Made by Ranjith R Thampi. A decent powerpoint on Bronchial Asthma, a short summary on various presentations and treatment options starting at Primary health level. Was made mainly for Primary Health setup. I've also added options at higher centres and also a few references for latest drug modalities and use.
Interstitial lung diseases (ILDs) are a group of more than 200 different disorders that cause scarring in the lungs. Scar tissue in the lungs can make it harder for you to breathe normally. In ILDs, scarring damages tissues in or around the lungs’ air sacs and airways.
Made by Ranjith R Thampi. A decent powerpoint on Bronchial Asthma, a short summary on various presentations and treatment options starting at Primary health level. Was made mainly for Primary Health setup. I've also added options at higher centres and also a few references for latest drug modalities and use.
Interstitial lung diseases (ILDs) are a group of more than 200 different disorders that cause scarring in the lungs. Scar tissue in the lungs can make it harder for you to breathe normally. In ILDs, scarring damages tissues in or around the lungs’ air sacs and airways.
Etiopathogenesis and pharmacotherapy of Asthma
the pathophysiology of selected disease states and the rationale for drug therapy;
b. the therapeutic approach to management of these diseases;
c. the controversies in drug therapy;
d. the importance of preparation of individualised therapeutic plans based on diagnosis;
e. needs to identify the patient-specific parameters relevant in initiating drug therapy,
and monitoring therapy (including alternatives, time-course of clinical and laboratory
indices of therapeutic response and adverse effects);
f. describe the pathophysiology of selected disease states and explain the rationale for
drug therapy;
g. summarise the therapeutic approach to management of these diseases including
reference to the latest available evidence;
h. discuss the controversies in drug therapy;
i. discuss the preparation of individualised therapeutic plans based on diagnosis; and
j. identify the patient-specific parameters relevant in initiating drug therapy, and
monitoring therapy (including alternatives, time-course of clinical and laboratory indices of therapeutic response and adverse effects).
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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.
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.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
- 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
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. Outline
• Biology of aging
▫ Immunosenescence
• Epidemiology
• Pathogenesis
• Risk factor
• Special characteristics of asthma in elderly
▫ Asthma VS COPD
• Diagnosis
• Management
3. Biology of aging
• Aging is natural process and not a disease
▫ Aging lung
aging process may be contributing factor to
deterioration of lung function with progressive age
▫ Proinflammatory condition associated with
dysregulated immune system
▫ Play significant role in pathogenesis of many
chronic inflammatory diseases eg. Alzheimer’s
dementia, cardiovascular disease, type 2 DM
Current Opinion in Pulmonary Medicine 2010, 16:55–
4. Immunosenescence
• changes in the innate and adaptive immune response
associated with increased age
• Increased susceptibility to infection, malignancy and
autoimmunity, decreased response to vaccination, and
impaired wound healing
• facilitate persistence of asthma into late adulthood or
development of asthma after the age of 50 to 60 years
J Allergy Clin Immunol 2010;126:690-9.
5. Age-related changes in innate immunity
Cell type Changes with aging
Epithelial cells Decreased ciliary beat frequency and clearance
Microtubular disarrangements
Dendritic cells Reduced phagocytosis and pinocytosis
Increased IL-6 and TNF-α production
Diminished TLR expression and function
Monocytes/macrophages Reduced phagocytosis
Reduced MHC clas II expression
Reduced cytokine and chemokine secretion
Reduced generation of NO and superoxide
J Allergy Clin Immunol 2010;126:690-9.
Clinical immunology, Principles and Practice.Third edition.
6. Age-related changes in innate immunity
Cell type Changes with aging
Neutrophils Reduced phagocytosis ,bactericidal activity
Reduced chemotaxis
Reduced ROS production
NK cells Increased numbers
Reduced cytotoxicity
Reduced proinflmmatory cytokine and chemokine
production
Reduced proliferative response to IL-2
NKT cells Reduced numbers
Reduced proliferation
Eosinophils Reduced degranulation
Reduced superoxide production
J Allergy Clin Immunol 2010;126:690-9.
Clinical immunology, Principles and Practice.Third edition.
7. Age-related changes in adaptive immunity
Cell type Changes with aging
T cells Reduced Naïve T cell count
Increase memory and effector T cell count
Reduced response and proliferation
Reduced CD28 expression
Accumulation of CD8+CD28+ T cells
Reduced TCR diversity
Reduced signal transduction
B cells Reduced generation of B cell precursors
Increase No. of B1 cells
Reduced BCR diversity
Reduced size and number of GC
Reduced expression of co-stimulatory molecule
Reduced Ab affinity, Isotype switch, Ab specific to foreign Ag
Increase Ab specific to self-Ag
J Allergy Clin Immunol 2010;126:690-9.
Clinical immunology, Principles and Practice.Third edition.
8. Role of immunosenescence on features of asthma.
potential mechanism and clinical effect of immunosenescence on long-
term asthma, late-onset asthma, and asthma exacerbations in the
elderly
J Allergy Clin Immunol 2010;126:690-9.
9. Prevalence of asthma in the US among different age groups.
Data are from the 1999 National Health Interview Study
Drugs & Aging 2000 Nov; 17 (5):385-397.
10. Epidemiology
• In 2004, the US prevalence of asthma for those 65 years
or older was 7%, with 1,088,000 reporting an asthma
attack in the previous 12 months.
• Older asthmatic patients are more likely to be
underdiagnosed, undertreated and hospitalized than
younger
• highest death rate (51.3 per million people) of any age
group .
• Older women are hospitalized more than twice as often
as older men
Current Opinion in Pulmonary Medicine 2010,16:55–59
11. Asthma mortality rates by age, per 1,000,000, age-
adjusted to the 1970 Standard Million
The American Journal of Medicine, Vol 122, No 1, January 2009
14. Potential mechanisms for asthma phenotypes in the elderly
long-standing asthma late-onset asthma
Age of onset
(years)
Child or young
adult (<40)
Adult (>40)
Genetic role Likely gene by environment Likely epigenetic, including oxidative
stress and shortened telomeres
Infection Viral – rhinovirus and RSV Viral – RSV, influenza and bacterial
(e.g. Chlamydia pneumoniae),
microbial superantigens
Allergy Likely Unlikely
Inflammation Th2 driven, eosinophilic Th1 or Th2 driven, neutrophilic and/or
eosinophilic, innate immunity, Th-17,
Proteases
Environment Allergens, daycare,
school and workplace
Workplace, dwelling type (house,
apartment and Institutional)
Current Opinion in Pulmonary Medicine 2010,16:55–59
15. Pathogenesis
• Airway inflammation plays a major role in asthma
including AIE
• IL-6, prominent in older adults with generalized
inflammation, may increase IL-17 and decrease Treg
cells, resulting in predominately neutrophilic
inflammation in the lungs
• Resistance of different inflammatory cells to initiate
apoptosis in asthmatic patients, causing persistence of
airway inflammation
Current Opinion in Pulmonary Medicine 2010, 16:55–59
16. Risk factor
• Genes, and especially epigenetic changes
• Respiratory infections
▫ viral [rhinovirus and RSV]
▫ bacteria
▫ Superantigen (staphylococcal enterotoxins)
• Atopy
• Obesity
▫ increased inflammation and may cause mechanical
impairment of diaphragm excursion
• Female sex
▫ prevalence, hospitalization and higher death rates
Current Opinion in Pulmonary Medicine 2010,16:55–59
17. Studies examining early versus late-onset asthma
Current Opinion in Pulmonary Medicine 2010,16:55–59
18. Special characteristics of asthma in elderly
• Lung function decreases with age, and decrease
greater in men
• reduced response to bronchodilators and
glucocorticoids
• Rarely IgE mediated, and often develops with
component of irreversible airway obstruction
• immunosenescence
▫ Naive T cells decrease, memory T cells increase, and
B-cell function decreases, but lesser decrease in
innate immunity
▫ Eosinophil function remains the same, but neutrophil
numbers increase
J Allergy Clin Immunol 2010;126:681-7.
19. Age-related decline in FEV1 by strata in men aged 18–80 years
derived from linear mixed effects models
Mean FEV1 is corrected for height, weight, and age at first survey
Am J Respir Crit Care Med Vol 171. pp 109–114, 2005.
20. Special characteristics
of asthma in elderly
1. great variability in the
duration and severity of the
disease
2. onset can have been at
any time since childhood
but more often begins in
middle age or later
3. many of these patients
have severe irreversible
obstruction unrelated to the
duration of the diseaseThese patients are random selection
of approximately 1,200 patients 65
years of age or older given diagnosis
of asthma at Mayo Clinic in 1993
J Allergy Clin Immunol 2010;126:681-7.
21. Special characteristics of asthma in elderly
• Coexistence of asthma and COPD in elderly
patients due to
▫ Cigarette smoking
▫ Exposure to airborne endotoxin
▫ Latent adenovirus in respiratory epithelial cells
J Allergy Clin Immunol 2010;126:681-7.
22. Non-proportional Venn diagram of chronic obstructive pulmonary
disease (COPD)
Thorax. 2008 September ; 63(9): 761–767.
23. Asthma and COPD
Asthma-specific feature COPD specific feature
• Reversibility
• Airway inflammation (E )
• Th2-cytokine pattern
• Reduced elastic recoil due to
edema
• Perfusion of underventilated
areas (esp. during
exacerbation)
• Irreversible airflow
obstruction (predominantly)
• Destruction of alveoli
• Reduced elastic recoil due to
loss of lung tissue
• Ventilation of underperfused
area
• Response to anticholinergic
agents
Clinical immunology, Principles and Practice.Third edition.
Common feature
- Airflow obstruction
- Shift of tidal breathing towards TLC during exacerbation
25. Percentage of adults (by gender) with airflow obstruction who have an
overlap syndrome with increasing age. Males are shown in the black bars and
females in the white bars
Thorax 2009;64:728–735.
26. Differentiating features of COPD and asthma
COPD Asthma
(early-onset)
Asthma (late-
onset)
Overlap
syndrome
Onset Mid life Early life 65 y or older May have history
of asthma in early
life
Risk factors Smoking Atopy, airway
hyperresponsiven
ess
Atopy, irritant
exposures
Smoking, aging
Symptoms Slowly progress Intermittent, worse
at
night/morning
Intermittent, poor
perception of
symptoms
Slowly
progressive
Family history May be present Frequently
present
May be present May be present
FEV1/FVC <70% ≥70% <70% <70%
FEV1% predicted <80% >80% <80% <80%
Bronchodilator
response
Absent present present Absent
J Allergy Clin Immunol 2010;126:702-9.
27. Diagnostic challenges of asthma in the elderly
• confused with COPD and heart failure
• Spirometry
▫ underutilized in primary care setting
▫ parameters define asthma in aging population
▫ performance of effective testing
• postbronchodilator PFT
• Alterations in perception of airway obstruction due to
aging
▫ underestimation of disease severity and delay in seeking advice
• Several systemic comorbidities may coexist with AIE
Current Opinion in Pulmonary Medicine 2010,16:55–59
28. Diagnostic details that affect management after the
diagnosis of asthma has been established
• Age at onset
• Upper airway disease, sinusitis, and polyps
• ADR
▫ Aspirin, beta blocker, including eyedrops, and ACEI
• Coexisting diseases
• Pack-years of cigarette smoking or passive exposure
• Past or present occupational exposures
• Domestic exposures to irritants, allergens, and
stimulants of innate immunity
• Persistent airway obstruction despite therapy
• Total and specific IgE levels
• Abnormal chest radiographic or CT scan results
J Allergy Clin Immunol 2010;126:681-7.
29. Management challenges of asthma in the elderly
• Physicians overlooking appropriate treatment of asthma
• Patient do not want to or cannot afford to take
‘prophylactic’ or preventive medicines
• psychomotor and cognitive disabilities affect choice of
inhaler delivery systems
• drug interactions and increased incidence of ADRs
• lack of many drug trials involving elderly asthma
Current Opinion in Pulmonary Medicine 2010,16:55–59
30. Details of asthma control important in elderly
patients
• Control exposure to environmental agents
• Monitor skill of inhaling aerosol medications
• Establish ‘‘personal best’’ FEV1
• Add oral medications, such as leukotriene antagonists or
low-dose theophylline, for patients with severe asthma
• If there is a concern about cardiotoxicity of b-adrenergic
agonists, substitute anticholinergic aerosols
• Manage osteoporosis and other coexisting diseases
• Influenza and pneumococcal immunization
J Allergy Clin Immunol 2010;126:681-7.
35. SMART trial
• possible link between LABA and respiratory-related
deaths in asthmatic patients >12 yr ( mean 40)
• subjects using LABA without ICS compared with
placebo, occurred primarily in African Americans
• respiratory-related deaths
▫ (24 vs 11; RR, 2.16; 95% CI, 1.06 to 4.41)
• asthma-related deaths
▫ (13 vs 3; RR, 4.37; 95% CI, 1.25 to 15.34)
• combined asthma-related deaths or life-threatening
experiences
▫ (37 vs 22; RR, 1.71; 95% CI, 1.01 to 2.89)
CHEST 2006; 129:15–26.
36. Anticholinergic Medications
• Cochrane review (22 studies)1
▫ statistically significant improvements in daytime dyspnea and peak
flow measurements in patients treated with inhaled anticholinergic
agents compared with placebo
▫ no difference between anticholinergic plus SABA and SABA alone in
the improvement of symptoms or PEF (maintenance Rx)
• Meta-analysis (23 RCT)2
▫ Reduction in hospitalization and improved spirometric function with
combination therapy when compared with SABA alone
• asthma guidelines recommend combining inhaled
ipratropium with SABA therapy in moderate or severe
asthma exacerbations
1.Cochrane Database Syst Rev. 2004;3:CD003269
2.Thorax. 2005;60:740-746.
37. Corticosteroids
• Adult patients with asthma did not sustain a significant
loss of BMD from ICS use1
▫ Adverse effects may be seen only after many years of high-dose
inhaled corticosteroid use
• study of 38,325 (age>66) more using ICS or INCS2
▫ increased risk of ocular HT and open-angle glaucoma with
prolonged administration (OR 1.44; 1.01-2.06)
• study of 3677 patients (aged >70) inhaled
beclomethasone or budesonide ( 1mg/d, >2 yrs.)3
▫ increased risk for cataracts (OR 3.40; 1.49-7.76)
1. CHEST 2003; 124:2329–2340
2. JAMA. 1997;277:722-727
3. JAMA. 1998;280:539-543.
38. Leukotriene Receptor Antagonists
• ACCEPT trial
▫ 4-week open-label trial of zafirlukast that included
321 asthmatic patients (aged >66)
▫ statistically significant improvements in symptoms
and morning PEF with zafirlukast, ( less than in
younger groups )
▫ Side effects in seniors were only slightly more
common than in younger adults (17.5% vs 18.8%)
Ann Allergy Asthma Immunol 2000;84:217–225.
39. Anti-immunoglobulin-E Therapies
• 2511 asthmatic patients aged 6 to 75 years
▫ Omalizumab use was associated with a reduction of
asthma exacerbations by 38% and emergency
department visits by 47%
▫ subgroup analysis showed beneficial effects among all
age groups, improvements in patients aged > 65 years
did not reach statistical significance
Allergy 2005: 60: 302–308
43. Take home message
• Asthma in elderly
▫ Underdiagnosis and undertreatment
▫ Multidimentional aspects of aging, disease
concurrence and comorbidity and patient
preference
Editor's Notes
anatomic and physiologic changes seen in asthma have also been described in the
The US population over the age of 65 years is projected to grow from about 40 million in 2005
asthma in the elderly, is handicapped by the difficulty of identifying appropriate subjects
based on physicians’ diagnoses or on patients’ recollections. Physicians are often reluctant to make the diagnosis, and the accuracy has varied over time and in different locations. include subjects who have only asthma and exclude those who have coexisting lung diseases.
Data about death from asthma are conflicting. Death certificates are often inaccurate
(group 1: 65 years or older, n = 50) with younger patients (group 2: !40 years, n = 99)
group A: onset before 40, n = 22) were compared with patients developing symptoms later in their lives (group B: onset after 40, n = 22).
The roles of different inflammatory pathways and mediators of inflammation described in asthma have not been well studied in the elderly with asthma
staphylococcal enterotoxins can amplify airway inflammation and thus may have an important role in the pathogenesis and progression of asthma
Allergies are commonly associated with LSA, but much less likely to be associated with LOA
Older age of onset is associated with less allergy sensitization.
allergy tests in older patients do not seem to correlate well with nasal provocation studies or the presence of allergens in the home environment
The reasons for the decrease include stiffening of the chest wall, reduced respiratory muscle function, and an increase in residual volume from loss of elastic recoil.
The values are the best recorded after inhalation of b-adrenergic bronchodilator and are not necessarily the best that could have been obtained after a course of systemic glucocorticoid treatment. The duration of asthma was dated from the first physician’s diagnosis or the first symptoms of wheezing and shortness of breath, whichever came first. There was no difference in the results of patients who received primary care at Mayo Clinic and those referred from other cities. Only 32% of these patients had FEV1 after bronchodilator of greater than 60% of predicted normal value, and 20% had FEV1 of less than 50% of predicted normal value
Reversible AO,reversible airflow obstruction with improvement in FEV1 after bronchodilator;
irreversible AO, incompletely reversible airflow obstruction, postbronchodilator FEV1 is <80%;
irreversible AO+BDR,incompletely reversible airflow obstruction with significant bronchodilator responsiveness (BDR);
irreversible AO+BHR, incompletely reversible airflow obstruction with significant bronchial hyperresponsiveness with fall in FEV1 after bronchoconstrictor. The label ‘asthma’ can be applied to reversible AO,irreversible AO+BDR and irreversible AO+BHR.
Chronic obstructive pulmonary disease (COPD) can be applied to each of the conditions with irreversible AO+BHR.
Overlap syndrome is present in irreversible AO+BDR and irreversible AO+BHR.
The subsets comprising COPD are shaded. Subset areas are not proportional to the actual relative subset sizes.
Asthma is by definition associated with reversible airflow obstruction although, in variant asthma, special manoeuvres may be necessary to make the obstruction evident. Patients with asthma whose airflow obstruction is completely reversible (subset 9) are not considered to have COPD. Because in many cases it is virtually impossible to differentiate patients with asthma whose airflow obstruction does not remit completely from persons with chronic bronchitis and emphysema who have partially reversible airflow obstruction with airway hyperreactivity, patients with unremitting asthma are classified as having COPD (subsets 6, 7 and 8). Chronic bronchitis and emphysema with airflow obstruction usually occur together (subset 5), and some patients may have asthma
associated with these two disorders (subset 8). Individuals with asthma who have been exposed to chronic irritation, as from cigarette smoke, may develop chronic productive cough, which is a feature of chronic bronchitis (subset 6). Persons with chronic bronchitis and/or emphysema without airflow obstruction (subsets 1, 2 and 11) are not classified as having COPD. Patients with airway obstruction due to diseases with known aetiology or specific pathology such as
cystic fibrosis or obliterative bronchiolitis (subset 10) are not included in this definition.
spirometry, which are essential to diagnose airway obstruction in this population, continues to be underutilized in the primary care setting. Even when these
tests are utilized, confusion exists as to what physiologic parameters define asthma in the aging population
Thirteen single-dose trials and 20 longer duration trials
single-dose trials, seven were of asthma, five were on COPD and one reported data on both. mean age of 56.6 years
14 were of asthma and 6 were of COPD
Mean age of 52.2 years in these trials, which ranged in duration from 3 days to 1 year with a mean trial duration of 4.7 months
For trials lasting from 3 days to 1 year, 2-agonist treatment
Mean age 40 yr for SMART increase re
none of which included only seniors
no controlled trials confirming the benefits of inhaled maintenance corticosteroid therapy in elderly asthmatic patients
Current users of high doses of inhaled steroids prescribed regularly for 3 or more months were at an increased risk with an OR of 1.44 (95% confidence interval, 1.01-2.06).
Irrespective of device selection, the practitioner must demonstrate the technique, and provide regular assessment and instruction.
Minimisation of polypharmacy of inhaler devices is recommended. pMDI=pressurised metered dose inhaler. DPI=dry powder inhaler
Multidimensional assessment is represented by the spokes of the wheel and the multidisciplinary intervention by
the outer rim of wheel. LABD=long acting bronchodilator. WAP=written action plan