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During an asthma attack, spasms in the muscles surrounding the bronchi (small airways in the lungs) constrict, impeding the outward passage of air. The spasms that characterized the acute attack are not the cause of the disorder, but a result of chronic inflammation and hypersensitivity of the airways to certain stimuli. There are two types of asthma: allergic and non-allergic, although the two often occur together. Asthma specialists speculate that rising levels of environmental pollution lead to a higher incidence of asthma. Cardiac asthma is a condition that causes the same symptoms as other types of asthma, but is caused by heart failure. A hereditary link to asthma was discovered in late 1999 by two Berkeley, California, researchers who spliced human genes into mice and determined that asthmatic activity could be diminished by slowing the activity of two particular genes. This genetic-based research milestone in asthma prevention arrived at an important juncture. Asthma is a respiratory condition in which breathing is suddenly and dramatically obstructed. The most common side effects in patients who received XOLAIR in clinical studies are listed below. Life-threatening cases of asthma diagnosed as status asthmaticus require immediate hospitalization, and sufferers may have to remain hospitalized for days. Until relatively recently, even with a good nutritional plan, the only sure way to avoid an allergic attack was to avoid the irritant that caused it. Inhaling a muscle-relaxing medication such as albuterol (Proventil, Ventolin) from a bronchodilator can relieve an acute asthma attack immediately by opening the bronchial tubes. The FDA has approved a new version of the albuterol sulfate HFA (Ventolin), metered dose inhaler (MDI) for asthma and other obstructive lung disease. Researchers at Cornell University studied children aged 4 through 16 years who were part of the Third National Health and Nutrition Survey. A sustained-release form of the drug theophylline, sold under the brand name Theo-Dur Sprinkle, has been used with good results in some asthmatics. Taking two Salmon Fish Oil capsules before each meal and eating fish 3 times weekly may be beneficial for asthma. Obtaining an air purifier(s) for the home and office, or even one that can be used as a personal device worn around the neck, will help to filter out potential allergens and impurities in the air. A study conducted by North Dakota State University found that people with asthma and arthritis markedly improved their health simply by setting aside time - from 20 minutes a day to 3 days a week - to write. Children with asthma experience much more successful treatment through mind and body control training, according to numerous recent studies. The NIOX Nitric Oxide Test System can measure how well anti-inflammatory drugs may be working. People with asthma may be deficient in certain nutrients, such as Vitamin B-6 (pyridoxine), Vitamin C, Magnesium, Manganese, and Selenium, as well as in the enzyme Glutathione Peroxidase.
Strong feelings of anger, anxiety, and depression may be an important cause of asthma attacks. Beta-blocking medications, used to treat high blood pressure, can constrict the bronchial muscles and cause life-threatening problems for a person with asthma. Ozone, sulfur dioxide, nitrogen dioxide, cigarette smoke, carbon monoxide, hydrocarbons, nitrogen oxide and photochemical substances are air pollutants that trigger asthma attacks.
Regular exercise is beneficial, but exercise can also trigger an acute attack in some individuals.
Zanamivir (Relenza), a relatively new antiviral drug used for the treatment of influenza, can have a detrimental side effect on asthma sufferers. The symptoms of asthma are similar to those of other diseases, including emphysema and bronchitis, so it is important to have a medical checkup for a pulmonary evaluation. Around The House - If your asthma is caused by dust, clean your home and change your bed linens frequently. Lobelia Inflata 4X: For a dry cough, nausea with cold sweat, tightness in the chest and impeded breathing. Eat a diet high in protein and low in carbohydrates to provide the necessary anti-inflammatory nutrients. Pour 1 cup of boiling water over 1 tablespoon of the blend and steep for 10 minutes; then strain.
Most processed foods contain coloring agents, preservatives and sulfites that can trigger an allergic response and an asthma attack. Magnesium is credited with having an antispasmodic effect on muscles, in particular, the muscles of the bronchial passages. Information and supplement to help with asthma, a respiratory disease that causes obstruction of the airways. Aromatherapy Scent Inhaler, Breathe Easy with Pure Essential Oils The pure essential oils used in the Breathe Easy Scent Inhaler were chosen by Earth Solutions specifically for their known benefits in helping to open the lungs and relieve sinus pressure often associated with asthma, seasonal allergies and the flu. HerbsPro: Bronkaid Dual Action, 60 CapletsTemporarily relieves shortness of breath tightness of chest and wheezing due to bronchial asthma.
HerbsPro: Asthmaclear Ephedrine Free, Ridgecrest Herbals, 500 mg, 60 CapsHomeopatic formula for asthma relief.
HerbsPro: Asthma Therapy Homeopathic Formula, TRP Company, 70 tabsBronchial Support for asthma and COPD-like symptoms. Helps loosen phlegm(mucus) and thin bronchial secretions to rid bronchial passageways of bothersome mucus and drain bronchial tubes.
Clearlungs from Ridgecrest Herbals is a Chinese herbal formula that is good for all lung disorders. Air passes into the lungs and flows through progressively smaller airways called bronchi and then bronchioles. All bronchioles lead to alveoli, which are microscopic sacs where oxygen and carbon dioxide are exchanged.
Asthma is a chronic condition in which these airways undergo changes when stimulated by allergens or other environmental triggers. These actions in the airway cause coughing, wheezing, and shortness of breath (dyspnea), the classic symptoms of asthma. In the hyperreactive response, smooth muscles in the airways of the lungs constrict and narrow excessively in response to inhaled allergens or other irritants.
When people without asthma breathe in and out deeply, the airways relax and open to rid the lungs of the irritant. When people with asthma try to take those same deep breaths, their airways do not relax and narrow, causing patients to pant for breath. In response to allergens or other environmental triggers, the immune system delivers white blood cells and other immune factors to the airways. These so-called inflammatory factors cause the airways to swell, to fill with fluid, and to produce a thick sticky mucus. This combination results in wheezing, breathlessness, an inability to exhale properly, and a phlegm-producing cough. Asthma often progresses very slowly to a serious condition or may develop to a fatal or near-fatal attack within a few minutes. Exercise-induced asthma (EIA) is a limited form of asthma in which exercise triggers coughing, wheezing, or shortness of breath.
EIA is triggered only by exercise and is distinct from ordinary allergic asthma in that it does not produce a long duration of airway activity, as allergic asthma does. Asthma occurs primarily at night (nocturnal asthma) in as many as 75% of patients with asthma.
Nearly half of adults with asthma have an allergy-related condition, which, in most cases developed first in childhood. Dust mites, specifically mite feces, which are coated with enzymes that contain a powerful allergen. Respiratory viral and bacterial infections play a role in some cases of adult-onset asthma. In mild-to-moderate cases, asthma can improve over time, and many adults even become symptom free. Even in some severe cases, adults may experience improvement depending on the degree of obstruction in the lungs and the timeliness and effectiveness of treatment. In about 10% of severe persistent cases, changes in the structure of the walls of the airways lead to progressive and irreversible problems in lung function, even in aggressively treated patients. Lung function declines faster than average in people with asthma, particularly in those who smoke and in those with excessive mucus production (an indicator of poor treatment control). Before puberty, asthma occurs more often in males, but after adolescence, it is common in females. Hormonal fluctuations or changes in hormone levels may play a role in the severity of asthma in women. Whether exercise, a respiratory infection, or exposure to cold air has ever triggered an attack. Asthma and chronic obstructive lung diseases (chronic bronchitis and emphysema) affect the lungs in similar ways and, in fact, may all be present in the same person. Other diseases that must be considered during diagnosis are pneumonia, bronchitis, severe allergic reactions, pulmonary embolism, cancer, heart failure, tumors, psychosomatic illnesses, and certain rare disorders (such as tapeworm and trichomoniasis). If symptoms and a patient's history suggest asthma, the doctor will usually perform pulmonary function tests to confirm the diagnosis and determine the severity of the disease. Peak expiratory flow rate (PEFR), commonly called the peak flow rate, the maximum flow rate that can be generated during a forced exhalation. The patient may receive skin or blood allergy tests, particularly if a specific allergen is suspected and available for testing. The severity of asthma is classified into four groups: Intermittent, Mild Persistent, Moderate Persistent, and Severe Persistent.
Patients can greatly reduce the frequency and severity of asthma attacks by understanding the difference between coping with asthma attacks and controlling the disease over time. In choosing therapy, doctors must also consider the risk an individual patient has for more severe exacerbations.
MDI-delivered drugs must be used regularly as prescribed, and the patient carefully trained in their use, for the drugs to be effective and safe. Dry-powder may cause tooth erosion, and children are advised to rinse their mouths out right after using a DPI and to brush twice a day with a fluoride toothpaste.
People who self-manage their asthma with peak air flow measurements and adjust their medications as needed have fewer hospitalizations and unplanned doctors visits, and, generally, have a better quality of life than those who rely only on the occasional doctor or emergency room visit to control symptoms.
A peak flow meter is the standard monitoring device for measuring peak expiratory flow rate (PEFR). It is important to use the meter at the same times each day and to stand or sit in the same position to keep an accurate record. Patients should keep an ongoing record of their peak flow readings to help them detect worsening of their condition.
They should also record attacks, exposure to any allergens or triggers, and medications taken. After about 2 months, patients and doctors can use the recorded data for administering medications effectively and to recognize problems before they become serious. Guidelines from the National Asthma Education and Prevention Program (NAEPP) emphasize that most asthma medications are safe for pregnant women. Beta2-agonists do not reduce inflammation or airway responsiveness but serve as bronchodilators, relaxing and opening constricted airways during an acute asthma attack. Asthma is a disease in which inflammation of the airways causes airflow into and out of the lungs to be restricted. Newer beta2-agonists, including levalbuterol (Xopenex), have more specific actions than the standard drugs. Short-acting bronchodilators are generally administered through inhalation and are effective for 3 - 6 hours. Beta2-agonists have serious interactions with certain other drugs, such as beta-blockers, and patients should tell the doctor about any other medications they are taking. Two inhaled drugs, ipratropium bromide (Atrovent) and tiotropium (Spiriva) act as bronchodilators over time. They may be useful for certain older patients with asthma who also have emphysema or chronic bronchitis. Combining them with a beta2-agonist might help patients who do not initially respond to treatment with a beta2-agonist alone. Common oral corticosteroids include prednisone, prednisolone, methylprednisolone, and hydrocortisone. Adverse effects of prolonged use of oral steroids include cataracts, glaucoma, osteoporosis, diabetes, fluid retention, susceptibility to infections, weight gain, hypertension, capillary fragility, acne, excess hair growth, wasting of the muscles, menstrual irregularities, irritability, insomnia, and psychosis.
Osteoporosis is a condition characterized by progressive loss of bone density, thinning of bone tissue, and increased vulnerability to fractures. Long-term use of oral steroid medications suppresses secretion of natural steroid hormones by the adrenal glands. Corticosteroids, also called glucocorticoids or steroids, are powerful anti-inflammatory drugs. Receiving corticosteroids using an inhaler makes it possible to provide effective local anti-inflammatory activity in the lungs with very few side effects elsewhere in the body. The most recent generation of inhaled steroids include fluticasone (Flovent), budesonide (Pulmicort), triamcinolone (Azmacort and others), flunisolide (AeroBid), mometasone furoate (Asmanex), and ciclesonide (Alvesco). The older corticosteroid inhalants are beclomethasone (Beclovent, Vanceril) and dexamethasone (Decadron Phosphate Respihaler and others).
Inhaled steroids are generally considered safe and effective and only rarely cause any of the more serious side effects reported with prolonged use of oral steroids. Rashes, wheezing, facial swelling (edema), fungal infections (thrush) in the mouth and throat, and bruising are also possible but not common with inhalators. Inhaled corticosteroids are associated with a higher risk for cataracts in patients over age 40, particularly with higher dosages.
Some studies report a higher risk for bone loss in patients who take inhaled steroids regularly, a side effect known to occur with oral steroids. Long-acting beta2-agonists are are used for preventing an asthma attack (not for treating attack symptoms). Doctors are still trying to determine when long-acting beta2-agonists should be added to an asthma treatment plan. Cromolyn sodium (Intal) is both an anti-inflammatory drug and has antihistamine properties that block asthma triggers, such as allergens, cold, or exercise.
Leukotriene antagonists (also called anti-leukotrienes or leukotriene modifiers) are pills that block leukotrienes. Leukotriene antagonists include montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo). Chronic smokers metabolize theophylline much more quickly and need higher doses of the drug than nonsmokers; prolonged-release versions are helpful for such people. Too much caffeine can increase the concentration of this drug and the amount of time it stays in the body. Theophylline also interacts with many other drugs that are taken for other common medical conditions, including asthma. Omalizumab (Xolair) is FDA-approved for patients age 12 and older who have moderate-to-severe persistent asthma related to allergies. Omalizumab prevents IgE from triggering the inflammatory events that lead to asthmatic attacks.
However, about 1 in 1,000 patients who take omalizumab develop anaphylaxis (a life-threatening allergic reaction). Omalizumab should always be injected in a doctor's office and health care providers should observe patients for at least 2 hours after an injection.
Asthma action plans create a written document for patients to manage asthma during stable times and to more easily identify when asthma is worsening. Monitoring response to treatments and communicating with doctor if symptoms worsen or if severe symptoms occur. Follow-up generally depends on the severity of asthma, how recently asthma was diagnosed, patient compliance, and whether recent changes in treatment were made.
Avoiding and controlling triggers that lead to asthma attacks are as much a priority as treatment of the disease. A High Efficiency Particle Arresting (HEPA) filter can remove the majority of harmful particles, including mold spores, dust, dust mites, pet dander and other irritating allergens from the air. Replace curtains with shades or blinds, and wash bedding using the highest temperature setting.
Encase mattress and pillow in special dust mite proof covers (synthetic pillows may pose a higher risk for asthma attacks than feather pillows, or no pillow at all). Fix all leaky faucets and pipes, and eliminate collections of water around the outside of the house.
Exterminate mice and attempt to remove all dust, which might contain mouse urine and dander.
Avoid scheduling camping and hiking trips during times of high pollen count (generally, May and June for grass pollen and mid-August to October for ragweed). Avoid strenuous activity when ozone levels are highest, which usually occur in early afternoon, particularly on hot hazy summer days. Patients who are allergic to mold should avoid barns, hay, raking leaves, and mowing grass.
Comply with long-term control medications, particularly inhaled corticosteroids, when prescribed. Participate in activities with short bursts of exercise (such as tennis and football) over exercises involving long-duration pacing (such as cycling, soccer, and distance running). Short-acting beta2-agonists taken before exercise are generally considered the first choice, and they last for 2 - 3 hours.
Patients with asthma should receive the flu vaccine annually, and they should receive the vaccination against pneumococcal pneumonia at least once. Immunotherapy ("allergy shots") may help reduce asthma symptoms, and the use of asthma medications, in patients with known allergies. Respiratory infections, including the common cold, can act with allergies to worsen asthma.
Women who suspect that menstrual-related changes may influence asthma severity should keep a diary of their menstrual dates and times of asthma attacks. National Asthma Education and Prevention Program Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma Update on Selected Topics -- 2002.
National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
Although much progress has been made in our understanding of bronchial asthma in recent years, asthma remains a commonly encountered condition that challenges physicians in the office setting as well as in acute care settings.1-3 Although the 1980s were characterized by increases in asthma morbidity and mortality in the United States, these trends reached a plateau in the 1990s, and asthma mortality rates have declined since 1999. The knowledge that asthma is an inflammatory disorder has become fundamental to our definition of asthma. This review of asthma for the practicing clinician summarizes these developments, including an update on the definition of asthma, its epidemiology, natural history, cause, and pathogenesis. Several government agencies have been charged with surveillance for asthma, including the NHLBI's National Asthma Education and Prevention Program (NAEPP), the Department of Health and Human Services (Healthy People 2010), and the Centers for Disease Control and Prevention (CDC).
Asthma is an inflammatory disease and not simply a result of excessive smooth muscle contraction.
Despite the explosion of information about asthma, the nature of its basic pathogenesis has not been established. Based on animal studies and limited bronchoscopic studies in adults, the immunologic processes involved in the airway inflammation of asthma are characterized by the proliferation and activation of helper T lymphocytes (CD4+) of the subtype Th2. Knockout studies and anticytokine studies suggest that lipid mediators are products of arachidonic acid metabolism. Most studies of airway inflammation in human asthma have been conducted in adults because of safety and convenience. Whether airway hyperresponsiveness is a symptom of airway inflammation or airway remodeling, or whether it is the cause of long-term loss of lung function, remains controversial. The relation between the several types of airway inflammation (early-phase and late-phase events) and the concept of airway remodeling, or the chronic nonreversible changes that can happen in the airways, remains a source of intense research.4 The natural history of airway remodeling is poorly understood, and although airway remodeling occurs in some patients with asthma, it does not appear to be a universal finding. Clinically, airway remodeling may be defined as persistent airflow obstruction despite aggressive anti-inflammatory therapies, including ICS and systemic corticosteroids.
Research has confirmed that the airway epithelium is an active regulator of local events, and the relation between the airway epithelium and the subepithelial mesenchyma is believed to be a key determinant in the concept of airway remodeling.
Although understanding of new vessel formation and its genesis in asthma is still in its early stages, it has been suggested that vascular remodeling may be a critical component in the pathophysiology of asthma and a determinant of asthma severity. Asthma is characterized by specific biomarkers in expired air that reflect an altered airway redox chemistry, including lower levels of pH and increased reactive oxygen and nitrogen species during asthmatic exacerbations.25-29 Reactive oxygen species (ROS) such as superoxide, hydrogen peroxide, and hydroxyl radicals cause inflammatory changes in the asthmatic airway. Much controversy has surrounded the excessive or regular use of β-agonist preparations and the contention that this could lead to worsening of asthma control and pose a risk for untoward outcomes, including near-fatal and fatal episodes of asthma. Sears and coworkers conducted a placebo-controlled, crossover study in patients with mild stable asthma to evaluate the effects of regular versus on-demand inhaled fenoterol therapy for 24 weeks.39 In the 57 patients who did better with one of the two regimens, only 30% had better asthma control when receiving regularly administered bronchodilators, whereas 70% had better asthma control when they employed the bronchodilators only as needed. Drazen and coworkers randomly assigned 255 patients with mild asthma to inhaled albuterol either on a regular basis (two puffs four times per day) or on an as-needed basis for 16 weeks.40 There were no significant differences between the two groups in a variety of outcomes, including morning peak expiratory flow, diurnal peak flow variability, forced expiratory volume in 1 second (FEV1), number of puffs of supplemental as-needed albuterol, asthma symptoms, or airway reactivity to methacholine. SMART found that in the salmeterol group there was a statistically significant increase in risk for asthma-related deaths and life-threatening experiences compared with placebo.
Of the 16 cases of asthma fatality in subjects enrolled in the study, 13 (81%) occurred in the initial phase of SMART, when subjects were recruited via print, radio, and television advertising; following this, subjects were recruited directly by investigators. Medication exposures were not tracked during the study, and allocation to ICS combined with a long-acting β agonist (LABA) was not randomized, so the effect of concomitant ICS use cannot be determined from these data. Data from SMART, combined with other recent reports,42 have fueled a controversy regarding the role of LABAs in asthma management, such that an honest difference of opinion currently exists regarding the appropriate level of asthma severity at which regular use of LABA combined with ICS is favorable from a risk-to-benefit standpoint. Previously published meta-analyses have shown that low-dose ICS combined with LABA is associated with superior outcomes compared with higher-dose ICS.44-46 These data led to the recommendation in the EPR-2 update of the NAEPP guidelines to prescribe the combination of ICS and LABA for patients with moderate persistent asthma and severe persistent asthma. In the presence of a polymorphism, the acute bronchodilator response to a β agonist, or protection from a bronchoconstrictor, may be affected. There are limited data on mutations involving the leukotriene cascade or corticosteroid metabolism. The cardinal symptoms of asthma include chest tightness, wheezing, episodic dyspnea, and cough.
Hyperinflation, the most common finding on a chest radiograph, has no diagnostic or therapeutic significance. In patients with atypical chest symptoms of unclear etiology (cough or dyspnea alone), a variety of challenge tests can identify airway hyperreactivity as the cause of symptoms. PEF monitoring has been advocated as an objective measure of airflow obstruction in patients with chronic asthma. The thesis of disease state management is a global approach to chronic diseases such as asthma by integrating various components of the health care delivery system.
There is limited evidence, however, that practice guidelines achieve favorable clinical outcomes.53 Some clinicians have advocated additional strategies to include removing disincentives, adding a variety of incentives, and including the guidelines in a broader program that addresses translation, dissemination, and implementation in the local community. The NAEPP guidelines recommend that asthma should be managed in an algorithmic manner, based on asthma severity; EPR-3 guidelines introduced the concept of asthma control and its importance in management.
A new paradigm was proposed in EPR-3 guidelines, based on the assessment of asthma control.55 Asthma severity and asthma control are not synonymous. Another limitation of EPR-2 was that the categorization of asthma severity was proposed at a time before long-term therapy was initiated; however, many patients are already taking controller medications when they are initially seen.
EPR-3 guidelines recommend that asthma should be categorized based on level of severity at the initial visit, and at subsequent visits the focus of providers should be on asthma control (Fig. For all patients with asthma, regardless of severity classification, the goal of asthma management as described in EPR-35 is the same: to achieve control by reducing both impairment and risk (see Table 2). The current paradigm for asthma management (see Fig 6), recommends that asthma care providers categorize asthma severity at the initial visit based on the criteria mentioned earlier, and subsequent visits should proceed with assessment of asthma control.
Although the concept of expert practice guidelines that have become increasingly evidence based merits widespread support, specific treatment regimens must be determined by the physician and patient based on consideration of risk relative to benefit and tailored to individual patient needs.
Clinical relevance of inhalant allergens can be demonstrated by immediate hypersensitivity skin testing or radioallergosorbent (RAST) assay. Air conditioning can be associated with a dramatic reduction in exposures to outdoor pollens and mold spores while indoors.


Dust mites are microscopic, and they rely on heat and humidity to survive and proliferate.61 Allergy to dust mites is common in patients with asthma. For patients who are allergic to cat or dog dander and who own pets, no avoidance strategy can rival the benefit that will occur with eliminating the pet from the home. When a regimen of avoidance measures combined with appropriate pharmacotherapy is undesirable, not feasible, or ineffective to achieve optimal asthma control, administration of allergen immunotherapy vaccines (allergy shots) can be considered.64,65 As shown in Figure 7, the EPR-3 guidelines recommend considering allergen immunotherapy for patients who have mild or moderate persistent asthma (steps 2-4) and who have a clinically relevant component of allergic potential to inhalant allergens. The immunologic changes that develop with administration of allergen immunotherapy are complex.
In contrast to medication that affects only symptoms, immunotherapy can favorably affect the disease process that underlies asthma symptoms. COX inhibition downregulates the enzyme PGE2, leading, in turn, to excessive production of sulfidopeptide leukotrienes (LTC4, LTD4, and LTE4). The pharmacotherapy for asthma, as recommended by current NAEPP guidelines, is summarized in Figure 7 and Tables 3 through 5. During an asthma attack, spasms in the muscles surrounding the bronchi (small airways in the lungs) constrict, impeding the outward passage of stale air. Asthma sufferers often describe this plight as "starving for air." Typical symptoms of an attack are coughing, wheezing, a feeling of tightness in the chest, and difficulty breathing. An attack may be triggered if a susceptible individual is exposed to an allergen or irritants, infection, stress, exercise, use of aspirin, ibuprofen, naproxen sodium, or other NSAIDS - or even rapid changes in weather and humidity, can trigger an attack.
Common asthma provoking allergens include animal and pet dander, cockroach allergens, pollens, mold, chemicals, drugs, dust mites, environmental pollutants, feathers, food additives (such as monosodium glutamate, sulfites such as sodium metabisulfite), seafood, dairy products, nuts, yeast-based foods, fumes, and tobacco smoke. Asthma epidemics related to atmospheric contamination - situations to which dust and chemical particulate matter are abundant, especially in enclosed environments - are well known. Today, asthma affects over 10 to 12 million people (more than 3 million children and 7 million adults), or 4 percent of the U.S. Its symptoms may resemble those of other diseases, including emphysema, bronchitis, and lower respiratory infections. Intrinsic asthma, a less common form of the disease, generally appears during adulthood, is often associated with other respiratory diseases such as bronchitis or sinusitis, and tends to appear during upper respiratory viral infections.
The value of the research, they said, centered on the fact that scientists now have an opportunity to develop a medicine to prevent asthma, rather than merely to treat its symptoms.
Medical scientists are growing increasingly alarmed over what they consider to be an epidemic rise in the number of new asthma cases each year. During a typical asthma attack, the bronchial tubes contract spasmodically, constrict and swell. There is growing speculation that the number is on the rise, due to the ever-increasing levels of toxins in our environment. It's the first asthma treatment that works by blocking immunoglobulin E (IgE), an underlying cause of allergic asthma symptoms. Today, treatment for asthma includes the use of anti-inflammatory and broncho-dilating medications.
Instead of treating the symptoms, the new medications goes to the source of the problem - the allergic reaction itself. Unlike the older versions of Ventolin, the new inhaler uses an alternative propellant called hydrofluoroalkane (HFA) rather than the traditional ozone-reducing chlorofluorocarbons (CFCs) used previously. It was found that the antioxidants Beta-Carotene and Vitamin C were associated with a very significant reduction in asthma prevalence. Budesonide inhalation suspension (Pulmicort Respules), a synthetic hormone, is designed for use once or twice daily to prevent asthma attacks, but is not used to treat acute attacks. For children, this medication can be administered by opening a capsule and sprinkling the contents on soft food such as applesauce. This is most likely due to the action of the caffeine, which has a dilating effect on the bronchial airways.
The air purifier usually contains a filter that traps microorganisms (viruses, mold, bacteria) and microparticles (dander, dust, pollen, and pollutants) in the air. Of the 70 patients participating in the one-month study, 47 percent showed improvement, as opposed to only 24 percent who showed improvement without writing.
People with asthma often have lower than normal levels of gastric hydrochloric acid, which is needed for proper digestion. Unfortunately, many of the drugs used to control and alleviate asthma themselves cause jittery nerves, mood swings, and insomnia. No one is sure why this is, but it has been speculated that inhaling lots of cool, dry air while working out aggravates the respiratory system.
The wide range of toxins contained in most cigarettes collect in the bronchial tubes and irritate the sensitive bronchial mucosa.
Essential Fatty Acids among many other beneficial effects, have been known to reduce asthmatic inflammation.
A diet based on fresh whole fruits and vegetables will help you to avoid these particular chemicals.
Supplementing your diet with 500 mg of magnesium daily can reduce the occurrences of asthma. These are to be used to increase the quality of life and health, not to replace convention medical therapies. Organically grown blend of Haritaki, dashmoola, chitrak, barly, camphor, shank pushpi, psyllium, bala, pushkarmool, bhangra, pipli, kapi kacchu. Helps loosen phlegm (mucus) and thin bronchial secretions to rid the bronchial passageways of bothersome mucus drain bronchial tubes and make coughs more productive. Ingredients include ambrosia artemisaefolia, antimonium tartaricum, carbo vegetabilis, ipecacuanha, kali carbonicum, lobelia inflata, oxygenium, phosphorus, pulsatilla, sambucus canadensis, silica, thuja occidentalis, angelica root, perilla fruit, cassia bark, ginger root, chinese licorice root, tree peony root bark, schizandra fruit, tangerine peel. Asthma Therapy is a homeopathic fast dissolving tablet for therapeutic support of healthy lung functioning. Indications: Helps loosen phlegm (mucus) and thin bronchial secretions to rid bronchial passageways of bothersome mucus and drain bronchial tubes.
The alveoli are the microscopic blood vessel-lined sacks in which oxygen and carbon dioxide gas are exchanged. Smooth muscles in the airways of people with asthma may have a defect, perhaps a deficiency in a critical chemical that prevents the muscles from relaxing.
SymptomsAsthma symptoms vary in severity from occasional mild bouts of breathlessness to daily wheezing that lasts even when a patient takes large doses of medication.
Usually the attack begins with wheezing and rapid breathing, and, as it becomes more severe, all breathing muscles become visibly active. Initial chest tightness without any other symptoms may be an early indicator of a serious attack. After an initial acute attack, inflammation lasts for days to weeks, often without symptoms. This condition generally occurs in children and young adults, most often during intense exercise in cold dry air.
Cats harbor significant allergens, which can even be carried on clothing; dogs usually cause fewer problems. Cockroach dust is a major asthma trigger and may reduce lung function even in people without a history of asthma.
Important irritants involved in asthma include cigarette smoke, indoor chemicals, and air pollution. Overall, one study reported that 72% of men and 86% of women with asthma had symptoms 15 years after an initial diagnosis.
In adults with similar cases of actual airway obstruction, women are likely to report more severe symptoms than men.
Between 30 - 40% of women with asthma experience fluctuations in severity that are associated with their menstrual cycle. Evidence also suggests that people who are overweight (body mass index greater than 25) have more difficulty getting their asthma under control. At least half of patients with asthma have gastroesophageal reflux disease (GERD), the cause of heartburn. If symptoms improve on weekends and vacation and are worse at work, the job is the likely source of the asthma, although not always. Unlike other chronic lung conditions, asthma usually first appears in patients younger than age 30 and with chest x-rays that are normal.
Spirometry is frequently used to evaluate lung function in people with obstructive or restrictive lung diseases such as asthma or cystic fibrosis.
This involves administering a specific drug (histamine or methacholine) that usually increases airway resistance only when asthma is present. This test is very accurate for ruling out asthma, but it is not sensitive enough to accurately identify asthma in adults. Allergy skin tests may help diagnose allergic asthma, although they are not recommended for people with year-round asthma. Medications that open the airways (bronchodilators, or inhalers) are used to quickly relieve any moderate or severe asthma attack. Simply coping with asthma symptoms without also controlling the damaging inflammatory response is a common and serious error.
Unfortunately, many patients do not understand the difference between medications that provide rapid short-term relief and those that are used for long-term symptom control.
Factors that may contribute to this include parental history of asthma, atopic dermatitis, and known sensitivity to different allergens or foods. Long-acting beta2-agonists and leukotriene antagonists are additional therapies usually used in addition to inhaled corticosteroids.
The standard device for administering any asthma medication is the metered-dose inhaler (MDI). Dry powder inhalers (DPIs) deliver a powdered form of beta2-agonists or corticosteroids directly into the lungs.
The overall goal should be to achieve less than a 20% (and ideally only 10%) variation in readings between evening and morning rates.
The guidelines recommend that pregnant women with asthma have albuterol available at all times. When an asthma attack occurs, mucus production is increased, muscles of the bronchial tree become tight, and the lining of the air passages swells, reducing airflow and producing the characteristic wheezing sound.
Other similar beta2-agonists are isoproterenol (Isuprel, Norisodrine, and Medihaler-Iso), metaproterenol (Alupent, Metaprel), pirbuterol (Maxair), terbutaline (Brethine, Brethaire, and Bricanyl), and bitolterol (Tornalate). Studies have indicated that levalbuterol is as effective as albuterol with fewer side effects. They relieve the symptoms of acute attacks, but they do not control the underlying inflammation. Notify a doctor immediately if this side effect occurs, particularly in people with existing heart conditions.
Individuals with diabetes, heart disease, high blood pressure, hyperthyroidism, an enlarged prostate, or a history of seizures should take these drugs with caution.
There has been some concern that short-acting beta2-agonists become less effective when taken regularly over time, increasing the risk for overuse.
Overdose can be serious and in rare cases even life threatening, particularly in patients with heart disease. Osteoporosis (bone thinning) is a common and particularly severe long-term side effect of prolonged steroid use. After withdrawal from these drugs, this so-called adrenal suppression persists, and it can take the body a while (sometimes up to a year) to regain its ability to produce natural steroids again. Steroids are not bronchodilators (they do not relax the airways) and have little effect on symptoms.
These steroids are sometimes combined with a long-acting beta2-agonist in a single inhaler, such as budesonide-formoterol (Symbicort) and fluticosone-salmeterol (Advair).. These drugs can be dangerous when used alone, because they can mask asthma symptoms, and they can increase the risk of asthma death unless paired with an inhaled steroid. If your symptoms do not improve or if symptoms worsen with this type of drug, your doctor will recommend discontinuing it.
A cromolyn nasal spray called NasalCrom has been approved for over-the-counter purchase, but only to relieve nasal congestion caused by allergies.
Cromolyn is a treatment option for exercise-induced asthma (EIA) in all age groups, for pregnant women, and possibly for preventing allergic asthma in adults as well as children. Side effects of cromolyn include nasal congestion, coughing, sneezing, wheezing, nausea, nosebleeds, and dry throat. Leukotrienes are powerful immune system factors that, in excess, produce a battery of damaging chemicals that can cause inflammation and spasms in the airways of people with asthma. These drugs are considered an alternative for long-term control of asthma, but inhaled corticosteroids should always be used first.
Patients who take a leukotriene antagonist drug should be monitored for signs of behavioral and mood changes.
Theophylline (Theo-Dur, Theolair, Slo-Phyllin, Slo-bid, Constant-T, and Respbid) relaxes the muscles around the bronchioles and also stimulates breathing. Toxicity can cause nausea, vomiting, headache, insomnia, and, in rare cases, disturbances in heart rhythm and convulsions. The elderly and anyone with heart disease, liver disease, hypertension, seizure disorders, or heart failure should take theophylline with caution. The presence of allergies must generally be proven by increased levels in the blood of a certain antibody called immunoglobulin E (IgE). Studies have shown excellent benefits of the drug, including a reduced need for corticosteroids, fewer hospitalizations, and significant symptomatic improvements.
Patients can develop anaphylaxis after any dose of omalizumab, even if they had no reaction to a first dose. Patients should also carry emergency self-treatment for anaphylaxis (such as an Epi-Pen) and know how to use it. Patients who already have pets and are not allergic to them probably have a low risk for developing allergies. Dry shampoos, available for both cats and dogs, can remove allergens from the skin and fur and are easier to administer than wet shampoos. Along with other methods to reduce allergens, such as frequent dusting, the use of a HEPA filtration system can help control the amount of allergens circulating in the air. EIA occurs only after exercise and is more likely to happen during regular paced activities in cold, dry air.
Patients with severe seasonal allergies may need to start medications a few weeks before the pollen season, and to continue medicine until the season is over. In one study, nearly half of asthma or allergy sufferers resorted to alternative treatments.
Some patients report benefits from many stress reduction techniques, such as acupuncture, hypnosis, breathing relaxation techniques, massage therapy, and meditation practices. Acupuncture involves the insertion of tiny sterile needles, slightly thicker than a human hair, at specific points on the body. Breathing exercises may help improve patients’ quality of life even if they do not have a major impact on medication reduction.
Probiotics are beneficial microbes that some believe may help protect against allergies and asthma.
Meta-analysis: effects of adding salmeterol to inhaled corticosteroids on serious asthma-related events. Probiotics and prebiotic galacto-oligosaccharides in the prevention of allergic diseases: a randomized, double-blind, placebo-controlled trial. Meta-analysis: effect of long-acting beta-agonists on severe asthma exacerbations and asthma-related deaths. Probiotics for the treatment of allergic rhinitis and asthma: systematic review of randomized controlled trials. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. In recent decades, a surge in asthma prevalence also occurred in the United States and other Western countries; data suggest this trend may also be reaching a plateau. Evidence-based practice guidelines have been disseminated with a goal of encouraging more frequent use of anti-inflammatory therapy to improve asthma outcomes. In addition, there is a discussion of the appropriate diagnostic evaluation of asthma and co-occurring conditions, management of asthma, and newer therapies for the future. This heterogeneity has been well established by a variety of studies that have demonstrated disease risk from early environmental factors and susceptibility genes, subsequent disease induction and progression from inflammation, and response to therapeutic agents (Fig.
Increased airway inflammation follows exposure to inducers such as allergens or viruses, exercise, or inhalation of nonspecific irritants. Studies suggest a genetic basis for airway hyperresponsiveness, including linkage to chromosomes 5q and 11q. They have been implicated in the airway inflammation of asthma and have been the target of pharmacologic antagonism by antileukotriene agents.
However, asthma often occurs in early childhood, and persistence of the asthmatic syndrome into later childhood and adulthood has been the subject of much investigation. A hypothesis by Holgate and colleagues20 proposes that airway epithelium in asthma functions in an inappropriate repair phenotype in which the epithelial cells produce proinflammatory mediators as well as transforming growth factor (TGF)-β to perpetuate remodeling.
Because neither benefit nor harm was seen, it was concluded that inhaled albuterol should be prescribed for patients with mild asthma on an as-needed basis.
Whether the statistically significant risk in untoward outcomes reflects genetic predisposition, risk associated with LABA monotherapy, or health maintenance behavior cannot be determined definitively at this time.
For the ADRB2, single nucleotide polymorphisms (SNPs) have been defined at codons 16 and 27.
Polymorphisms of the 5-lipoxygenase (5-LO) gene promoter and the LTC4 synthase gene (LTC4S) have been described. Polymorphisms in the glucocorticoid receptor gene have been identified that appear to affect steroid binding and downstream pathways in various in vitro studies.
Some patients present with atypical symptoms, such as cough alone (cough-equivalent asthma) or primarily dyspnea on exertion. A chest radiograph should not be obtained unless complications of pneumonia, pneumothorax, or an endobronchial lesion are suspected. By far, the most commonly used agents are methacholine or histamine, which give comparable results. Studies suggest that a small subset of patients uses a large percentage of health care resources. It is hoped that managing all costs of care comprehensively, rather than seeking to minimize the costs of each component, will improve health outcomes and be cost beneficial. These studies have often used proprietary data systems and algorithms that make reproducing them difficult.
The overall goal of practice guidelines is to improve quality of care, reduce costs, and enhance health care outcomes. Patients are to be classified as having intermittent, mild persistent, moderate persistent, or severe persistent asthma, based on assessment of the level of symptoms (day or night), reliance on reliever medication, and lung function at time of presentation, with pharmacologic management (see later) then being prescribed in an evidence-based fashion according to each respective categorization. Asthma severity is clearly a determinant of asthma control, but its impact is affected by a variety of factors, including patterns of therapeutic adherence and the degree to which recommended avoidance measures for clinically relevant aeroallergens are pursued.
EPR-3 guidelines5 stipulate that the asthma severity level can be inferred, based upon response, or lack thereof, to asthma pharmacotherapy. The impairment domain is focused on the present and entails assessments of frequency and intensity of asthma symptoms, functional limitation, lung function, and meeting expectations of, and satisfaction with, asthma treatment. The level of intensity does not correlate to specific levels of control but should be considered in the overall assessment of risk.
Asthma control can be assessed by use of validated instruments, including the Asthma Control Questionnaire (ACQ), Asthma Therapy Assessment Questionnaire (ATAQ), and the Asthma Control Test (ACT). If asthma is well controlled (ACT = 20), the provider, in collaboration with the patient, may consider maintaining current management or a step down. Because asthma research is rapidly evolving and new pharmacotherapeutics are anticipated, continued periodic revision of guidelines for asthma can be anticipated. Of these, skin testing is more sensitive, is less costly, and entails no delay in yielding results; for these reasons, skin testing is preferred. Because we now spend the majority of our time indoors,60 the usefulness of air conditioning for improving asthma symptoms should not be underestimated. If a cat or dog is removed from the home, however, the allergen can persist for several months. Allergen immunotherapy entails the incremental administration of inhalant allergens for the purpose of inducing immune system changes in the host response with natural exposure to these allergens. ASA and NSAIDs, including ibuprofen, naproxen, sulindac, indomethacin, and etodolac, inhibit cyclooxygenases 1 and 2 (COX-1 and COX-2) and are 100% cross-reactive in ASA-sensitive asthmatic patients. These mediators participate in acute bronchospastic reaction provoked by ASA ingestion and also contribute to the ongoing airways obstruction and inflammation that persist in AERD patients despite avoidance of ASA and other COX-inhibiting drugs.69 Administration of antileukotriene agents, which either selectively block leukotriene receptors or inhibit leukotriene synthesis by blocking 5-LO or its activator, 5-LO activating protein (FLAP), are efficacious in the management of chronic persistent asthma in patients with AERD.
Hot humid weather or a room full of steam, such as a sauna, or cold air with temperatures below freezing can bring on an asthma attack in some sensitive individuals.
To distinguish asthma from other conditions, a health care provider may recommend blood tests, chest x-rays, and spirometry (a procedure that measures air taken into and out of the lungs). People who suffer from intrinsic asthma are usually vulnerable to changes in weather, exercise, emotional stress, and other factors related to inner feelings. Asthma now affects more than 20 million people according to the National Institutes of Health.
These toxins include exhaust fumes from cars, chemicals found in cleaning products and tobacco smoke.
The anti-inflammatories can halt inflammation quickly, but only temporarily, and there are side effects to using these drugs over long periods. Omalizumab (Xolair) is a drug that is designed to bind to the circulating antibodies in the blood, which decreases the amount of antibodies that are available to bind to mast cells. An increase in Selenium intake also was associated with a similar decrease in asthma prevalence. If the medication is in the form of a solid pill, the pill can be crushed and added to the soft food.
The researchers concluded that putting your thoughts and observations on paper relieves stress and eases the mind.
He calmly guides their thought processes to focus on images and smells that please them, like the warm sun, hot dogs, or a favorite pet. Many restaurants use sulfiting agents - including sodium bisulfite, potassium metabisulfite, potassium bisulfite, and sulfur dioxide - to prevent discoloration and bacterial growth in green salads, cut and sliced fruit, frozen shellfish, and other foods. It is best to obtain hypoallergenic foam or other fillers for bedroom items or down-filled coats and outer wear.
Food and Drug Administration notes that it should be used with caution by anyone with asthma or chronic lung disease, and if a person with asthma does take this drug, he or she should have emergency bronchodilator therapy readily available. To rid your home of these tiny pests, use a commercial vacuum cleaner made specifically for this purpose.
Certain essential oils are considered antimicrobial, as well, and will benefit those who suffer from asthma caused by an underlying infection. Supplement your diet with such excellent sources of essential fatty acids as Borage Herbal Oil, Flaxseed Herbal Oil or Evening Primrose Herbal Oil. Drink 2 to 3 cups a day as a preventative measure during a cold or exposure to an allergen.
In addition, a trial elimination of dairy products, wheat, sugar, or any other suspected foods can determine if an individual food worsens the problem.
This homeopathic formula assists the bodys natural ability to address asthma and COPD symptoms. Essentially, asthma is an inflammatory lung condition that makes it difficultto breathe properly. After exposure to asthma triggers, symptoms rarely develop abruptly but progress over a period of hours or days. However, the severity of this symptom does not always reflect the degree to which lung function is impaired.
Symptoms are generally most intense about 10 minutes after exercising and then gradually resolve. People with asthma who already have pets and are not allergic to them probably have a low risk for developing such allergies later on.
PrognosisAsthma is usually chronic, although it occasionally goes into long periods of remission.
Only 19% of these people, however, were still seeing a doctor, and only 32% used any maintenance medication.


Some women first develop asthma during or shortly after pregnancy, while others first develop it around the time of menopause (perimenopause). Ethnicity and genetics, however, are less likely to play a role in these differences than socioeconomic differences, such as having less access to optimal health care, and greater likelihood of living in an urban area (another asthma risk factor). Weight loss in anyone who is obese and has asthma or shortness of breath helps reduce airway obstruction and improve lung function.
It is not entirely clear which condition causes the other or whether they are both due to common factors. With this condition, asthma gets worse when patients take aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs). Still, it may be difficult to distinguish among these disorders in some adults with late onset asthma. For adults and children over age 5 with moderate-to-severe persistent asthma, doctors recommend inhaled corticosteroids sometimes with long-acting beta2-agonists. Many patients with moderate or severe asthma overuse their short-term medications and underuse their corticosteroid medications. Based on severity of patients' asthma and their age, there are specific recommendations regarding whether to use long-term control medications and which ones to use. A nebulizer is a device that administers the drug in a fine spray that the patient breathes in.
For mild-to-moderate asthma, a single determination each morning usually suffices, but patients should check with their doctors.
If asthma continues to worsen with the use of these drugs, patients should discuss corticosteroids or other drugs to treat underlying inflammation. Over time some patients may become tolerant to many effects of short-acting beta2-agonists. Regular exercise and vitamin and mineral supplements can reduce and even reverse loss of bone density. There have been a few cases of severe adrenal insufficiency that occurred when switching from oral to inhaled steroids, which, in rare cases, has resulted in death.
Instead, they work over time to reduce inflammation and prevent permanent injury in the lungs. In 2008, an FDA advisory panel voted to ban the use of salmeterol (Serevent) and formoterol (Foradil) for treatment of asthma in children and adults.
Do not, however, stop taking this drug or other asthma medications without first talking with your doctor. Cromolyn may be used as an alternative to inhaled corticosteroids, inhaled corticosteroids are considered the preferred choice for long-term control of persistent asthma. As with other anti-inflammatory drugs, leukotrienes are used for prevention, NOT for treating acute asthma attacks.
Other concerns are indications of liver injury in patients when taking zafirlukast at higher than standard doses. The use of inhaled corticosteroids and long-acting beta2-agonists has dramatically reduced the need to use theophylline in most patients with asthma. People with heart conditions who take theophylline by mouth have an increased risk for sudden death from heart-related problems. The first drug of this type to be approved for asthma, omalizumab is a monoclonal antibody (MAb), a genetically developed drug designed to attack very specific targets.
With an Epi-Pen, or similar auto-injector device, patients can quickly give themselves a life-saving dose of epinephrine.
Peak flow monitoring should be performed in patients with moderate or severe persistent asthma or those with a history of more severe exacerbations (sudden worsening or increase in severity of symptoms).
Air cleaners, filters for air conditioners, and vacuum cleaners with High Efficiency Particle Arresting (HEPA) filters can help remove particles and small allergens found indoors.
Even exposure to secondhand smoke can double the risk of asthma-related emergency room visits. Some studies indicate that long-term exercise even helps control asthma and reduce hospitalization. Yoga, which uses stretching, breathing, and meditation techniques, may have particular benefits.
Immunotherapy poses some risk for severe allergic reactions, however, especially for children with poorly controlled asthma.
To date, however, evidence does not support any value from most alternative therapies, including high-dose vitamins, urine injections, homeopathic remedies, and most herbal remedies. Probiotics can be obtained in active yogurt cultures and supplements, which are being studied for protection. Manufacturers of herbal remedies and dietary supplements do not need FDA approval to sell their products.
Tremendous progress has been made in our fundamental understanding of asthma pathogenesis by virtue of invasive research tools such as bronchoscopy, bronchoalveolar lavage, airway biopsy, and measurement of airway gases, although the cause of airway inflammation remains obscure.
To this extent, there has been much emphasis on early diagnosis and longitudinal care of patients with asthma, along with ensuring adherence to recommended therapies. Increased inflammation leads to exacerbations characterized by dyspnea, wheezing, cough, and chest tightness.
Also, specific monoclonal antibodies or cytokine antagonists have been used in various asthma models. Asthma clearly does not result from a single genetic abnormality; rather it is a complex multigenic disease with a strong environmental contribution. Prostaglandins are generated by the cyclooxygenation of arachidonic acid, and leukotrienes are generated by the lipoxygenation of arachidonic acid.
Angiogenesis itself may play a role in the disease progression through recruitment of inflammatory cells, effects that alter airway physiology, or by secretion of proinflammatory mediators. The primary limitation of these data, and a number of other case-controlled studies, relates to the comparability of cases and controls in terms of severity of their underlying disease. There were 13 asthma-related deaths and 37 combined asthma-related deaths or life-threatening experiences in the salmeterol group, compared with 3 and 22, respectively, in those randomized to placebo.
Asthmatics with the wild-type allele at 5-LO have a greater response with 5-LO inhibitor therapy compared with asthmatics with a mutant gene. However, polymorphisms in the glucocorticoid pathways have not been associated with the asthma phenotype or clinical steroid resistance.
The most objective indicator of asthma severity is the measurement of airflow obstruction by spirometry or peak expiratory flow (PEF).
A major challenge in improving outcomes for asthma is implementing basic asthma management principles widely at the community level. This approach relies on information technology to identify patients, monitor care, and assess outcomes and costs. These guidelines are of interest to many groups including specialty medical societies, state and federal government, insurers and managed care organizations, commercial enterprises, and hospitals. In an ideal world, this recommendation, described in EPR-2 would have resulted in patients with asthma receiving pharmacotherapeutic agents associated with favorable asthma care outcomes that are also appropriate from both cost and risk-to-benefit standpoints. Patterns of health service use, including hospitalization and emergency department visits, correlate more closely with asthma control than with asthma severity.55 This follows from the understanding that a patient with severe persistent asthma who is treated appropriately with multiple controllers and who adheres to orders regarding medications and recommended avoidance strategies can achieve well-controlled (or totally controlled) asthma.
This concept, responsiveness, is defined as the ease with which asthma control can be achieved by therapy.
At the initial visit, severity is assigned based on assessment of both impairment and risk domains, as illustrated in Table 1, for patients who are not taking regular controller medication, and for patients on regular pharmacotherapy for asthma. The risk domain is focused on the future and includes preventing asthma exacerbations and severe exacerbations, minimizing the need for using health services (emergency department visits or hospitalization), reducing the tendency for progressive decline in lung function, and providing pharmacotherapy that offers minimal or no risk for untoward effects. These instruments include assessment of asthma symptoms, frequency of use of as-needed rescue medication, the impact of asthma on everyday functioning, and, in the case of the ACQ, the impact of asthma on lung function. If asthma is not well controlled, it is appropriate to step up management or carry out an assessment to determine whether factors such as poor adherence or a comorbid condition is present that is complicating response to therapy.
The information that these diagnostic tests provide, whether the asthmatic patient exhibits IgE-mediated (allergic) potential to inhalant allergens, and which allergens the patient can be said to be allergic to, is used to direct relevant avoidance measures. For this reason, clinical benefit cannot be expected promptly.62 When it is not possible to eliminate pets from the home, second-best measures include restricting the pet from the bedroom, using high-efficiency particulate or electrostatic air cleaners, and removing carpets and other furnishings that otherwise serve as an allergen reservoir. Immunotherapy is efficacious for pollen, mold, dust mite, cockroach, and animal allergens; however, its effectiveness is more established for dust mite, animal dander, and pollen allergens, because fewer studies have been published demonstrating efficacy using mold and cockroach allergens.
In AERD patients, cross-reaction can also occur with higher doses of salsalate or acetaminophen, which are weak inhibitors of COX-1 and COX-2.
Based on these findings and previous experience with ASA desensitization50 this intervention can also be considered for patients with corticosteroid dependency, poorly controlled asthma, or refractory rhinosinusitis who require repeated sinus surgery procedures. Inhaled short-acting β agonists (relievers) used on an as-needed basis are recommended for patients who have intermittent asthma and who are asymptomatic between episodes. Factors that can trigger non-allergic asthma attacks include adrenal disorders, anxiety, temperature changes, exercise, extremes of dryness or humidity, fear, laughing, low blood sugar, and stress. Children under sixteen and adults over 65 are more likely than other people to suffer from asthma. With prompt diagnosis and appropriate treatment, serious danger from asthma should be preventable. Children under age 16, particularly those living in urban areas, and adults over the age of 65 are most likely to suffer from asthma. Asthma can be triggered by an allergen, such as mold spores, pollen, food additives, dust and animal dander. Most medications stimulate the sympathetic nervous system and can produce anxiety, nervousness, insomnia, and dry or cotton mouth. This ultimately inhibits the mast cell's release of the chemicals that cause the inflammatory response of asthma. The drug is generally well tolerated, but side effects can include respiratory infection, coughing, and congestion.
One way to control exercise-induced asthma is to wear a mask that retains heat and moisture and limits the effects of breathing cold, dry air.
Interestingly, although the FDA granted clearance for the drug to be marketed, and FDA advisory panel voted against approval, noting that it considered the drug's overall effectiveness as negligible. For asthmatics, this may include tension in the muscles of the bronchial tubes, which can lead to tightness in the chest and difficulty breathing. These oils include Fennel Essential Oil, Chamomile Essential Oil, Thyme Essential Oil, and Eucalyptus Essential Oil. John's Wort Flower Buds (Hypericum perforatum), Vegetable Glycerin, Vegetable cellulose (capsule). Occasionally, the airways have become seriously obstructed by the time the patient calls the doctor.
If the measurements are more normal, the drug likely has cleared the airways and a diagnosis of asthma is likely. It is not always accurate, particularly in patients whose only symptom is persistent coughing. Other drugs used in special cases include corticosteroids taken by mouth and anticholinergic drugs. The overuse of bronchodilators can have serious consequences; not using steroids can lead to permanent lung damage. Patient education, environmental control measures, and management of any other conditions are also included. The two basic inhaler devices are the metered-dose inhaler (MDI) and dry powder inhalers (DPIs). A spacer, which is short tube attached to the mouthpiece, can help patients make sure they are getting the right amount of medication. Humidity or extreme temperatures can affect the performance of these inhalers, so they should not be stored in humid places (bathroom cabinets) or locations subject to high temperatures (glove compartments during summer months. Patients whose persistent asthma does not respond to standard dosages of inhaled corticosteroids may need a higher dosage or the addition of a long-acting beta-agonist to their drug regimen. Long-Term Relief MedicationsThese medications are taken on a regular basis to prevent asthma attacks and control chronic symptoms. The FDA panel decided that salmeterol-fluticasone (Advair) and formoterol-budesonide (Symbicort), long-acting beta2 agonists products that are combined with a steroid in a single inhaler, can continue to be used for treatment of moderate-to-severe asthma. Neither vacuuming nor the use of anti-mite carpet shampoo, however, is effective in removing mites in house dust.
Just like a drug, herbs and supplements can affect the body's chemistry, and therefore have the potential to produce side effects that may be harmful. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites.
In this context, there have been advances in our pharmacologic armamentarium in both chronic and acute therapy with the development and approval of novel medications.
Abnormal histopathology including edema, epithelial cell desquamation, and inflammatory cell infiltration are found not only in autopsy studies of severe asthma cases but even in patients with very mild asthma.
A number of limitations have hindered our understanding of asthma obtained from these model systems: There are important differences between animal models of asthma and human disease, there are few longitudinal studies of human asthma with serial airway sampling, and it is often difficult to determine cause and effect from multiple mediator studies. The proinflammatory prostaglandins (prostaglandin [PG]D2, PGF2, and TXB2) cause bronchoconstriction, whereas other prostaglandins are considered protective and elicit bronchodilation (PGE2 and PGI2, or prostacyclin). Specifically, early exposure to the various triggers that can occur with higher frequency in a rural setting might protect against the allergic diathesis that is characteristic of the Th2 paradigm. Many biopsy studies show these pathologic features in the airways of patients with chronic asthma. Food and Drug Administration (FDA) issued a black box warning, public health advisory, and subsequent label changes for LABA and LABA-containing medications. The frequency of these polymorphisms is the same in the normal population as in asthmatics.
However, mutations of the 5-LO gene promoter occur only in about 5% of asthmatic patients; for this reason, it is unlikely to play an important role in most patients. Mild-to-moderate asthma is typically associated with respiratory alkalosis and mild hypoxemia on the basis of ventilation-perfusion mismatching. In a patient with clinical features typical for asthma, along with reversible airflow obstruction, there is no need for a provocation procedure to establish a diagnosis. Excessive diurnal variation and a morning dip of PEF imply poor control and a need for careful re-evaluation of the management plan.
Possible mechanisms by which practice guidelines can improve patient care include improved clinician knowledge, encouraging clinicians to agree with and accept the guidelines as standard of care, and influencing clinician asthma care behavior.
This education includes knowledge of the disease, proper use of medications, including appropriate metered-dose inhaler technique, and a written action plan for managing exacerbations. In the real world, however, this paradigm was imperfect, because it relied on the correct categorization of patients for pharmacotherapy to be prescribed appropriately.
This patient will not require hospitalization or emergency department management, will not miss school or work days, and will not experience nocturnal awakening or limitation in routine activities because of asthma. The ACT is highlighted herein as an example of a validated instrument that can be used in routine asthma management as a gauge of asthma control. Because of potentially serious bronchospastic reaction that can occur during desensitization, this procedure should only be carried out in settings with experienced physicians and appropriate equipment to treat such reactions.
Patients with persistent asthma, with more frequent symptoms, are treated with the addition of an anti-inflammatory agent (controller) used on a scheduled basis in addition to an inhaled short-acting β agonist on an as-needed basis. Other symptoms include wheezing, gasping, coughing and an intense, tight feeling in the chest.
Heredity and age predispose people to the condition, but fear or stress can cause an abrupt attack in anyone. Additionally, these can cause blood pressure to rise and, over the long term, can contribute to kidney and liver damage. Thus, the first preventative medication is available for those adults and adolescents (aged 12 and up) with moderate to severe persistent asthma, especially those whose symptoms have not been adequately controlled by the use of inhaled corticosteroids.
Caution: Inhaled corticosteroids can have an effect on growth in children, and the effect on eventual adult height is not known. Some health care providers believe that inhaled drugs or topical treatments are safer than asthma pills because they are drawn directly into the bronchial tubes and lungs. If your asthma attacks seem to be triggered by stress, relaxation techniques may prove to be beneficial. This includes herbal cigarettes and marijuana or any other drug or chemicals used by inhalation. This convenient homeopathic oral spray makes it easy to get the safe and natural holistic relief you need. These patients are at particular risk for very serious and even life-threatening asthma attacks, since they are less conscious of symptoms. Asthma is most likely caused by a combination of genetic (inherited) factors and environmental triggers (such as allergens and infections). It is a particularly severe asthmatic condition, associated with many asthma-related hospitalizations. Usually, the dosage starts out higher and is then gradually reduced over a 5 - 7 day period. The use of inhaled corticosteroids in patients with moderate-to-severe asthma reduces the rate of rehospitalizations and deaths from asthma. Available in tablet, liquid, and injectable forms, some theophylline sustained-release tablets and capsules work for a long time and can, therefore, be taken once or twice a day with good results. It is used only to treat patients who have moderate-to-severe persistent asthma related to allergies whose symptoms are not controlled by inhaled corticosteroids. There have been a number of reported cases of serious and even lethal side effects from herbal products.
Yet, as exciting as this revolution has been in asthma research and practice, a number of controversies persist, and further fundamental developments in novel therapeutics are imminent.
Heterogeneity in the pattern of asthma inflammation has been recognized, consistent with the interpretation that phenotypic differences exist that influence treatment response. Reconstructive lesions, including goblet cell hyperplasia, subepithelial fibrosis, smooth muscle cell hyperplasia, and myofibroblast hyperplasia can lead to remodeling of the airway wall. Leukotrienes C4, D4, and E4 compose the compound formerly known as slow-reacting substance of anaphylaxis, a potent stimulus of smooth muscle contraction and mucus secretion. However, there are many unanswered questions, including whether features of remodeling are related to an inexorable progression of acute or chronic airway inflammation or whether remodeling is a phenomenon separate from inflammation altogether (Figs. These same patients, when switched to as-needed albuterol, had no decrease in lung function, as is the case for homozygous Gly16.
An SNP in LTC4S is associated with increased leukotriene production and has a lower response to leukotriene-modifying agents.
For initial diagnostic purposes in most patients, spirometry rather than a simple PEF should be performed, although PEF may be a reasonable tool for long-term monitoring. The use of measures of airway hyperreactivity has been proposed as a tool to guide anti-inflammatory therapy, but it is not recommended for routine clinical practice. PEF alone is never appropriate; rather, PEF should be part of a comprehensive patient education program. A second component involves measures to minimize or avoid exposure to clinically relevant aeroallergens and irritants that can exacerbate asthma. Both health care providers and patients are prone to underestimate asthma severity,54 and for this reason, many patients managed based on this paradigm were undertreated.
The inhalant allergens that can provoke and perpetuate asthma symptoms are listed in Box 1. For patients with more-severe disease and during acute exacerbations, addition of oral corticosteroids as a short-term burst is appropriate.
Whatever the particular instigator, it causes the bronchial tubes to swell and become plugged with mucus. This is not a replacement for existing corticosteroid treatment and any such replacement must be done under a health care provider's control. If you are using oral theophylline medication, you should periodically have your theophylline levels checked in your blood. Asthma tends to run in families, so children whose parents have asthma are more likely to develop it themselves.
In about 5% of cases, aspirin is responsible for a syndrome that involves multiple attacks of asthma, sinusitis, and nasal congestion. Patients should track their medicine and throw the device away when the last dose has been administered. The NAEPP notes that while it is not clear if oral corticosteroids are safe for pregnant women, uncontrolled asthma poses an even greater risk for a woman and her fetus. Uncontrolled asthma can be dangerous and, rarely, fatal for athletes, even some with mild asthma. Any duplication or distribution of the information contained herein is strictly prohibited. The inflammation of asthma leads to an associated increase in the existing bronchial hyperresponsiveness to a variety of stimuli.Although the absolute minimum criteria to establish a diagnosis of asthma are not widely agreed on, the presence of airway hyper-reactivity can be regarded as a sine qua non for patients with current symptoms and active asthma. Many studies have emphasized the multifactorial nature of asthma, with interactions between neural mechanisms, inflammatory cells (mast cells, macrophages, eosinophils, neutrophils, and lymphocytes), mediators (interleukins, leukotrienes, prostaglandins, and platelet-activating factor), and intrinsic abnormalities of the arachidonic acid pathway and smooth muscle cells. Ultimately, mediators lead to degranulation of effector or proinflammatory cells in the airways that release other mediators and oxidants, a common final pathway that leads to the chronic injury and inflammation noted in asthma.
Normocapnia and hypercapnia imply severe airflow obstruction, with FEV1 usually less than 25% of the predicted value. The methacholine challenge test, which is most commonly used in the United States, is very sensitive; a positive test result is defined as a 20% decline in FEV1 during incremental methacholine aerosolization. In contrast, a patient with mild-persistent to moderate-persistent asthma who either does not receive appropriate instructions for avoidance measures and controller medications, or both, or who is poorly adherent to therapy, will likely have poor control of asthma. This inflammation further irritates the airways, resulting in even greater sensitivity; the attacks become more frequent and the inflammation more severe. The incidence of asthma has s hot up 75 percent since 1980 and, unfortunately, the rate among children has increased 160 percent. However, natural remedies can offer relief from asthma attacks, they can even provide some means of prevention.
If you are a smoker and you quit smoking, your dosage will need to be adjusted accordingly. Although these types of descriptive studies have revealed a composite picture of asthma (Fig. Hypercapnia in the setting of acute asthma does not necessarily mandate intubation or suggest a poor prognosis.49 Spirometry in an asthmatic patient typically shows obstructive ventilatory impairment with reduced expiratory flows that improve with bronchodilator therapy. However, methacholine responsiveness is nonspecific, and it can occur in a variety of other conditions, including allergic rhinitis, chronic obstructive pulmonary disease, and airway infection. This patient is more likely to require hospitalization or emergency department management, miss school or work days, and experience nocturnal awakening or limitation in routine activities because of asthma. The cause of asthma's continued rise over the years has researchers scratching their heads and looking at a vide spectrum of possible causes, including pollution, global warming, food additives, genetics, toxins, and allergens.
Typically, there is an improvement in either FEV1 or forced vital capacity (FVC) with acute administration of an inhaled bronchodilator (12% and 200 mL). For practical purposes, a negative inhalation challenge with methacholine (or histamine) excludes active, symptomatic asthma. Recently it has been discovered that large increases in the number of asthma sufferers in the American Southwest, the Caribbean, and Central American regions seem to have been brought on by drought-caused sub-Saharan dust and mold spores being swept across the Atlantic by prevailing winds - winds that have recently changed due to the effects of global warming. I ended up in the emergency room with a critical level of serum theophylline when I quit smoking and my dosage was not adjusted (reduced) accordingly.
Measurement of FENO has been associated with a negative predictive value of 92%50 for ruling out presence of asthma; however, additional studies are required for this more-convenient and less-costly test to supplant methacholine challenge, which is still regarded as the gold standard for the diagnosis of asthma. Asthma specialists speculate that rising levels of environmental pollution also lead to higher incidences of asthma.
So, please if you decide to use theophylline therapy, get your levels checked regularly and if you change your lifestyle habits, let your health care provider know so you can be tested and dosages adjusted. The shape of the flow volume loop can provide insight into the nature and location of airflow obstruction. Asthma epidemics related to atmospheric contamination - situations in which dust and chemical particles are abundant, especially in enclosed environments - are well known. Occupational exposure to certain substances, such as urethane and polyurethane, used in the adhesives and plastics industry, along with rubber epoxy resins from paint, textile cleanser's fumes, dry-cleaning chemicals, and others also may be major risk factors.



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