The document discusses definitions, descriptions, diagnosis and treatment of asthma according to GINA and PRACTALL guidelines. It provides definitions of asthma as a chronic inflammatory disease of the airways characterized by variable respiratory symptoms and airflow limitation. Diagnosis is based on symptoms, reversibility testing and variability in lung function. Treatment involves a stepwise approach starting with reliever medication and low-dose inhaled corticosteroids, escalating up treatments based on symptom control and risk of exacerbations. The goal is to achieve good symptom control and reduce risk of exacerbations and side effects.
FPIAP is a non-IgE mediated gastrointestinal food allergy that is the mildest form. It is characterized by the presence of blood and sometimes mucus in the stools of otherwise healthy infants. It affects infants under 6 months of age, with symptoms appearing between 2-8 weeks of life. The most common triggering foods are cow's milk protein in breastfed infants and soy, cow's milk protein, and extensively hydrolyzed formulas in formula-fed infants. The diagnosis is based on clinical history and resolution of symptoms with dietary elimination of trigger foods. Prognosis is excellent, with tolerance developing in most children by 1-3 years of age.
The Future of Allergy and Clinical Immunology Prof. G. Walter Canonica - Con...Juan Carlos Ivancevich
Prof.G.Walter Canonica
Allergy and Respiratory Diseases Clinic
DIMI-‐University of Genoa
Italy
Presidente Congreso SLaai 2015: Dr. Alfonso Cepeda Sarabia
This document discusses severe asthma in Europe, its prevalence, impact, and treatment options. It notes that severe asthma affects up to 1.5 million Europeans and is difficult to control, often limiting daily activities. Bronchial thermoplasty is introduced as a minimally invasive treatment that uses thermal energy to reduce airway smooth muscle and decrease asthma attacks for at least 5 years. The document calls for better management of severe asthma and faster access to specialized care given its significant burden.
Programa Congreso Para Todos
XVIII Congreso Latinoamericano de Alergia, Asma e Inmunología 2015.XVIII 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 - http://www.slaai2015.com
This document summarizes research on drug-induced anaphylaxis in Latin America. Some key findings include:
- Drugs are a leading cause of anaphylaxis in Latin America, reported in 34% of cases in one study. NSAIDs and beta-lactams are among the most common culprits.
- Studies in Latin America found cardiovascular involvement in over 45% of anaphylaxis cases, and was more frequent in elderly patients. Shock and severe reactions were also more common in the elderly.
- A study of over 800 anaphylaxis cases across Latin America found NSAIDs to be the predominant cause in adults, while beta-lactams were more common in children and
This document provides an overview of drug hypersensitivity during anesthesia. It begins with a brief history of anesthesia practice dating back to ancient civilizations. It then defines anesthesia and introduces the topic of drug hypersensitivity during anesthesia. It discusses the epidemiology, risk factors, pathophysiology, clinical manifestations, diagnosis and treatment of drug hypersensitivity reactions that can occur during anesthesia. It also provides specific information on reactions to common anesthetic agents like neuromuscular blockers, opioids and benzodiazepines. The document includes a case report example and discusses special considerations for conditions like mastocytosis and the alpha-gal syndrome.
FPIAP is a non-IgE mediated gastrointestinal food allergy that is the mildest form. It is characterized by the presence of blood and sometimes mucus in the stools of otherwise healthy infants. It affects infants under 6 months of age, with symptoms appearing between 2-8 weeks of life. The most common triggering foods are cow's milk protein in breastfed infants and soy, cow's milk protein, and extensively hydrolyzed formulas in formula-fed infants. The diagnosis is based on clinical history and resolution of symptoms with dietary elimination of trigger foods. Prognosis is excellent, with tolerance developing in most children by 1-3 years of age.
The Future of Allergy and Clinical Immunology Prof. G. Walter Canonica - Con...Juan Carlos Ivancevich
Prof.G.Walter Canonica
Allergy and Respiratory Diseases Clinic
DIMI-‐University of Genoa
Italy
Presidente Congreso SLaai 2015: Dr. Alfonso Cepeda Sarabia
This document discusses severe asthma in Europe, its prevalence, impact, and treatment options. It notes that severe asthma affects up to 1.5 million Europeans and is difficult to control, often limiting daily activities. Bronchial thermoplasty is introduced as a minimally invasive treatment that uses thermal energy to reduce airway smooth muscle and decrease asthma attacks for at least 5 years. The document calls for better management of severe asthma and faster access to specialized care given its significant burden.
Programa Congreso Para Todos
XVIII Congreso Latinoamericano de Alergia, Asma e Inmunología 2015.XVIII 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 - http://www.slaai2015.com
This document summarizes research on drug-induced anaphylaxis in Latin America. Some key findings include:
- Drugs are a leading cause of anaphylaxis in Latin America, reported in 34% of cases in one study. NSAIDs and beta-lactams are among the most common culprits.
- Studies in Latin America found cardiovascular involvement in over 45% of anaphylaxis cases, and was more frequent in elderly patients. Shock and severe reactions were also more common in the elderly.
- A study of over 800 anaphylaxis cases across Latin America found NSAIDs to be the predominant cause in adults, while beta-lactams were more common in children and
This document provides an overview of drug hypersensitivity during anesthesia. It begins with a brief history of anesthesia practice dating back to ancient civilizations. It then defines anesthesia and introduces the topic of drug hypersensitivity during anesthesia. It discusses the epidemiology, risk factors, pathophysiology, clinical manifestations, diagnosis and treatment of drug hypersensitivity reactions that can occur during anesthesia. It also provides specific information on reactions to common anesthetic agents like neuromuscular blockers, opioids and benzodiazepines. The document includes a case report example and discusses special considerations for conditions like mastocytosis and the alpha-gal syndrome.
This document discusses platinum hypersensitivity, including the case of a 60-year-old woman who experienced anaphylactic shock during carboplatin treatment for ovarian cancer. It outlines the mechanisms, incidence, and risk factors of platinum hypersensitivity reactions. It describes the different platinum agents (cisplatin, carboplatin, oxaliplatin) and approaches to address hypersensitivity reactions, including reducing infusion rates, premedication, switching agents, skin testing, and desensitization.
1. NSAID hypersensitivity is common, affecting up to 1.9% of the general population. It is classified into 5 types based on clinical manifestations and pathophysiology.
2. AERD is characterized by respiratory symptoms like asthma and chronic sinusitis. NSAID-exacerbated cutaneous disease presents with urticaria and angioedema.
3. Diagnosis involves a medical history, skin or oral drug challenge tests, and occasionally immunological tests. Provocation tests with aspirin or other NSAIDs can identify safe alternative medications.
Dr. José Antonio Ortega Martell presented on allergic rhinitis (AR) and the role of intranasal corticosteroids (INS) in its treatment. AR is a common condition worldwide that can impair quality of life. While symptoms can be relieved by various medications, INS are the most effective treatment due to their ability to reduce inflammation and prevent exacerbations. INS work both acutely and prevent persistent minimal inflammation. Potential side effects are typically minor and can be reduced by proper administration. INS should be used as the preferred treatment for AR due to their efficacy and ability to alter the disease course over time.
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
This document discusses biomarkers in asthma and the 2020 Mexican consensus on fractional exhaled nitric oxide (FeNO) in asthma. It provides background on the population affected by asthma and the economic burden. Biomarkers can help identify asthma phenotypes and endotypes, guiding treatment. Fractional exhaled nitric oxide (FeNO) is a non-invasive marker of eosinophilic airway inflammation and can help monitor asthma control and response to treatment. The document reviews the use of FeNO and other biomarkers to identify inflammation phenotypes and optimize asthma management.
This document discusses diagnostic tests for NSAID/ASA hypersensitivity, including the nasal provocation test and basophil activation test. It provides details on:
1. A study that evaluated the efficacy of the nasal provocation test and basophil activation test in diagnosing various subtypes of ASA hypersensitivity, finding the nasal test detected 60% of cases while the combination of the two tests increased sensitivity.
2. Guidelines for oral and nasal aspirin provocation tests, noting oral challenges have higher sensitivity but nasal tests are safer with lower risk of systemic reactions.
3. A study that assessed the nasal provocation test and basophil activation test's ability to diagnose different clinical patterns of ASA sensitivity, finding
Drug reaction with eosinophilia and systemic symptoms & acute generalized exanthematous pustulosis 2019
Presented by Nattasasi Suchamalawong, MD.
November 15, 2019
Cephalosporin use on Penicillin Allergy patientsrishad_87
IgE is involved in mediating the life threatening allergic reactions caused by penicillin. Penicillin allergy is commonly reported and affects 5-10% of patients. Immediate IgE-mediated reactions are responsible for more severe manifestations. While penicillin allergy was thought to affect 10% based on early studies, more recent studies using skin testing and in vitro testing have found the true incidence and rate of cross-reactivity between penicillins and cephalosporins to be lower, around 1-2%. Risk assessment including skin testing should be performed before using cephalosporins in patients with a history of penicillin allergy.
Dr. ihsan edan abdulkareem alsaimary
PROFESSOR IN MEDICAL MICROBIOLOGY AND MOLECULAR IMMUNOLOGY
ihsanalsaimary@gmail.com
mobile : 009647801410838
university of basrah - college of medicine - basrah -IRAQ
This document summarizes beta-lactam hypersensitivity. It discusses the epidemiology of beta-lactam allergies and classifications of adverse drug reactions. It describes the immunological mechanisms involving hapten formation and carrier proteins. It examines the determinants of different beta-lactams including penicillins, cephalosporins, carbapenems, monobactams, and clavams. Diagnosis and management of beta-lactam hypersensitivity are also mentioned.
201911 - Tripodi - Immunoterapia specifica alla luce della e-mobile health?Asmallergie
1. The document discusses using digital solutions like mobile health to improve allergen immunotherapy (AIT) by combining clinical research data and mobile health for AIT prescription.
2. It proposes the "@IT-2020" process, a flexible 4-step modular approach for prescribing AIT for pollen allergy patients in Southern Europe/Mediterranean countries, to be validated in a pilot study (2016-2017) and multicenter study (2018-2019).
3. The 4 diagnostic steps of "@IT-2020" and validation testing are described, aiming to determine genuine vs false sensitization, primary sensitization, and the relationship between sensitization and symptoms to guide personalized AIT prescription.
This document summarizes information about asthma phenotypes from several sources. It begins by defining asthma as a heterogeneous disease characterized by chronic airway inflammation and variable airflow limitation. Phenotypes are the observable characteristics of a disease, and examples of asthma phenotypes include allergic asthma, non-allergic asthma, and obesity-related asthma. Endotypes are disease subtypes defined by distinct molecular mechanisms. Biomarkers can help identify phenotypes and predict treatment responses. The document then reviews biomarkers and features of eosinophilic versus non-eosinophilic asthma and discusses mechanisms and treatment approaches for different phenotypes.
Pearls in Allergy and Immunology - August 2014Juan Aldave
The document summarizes recent guidelines on anaphylaxis from the European Academy of Allergy and Clinical Immunology. It discusses:
1) The definition, prevalence, mechanisms, common triggers, factors influencing severity, diagnosis and treatment of anaphylaxis.
2) The mechanisms of action of epinephrine and its role as first-line treatment.
3) Common cofactors ("augmentation factors") that can lower the threshold for anaphylaxis, including physical exercise, alcohol, infections, NSAIDs and certain drugs.
Hereditary angioedema (HAE) is caused by C1 inhibitor deficiency or dysfunction. There are three main types: HAE type I and II involve C1INH mutations, while HAE type III has normal C1INH levels. Symptoms include non-pruritic swelling of the skin or mucosa. Abdominal or laryngeal attacks can be life-threatening. Diagnosis involves evaluating C1INH antigenic and functional levels. Treatment focuses on preventing attacks or treating acute episodes. Acquired angioedema has similar symptoms but later onset and is sometimes associated with lymphoproliferative disorders.
Pearls in Allergy and Immunology - July 2014Juan Aldave
The purpose of the document is to provide educational material for Allergy/Immunology physicians. It summarizes several recent journal articles on topics related to allergy and immunology. Specifically, it discusses that allergic rhinitis is a risk factor for decreased traffic safety due to impaired cognitive and psychomotor functions. It also summarizes articles on differences in IgE sensitization patterns between atopic dermatitis and other hyper-IgE syndromes. Additionally, it discusses the efficacy of IgE-targeted versus empirical elimination diets for eosinophilic esophagitis.
Omalizumab is an anti-IgE monoclonal antibody approved for treating allergic asthma, chronic urticaria, and other allergic diseases. It binds to IgE and forms complexes that are cleared, reducing free IgE levels and decreasing FcεRI expression on mast cells and basophils. For asthma, omalizumab improves symptoms and lung function and reduces exacerbations and steroid use. It may be more effective in patients with elevated type 2 biomarkers. Omalizumab also improves symptoms of chronic urticaria by decreasing mediators released in response to autoantibodies. Other anti-IgE biologics in development have distinct binding properties from omalizumab.
Este documento presenta información sobre la rinitis alérgica, incluyendo su definición, clasificación, prevalencia, factores de riesgo, mecanismos fisiopatológicos, relación con el asma y diagnóstico. La rinitis alérgica es una enfermedad inflamatoria crónica de la mucosa nasal que afecta a cientos de millones de personas y tiene un impacto significativo en la calidad de vida. Su prevalencia varía entre 1-40% dependiendo de la región. Los principales factores de riesgo
Este documento describe los diferentes fenotipos clínicos del asma y sus implicaciones. Discute el asma desde perspectivas pediátrica y en adultos, identificando varios fenotipos como el asma atópica, no atópica, inducida por virus u otros desencadenantes. También analiza factores de riesgo como la obesidad, exposición a infecciones y ambientes. El asma es heterogénea y su patogénesis depende de interacciones genético-ambientales. Identificar fenotipos ayuda a comp
This document discusses platinum hypersensitivity, including the case of a 60-year-old woman who experienced anaphylactic shock during carboplatin treatment for ovarian cancer. It outlines the mechanisms, incidence, and risk factors of platinum hypersensitivity reactions. It describes the different platinum agents (cisplatin, carboplatin, oxaliplatin) and approaches to address hypersensitivity reactions, including reducing infusion rates, premedication, switching agents, skin testing, and desensitization.
1. NSAID hypersensitivity is common, affecting up to 1.9% of the general population. It is classified into 5 types based on clinical manifestations and pathophysiology.
2. AERD is characterized by respiratory symptoms like asthma and chronic sinusitis. NSAID-exacerbated cutaneous disease presents with urticaria and angioedema.
3. Diagnosis involves a medical history, skin or oral drug challenge tests, and occasionally immunological tests. Provocation tests with aspirin or other NSAIDs can identify safe alternative medications.
Dr. José Antonio Ortega Martell presented on allergic rhinitis (AR) and the role of intranasal corticosteroids (INS) in its treatment. AR is a common condition worldwide that can impair quality of life. While symptoms can be relieved by various medications, INS are the most effective treatment due to their ability to reduce inflammation and prevent exacerbations. INS work both acutely and prevent persistent minimal inflammation. Potential side effects are typically minor and can be reduced by proper administration. INS should be used as the preferred treatment for AR due to their efficacy and ability to alter the disease course over time.
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
This document discusses biomarkers in asthma and the 2020 Mexican consensus on fractional exhaled nitric oxide (FeNO) in asthma. It provides background on the population affected by asthma and the economic burden. Biomarkers can help identify asthma phenotypes and endotypes, guiding treatment. Fractional exhaled nitric oxide (FeNO) is a non-invasive marker of eosinophilic airway inflammation and can help monitor asthma control and response to treatment. The document reviews the use of FeNO and other biomarkers to identify inflammation phenotypes and optimize asthma management.
This document discusses diagnostic tests for NSAID/ASA hypersensitivity, including the nasal provocation test and basophil activation test. It provides details on:
1. A study that evaluated the efficacy of the nasal provocation test and basophil activation test in diagnosing various subtypes of ASA hypersensitivity, finding the nasal test detected 60% of cases while the combination of the two tests increased sensitivity.
2. Guidelines for oral and nasal aspirin provocation tests, noting oral challenges have higher sensitivity but nasal tests are safer with lower risk of systemic reactions.
3. A study that assessed the nasal provocation test and basophil activation test's ability to diagnose different clinical patterns of ASA sensitivity, finding
Drug reaction with eosinophilia and systemic symptoms & acute generalized exanthematous pustulosis 2019
Presented by Nattasasi Suchamalawong, MD.
November 15, 2019
Cephalosporin use on Penicillin Allergy patientsrishad_87
IgE is involved in mediating the life threatening allergic reactions caused by penicillin. Penicillin allergy is commonly reported and affects 5-10% of patients. Immediate IgE-mediated reactions are responsible for more severe manifestations. While penicillin allergy was thought to affect 10% based on early studies, more recent studies using skin testing and in vitro testing have found the true incidence and rate of cross-reactivity between penicillins and cephalosporins to be lower, around 1-2%. Risk assessment including skin testing should be performed before using cephalosporins in patients with a history of penicillin allergy.
Dr. ihsan edan abdulkareem alsaimary
PROFESSOR IN MEDICAL MICROBIOLOGY AND MOLECULAR IMMUNOLOGY
ihsanalsaimary@gmail.com
mobile : 009647801410838
university of basrah - college of medicine - basrah -IRAQ
This document summarizes beta-lactam hypersensitivity. It discusses the epidemiology of beta-lactam allergies and classifications of adverse drug reactions. It describes the immunological mechanisms involving hapten formation and carrier proteins. It examines the determinants of different beta-lactams including penicillins, cephalosporins, carbapenems, monobactams, and clavams. Diagnosis and management of beta-lactam hypersensitivity are also mentioned.
201911 - Tripodi - Immunoterapia specifica alla luce della e-mobile health?Asmallergie
1. The document discusses using digital solutions like mobile health to improve allergen immunotherapy (AIT) by combining clinical research data and mobile health for AIT prescription.
2. It proposes the "@IT-2020" process, a flexible 4-step modular approach for prescribing AIT for pollen allergy patients in Southern Europe/Mediterranean countries, to be validated in a pilot study (2016-2017) and multicenter study (2018-2019).
3. The 4 diagnostic steps of "@IT-2020" and validation testing are described, aiming to determine genuine vs false sensitization, primary sensitization, and the relationship between sensitization and symptoms to guide personalized AIT prescription.
This document summarizes information about asthma phenotypes from several sources. It begins by defining asthma as a heterogeneous disease characterized by chronic airway inflammation and variable airflow limitation. Phenotypes are the observable characteristics of a disease, and examples of asthma phenotypes include allergic asthma, non-allergic asthma, and obesity-related asthma. Endotypes are disease subtypes defined by distinct molecular mechanisms. Biomarkers can help identify phenotypes and predict treatment responses. The document then reviews biomarkers and features of eosinophilic versus non-eosinophilic asthma and discusses mechanisms and treatment approaches for different phenotypes.
Pearls in Allergy and Immunology - August 2014Juan Aldave
The document summarizes recent guidelines on anaphylaxis from the European Academy of Allergy and Clinical Immunology. It discusses:
1) The definition, prevalence, mechanisms, common triggers, factors influencing severity, diagnosis and treatment of anaphylaxis.
2) The mechanisms of action of epinephrine and its role as first-line treatment.
3) Common cofactors ("augmentation factors") that can lower the threshold for anaphylaxis, including physical exercise, alcohol, infections, NSAIDs and certain drugs.
Hereditary angioedema (HAE) is caused by C1 inhibitor deficiency or dysfunction. There are three main types: HAE type I and II involve C1INH mutations, while HAE type III has normal C1INH levels. Symptoms include non-pruritic swelling of the skin or mucosa. Abdominal or laryngeal attacks can be life-threatening. Diagnosis involves evaluating C1INH antigenic and functional levels. Treatment focuses on preventing attacks or treating acute episodes. Acquired angioedema has similar symptoms but later onset and is sometimes associated with lymphoproliferative disorders.
Pearls in Allergy and Immunology - July 2014Juan Aldave
The purpose of the document is to provide educational material for Allergy/Immunology physicians. It summarizes several recent journal articles on topics related to allergy and immunology. Specifically, it discusses that allergic rhinitis is a risk factor for decreased traffic safety due to impaired cognitive and psychomotor functions. It also summarizes articles on differences in IgE sensitization patterns between atopic dermatitis and other hyper-IgE syndromes. Additionally, it discusses the efficacy of IgE-targeted versus empirical elimination diets for eosinophilic esophagitis.
Omalizumab is an anti-IgE monoclonal antibody approved for treating allergic asthma, chronic urticaria, and other allergic diseases. It binds to IgE and forms complexes that are cleared, reducing free IgE levels and decreasing FcεRI expression on mast cells and basophils. For asthma, omalizumab improves symptoms and lung function and reduces exacerbations and steroid use. It may be more effective in patients with elevated type 2 biomarkers. Omalizumab also improves symptoms of chronic urticaria by decreasing mediators released in response to autoantibodies. Other anti-IgE biologics in development have distinct binding properties from omalizumab.
Este documento presenta información sobre la rinitis alérgica, incluyendo su definición, clasificación, prevalencia, factores de riesgo, mecanismos fisiopatológicos, relación con el asma y diagnóstico. La rinitis alérgica es una enfermedad inflamatoria crónica de la mucosa nasal que afecta a cientos de millones de personas y tiene un impacto significativo en la calidad de vida. Su prevalencia varía entre 1-40% dependiendo de la región. Los principales factores de riesgo
Este documento describe los diferentes fenotipos clínicos del asma y sus implicaciones. Discute el asma desde perspectivas pediátrica y en adultos, identificando varios fenotipos como el asma atópica, no atópica, inducida por virus u otros desencadenantes. También analiza factores de riesgo como la obesidad, exposición a infecciones y ambientes. El asma es heterogénea y su patogénesis depende de interacciones genético-ambientales. Identificar fenotipos ayuda a comp
Este documento fornece diretrizes para o tratamento da asma e rinite na atenção básica em saúde, incluindo definições, classificação, diagnóstico e condutas terapêuticas para cada doença. O objetivo é orientar profissionais da rede básica a tomarem decisões custo-efetivas com base em evidências atuais.
Este documento presenta una sesión de un curso sobre la medición de riesgos asociados a los cuidados de salud. El objetivo es conocer los métodos para medir la frecuencia y tipo de eventos adversos relacionados con la atención médica de manera robusta. Se describen diferentes fuentes de datos como historias clínicas, sistemas de notificación, autopsias y entrevistas con profesionales, así como métodos como revisión de documentación, observación directa y análisis de datos administrativos.
Este documento discute el concepto de cliente y cómo atender a diferentes tipos de clientes. Define al cliente como una persona u organización que demanda bienes o servicios. Explica que el cliente es el rey porque los negocios dependen de las ventas a clientes. También describe al "cliente patán", que se comporta de manera arrogante y agresiva, e indica que la mejor forma de atender a este tipo de cliente es manteniendo siempre la cortesía y la calma.
¿Qué es el error? Carlos Aibar Remón (Universidad de Zaragoza) Jesús M. Ara...Lola Montalvo
Este documento trata sobre el error en la práctica clínica. Brevemente resume los tipos de errores, sus causas y clasificaciones. También analiza estrategias para evitarlos, como aprender de ellos en lugar de culpar, mejorar la comunicación en equipo, y diseñar sistemas que prevengan errores. El objetivo es comprender el error para mejorar la seguridad del paciente, no señalar culpas.
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.
1. The document discusses guidelines from the Global Initiative for Asthma (GINA) for diagnosing and managing asthma.
2. Asthma is defined as a chronic inflammatory disease characterized by variable respiratory symptoms and airflow limitation. It affects 300 million people worldwide.
3. GINA recommends a stepwise approach to asthma treatment based on symptom control and exacerbation risk. Treatment includes inhaled corticosteroids, long-acting beta-agonists, and leukotriene modifiers. The goal is to control symptoms and reduce future risk.
Gina pocket guide for asthma management 2013Marko Parra
MA
The document outlines the four components of asthma care: developing a patient-doctor partnership; identifying and reducing risk factors; assessing, treating, and monitoring asthma; and managing exacerbations. It provides guidance on diagnosing asthma, classifying asthma control, developing action plans, using medications appropriately, and addressing special considerations. The overall goal is to help patients achieve and maintain control of their asthma.
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.
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.
RI
The patient/doctor partnership involves:
NO
1. Educating patients about asthma and its management
2. Developing an agreed written asthma action plan
3. Monitoring the patient's level of control and adjusting treatment accordingly
TE
The key elements of the patient/doctor partnership are educating patients about asthma and
its management, developing an agreed upon written asthma action plan, and monitoring the
patient's level of control and adjusting treatment accordingly.
MA
Component 2: Identify and Reduce Exposure to Risk Factors
D
Common risk factors that can trigger asthma symptoms or exacerbations should be identified
and avoided or reduced. Strategies include controlling
The Global Initiative for Asthma (GINA) aims to increase awareness of asthma as a global health problem, present recommendations for diagnosis and management, and provide strategies to adapt recommendations based on varying resources. GINA works with a global network to disseminate asthma programs. The key documents produced by GINA include the Global Strategy for Asthma Management and Prevention, which provides an evidence-based framework for diagnosis, treatment, and prevention of asthma. The strategy emphasizes a stepwise approach and partnership between patients and healthcare providers to achieve optimal asthma control and management.
The document provides guidelines for the global strategy for asthma management and prevention as updated in 2022. It discusses that asthma is a serious global health problem affecting 300 million individuals worldwide. The guidelines provide a comprehensive approach to asthma management that can be adapted locally. It defines asthma as having respiratory symptoms such as wheezing and shortness of breath that vary over time in intensity, as well as variable expiratory airflow limitation. The diagnosis of asthma involves assessing symptoms, triggers, and lung function testing with reversibility. Treatment should be customized for each patient based on symptom control, risk factors, and medication effectiveness, safety and cost.
Treatment of Asthma Exacerbations in the Pediatric Emergency Departmentjrhoffmann
This document discusses the treatment of asthma exacerbations in pediatric emergency departments. It begins with definitions of an asthma exacerbation and status asthmaticus. It then covers approaches to determining the severity of an exacerbation. The primary treatments discussed are bronchodilation with inhaled beta agonists and systemic corticosteroids. Delivery methods like nebulizers and metered dose inhalers are compared. Overall, the document provides an overview of assessing and treating pediatric asthma exacerbations in the emergency department.
1) Bronchial asthma is a chronic inflammatory airway disease characterized by intermittent airway obstruction and hyper-reactivity.
2) It affects approximately 300 million people worldwide with 250,000 annual deaths. In Saudi Arabia, the prevalence is estimated to be 4.05-11.3%.
3) Diagnosis is based on a history of characteristic symptoms, evidence of variable airflow limitation from pulmonary function tests, and reversibility with bronchodilators.
This document provides an overview of asthma, including its definition, epidemiology, risk factors, pathogenesis, diagnosis, classification, and management. Some key points:
- Asthma is a chronic inflammatory airway disease characterized by variable airflow obstruction and airway hyperresponsiveness leading to recurrent wheezing, breathlessness, chest tightness and coughing.
- It is a common disease worldwide with increasing prevalence. Risk factors include genetic, environmental and infectious factors.
- Diagnosis involves assessing symptoms, lung function tests, and allergy testing. Severity is classified based on symptoms and lung function.
- Management follows a six-part asthma action plan including education, monitoring, avoiding triggers, medication plans,
This document provides an overview of asthma, including its definition, epidemiology, risk factors, pathogenesis, diagnosis, classification, and management. Some key points:
- Asthma is a chronic inflammatory airway disease characterized by variable airflow obstruction and airway hyperresponsiveness leading to recurrent wheezing, breathlessness, chest tightness and coughing.
- It affects over 300 million people worldwide and its prevalence is increasing, especially in children. Common risk factors include atopy, air pollution, infections and obesity.
- Diagnosis involves assessing symptoms, lung function tests and allergy testing. Severity is classified based on symptoms, lung function and medication needs.
- Management follows a six-part asthma
Gina - global initiative against asthmaadithya2115
The document describes the Global Initiative for Asthma (GINA) program, which aims to increase awareness of asthma as a global health problem and provide evidence-based guidelines for diagnosis and management. GINA develops global strategy documents and provides resources to help implement asthma guidelines. The strategy follows a stepwise treatment approach based on asthma control levels to achieve treatment goals of control and prevention of exacerbations using inhaled corticosteroids and other controllers.
This document provides guidelines for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (COPD). It defines COPD as a common, preventable and treatable disease characterized by persistent airflow limitation associated with an enhanced chronic inflammatory response in the airways and lungs to noxious particles or gases. The guidelines discuss the underlying mechanisms of airflow limitation in COPD, epidemiology, risk factors, diagnosis, assessment, classification, therapeutic options including pharmacologic and non-pharmacologic treatments, management of stable COPD, and treatment of exacerbations.
This document provides a summary of asthma management and prevention guidelines from the Global Initiative for Asthma (GINA). It discusses diagnosing asthma based on symptoms and lung function tests. It classifies asthma control into controlled, partly controlled, and uncontrolled. It outlines four components of asthma care: developing a patient-doctor partnership through education and action plans; identifying and reducing risk factors; assessing, treating, and monitoring asthma; and managing exacerbations. Treatment is based on a stepwise approach to achieve control. The document provides guidance on special considerations, medications, and references other GINA resources.
This document provides a summary of asthma management and prevention guidelines from the Global Initiative for Asthma (GINA). It discusses diagnosing asthma based on symptoms and lung function tests. It classifies asthma control into controlled, partly controlled, and uncontrolled. It outlines four components of asthma care: developing a patient-doctor partnership through education and action plans; identifying and reducing risk factors; assessing, treating, and monitoring asthma; and managing exacerbations. It provides figures to aid in diagnosis, classification, treatment approach, and monitoring based on control level. The goal is to help physicians and nurses effectively diagnose and manage asthma to achieve long-term control for patients.
This article presents a case report of a 26-year-old woman diagnosed with hereditary angioedema (HAE) with intestinal involvement after 13 years of recurrent abdominal pain, diarrhea, nausea, and swelling of the hands, lips and eyelids. Over this period, she underwent six laparoscopic surgeries that revealed small amounts of free intraperitoneal fluid but no definitive cause of her symptoms. Biochemical testing found decreased levels of C1 esterase inhibitor and C4, confirming the diagnosis of HAE. Treatment with oxandrolone has partially controlled her abdominal pain attacks by decreasing their frequency. The case report discusses the challenges of diagnosing intestinal angioedema and highlights the importance of considering HAE
This document provides a pocket guide for physicians and nurses on asthma management and prevention. It discusses diagnosing asthma based on symptoms of variable respiratory symptoms and expiratory airflow limitation. It provides criteria for diagnosing asthma, including documenting reversibility of airflow limitation. It also discusses assessing asthma control, determining level of symptom control and future risk factors. Treatment is based on a stepwise approach to gain and maintain control of symptoms and minimize future risk.
This document provides a summary of asthma management and prevention guidelines. It discusses diagnosing asthma based on symptoms and lung function tests. Asthma is classified by level of control into controlled, partly controlled, and uncontrolled. The four components of effective asthma care are outlined as developing a patient-doctor partnership, identifying and reducing risk factors, assessing and treating asthma, and managing exacerbations. Key aspects of each component are defined, such as developing a written asthma action plan and using inhaled corticosteroids appropriately based on control level. Treatment goals are to achieve good control to prevent symptoms and exacerbations.
The document discusses asthma, including its definition, epidemiology, risk factors, pathogenesis, diagnosis, classification, and management. It provides details on defining asthma as a chronic inflammatory airway disease characterized by variable airflow obstruction and hyperresponsiveness. Key points include that asthma is increasing worldwide, especially in children, and its severity varies depending on symptoms, lung function measurements, and medication needs. A six-part management plan is outlined focusing on education, monitoring, avoiding triggers, long-term medication plans, managing exacerbations, and follow-up care.
Similar to Sesión Académica del CRAIC: Guías GINA y PRACTALL (20)
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El documento describe un seminario web sobre vacunas COVID para alergólogos. Incluye información sobre los diferentes tipos de vacunas disponibles (de mRNA y vector viral), sus características, eficacia y efectos secundarios. También cubre posibles reacciones alérgicas a las vacunas y cómo diagnosticar anafilaxia. Los presentadores son expertos en alergia e inmunología de Estados Unidos, México y otros países.
El documento presenta información sobre el síndrome de alergia oral (SAO). Explica que el SAO representa una reacción alérgica localizada en boca y garganta a alimentos que comparten antígenos con pólenes. Describe los grupos antigénicos más relevantes como profilinas, proteínas de respuesta a patógenos, proteínas de transferencia lipídica y cupinas, y los alérgenos alimentarios asociados con cada grupo. También presenta datos epidemiológicos e información sobre la fisiopatología
La guía mexicana de inmunoterapia 2019 describe las pruebas diagnósticas para identificar la sensibilización alérgica mediada por IgE. Recomienda las pruebas cutáneas como la principal herramienta de diagnóstico, mientras que las pruebas de laboratorio son útiles como complemento. Describe los alérgenos comunes que deben incluirse en las pruebas cutáneas en México y proporciona pautas sobre la preparación, aplicación e interpretación de los resultados. No recomienda repetir las pruebas cutáne
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Este documento resume la presentación de la Dra. Elma Isela Fuentes Lara sobre el abordaje de las inmunodeficiencias primarias. En 3 oraciones o menos, el documento describe la clasificación de las inmunodeficiencias en primarias y secundarias, ofrece una breve historia del descubrimiento de las IDP y resalta que aunque individualmente son raras, las IDP en conjunto afectan a un gran número de pacientes.
El resumen del documento en 3 oraciones o menos es:
La Dra. María del Rocío Salinas Díaz presentó una sesión académica sobre dermatitis atópica en la que revisó la definición, antecedentes históricos, epidemiología, factores de riesgo, fisiopatología, diagnóstico y tratamiento de esta enfermedad. La sesión incluyó información sobre las escalas de gravedad, los criterios de Hanifin y Rajka y Williams para el diagnóstico, así como estadísticas sobre la pre
Este documento presenta información sobre la conjuntivitis alérgica. Se discute la epidemiología, clasificación, signos y síntomas, factores de riesgo, mecanismos fisiopatológicos y tipos como la estacional, perenne, queratoconjuntivitis atópica y vernal de la enfermedad. También se analizan los resultados de estudios sobre la prevalencia de la conjuntivitis alérgica en diferentes grupos de edad y su asociación con otras enfermedades alérgicas.
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La sesión académica trata sobre fibromialgia y espondiloartropatías. La Dra. Carrasco, residente de segundo año de Alergia e Inmunología Clínica, es la ponente. Su presentación cubre las generalidades, historia, epidemiología, fisiopatología, manifestaciones clínicas y diagnóstico de la fibromialgia.
El documento presenta información sobre el prurito crónico, incluyendo su definición, epidemiología, vías del prurito, procesamiento en la médula espinal y cerebro, y clasificaciones. 1) El prurito crónico es una sensación no placentera de la piel que persiste por más de 6 semanas y puede afectar la calidad de vida. 2) Su prevalencia varía de 8-38% en la población general y aumenta con la edad. 3) Está mediado por vías histaminérgicas y no histaminérg
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Sara Brusasco, MD
Editorial Board:
Jean Bousquet, MD
Walter Canonica, MD
Giorgio Walter Canonica, MD
Mario Sánchez-Borges, MD
Managing Editor:
Cristina Mariani
Publisher:
MediPost Inc.
Address:
World Allergy Organization Journal
c/o MediPost Inc.
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Palo Alto, CA 94301 USA
Phone: +1 650-326-1137
Fax: +1 650-326-1138
Email: journal@worldallergy.org
Website: www.WA
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- 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
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
Visit Us: https://drdeepikashomeopathy.com/service/irregular-periods-treatment/
3. Introducción
El asma es un problema de salud global que afecta todos
los grupos de edades, con prevalencia en aumento,
especialmente en niños.
En 1993 el National Heart, Lung and Blood Institute en
colaboración con la Organización Mundial de la Salud
creó el informe ‘Estrategia Global para el Tratamiento y la
Prevención del Asma´.
Tras ello se formó la Iniciativa Global para el Asma
(GINA)
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
4. Definición
El asma es una enfermedad heterogénea, caracterizada
por una inflamación crónica de las vías aéreas.
Se define por síntomas respiratorios como sibilancias,
dificultad respiratoria, opresión torácica y tos, con una
limitación variable del flujo aéreo espiratorio.
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
5. Descripción del asma
Es una enfermedad crónica común que afecta 1-18% de la
población
Síntomas variables de disnea, sibilancias, opresión torácica
y tos con limitación variable del flujo aéreo espiratorio
Desencadenada por factores como ejercicio, alérgenos,
infecciones, etc.
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
6. Criterios diagnósticos
Antecedentes de sibilancias, opresión torácica, tos, disnea
Más de un síntoma respiratorio
Ocurren con tiempo e intensidad variable
Empeoran en la noche o al despertar
Desencadenadas por ejercicio, risa, alérgenos, frío
Empeoran con infecciones
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
7. Criterios diagnósticos
Reversibilidad con broncodilatador
Exceso de variabilidad 2 veces al vía por dos semanas
>10% en adultos, >13% en niños
Mejoría en función pulmonar después de 4 semanas de
antiinflamatorio
Prueba de esfuerzo positiva
Prueba de reto bronquial positiva
Exceso de variación entre función pulmonar entre
consultas
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
8. Diagnóstico
Antecedentes personales y familiares
Exploración física
Pruebas de función pulmonar para documentar
variabilidad en flujo espiratorio
Otras pruebas:
Test de provocación bronquial
Pruebas de alergia
FENO
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
10. Diagnóstico en poblaciones especiales
Tos como único síntoma
Considerar:
Variante tos
IECA
ERGE
Sinusitis crónica
Disfunción de cuerdas vocales
Documentar variabilidad en función pulmonar
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
11. Diagnóstico en poblaciones especiales
Asma ocupacional
Inducida o agravada por alérgenos
5-20% de asma de inicio en adultos
Interrogar síntomas fuera del trabajo
Atletas
Confirmar con pruebas de función pulmonar
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
12. Diagnóstico en poblaciones especiales
Tercera edad
Pobre percepción de limitación del flujo aéreo
Disnea “normal”
Actividad física disminuida
Comorbilidades
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
13. Patrones de sibilancias
Transitorias
No-atópicas
Asma persistente
Sibilancias intermitentes
graves
Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report”, L. B. Bacharier et
al.Allergy.Volume 63 Issue 1 Page 5-34, January 2008
Dr. Ochoa
CRAIC Mty
14. Factores determinantes
Factores genéticos
Ambiente y estilo de vida
Aeroalérgenos
Alergias alimentarias
Infección
Humo de tabaco
Contaminación
Nutrición
Ejercicio
Clima
Estrés
Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report”, L. B. Bacharier et
al.Allergy.Volume 63 Issue 1 Page 5-34, January 2008
Dr. Ochoa
CRAIC Mty
15. Elementos que definen fenotipo
Edad
Lactantes
Preescolares
Escolares
Adolescentes
Gravedad
Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report”, L. B. Bacharier et
al.Allergy.Volume 63 Issue 1 Page 5-34, January 2008
Dr. Ochoa
CRAIC Mty
16. Fisiopatología
Anomalías inmunológicas
Inmunidad de célulasT
Atopia
Remodelación de la vía aérea
Inflamación bronquial
Inflamación nasal
Epitelio
Células inflamatorias
Obstrucción de la vía aérea
Hiperreactividad
Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report”, L. B. Bacharier et
al.Allergy.Volume 63 Issue 1 Page 5-34, January 2008
Dr. Ochoa
CRAIC Mty
17. Diagnóstico
Historia clínica
Frecuencia y gravedad de los síntomas
Patrón de los síntomas
Confirmación de sibilancias por el médico
Interrogar sobre
Tos, sibilancias
Relación causal
Patrón de sueño
Exacerbaciones
Síntomas nasales
Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report”, L. B. Bacharier et
al.Allergy.Volume 63 Issue 1 Page 5-34, January 2008
Dr. Ochoa
CRAIC Mty
18. Diagnóstico
Lactantes
Ruidos al respirar
Vómito asociado a la tos
Retracción
Dificultad para la alimentación
Cambios en la frecuencia respiratoria
Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report”, L. B. Bacharier et
al.Allergy.Volume 63 Issue 1 Page 5-34, January 2008
Dr. Ochoa
CRAIC Mty
19. Diagnóstico
Niños mayores de 2 años
Disnea
Fatiga
Malestar
Desempeño escolar
Desempeño en actividad física
Evita actividades
Relación causal
Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report”, L. B. Bacharier et
al.Allergy.Volume 63 Issue 1 Page 5-34, January 2008
Dr. Ochoa
CRAIC Mty
21. Evaluación del asma
Control: Grado en el cual las manifestaciones se observan
en el paciente o se reducen/desaparecen con el
tratamiento.
Tiene dos componentes
Control de los síntomas
Riesgo de resultados adversos
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
22. Evaluación de control de los síntomas
Los síntomas varían en intensidad y frecuencia,
contribuyendo a la carga para el paciente.
El mal control se asocia fuertemente con un aumento en
el riesgo de exacerbaciones
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
23. Herramientas para evaluar control del asma
Asthma Control Questionnaire (ACQ)
Valores de 0-6
0 – 0.75: bien controlada
>1.5: con pobre control
Asthma ControlTest (ACT)
Valores de 5-25
20-25: bien controlada
16-19: parcialmente controlada
5-15: con pobre control
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
24. A. Symptom control
In the past 4 weeks, has the patient had:
Well-
controlled
Partly
controlled
Uncontrolled
• Daytime asthma symptoms more
than twice a week? Yes No
None of
these
1-2 of
these
3-4 of
these
• Any night waking due to asthma? Yes No
• Reliever needed for symptoms*
more than twice a week? Yes No
• Any activity limitation due to asthma? Yes No
Dr. Ochoa
CRAIC Mty
25. Evaluar el riesgo a futuro
FEV1 disminuido
Identifica pacientes con mayor riesgo de exacerbaciones
(<60%)
Inflamación no tratada
FEV1 normal o aumentado
Considerar otras causas
Reversibilidad persistente
Mal control
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
27. Gravedad del asma
Se evalúa de manera retrospectiva
Leve: paso 1, 2
Moderada: paso 3
Grave: paso 4 o 5
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
28. Asma grave VS no controlada
Técnica de inhalador (80%)
Apego
Diagnóstico incorrecto
Comorbilidades
Exposición al medio ambiente
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
30. Tratamiento
Metas
Alcanzar buen control de los síntomas y mantener un nivel
normal de actividades diarias
Disminuir el riesgo de exacerbaciones, limitación del flujo
aéreo, efectos adversos
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
31. Ciclo de tratamiento
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Diagnosis
Symptom control & risk factors
(including lung function)
Inhaler technique & adherence
Patient preference
Asthma medications
Non-pharmacological strategies
Treat modifiable risk factors
Symptoms
Exacerbations
Side-effects
Patient satisfaction
Lung function
Dr. Ochoa
CRAIC Mty
32. Tratamiento
Criterios para elección
Poblacionales
Paciente
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
33. Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
34. *For children 6-11 years,
theophylline is not
recommended, and preferred
Step 3 is medium dose ICS
**For patients prescribed
BDP/formoterol or BUD/
formoterol maintenance and
reliever therapy
# Tiotropium by soft-mist
inhaler is indicated as add-on
treatment for adults
(≥18 yrs) with a history of
exacerbations
Diagnosis
Symptom control & risk factors
(including lung function)
Inhaler technique & adherence
Patient preference
Asthma medications
Non-pharmacological strategies
Treat modifiable risk factors
Symptoms
Exacerbations
Side-effects
Patient satisfaction
Lung function
Other
controller
options
RELIEVER
STEP 1 STEP 2
STEP 3
STEP 4
STEP 5
Low dose ICS
Considerlow
dose ICS
Leukotriene receptor antagonists (LTRA)
Low dose theophylline*
Med/high dose ICS
Low dose ICS+LTRA
(or + theoph*)
As-needed short-acting beta2-agonist (SABA) As-needed SABA or
low dose ICS/formoterol**
Low dose
ICS/LABA*
Med/high
ICS/LABA
Refer for
add-on
treatment
e.g.
anti-IgE
PREFERRED
CONTROLLER
CHOICE
Add tiotropium#
High dose ICS
+ LTRA
(or + theoph*)
Add
tiotropium#
Add low
dose OCS
Dr. Ochoa
CRAIC Mty
35. Revisión y ajuste de tratamiento
Beneficio total a los 3-4 meses de tratamiento
Evaluar en cada visita, frecuencia según el paciente
Incremento
Sostenido (2-3 meses)
Corto plazo (1-2 semanas)
Día a día
Descenso
Se puede reducir al lograr control por 3 meses
Metas
Encontrar el tratamiento mínimo efectivo
Estimular al paciente para continuar un control regular
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
36. Tratamiento no farmacológico
Cesar el tabaquismo
Actividad física
Control de medio ambiente
Uso de medicamentos
Dieta
Control de peso
Vacunación
Control de estrés
Inmunoterapia
Evitar alérgenos (intra/extramuros)
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
37. Comorbilidades
Obesidad
ERGE
Ansiedad/depresión
Alergia alimentaria/anafilaxia
Rinitis, sinusitis y pólipos nasales
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
38. Tratando poblaciones especiales
Adolescentes
Broncoconstricción inducida por el ejercicio
Atletas
Embarazo
Asma ocupacional
Tercera edad
Procedimientos quirúrgicos
Enfermedad respiratoria exacerbada por aspirina
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
40. Definiciones
EPOC: Enfermedad común prevenible y tratable
caracterizada por limitación del flujo aéreo persistente
progresivo asociado a respuestas inflamatorias crónicas
incrementadas por partículas o gases nocivos.
Asthma-COPD overlap syndrome (ACOS): Limitación del
flujo aéreo persistente con características asociadas a
asma y características asociadas a EPOC.
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
41. Abordaje diagnóstico por pasos
Paso 1: ¿El paciente tiene enfermedad respiratoria
crónica?
Historia clínica
Exploración física
Radiografías
Cuestionarios
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
42. Abordaje diagnóstico por pasos
Paso 2: Diagnóstico sindromático
Reunir características que apoyen diagnóstico de asma o EPOC
Comparar entre asma y EPOC
Considerar el nivel de certeza de diagnóstico de asma o
COPD
Paso 3: Espirometría
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
45. Abordaje diagnóstico por pasos
Paso 4: Iniciar tratamiento
Si apoya asma como diagnóstico único
Iniciar tratamiento según estrategia de GINA
Si apoya EPOC como diagnóstico único
Iniciar tratamiento según reporte de GOLD
ACOS
Tratamiento para asma de manera inicial
Corticoesteroide inhalado a dosis bajas
Agregar LABA o LAMA
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
46. Abordaje diagnóstico por pasos
Paso 5: Referir para investigaciones especializadas
Pacientes con síntomas persistentes a pesar del tratamiento
Incertidumbre diagnóstica
Sospecha de un diagnóstico pulmonar adicional
Enfermedad crónica con poca evidencia de asma o EPOC
Pacientes con comorbilidades
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
48. Diagnóstico
Asma y sibilancias en niños
El asma es la enfermedad crónica de la infancia más común,
siendo la primera causa de morbilidad infantil.
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
49. Diagnóstico
Inducida por virus
Sibilancias recurrentes en niños
Asociadas a IVRS (6-8/año)
Fenotipos de sibilancias
Basado en síntomas
Sibilancias episódicas o por múltiples desencadenantes
Basado en tiempo
Transitorios (inicio y fin antes de los 3 años), persistentes (antes de
los 3 hasta después de los 6) e inicio tardío (después de los 3)
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
51. Pruebas adicionales
Prueba terapéutica
Pruebas de atopia
Radiografía de tórax
Pruebas de función pulmonar
FENO
Perfil de riesgo (API)
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
52. Diagnósticos diferenciales
Buscar otro diagnóstico en caso de encontrar:
Falla en el crecimiento
Inicio muy temprano de los síntomas
Vómito y síntomas respiratorios
Sibilancias continuas
Respuesta nula al tratamiento
Sin asociación a desencadenantes (IVRS)
Signos focales pulmonares o cardiovasculares
Hipoxemia fuera de infecciones virales
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
55. Tratamiento
Infrequent
viral wheezing
and no or
few interval
symptoms
Symptom pattern consistent with asthma
and asthma symptoms not well-controlled, or
≥3 exacerbations per year
Symptom pattern not consistent with asthma but
wheezing episodes occur frequently, e.g. every
6–8 weeks.
Give diagnostic trial for 3 months.
Asthma diagnosis, and
not well-controlled on
low dose ICS
Not well-
controlled
on double
ICS
First check diagnosis, inhaler skills,
adherence, exposures
CONSIDER
THIS STEP FOR
CHILDREN WITH:
RELIEVER
Other
controller
options
PREFERRED
CONTROLLER
CHOICE
As-needed short-acting beta2-agonist (all children)
Leukotriene receptor antagonist (LTRA)
Intermittent ICS
Low dose ICS + LTRA Add LTRA
Inc. ICS
frequency
Add intermitt ICS
Daily low dose ICS
Double
‘low dose’
ICS
Continue
controller
& refer for
specialist
assessment
STEP 1 STEP 2
STEP 3
STEP 4
Dr. Ochoa
CRAIC Mty
56. Dosis de corticosteroides inhalados
Inhaled corticosteroid Low daily dose (mcg)
Beclometasone dipropionate (HFA) 100
Budesonide (pMDI + spacer) 200
Budesonide (nebulizer) 500
Fluticasone propionate (HFA) 100
Ciclesonide 160
Mometasone furoate Not studied below age 4 years
Triamcinolone acetonide Not studied in this age group
Dr. Ochoa
CRAIC Mty
57. Tratamiento inicial
SABA con espaciador
Corticoesteroides iniciados por el familiar
Antagonista de receptores de leucotrienos.
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015.
Dr. Ochoa
CRAIC Mty
58. Algoritmo de
tratamiento de
niños mayores
de 2 años
Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report”, L. B.
Bacharier et al.Allergy.Volume 63 Issue 1 Page 5-34, January 2008
Dr. Ochoa
CRAIC Mty
59. Tratamiento
Menores de 2 años
Existe información muy limitada, por lo que el diagnóstico y
tratamiento es difícil.
Una revisión de Cochrane no encontró evidencia clara del
beneficio de tratamiento con B2-agonistas, con información en
conflicto en otros estudios.
Estudios aleatorizados doble-ciego en lactantes con asma leve
persistente o grave con corticoesteroides nebulizados
demostraron menos síntomas nocturnos y menos
exacerbaciones.
Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report”, L. B. Bacharier et
al.Allergy.Volume 63 Issue 1 Page 5-34, January 2008
Dr. Ochoa
CRAIC Mty
60. Dr. Ochoa
CRAIC Mty
Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report”, L. B. Bacharier et
al.Allergy.Volume 63 Issue 1 Page 5-34, January 2008
61. Dr. Ochoa
CRAIC Mty
Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report”, L. B. Bacharier et
al.Allergy.Volume 63 Issue 1 Page 5-34, January 2008
62. Dr. Ochoa
CRAIC Mty
Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report”, L. B. Bacharier et
al.Allergy.Volume 63 Issue 1 Page 5-34, January 2008