Dictionary
respiratory disorder characterized by wheezing usually of allergic origin
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Wikipedia
attached to a Asthma spacer spacer.]]Asthma is a disease of the human respiratory system in which the Lungairways narrow, often in response to a "trigger" such as exposure to an allergen, cold air, exercise, or emotional stress (medicine)stress. This narrowing causes Symptomsymptoms such as wheezing, dyspneashortness of breath, chest tightness, and coughcoughing, which are the hallmarks of asthma. Between episodes, most patients feel fine. The disorder is a chronic inflammationinflammatory condition in which the lungairways develop increased responsiveness to various stimuli, characterized by bronchusbronchial hyper-responsiveness, inflammation, increased mucus production, and intermittent airway obstruction. The symptoms of asthma, which can range from mild to life threatening, can usually be controlled with a combination of medicationdrugs and lifestyle changes.Public attention in the developed country developed world has recently focused on asthma because of its rapidly increasing prevalence, affecting up to one in four urban children.anLilly Susceptibility to asthma can be explained in part by geneticsgenetic factors, but no clear pattern of inheritance has been found. Asthma is a complex disease that is influenced by multiple genetic, developmental biologydevelopmental, and environmental factors, which interact to produce the overall condition.
History - The word ''asthma'' is derived from the Ancient GreekGreek ''aazein'', meaning "sharp breath". The word first appears in Homer's ''Iliad'';anMarketos Hippocrates was the first to use it in reference to the medical condition. Hippocrates thought that the spasms associated with asthma were more likely to occur in tailors, anglers, and metalworkers. Six centuries later, Galen wrote much about asthma, noting that it was caused by partial or complete bronchial obstruction. Moses Maimonides, an influential medieval rabbi, philosopher, and physician, wrote a treatise on asthma, describing its prevention, diagnosis, and treatment.anRosner In the 17th century, Bernardino Ramazzini noted a connection between asthma and organic compound organic dust. The use of bronchodilators started in 1901, but it was not until the 1960s that the inflammatory component of asthma was recognized, and anti-inflammatory medications were added to the regimen.
Signs and symptoms - An acute exacerbation of asthma is referred to colloquially as an ''asthma attack''. The clinical hallmarks of an attack are shortness of breath (dyspnea) and wheezewheezing, the latter "often being regarded as the ''sine qua non''".anMcFadden A cough—sometimes producing clear sputum—may also be present. The onset is often sudden; there is a "sense of constriction" in the chest, breathing becomes difficult, and wheezing occurs (typically in both respirationrespiratory phases). Sign (medicine)Signs of an asthmatic episode are wheezing, rapid breathing (tachypnea), prolonged expiration, a rapid heart rate (tachycardia), rhonchusrhonchous lung sounds (audible through a stethoscope), and over-inflation of the chest. During a serious asthma attack, the accessory muscles of respiration may be used, shown as in-drawing of biological tissuetissues between the ribs and above the sternum and clavicles, and the presence of a paradoxical pulse (a pulse that is weaker during inhalation and stronger during exhalation).an numMcFadden4 During very severe attacks, an asthma sufferer can turn blue from lack of oxygen, and can experience chest pain or even loss of consciousness. Severe asthma attacks may lead to respiratory arrest and death. Despite the severity of symptoms during an asthmatic episode, between attacks an asthmatic may show few signs of the disease.
Diagnosis -
Diagnosing asthma - In most cases, a physician can diagnosisdiagnose asthma on the basis of typical findings in a patient's clinical history and examination. Asthma is strongly suspected if a patient suffers from eczema or other allergyallergic conditions—suggesting a general atopyatopic constitution—or has a Family history (medicine)family history of asthma. While measurement of airway function is possible for adults, most new cases are diagnosed in children who are unable to perform such tests. Diagnosis in children is based on a careful compilation and analysis of the patient's medical history and subsequent improvement with an inhaled bronchodilator medication. In adults, diagnosis can be made with a peak flow meter (which tests airway restriction), looking at both the diurnal Circadian rhythmvariation and any reversibility following inhaled bronchodilator Asthma#Rapid reliefmedication. Testing peak flow at rest (or baseline) and after exercise can be helpful, especially in young asthmatics who may experience only exercise-induced asthma. If the diagnosis is in doubt, or if chronic obstructive pulmonary disease is suspected, a more formal spirometrylung function testing may be conducted. Once a diagnosis of asthma is made, a patient can use peak flow meter testing to monitor the severity of the disease.
Differential diagnosis - Before diagnosing someone as asthmatic, differential diagnosisalternative possibilities should be considered. A physician taking a history should check whether the patient is using any known bronchoconstrictors (substances that cause narrowing of the airways, e.g., certain anti-inflammatory agents or beta-blockers).Only a minority of asthma sufferers have any identifiable allergy trigger. The majority of these triggers can often be identified from the history; for instance, asthmatics with hay fever or pollen allergy will have seasonal symptoms, those with allergies to pets may experience an abatement of symptoms when away from home, and those with occupational asthma may improve during leave from work. Occasionally, allergy#Diagnosisallergy tests are warranted and, if positive, may help in identifying avoidable symptom triggers. After pulmonary function has been measured, radiological tests, such as a chest X-ray or CT scan, may be required to exclude the possibility of other lung diseases. In some people, asthma may by triggered by gastroesophageal reflux disease, which can be treated with suitable antacids. Very occasionally, specialized tests after inhalation of methacholine challenge testmethacholine—or even less commonly histamine—may be performed.
Pathophysiology -
Bronchoconstriction - episode, inflamed bronchioleairways react to environmental triggers such as smoke, dust, or pollen. The airways narrow and produce excess mucus, making it difficult to breathe.]]In essence, asthma is the result of an abnormal immune response in the bronchial airways.anMaddox The airways of asthmatics are "hypersensitivityhypersensitive" to certain triggers, also known as ''stimuli'' (see below). In response to exposure to these triggers, the bronchi (large airways) contract into spasm (an "asthma attack"). Inflammation soon follows, leading to a further narrowing of the airways and excessive mucus production, which leads to coughing and other breathing difficulties.There are seven categories of stimuli: allergens, typically inhaled, which include waste from common household insects, such as the house dust mite and cockroach, pollengrass pollen, mould spores and pet epitheliumepithelial cells; medications, including aspirinanJenkins and the common beta blockerβ-adrenergic antagonist (beta blockers); Pollutionair pollution, such as ozone, nitrogen dioxide, and sulfur dioxide, which is thought to be one of the major reasons for the high prevalence of asthma in urban areas;various industrial compounds and other chemicals, notably sulfites; chlorinechlorinated swimming pools generate chloramines—monochloramine !(NH2Cl) ,? dichloramine (NHCl2) and trichloramine !(NCl3) in? the air around them, which are known to induce asthma;anNemery early childhood infections, especially virusviral URTIrespiratory infections; exercise, the effects of which differ somewhat from those of the other triggers; and stress (medicine)emotional stress, which is poorly understood as a trigger.
Bronchial inflammation - The mechanisms behind allergic asthma—i.e., asthma resulting from an immune response to inhaled allergens—are the best understood of the causal factors. In both asthmatics and non-asthmatics, inhaled allergens that find their way to the inner bronchioleairways are phagocytosisingested by a type of cell known as antigen presenting cells, or APCs. APCs then "present" pieces of the allergen to other immune system cells. In most people, these other immune cells (T helper cellTH0 cells) "check" and usually ignore the allergen molecules. In asthmatics, however, these cells differentiationtransform into a different type of cell (TH2), for reasons that are not well understood. The resultant TH2 cells activate an important arm of the immune system, known as humoral immunityhumoral immune system. The humoral immune system produces antibodyantibodies against the inhaled allergen. Later, when an asthmatic inhales the same allergen, these antibodies "recognize" it and activate a Humoral immune responsehumoral response. Inflammation results: chemicals are produced that cause the airways to constrict and release more mucus, and the Cellular immune systemcell-mediated arm of the immune system is activated. The inflammatory response is responsible for the clinical manifestations of an asthma attack. The following section describes this complex series of events in more detail.
The immune response - When an inhaled antigen becomes trapped in the bronchial tubesairways, it is proteaseenzymatically degraded into shorter peptides by APCs such as dendritic cells. APCs express the peptides derived from the antigen on the cell membranecell surface, in what is known as the binding groove of the class II Major Histocompatibility Complexmajor histocompatiblity complex (MHC) molecule. Now located on the cell surface, the antigen-MHC complex is presented to T cells, which express a receptor (biochemistry)receptor that is specific to the MHC II peptide.an numMaddox5 Presented with the antigen-MHC II complex, T helper cellT helper 0 (TH0) cells become activated and start to differentiationdifferentiate into either T helper type 1 (TH1) or type 2 (TH2) cells. The selective differentiation of TH0 cells has profound consequences for the immune system: TH1 cell production leads to cell-mediated immunity, while the production of predominantly TH2 cells provides humoral immunity. The resulting balance of TH1 or TH2 cells is a crucial variable in the development of asthma; the dominance of the TH2 cell type appears to be necessary for the development of asthma. In one study, knockout mousemice that lacked the ability to create TH1 cells displayed an asthma-like phenotype.anFinotto The variables that decide the fate of TH1 vs. TH2 cells are not well understood, but depend on many factors, including childhood exposure to infectious agents and the cytokines elicited by those agents. One cytokine secreted by TH2 cells—interleukin-4IL-4—combined with the action of other cytokines induces synthesis by antigen-stimulated B cells of IgE, an allergen-specific antibody. IgE binds allergens and then receptors on mast cells, basophils, and eosinophils in the airway epithelium. Subsequent exposure of the same antigen to these cells in the airway epithelium initiates the acute-phase reaction of asthma. Stimulated mast cells in the airway release preformed granules of mediators such as histamine, eicosanoids, and cytokines. These molecules are responsible for the symptoms of asthma. They affect the mucosa of the airways, increasing mucosal edema, and mucus production, smooth muscle constriction, and recruit other immune cells, thereby exacerbating the reaction.The late phase of an asthmatic reaction is characterized by an influx of inflammatory and immune cells during the first several hours after antigen exposure. These cells—particularly eosinophils—secrete a series of cytokines, leukotrienes, and polypeptides, which contribute to hyperresponsiveness, mucus secretion, bronchoconstriction, and sustained inflammation.
Pathogenesis - The fundamental problem in asthma appears to be immunologyimmunological: young children in the early stages of asthma show signs of excessive inflammation in their airways. EpidemiologyEpidemiological findings give clues as to the pathogenesis: the incidence of asthma seems to be increasing worldwide, and asthma is now very much more common in affluent countries.One theory of pathogenesis is that asthma is a disease of hygiene. In nature, babies are exposed to bacteria and other antigens soon after birth, "switching on" the TH1 lymphocyte cells of the immune system that deal with bacterial infection. If this stimulus is insufficient—as it may be in modern, clean environments—then TH2 cells predominate, and asthma and other allergic diseases may develop. This "hygiene hypothesis" may explain the increase in asthma in affluent populations. The TH2 lymphocytes and eosinophil cells that protect us against parasites and other infectious agents are the same cells responsible for the allergic reaction. In the developed world, these parasites are now rarely encountered, but the immune response remains and is wrongly triggered in some individuals by certain allergens.Another theory is based on the correlation of air pollution and the incidence of asthma. Although it is well known that substantial exposures to certain industrial chemicals can cause acute asthmatic episodes, it has not been proved that air pollution is responsible for the development of asthma. In Western Europe, most atmospheric pollutants have fallen significantly over the last 40 years, while the prevalence of asthma has risen.
Treatment - The most effective treatment for asthma is identifying triggers, such as pets or aspirin, and limiting or eliminating exposure to them. Desensitization is commonly attempted, but has not been shown to be effective. As is common with respiratory disease, tobacco smokingsmoking adversely affects asthmatics in several ways, including an increased severity of symptoms, a more rapid decline of lung function, and decreased response to preventive medications.anThomson Asthmatics who smoke typically require additional medications to help control their disease. Furthermore, exposure of both nonsmokers and smokers to secondhand smoke is detrimental, resulting in more severe asthma, more emergency room visits, and more asthma-related hospital admissions.anEisner Smoking cessation and avoidance of those who smoke is strongly encouraged in asthmatics.anEPR2 The specific medical treatment recommended to patients with asthma depends on the severity of their illness and the frequency of their symptoms. Specific treatments for asthma are broadly classified as relievers, preventers and emergency treatment. The ''Expert panel report 2: Guidelines for the diagnosis and management of asthma'' (EPR-2)an numEPR211 of the U.S. National Asthma Education and Prevention Program, and the ''British guideline on the management of asthma'' anSIGN are broadly used and supported by many doctors. Bronchodilators are recommended for short-term relief in all patients. For those who experience occasional attacks, no other medication is needed. For those with mild persistent disease (more than two attacks a week), low-dose inhaled glucocorticoids—or alternatively, an oral leukotriene modifier, a mast-cell stabilizer, or theophylline—may be administered. For those who suffer daily attacks, a higher dose of glucocorticoid in conjunction with a long-acting inhaled β-2 agonist may be prescribed; alternatively, a leukotriene modifier or theophylline may substitute for the β-2 agonist. In severe asthmatics, oral glucocorticoids may be added to these treatments during severe attacks.For those in whom exercise can trigger an asthma attack (exercise-induced asthma), higher levels of ventilation and cold, dry air tend to exacerbate attacks. For this reason, activities in which a patient breathes large amounts of cold air, such as cross-country skiing, tend to be worse for asthmatics, whereas swimming in an indoor, heated pool, with warm, humid air, is less likely to provoke a response.an numMcFadden4
Relief medication - , of salmeterolSerevent (salmeterol)]]Symptomatic control of episodes of wheezing and shortness of breath is generally achieved with fast-acting bronchodilators. These are typically provided in pocket-sized, metered-dose inhalerinhalers (MDIs—see the image to the right). In young sufferers, who may have difficulty with the coordination necessary to use inhalers, or those with a poor ability to hold their breath for 10 seconds after inhaler use (generally the elderly), an asthma spacer is used. The spacer is a plastic cylinder that mixes the medication with air in a simple tube, making it easier for patients to receive a full dose of the drug (see top image) and allows for the active agent to be dispersed into smaller, more fully inhaled bits. A nebulizer—which provides a larger, continuous dose—can also be used. Nebulizers work by vapourizing a dose of medication in a saline solution into a steady stream of foggy vapor, which the patient inhales continuously until the full dosage is administered. There is no clear evidence, however, that they are more effective than inhalers used with a spacer. Nebulizers may be helpful to some patients experiencing a severe attack. Such patients may not be able to inhale deeply, so regular inhalers may not deliver medication deeply into the lungs, even on repeated attempts. Since a nebulizer delivers the medication continuously, it is thought that the first few inhalations may relax the airways enough to allow the following inhalations to draw in more medication. Relievers include: Short-acting, selective Beta2-adrenergic receptor agonist!beta2-a drenoceptor? agonists (salbutamol albuterol, levalbuterol, terbutaline, bitolterol, pirbuterol, procaterol, fenoterol, bitolterol, reproterol). tremorTremors, the major side effect, have been greatly reduced by inhaled delivery, which allows the drug to target the lungs specifically; oral and injected medications are delivered throughout the body. There may also be cardiac side effects at higher doses, such as elevated heart rate or blood pressure; with the advent of selective agents, these side effects have become less common. Patients must be cautioned against using these medicines too frequently, as with such use their efficacy may decline, resulting in an exacerbation of symptoms which may lead to refractory asthma and death. Older, less selective adrenergic receptoradrenergic agonists, such as inhaled epinephrine and ephedrine tablets—both of which, unlike other medications, are available over the counter in the US under the primatene.com - Primatene brand. Cardiac side effects, although uncommon, occurred more often with the less selective drugs. They also have the disadvantage of providing a shorter period of relief than the selective bronchodiolators. Nowadays, they are usually avoided in patients with heart disease. In emergencies, these drugs were sometimes administered by injection in severe attacks. Their use in this situation has declined. Anticholinergic medications, such as ipratropium bromide may be used instead. They have no cardiac side effects and thus can be used in patients with heart disease; however, they take up to an hour to achieve their full effect and are not as powerful as the !β2 -adrenoreceptor? agonists.
Prevention medication - Current treatment protocols recommend prevention medications such as an inhaled corticosteroid, which helps to suppress inflammation and reduces the swelling of the lining of the airways, in anyone who has frequent (greater than twice a week) need of relievers or who has severe symptoms. If symptoms persist, additional preventive drugs are added until the asthma is controlled. With the proper use of prevention drugs, asthmatics can avoid the complications that result from overuse of relief medications.Asthmatics sometimes stop taking their preventative medication when they feel fine and have no problems breathing. This often results in further attacks, and no long-term improvement.Preventive agents include the following. Inhaled glucocorticoids (fluticasone, budesonide, beclomethasone, mometasone, flunisolide, and triamcinolone). !Antimuscarinics/anticholinergi cs? (ipratropium, oxitropium), which have a mixed reliever and preventer effect. They are rarely used in asthma. Leukotriene modifiers (montelukast, zafirlukast, pranlukast, and zileuton). Mast cell stabilizers (cromoglicate (cromolyn), and nedocromil). Methylxanthines (theophylline and aminophylline), which are sometimes considered if sufficient control cannot be achieved with inhaled glucocorticoids and long-acting β-agonists alone. Antihistamines, often used to treat allergic symptoms that may underlie the chronic inflammation. In more severe cases, hyposensitization ("allergy shots") may be recommended. Omalizumab, an immunoglobulin EIgE blocker; this can help patients with severe allergic asthma that does not respond to other drugs. However, it is expensive and must be injected. Methotrexate is occasionally used in some difficult-to-treat patients. If chronic acid indigestion (Gastroesophageal reflux diseaseGERD) contributes to a patient's asthma, it should also be treated, because it may prolong the respiratory problem.
Long-acting !β2 -agonists - Long-acting bronchodilators (LABD) give a 12-hour effect, and are used to give a smoothed symptomatic effect (used morning and night). While patients report improved symptom control, these drugs do not replace the need for routine preventers, and their slow onset means the short-acting dilators may still be required. Currently available long-acting beta2-adrenergic receptor agonist!beta2-a drenoceptor? agonists include salmeterol, formoterol, bambuterol, and sustained-release oral albuterol. Combinations of inhaled steroids and long-acting bronchodilators are becoming more widespread; the most common combination currently in use is fluticasone/salmeterol (Advair in the United States, and Seretide in the UK).
Emergency treatment - When an asthma attack is unresponsive to a patient's usual medication, other treatments are available to the physician or hospital:anRodrigo oxygen to alleviate the hypoxia (but not the asthma ''per se'') that results from extreme asthma attacks; nebulized salbutamol (2.5-5 mg), usually three in rapid succession !("back-to-back"); systemic steroids, oral or intravenous (prednisone, prednisolone, methylprednisolone, dexamethasone, or hydrocortisone) other bronchodilators that are occasionally effective when the usual drugs fail:* nonspecific beta-agonists, injected or inhaled (epinephrine, isoetharine, isoproterenol, metaproterenol);* anticholinergics, IV or nebulized, with systemic effects (glycopyrrolate, atropine);* methylxanthines (theophylline, aminophylline);* inhalation anesthetics that have a bronchodilatory effect (isoflurane, halothane, enflurane);* the dissociative anesthetic ketamine, often used in endotracheal tube induction* magnesium sulfate, intravenous; and intubation and mechanical ventilation, for patients in or approaching respiratory arrest.
Alternative medicine - Many asthmatics, like those who suffer from other chronic disorders, use alternative treatments; surveys show that roughly 50% of asthma patients use some form of unconventional therapy.anBlanc anShenfield There are little data to support the effectiveness of most of these therapies. A Cochrane CollaborationCochrane Evidence-based medicinesystematic review of acupuncture for asthma found no evidence of efficacy.anMcCarney A similar review of air ionisers found no evidence that they improve asthma symptoms or benefit lung function; this applied equally to positive and negative ion generators.anBlackhall A study of "manual therapies" for asthma, including osteopathic, chiropractic, physiotherapyphysiotherapeutic and respiratory therapyrespiratory therapeutic maneuvers, found no evidence to support their use in treating asthma;anHondras these maneuvers include various osteopathic and chiropractic techniques to "increase movement in the rib cage and the spine to try and improve the working of the lungs and circulation"; chest tapping, shaking, vibration, and the use of "postures to help shift and cough up phlegm". On the other hand, one meta-analysis found that homeopathy has a potentially mild benefit in reducing symptom intensity;anReilly however, the number of patients involved in the analysis was small, and subsequent studies have not supported this finding.anWhite Several small trials have suggested some benefit from various yoga practices, ranging from integrated yoga programsanNagendra —"yogasanas, Pranayama, meditation, and kriyas"—to ''sahaja'' yogaanManocha , a form of meditation. A randomized, controlled trial of just 39 patients suggested that the Buteyko method may moderately reduce the need for beta-agonists among asthmatics, but found no objective improvement in lung function.anBowler See also ''Complementary and alternative medicine''.
Prognosis - The prognosis for asthmatics is good, especially for children with mild disease. For asthmatics diagnosed during childhood, 54% will no longer carry the diagnosis after a decade. The extent of permanent lung damage in asthmatics is unclear. Airway remodelling is observed, but it is unknown whether these represent harmful or beneficial changes.an numMaddox5 Although conclusions from studies are mixed, most studies show that early treatment with glucocorticoids prevents or ameliorates decline in lung function as measured by several parameters.anBeckett For those who continue to suffer from mild symptoms, corticosteroids can help most to live their lives with few disabilities. The mortality rate for asthma is low, with around 6000 deaths per year in a population of some 10 million patients in the United States.an numMcFadden4 Better control of the condition may help prevent some of these deaths.
Epidemiology - of childhood asthma has increased since 1980, especially in younger children.]]Asthma is usually diagnosed in childhood. The risk factors for asthma include:a personal or family history of asthma or atopy;triggers (see !''Asthma#Pathophysiology Pathophysiology'' above);premature birth or low birth weight; viral URTIrespiratory infection in early childhood; maternal smoking; being male, for asthma in prepubertal children; andbeing female, for persistence of asthma into adulthood.There is a reduced occurrence of asthma in people who were breast-fed as babies. Current research suggests that the prevalence of childhood asthma has been increasing. According to the Centers for Disease Control and Prevention's National Health Interview Surveys, some 9% of US children below 18 years of age had asthma in 2001, compared with just 3.6% in 1980 (see figure). The World Health Organization (WHO) reportsanWHO that some 8% of the Swiss population suffers from asthma today, compared with just 2% some 25–30 years ago. Although asthma is more common in affluent countries, it is by no means a problem restricted to the affluent; the WHO estimate that there are between 15 and 20 million asthmatics in India. In the U.S., urban residents, Hispanics, and African Americans are affected more than the population as a whole. Globally, asthma is responsible for around 180,000 deaths annually.an numWHO25
Asthma and athletics - Asthma appears to be more prevalent in athletes than in the general population. One survey of participants in the 1996 Summer Olympic Games showed that 15% had been diagnosed with asthma, and that 10% were on asthma medication.anOlympics There appears to be a relatively high incidence of asthma in sports such as cycling, mountain biking, and long-distance running, and a relatively low incidence in weightlifting and diving. It is unclear how much of these disparities are because of the effects of training in the sport, and self-selection of sports that may appear to minimize the triggering of asthma.an numOlympics26 anathletes It has also been suggested that some professional athletes who do not suffer from asthma claim to do so in order to obtain special permits to use certain performance-enhancing drugs.
See also - Atopy.Hopkins syndrome.Immune response.
References - #anbLilly Lilly CM. Diversity of asthma: Evolving concepts of pathophysiology and lessons from genetics. ''J Allergy Clin Immunol''. 2005;115(4 Suppl):S526-31. PMID 15806035#anbMarketos Marketos SG, Ballas CN. Bronchial asthma in the medical literature of Greek antiquity. ''J Asthma''. 1982;19(4):263-9. PMID 6757243#anbRosner Rosner F. Moses Maimonides' treatise on asthma. ''Thorax''. 1981;36:245-251. PMID 7025335#anbMcFadden McFadden ER, Jr. Asthma. In Kasper DL, Fauci AS, Longo DL, et al (eds.). ''Harrison's Principles of Internal Medicine'' (16th Edition), pp. 1508-1516. New York: McGraw-Hill;2004.#anbMaddox Maddox L, Schwartz DA. The Pathophysiology of Asthma. ''Annu. Rev. Med.'' 2002, 53:477-98. PMID 11818486#anbJenkins Jenkins C, Costello J, Hodge L. Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice. ''British Medical JournalBMJ'' 2004;328:434. PMID 14976098#anbNemery Nemery B, Hoet PH, Nowak D. Indoor swimming pools, water chlorination and respiratory health. ''Eur Respir J''. 2002;19(5):790-3. PMID 12030714#anbFinotto Finotto S, Glimcher L. T cell directives for transcriptional regulation in asthma. ''Springer Semin. Immunopathology'' 2004;25(3-4):281-94. PMID 15007632#anbThomson Thomson NC, Spears M. The influence of smoking on the treatment response in patients with asthma. ''Curr Opin Allergy Clin Immunol''. 2005;5(1):57-63. PMID 15643345#anbEisner Eisner MD, Yelin EH, Katz PP, et al. Exposure to indoor combustion and adult asthma outcomes: environmental tobacco smoke, gas stoves, and woodsmoke. ''Thorax''. 2002;57(11):973-8. PMID 12403881#anbEPR2 National Asthma Education and Prevention Program. ''Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma''. National Institutes of Health pub no 97-4051. Bethesda, MD, 1997. (nhlbi.nih.gov - PDF)#anbSIGN British Thoracic Society & Scottish Intercollegiate Guidelines Network (SIGN). ''British Guideline on the Management of Asthma''. Guideline No. 63. Edinburgh:SIGN; 2004. (sign.ac.uk - HTML, sign.ac.uk - Full PDF, sign.ac.uk - Summary PDF)#anbRodrigo Rodrigo GJ, Rodrigo C, Hall JB. Acute asthma in adults: a review. ''Chest''. 2004;125(3):1081-102. PMID 15006973 #anbBlanc Blanc PD, Trupin L, Earnest G, et al. Alternative therapies among adults with a reported diagnosis of asthma or rhinosinusitis: data from a population-based survey. ''Chest''. 2001;120(5):1461-7. PMID 11713120#anbShenfield Shenfield G, Lim E, Allen H. Survey of the use of complementary medicines and therapies in children with asthma. ''J Paediatr Child Health''. 2002;38(3):252-7. PMID 12047692#anbMcCarney McCarney RW, Brinkhaus B, Lasserson TJ, et al. Acupuncture for chronic asthma. ''Cochrane Database Syst Rev''. 2004;(1):CD000008. PMID 14973944#anbBlackhall Blackhall K, Appleton S, Cates CJ. Ionisers for chronic asthma. ''Cochrane Database Syst Rev.'' 2003;(3):CD002986 PMID 12917939#anbHondras Hondras MA, Linde K, Jones AP. Manual therapy for asthma. ''Cochrane Database Syst Rev''. 2005;(2):CD001002. PMID 15846609#anbReilly Reilly D, Taylor MA, Beattie NG, et al. Is evidence for homoeopathy reproducible? ''Lancet.'' 1994;344(8937):1601-6. PMID 7983994#anbWhite White A, Slade P, Hunt C, et al. Individualised homeopathy as an adjunct in the treatment of childhood asthma: a randomised placebo controlled trial. ''Thorax.'' 2003;58(4):317-21. PMID 12668794#anbNagendra Nagendra HR, Nagarathna R. An integrated approach of yoga therapy for bronchial asthma: a 3-54-month prospective study. ''J Asthma.'' 1986;23(3):123-37. PMID 3745111#anbManocha Manocha R, Marks GB, Kenchington P, et al. Sahaja yoga in the management of moderate to severe asthma: a randomised controlled trial. ''Thorax.'' 2002;57(2):110-5. PMID 11828038#anbBowler Bowler SD, Green A, Mitchell CA. Buteyko breathing techniques in asthma: a blinded randomised controlled trial. ''Med J Aust''. 1998;169(11-12):575-8. PMID 9887897#anbBeckett Beckett PA, Howarth PH. Pharmacotherapy and airway remodelling in asthma? ''Thorax''. 2003;58(2):163-74. PMID 12554904#anbWHO World Health Organization homepage - on the Internet. Bronchial asthma: scope of the problem. Geneva: World Health Organization; ©2005. Available from who.int - !http://www.who.int/entity/resp iratory/asthma/scope/en/index. html.? Accessed on 23 Aug 2005.#anbOlympics Weiler JM, Layton T, Hunt M. Asthma in United States Olympic athletes who participated in the 1996 Summer Games. ''J Allergy Clin Immunol''. 1998;102(5):722-6. PMID 9819287#anbathletes Helenius I, Haahtela T. Allergy and asthma in elite summer sport athletes. ''J Allergy Clin Immunol''. 2000;106(3):444-52 PMID 10984362
External links - asthma.org.uk - Asthma UK - a user-friendly site with information on asthma and ways that UK residents can help improve asthma-related policy.nlm.nih.gov - MedLinePlus: Asthma - a U.S. National Library of Medicine page.nhlbi.nih.gov - National Heart, Lung, and Blood Institute — Asthma - U.S. NHLBI Information for Patients and the Public page.nhlbi.nih.gov - National Heart, Lung, and Blood Institute — Asthma - U.S. NHLBI Information for Health Professionals page.atsdr.cdc.gov - Case Studies in Environmental Medicine (CSEM) - Environmental Triggers of Asthma - a page from the Agency for Toxic Substances and Disease Registry, a service of the U.S. Department of Health and Human !Services.Category:Asthma !*zh-min-nan:He-kucy:Asthmada:A stmade:Asthma? !bronchialees:Asmafr:Asthmegl:A smako:천식ia:Asthmait:Asmahe :אסטמהhu:Asztmanl:Astmaja :喘息no:Astmann:Astmapl:Astm a? !oskrzelowapt:Asmaru:Бронх иальная? астмаsv:Astmavi:Bệnh suyễntr:Astımwa:Coûtresse d' alinnezh:哮喘
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Websites
The author's site, devoted to the buteyko therapy which corrects the breath for treatment of an allergy, an asthma, bronchites and other illnesses
Author's Buteyko site, documents, author - Konstantin P. Buteyko, history of the Buteyko discovery, the scientific and popular literature on the Buteyko therapy, consultations of experts on Buteyko therapy
http://www.buteyko.ru/
DR.PAUL's CHILD HEALTH AND WELLNESS INFO SITE
On-line since 1995, this multi-award winning site offers parents instant access to a wide range of child health and wellness information. Topics include breastfeeding, nutrition, injury prevention, common illness and conditions, immunizations, asthma, growth and development, and behavioral issues. Consistently updated, Pediatrician Dr. Paul utilizes, live weekly on line radio show,weekly Q & A as well as an extensive archived Ask Dr.Paul library.
http://www.drpaul.com/
Living Proof
Living Proof is a national educational campaign for Americans aged 55 and older about medical research. Living Proof archives stories about healthcare, research and medical advances, provides up to date information about biomedical research, and honors senior scientists. Living Proof is a project of States United for Biomedical Research and is supported by the National Institutes of Health.
http://www.living-proof.us/
ChiroTouch -- FREE Chiropractic For Life
FREE online instructions for mothers around the world. Bless your family and loved ones with these soft, slow, safe home chiropractic healing methods.
http://www.chiromoms.com/
AroMed vaporizer
The AroMed is a very precise hot-air vaporizer. The active substances of about any given plant can be inhaled. Fresh or dried plant material, tinctures, or essential oils are all the same applicable with the AroMed. The AroMed vaporizer can be employed in many ways: •inhale medicinal plants •use stimulating, sleep inducing, and mood lifting herbs to improve climate of the room with the additional AromaTop •use as recreation device for well-being In German, the publication ‘Phyto-Inhalation’ expaling the use of the AroMed vaporizer has been edited by : http://www.gruenekraft.net
http://www.aromed.com
mutter erde
mutter erde online-shop sortiment rheuma osteoporose diabetes asthma schmerzen blutdruck bronchitis schuppenflechte
http://www.naturprodukt24.de/
Dust mite proof bedding covers
100% pure cotton dust mite proof encasings
http://www.protexom.com
Arzt Dr. C. Schnürer Internist am Gemeinschaftskrankenhaus Herdecke Privatpraxis
Privatpraxis am Gemeinschaftskrankenhaus. Schwerpunkte: Imunerkrankungen- Asthma, Allergien, Allgemeinmedizin. Komplementärmedizinische Behandlung Termine nach Vereinbarung
http://www.dr-schnuerer.de/
St. Barnabas Hospital
St. Barnabas Hospital is the flagship of an expanding healthcare network located in the heart of the Bronx. Our hospital provides comprehensive inpatient and outpatient services, and operates a 199-bed skilled nursing facility for long-term and subacute care. Outpatient services include a large network of primary care sites and community mental health centers, located throughout the Bronx.
http://www.stbarnabashospital.org
American Academy of Asthma, Allergy, and Immunology
Resources and research funding information about those disorders.
http://www.aaaai.org/
National Asthma Campaign
Includes general information, a personal plan, and message board. Offers sections for Health Professionals and Researchers.
http://www.asthma.org.uk/
Allergy, Asthma and Immunology (ACAAI)
Information, articles and news for patients and physicians.
http://allergy.mcg.edu
Asthma and Allergy Foundation of America
Not-for-profit organization dedicated to finding a cure for and controlling asthma and allergic diseases.
http://www.aafa.org/
American Lung Association
Provides information on various conditions, research and statistics, plus programs and events.
http://www.lungusa.org/
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