EXACERBATIONSBox 4-1.Factors that increase the risk of asthma-related death Box 4-2.Self-management of worsening asthma in adults and adolescents with a written asthma action plan Box 4-3.Management of asthma exacerbations in primary care (adults, adolescents, children 6-11 years) Box 4-4.Management of asthma exacerbations in acute care facility, e.g.emergency department Box 4-5.Discharge management after hospital or emergency department care for asthma Members of GINA committees (2019-20)
Abstract The 2007 National Heart, Lung and Blood Institute/National Asthma Education and Prevention Program of the National Institutes of Health (NHLBI/NAEPP) guidelines state that chronic adult asthma should be managed in a stepwise fashion (Fig. 4.1). Treatment can be started at any of the six steps—largely determined by the severity of symptoms—in an attempt to control symptoms rapidly.
Abstract Although asthma has been described in the literature since antiquity, the condition effectively remains undefined since no clear-cut criteria have been established to decide whether an individual has asthma or not. However, a 1992 International Consensus Report described asthma as: a chronic inflammatory disorder of the airways in which many cells play a role, in particular mast cells and eosinophils. In susceptible individuals, this inflammation causes symptoms which are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment and causes an associated increase in airway responsiveness to a variety of stimuli.
Abstract Asthma is a common condition, and the responsibility for both the diagnosis and subsequent long-term management often rests with the primary health-care team. Indeed, asthma is one of the chronic conditions most frequently diagnosed in a primary care setting, and many patients are initially managed by the primary team, with subsequent referral to a specialist to help manage the more challenging cases. Asthma lends itself to assessment of quality of care by outcome measures.
Abstract Although inhaled corticosteroids are a fundamental component in the management of asthma, in some patients, adherence is often poor, in part due to concerns about long-term systemic and local adverse effects. Ciclesonide is a novel lipophilic inhaled corticosteroid that has recently become licensed in the United States for once-daily use in asthma. It represents an exciting development because it becomes activated in the lung by esterase cleavage, minimizing extrapulmonary adverse effects. The unique pharmacological properties of ciclesonide, fewer local adverse effects, and limited effect on the hypothalamic–pituitary–adrenal axis due to onsite lung activation (in addition to its once-daily dosing regimen) make it particularly attractive in encouraging compliance without the concerns of local and systemic complications.
Abstract In 2007, the National Heart, Lung and Blood Institute/National Asthma Education and Prevention Program of the National Institutes of Health (NHLBI/NAEPP) convened an expert panel to update clinical guidelines for the diagnosis and management of asthma.
Abstract Asthma is one of the most common chronic conditions that affect women during pregnancy, with approximately 4% to 12% of pregnancies affected. When asthma is poorly controlled, potentially serious consequences can affect the health of both the mother and unborn child. For example, retrospective studies have found that uncontrolled asthma can be associated with preterm birth, low birthweight, and preeclampsia. It is often reported that clinical control of asthma improves in about one-third of women during pregnancy, remains the same in one-third, and deteriorates in one-third, although it is more likely to decline in those with more severe disease. The reasons for this and the mechanisms involved still await clarification.
Myocardial infarction is emerging as a foremost public health concern in most parts of the world even in developing countries still afflicted by infectious diseases, under nutrition and other illnesses related to poverty. There has been increasing recognition that certain natural substances have the potential to reduce the detrimental effect of a number of cardiovascular risk factors. In the present study, we have investigated the protective effect of betaine administration on changes in the levels of protein, glycoproteins and amino acids was studied in isoprenaline-induced myocardial infarction in rats as an animal model of myocardial infarction in man. Oral pre-treatment with betaine significantly attenuated (P < 0.01) the isoprenaline-induced rise in the levels of troponin-T and creatine phosphokinase [CPK]. Oral supplementation of betaine also significantly (P < 0.01) counteracted the isoprenaline-induced alterations in the levels of amino acids [taurine, aspartate, glutamate, arginine, hydroxy proline and homocysteine], protein content, glycoprotein components [hexose and hexosamine] and lipid peroxidation in the heart tissue and maintained their levels comparable to that of control animals. The results indicated that the overall cardioprotective effect of betaine was probably related to its ability to strengthen the myocardial membrane by its membrane stabilizing action or to a counteraction of free radicals by its antioxidant property.
Garcinia indica Choisy (Family: Guttiferae/Clusiaceae) is a slender evergreen tree endemic to the west coast of India. The dried rind of the fruit of Garcinia indica known as “kokum” is an Indian spice and a food additive. Many therapeutic effects of the fruit have been reported in literature. The present study evaluates the antiulcer activity of the aqueous extract of Garcinia indica fruit rind (GIE) against absolute ethanol- (necrotizing agent), aspirin- (non-steroidal anti-inflammatory drug) and histamine- (gastric secretion stimulator via H2 receptor) induced ulcers in rats. GIE (400 mg/kg and 800 mg/kg) was administered orally to the overnight fasted rats, 1 h prior to the absolute ethanol/aspirin/histamine challenge. The ulcer index, gastroprotective potential, status of the antioxidant enzymes {superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx) and glutathione reductase (GR)} along with reduced glutathione (GSH), and lipid peroxidation were studied in all the three models. Pre-treatment with GIE showed a dose-dependent decrease in the ulcer index in all three models. GIE, at both doses, elicited significant antioxidant activity by attenuating the ulcer elevated levels of MDA and restored the ulcer-depleted levels of GSH, SOD, CAT, GPx and GR. In conclusion, GIE possesses potent antiulcer activity, which may be attributed to an underlying antioxidant activity.
Many of us refer to any over-the-counter analgesic as an “aspirin.” The choices in the pain reliever aisle of your drug store are tremendous—often with different versions or formulations to address specific symptoms. Despite the variety, most over-the-counter pain relievers can be broken down into two types: nonsteroidal anti-inflammatory drugs (NSAIDs) and acetametaphin.
Jerome Bettis, the Pittsburgh Steelers's star running back, may be best known for the rushing records he has accumulated. He is fifth on the NFL's all-time rushing list with 13,467 yards and is third in NFL history with 3428 rushing attempts. He is only the second Steelers running back to pass the 10,000-yard rushing mark, and now he is a Super Bowl Champion, too. However, what many people don't know is that Jerome has asthma. He works hard to keep it well-controlled so that it does not interfere with his football career.
For parents of children with asthma, the thought of sending a child to camp raises numerous questions and conjures up difficult images. How will my child remember to take his medications during the day? What if my child has an asthma attack? How will my child keep up, since he can't run or swim like other kids can? These real fears and concerns about daily management of asthma prevent many parents from considering summer camp for their children.
In the United States, the incidence of people with asthma has nearly doubled over the past 20 years. It is possible for anyone to develop asthma, yet there are some people who are more predisposed to developing the disease, either due to genetic or environmental factors. Who is at risk for developing asthma and can steps be taken to reduce this risk?
For parents of children with asthma, the thought of sending a child to camp raises numerous questions and conjures up difficult images. How will my child remember to take his medications during the day? What if my child has an asthma attack? How will my child keep up, since he can't run or swim like other kids can? These real fears and concerns about daily management of asthma prevent many parents from considering summer camp for their children.
