respiratory syncytial virus or non-respiratory syncytial virus bronchiolitis in infancy: a 3-year follow-up. Valkonen Allergy 2009:64:1359 Background: Recent studies have suggested that rhinovirus -associated early wheezing is a greater risk factor for development of recurrent wheezing in children than is early wheezing associated with respiratory syncytial virus (RSV). We determined the development of recurrent wheezing in young children within 3 years after hospitalization for RSV or non-RSV bronchiolitis.
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56. In vitro susceptibility to rhinovirus infection is greater for bronchial than for nasal airway epithelial cells in human subjects Lopez-Souza JACI 2009;123:1384 Background: Human rhinoviruses (HRVs) characteristically cause upper respiratory tract infection, but they also infect the lower airways, causing acute bronchitis and exacerbating asthma. Objective: Our purpose was to study ex vivo the differences in the response to HRV infection of nasal and bronchial epithelial cultures from the same healthy and asthmatic individuals using conditions favoring development of fully differentiated, pseudostratified mucociliary epithelium.
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58. Immunocytochemistry for rhinovirus RNA (HRV-16) Micrograph of noninfected control HBE cells showing no HRV-16. Micrograph of infected HBE cells showing a high number of HRV-16–infected cells, some with condensed chromatin/nuclei (bright green). In vitro susceptibility to rhinovirus infection is greater for bronchial than for nasal airway epithelial cells in human subjects Lopez-Souza JACI 2009;123:1384
64. A low dose of Mycoplasma pneumoniae infection enhances an established allergic inflammation in mice: the role of the prostaglandin E 2 pathway Wu , CEA 2009;39:1754 Background: Over 40% of chronic stable asthma patients have evidence of respiratory Mycoplasma pneumoniae (Mp) infection as detected by PCR, but not by serology and culture, suggesting that a low-level Mp is involved in chronic asthma. However, the role of such a low-level Mp infection in the regulation of allergic inflammation remains unknown. Objective: To determine the impact of a low-level Mp infection in mice with established airway allergic inflammation on allergic responses such as eosinophilia and chemokine eotaxin-2, and the underlying mechanisms [i.e. the prostaglandin E2 (PGE2) pathway] since PGE2 inhalation before an allergen challenge suppressed the eosinophil infiltration in human airways.
65. A low dose of Mycoplasma pneumoniae infection enhances an established allergic inflammation in mice: the role of the prostaglandin E 2 pathway Wu, CEA 2009;39:1754 Ovalbumin induced asthma IL-4 expression, bronchoalveolar lavage (BAL) eosinophil, eotaxin-2 and PGE 2 levels.
66. A low dose of Mycoplasma pneumoniae infection enhances an established allergic inflammation in mice: the role of the prostaglandin E 2 pathway Wu, CEA 2009;39:1754 Ovalbumin induced asthma Low-dose Mp in allergic mice significantly enhanced IL-4 and eotaxin-2, and lung eosinophilia. IL-4 expression, bronchoalveolar lavage (BAL) eosinophil, eotaxin-2 and PGE 2 levels.
67. Ovalbumin induced asthma Low-dose Mp in allergic mice significantly enhanced IL-4 and eotaxin-2, and lung eosinophilia. IL-4 expression, bronchoalveolar lavage (BAL) eosinophil, eotaxin-2 and PGE 2 levels. High-dose Mp significantly reduced lung eosinophilia and tended to decrease IL-4 and eotaxin-2. A low dose of Mycoplasma pneumoniae infection enhances an established allergic inflammation in mice: the role of the prostaglandin E 2 pathway Wu, CEA 2009;39:1754
68. A low dose of Mycoplasma pneumoniae infection enhances an established allergic inflammation in mice: the role of the prostaglandin E 2 pathway Wu, CEA 2009;39:1754 CFU, colony-forming unit; Mp, Mycoplasma pneumoniae; Sal, saline.
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73. Is intrinsic asthma synonymous with infection? Dahlberg Clinical & Experimental Allergy 2009;39:1324 Rackemann described the ‘intrinsic asthma’ population over 50 years ago as a unique subgroup that was characterized by onset of progressive loss of lung function beginning later in life , possibly after a respiratory infection. It has also been associated with a female predominance , aspirin-sensitive bronchospasm , and nasal polyposis . While the aetiology is not understood, we propose that persistent respiratory infections play a central role in the development of intrinsic asthma .
74. Is intrinsic asthma synonymous with infection? Dahlberg Clinical & Experimental Allergy 2009;39:1324 Respiratory tract infections incite established asthma and likely participate in the initiation of chronic allergic pulmonary inflammation in both infancy and adulthood
75. Is intrinsic asthma synonymous with infection? Dahlberg Clinical & Experimental Allergy 2009;39:1324 Intrinsic asthma may develop in individuals who are unable to eliminate an acute respiratory infection due to previously acquired subtle immune impairments .
82. la prevalenza misura la proporzione di "eventi" presenti in una popolazione in un dato momento . l'incidenza misura la proporzione di "nuovi eventi" che si verificano in una popolazione in un dato lasso di tempo.
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90. TWO REPRESENTATIVE HOUSEHOLD KITCHEN MEXICO Patsari chimney wood stove Open wood fire Improved Biomass Stove Intervention in Rural Mexico Romieu Am. J. Respir. Crit. Care Med 2009;180:649
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94. Background: Ambient fine particles (particular matter <2.5 µm diameter [PM 2.5 ]) and ozone exacerbate respiratory conditions including asthma. There is little documentation determining whether children are more vulnerable to the effects of ambient pollution than adults , or whether pollution causes life-threatening episodes requiring intensive care unit (ICU) admission . Objective: We investigate the relationship between severe asthma morbidity and PM 2.5 and ozone in the warm season, and determine whether there is an age-related susceptibility to pollution. Age-related association of fine particles and ozone with severe acute asthma in New York City Silverman JACI 2010;125:367
107. Role of Oxidative Stress in Ultrafine Particle–induced Exacerbation of Allergic Lung Inflammation Alessandrini Am J Respir Crit Care Med 2009;179:984 Exposed to elemental carbon ultrafine particles (EC-UFPs) Exposed to filtered air immediately before allergen challenge and systemically treated with N-acetylcysteine or vehicle. In sensitized and challenged mice EC-UFP inhalation increased allergen-induced lung lipid peroxidation and NF- κ B activation in addition to inflammatory infiltrate, cytokine release, and airway hyperresponsiveness. Ovalbumin-sensitized mice
108. Role of Oxidative Stress in Ultrafine Particle–induced Exacerbation of Allergic Lung Inflammation Alessandrini Am J Respir Crit Care Med 2009;179:984 Exposed to elemental carbon ultrafine particles (EC-UFPs) Exposed to filtered air immediately before allergen challenge and systemically treated with N-acetylcysteine or vehicle. N-acetylcysteine treatment significantly reduced the adjuvant activity of EC-UFPs. In sensitized and challenged mice EC-UFP inhalation increased allergen-induced lung lipid peroxidation and NF- κ B activation in addition to inflammatory infiltrate, cytokine release, and airway hyperresponsiveness. Ovalbumin-sensitized mice
109. Role of Oxidative Stress in Ultrafine Particle–induced Exacerbation of Allergic Lung Inflammation Alessandrini Am J Respir Crit Care Med 2009;179:984 ( A ) Nonsensitized mice exposed for 24 hours to EC-UFPs (NS/UFP); ( B ) Sensitized and challenged mice exposed to filtered air (S/OVA); A B
110. Role of Oxidative Stress in Ultrafine Particle–induced Exacerbation of Allergic Lung Inflammation Alessandrini Am J Respir Crit Care Med 2009;179:984 C D ( C ) sensitized mice exposed to EC-UFP 24 hours before OVA challenge (S/UFP/OVA); ( D ) sensitized mice exposed to EC-UFP 24 hours before OVA challenge and treated with NAC (S/NAC/UFP/OVA).
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119. Histone deacetylase-2 and airway disease. Barnes PJ. Ther Adv Respir Dis. 2009;3:235-43. The increased expression of inflammatory genes in inflammatory lung diseases is regulated by acetylation of core histones , whereas histone deacetylase-2 (HDAC2) suppresses inflammatory gene expression . increased expression of inflammatory genes suppresses inflammatory gene expression
120. Histone deacetylase-2 and airway disease. Barnes PJ. Ther Adv Respir Dis. 2009;3:235-43. The increased expression of inflammatory genes in inflammatory lung diseases is regulated by acetylation of core histones , whereas histone deacetylase-2 (HDAC2) suppresses inflammatory gene expression . The reduction in HDAC2 appears to be secondary to increased oxidative stress in the lungs. Antioxidants such as curcumin may therefore restore corticosteroid sensitivity
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123. The predicted probability of current asthma at age 10 among boys and girls based on risk calculation [odds ratio (OR)] per increase in cat allergen exposure at age 2. asthma Childhood asthma and early life exposure to indoor allergens, endotoxin and β (1,3)-glucans Bertelsen CEA 2010;40:307 per 10 µg/g dust increase in cat allergen exposure at 2 years of age OR for 2 – 1 – 0 1.20 BHR 1.22
124. The predicted probability of current asthma at age 10 among boys and girls based on risk calculation [odds ratio (OR)] per increase in cat allergen exposure at age 2. asthma Childhood asthma and early life exposure to indoor allergens, endotoxin and β (1,3)-glucans Bertelsen CEA 2010;40:307 per 10 µg/g dust increase in cat allergen exposure at 2 years of age OR for 2 – 1 – 0 1.20 BHR 1.22 No association was seen with allergic sensitization.
125. The predicted probability of current asthma at age 10 among boys and girls based on risk calculation [odds ratio (OR)] per increase in cat allergen exposure at age 2. asthma Childhood asthma and early life exposure to indoor allergens, endotoxin and β (1,3)-glucans Bertelsen CEA 2010;40:307 per 10 µg/g dust increase in cat allergen exposure at 2 years of age OR for 2 – 1 – 0 1.20 BHR 1.22 In a community with a low prevalence of pet keeping and low mite allergen levels, exposure to cat allergens early in life increased the risk of late childhood asthma and BHR, but not the risk of allergic sensitization.
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133. House Dust Mite–Promoted Epithelial-to-Mesenchymal Transition in Human Bronchial Epithelium Heijink AJRCMB 2010;42:69 Human bronchial epithelium (16HBE cells) Fibrogenic cytokine TGF-β and protease-containing aeroallergen house dust mite induce epithelial-to-mesenchymal transition (EMT), a key process in tissue repair and remodeling +TGF- β TGF- β +
134. House Dust Mite–Promoted Epithelial-to-Mesenchymal Transition in Human Bronchial Epithelium Heijink AJRCMB 2010;42:69 Mesenchymal stem cells , or MSCs , are multipotent stem cells that can differentiate into a variety of cell types . Cell types that MSCs have been shown to differentiate in ex vivo cultures and in vitro or in vivo include: - osteoblasts (bone cells), - chondrocytes (cartilage cells) and - adipocytes (fat cells). Mesenchymal stem cells
135. The non-proteolytic house dust mite allergen Der p2 induce NF- κ B and MAPK dependent activation of bronchial epithelial cells . Österlund C EA 2010;39:1199 Der p2, a major non-proteolytic allergen of Dermatophagoides pteronyssinus , Human bronchial epithelial cell line BEAS-2B Dose-dependent up-regulation of: - granulocyte-macrophage colony-stimulating f factor (GMC-SF), - IL-6, IL-8, - monocyte-chemotactic protein-1 (MCP-1) - macrophage inflammatory protein-3 α - intercellular adhesion molecule (ICAM)-1.
136. The non-proteolytic house dust mite allergen Der p2 induce NF- κ B and MAPK dependent activation of bronchial epithelial cells . Österlund C EA 2010;39:1199 Der p2, a major non-proteolytic allergen of Dermatophagoides pteronyssinus , Human bronchial epithelial cell line BEAS-2B This non-proteolytic allergen, in addition to its immunogenic properties, can aggravate respiratory airway disease by adjuvant-like activation of the lung epithelium. Dose-dependent up-regulation of: - granulocyte-macrophage colony-stimulating f factor (GMC-SF), - IL-6, IL-8, - monocyte-chemotactic protein-1 (MCP-1) - macrophage inflammatory protein-3 α - intercellular adhesion molecule (ICAM)-1.
137. The non-proteolytic house dust mite allergen Der p2 induce NF- κ B and MAPK dependent activation of bronchial epithelial cells . Österlund C EA 2010;39:1199 Der p 2 ( μ g/mL) Der p 2 ( μ g/mL) Der p 2 ( μ g/mL)
164. 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 23% 0% 0% 60% 33% Children with metabolic syndrome Snoring Obese Non obese Obese Non obese Obesity and obesity related co-morbidities in a referral population of children with asthma Ross, Ped Pul 2009;44:877
165. 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 23% 0% 0% 60% 33% Children with metabolic syndrome Snoring Obese Non obese Obese Non obese Obesity and obesity related co-morbidities in a referral population of children with asthma Ross, Ped Pul 2009;44:877 Insufficient sleep and nocturnal desaturations tended to be more prevalent among obese subjects.
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171. Comparison of anthropometric measures of obesity in childhood allergic asthma: Central obesity is most relevant. Musaad JACI 2009;123:1321 Health risks for obesity are most associated with fat distribution rather than body weight. Alternative measures that account for fat distribution include waist circumference, a measure of abdominal (central) obesity that, compared with BMI percentiles, better predicts risk for some diseases, such as cardiovascular disease. Similarly, waist/height ratio and the conicity index have been found to be more sensitive than BMI in predicting the risk for cardiovascular disease.
172. Obesity, waist size and prevalence of current asthma in the California Teachers Study cohort Von Behren Thorax 2009;64:889–893 Background: Obesity is a risk factor for asthma, particularly in women, but few cohort studies have evaluated abdominal obesity which reflects metabolic differences in visceral fat known to influence systemic inflammation. A study was undertaken to examine the relationship between the prevalence of asthma and measures of abdominal obesity and adult weight gain in addition to body mass index (BMI) in a large cohort of female teachers.
183. Beneficial effects of high dose of L-arginine on airway hyperresponsiveness and airway inflammation in a murine model of asthma Mabalirajan JACI 2010;125:626 Ovalbumin–sensitized and challenged mice. L-arginine significantly reduced AHR and airway inflammation including bronchoalveolar lavage fluid eosinophilia, T H 2 cytokines, TGF- β 1, goblet cell metaplasia, and subepithelial fibrosis. Different doses of L-arginine.
184. Beneficial effects of high dose of L-arginine on airway hyperresponsiveness and airway inflammation in a murine model of asthma Mabalirajan JACI 2010;125:626 Ovalbumin–sensitized and challenged mice. L-arginine significantly reduced AHR and airway inflammation including bronchoalveolar lavage fluid eosinophilia, T H 2 cytokines, TGF- β 1, goblet cell metaplasia, and subepithelial fibrosis. Different doses of L-arginine. Further, L-arginine increased exhaled nitric oxide levels and reduced the markers of nitro-oxidative stress such as nitrotyrosine, 8-isoprostane, and 8-hydroxy-2’-deoxyguanosine.
185. Beneficial effects of high dose of L-arginine on airway hyperresponsiveness and airway inflammation in a murine model of asthma Mabalirajan JACI 2010;125:626 Ovalbumin–sensitized and challenged mice. L-arginine significantly reduced AHR and airway inflammation including bronchoalveolar lavage fluid eosinophilia, T H 2 cytokines, TGF- β 1, goblet cell metaplasia, and subepithelial fibrosis. Different doses of L-arginine. This was associated with reduced activity and expression of arginase 1, increased expression of endothelial NOS, and reduction of inducible NOS in bronchial epithelia.
191. The airway smooth muscle cell , as well as contracting and relaxing, produces myriad inflammatory and growth factors as well as extracellular matrix proteins and adhesion molecules, which enable interactions with inflammatory cells. Asthma may arise from an intrinsic defect in the smooth muscle cell, which could then be the primary driver of inflammation and remodelling . Intrinsic asthma: is it intrinsic to the smooth muscle? Black CEA 2010;39:962
192. The airway smooth muscle cell , as well as contracting and relaxing, produces myriad inflammatory and growth factors as well as extracellular matrix proteins and adhesion molecules, which enable interactions with inflammatory cells. Asthma may arise from an intrinsic defect in the smooth muscle cell, which could then be the primary driver of inflammation and remodelling . Intrinsic asthma: is it intrinsic to the smooth muscle? Black CEA 2010;39:962 An abnormality in the airway smooth muscle cell, which is capable of producing inflammatory, immunological and growth factors as well as molecules, which facilitate interaction with inflammatory cells, is the primary or instigating event.
193. Intrinsic asthma: not so different from allergic asthma but driven by superantigens? Barnes C EA 2010;39:1145 Invasion of airway epithelial cells by Staphylococcus aureus (and other microorganisms) causes the release of Staphylococcal superantigens (Sag) (and other superantigens), which act on airway B lymphocytes to cause class-switching with the local production of polyclonal IgE, together with IgE directed against SSa (which acts as a 'superallergen'). This causes mast cell activation and release of bronchoconstrictor mediators .
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195. Stimulated airway smooth muscle supernatant (ASMS) elicited an eosinophilopoietic response by blood progenitors from (a) normals (n=11) and (b) atopic asthmatics (n=12), optimal at 1/10 dilution. Eosinophil/basophil colony forming unit (Eo/B CFU) numbers. Human airway smooth muscle promotes eosinophil differentiation Fanat CEA 2010;39:1009
196. Plasmacytoid dendritic cells during infancy are inversely associated with childhood respiratory tract infections and wheezing Upham JACI 2009;124:707 DCs are a family of bone marrow–derived cells that can be separated into 2 major subgroups: conventional or myeloid DCs (mDCs) and plasmacytoid DCs (pDC). Animal models have highlighted the importance of mDCs in the pathogenesis of allergic airway inflammation, whereas pDCs appear to play a specialized role in host defense against viral infections at mucosal surfaces and in some circumstances might mediate immune tolerance.
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201. Regulatory cells, cytokine pattern and clinical risk factors for asthma in infants and young children with recurrent wheeze Borrego C EA 2010;39:1160 HC, healthy children; LRC, low risk for asthma wheezing children; HRC, high risk for asthma wheezing children.
202. Background: Asthma phenotypes are well described among children. However, there are few studies comparing airway inflammation in different clinical presentations of pediatric asthma. We tested the hypothesis that nonatopic asthma is associated with a predominant noneosinophilic inflammation in the airways, as assessed by induced sputum. The objective of this study was to evaluate the cytological characteristics of induced sputum (IS) in atopic (AA), nonatopic asthmatics (NAA) and nonatopic nonasthmatic children (NANA). Neutrophilic airway inflammation is a main feature of induced sputum in nonatopic asthmatic children Drews Allergy 2009:64:1597
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205. AA, atopic asthma; NAA, nonatopic asthma; NANA, no asthma/no atopy. * Data expressed as median (minimum–maximum). Significant difference when compared with NANA, P < 0.001. ‡ Significant difference when compared with AA, P < 0.001. § Significant difference when compared with NAA and NANA, P < 0.001. ¶ Eosinophilia = if sputum eosinophils ≥3%. Differential cell counts * from induced sputum in the three clinical phenotypes Cell viability, % 86 (64–95) 84 (50–95) 88 (66–93) TCC†×10 6 /mg 3.4 (1.2–13.0) 4.0 (1.5–7.6) 2.2 (1.8–8.0) Neutrophils % 11.0 (7.0–16) 18.0 (7.0–31) ‡ 13.0 (8.0–22.0) Eosinophils % 9.0 (0.2–64.0) § 1.0 (0–66.0) 0.5 (0–1.8) Macrophages % 76.4 (29–86) 78.0 (24–84) 81.0 (74–87) Lymphocytes % 0.8 (0–4) 1.0 (0–5.0) 0.8 (0–2.0) Sputum eosinophilia ¶ , n (%) 17 (81) 5 (23.8) 0 (0) Neutrophilic airway inflammation is a main feature of induced sputum in nonatopic asthmatic children Drews Allergy 2009:64:1597
206. Relationship Between Amphiregulin and Airway Inflammation in Children With Asthma and Eosinophilic Bronchitis Won Kim Chest 2009;136:805 Background: Amphiregulin , a member of the epidermal growth factor family , has been shown to promote the growth of fibroblasts, to be associated with the T-helper type 2 cell adaptive immune response, and to up-regulate mucin gene expression. We aimed to determine whether sputum amphiregulin is expressed at elevated levels in patients with asthma or eosinophilic bronchitis (EB), and whether it is associated with eosinophilic inflammation, pulmonary function, and bronchial hyperresponsiveness in children.
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210. Tissue remodeling induced by hypersecreted epidermal growth factor and amphiregulin in the airway after an acute asthma attack Enomoto JACI 2009;124:913 Backgroun