Stop Asthma Naturally

Asthma Free Forever

Asthma Free Forever, written by Jerry Ericson, covers simple and easy ways you can do to deal with your asthma on a daily basis such as knowing what your symptoms are, learning to recognize your asthma triggers, and controlling your asthma through better environment and diet. The book also consists of natural methods you can use to help cure your asthma. A well organized and precisely explained all natural asthma recovery methods keeps you out from having on the counter drugs pr from so highly priced medicines prescribed by the doctors, even you need to revolve around the doctor for good results to be shown, there is all consists inside the content of this online health guide and by following it properly and timely you will get treated soon. Along with a wealth of real-life success stories, these strategies can prevent panic, clarify the meaning of symptoms, increase energy levels, and achieve a deeper healing than you ever thought possible. Whether used as a complement to conventional medicine or as a medication reducing alternative, this program empowers people of all ages to live more active, fulfilling lives. Continue reading...

Asthma Free Forever Summary


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The author presents a well detailed summery of the major headings. As a professional in this field, I must say that the points shared in this book are precise.

Purchasing this book was one of the best decisions I have made, since it is worth every penny I invested on it. I highly recommend this to everyone out there.

Prenatal Antecedents of Allergies and Asthma

While fetal growth is manifest clearly by infant size at birth, prenatal influences on other physiological systems are also occurring but are less overtly evident. For example, there is extensive evidence documenting the significance of prenatal priming for the developing immune system. It includes fetal exposure to allergens, which has a special relevance to pediatric medicine because it may contribute to the rising incidence of allergies and asthma worldwide. Although the placenta is usually an effective barrier that blocks the transfer of viruses and bacteria and keeps the fetal compartment sterile, the immune system actually starts to develop and become functional early in gestation. By 2 months after conception, the fetus has lymphocytes that can respond and proliferate. By mid-gestation, analyses of cell subsets in cord blood indicate the presence of activated T cells (Devereux et al, 2001 Warner et al, 2000). Some of this cellular activation is likely due to reactions to food...

Environmental risk factors for the development of asthma

The prevalence of asthma has increased in Western countries over the past three to four decades (Anderson et al., 1994 Burney et al., 1990 Peat etal., 1994). In 1995 6 18-21 of children under 15 years of age, and 11 of adults, in England had been diagnosed as having asthma at some point in their life (British Thoracic Society, 2003). The marked increase in asthma strongly suggests that environmental exposures must be instrumental in the development of disease. This is supported by reports in the developing world of an increase in asthma with increasing affluence or urbanization (Keeley etal., 1991 Yemaneberhan etal., 1997) and it has been suggested that a Western lifestyle may predispose individuals to the development of asthma (Woolcock, 1996). A large number of environmental exposures have been identified as risk factors for the development of asthma atopy (Table 26.1). Three of these, air pollution, childhood infections and diet, will be considered in more detail. *Suggested to...

Genetic risk factors for the development of asthma

Twin studies have a shown a greater concordence of asthma in monozygotic than dizygotic twins (Edfors-Lubs, 1971) and more recently family studies have shown greater heritability of extrinsic than intrinsic asthma (The European Community Respiratory Health Survey Group, 1997). As well as confirming a genetic susceptibility to asthma and allergy, these studies showed that inheritance does not follow a mendelian pattern. Linkage studies have identified many genomic regions that may be linked with the asthma and the atopic pheno-type. Indeed if all of the loci reported to be associated, at least vaguely, with asthma or atopy were taken into consideration they would constitute about half of the genome (Heinzmann and Deichmann, 2001). Examples of loci that have been reported to be associated with asthma by several different investigators are shown in Table 26.2. In some cases these regions harbour potentially important candidate genes (Heinzmann and Deichmann, 2001). Similarly, association...

Asthma bronchiale

One would think that an immunosuppressing disease like HIV infection would at least protect patients from manifestations of exaggerated immune reaction such as allergies and asthma. However, the opposite is the case in a study from Canada concerning HIV-infected men, more than 50 had suffered an episode of wheezing within the previous 12 months, and nearly half of those showed evidence of bronchial hyperreactivity. These findings were particularly distinct among smokers (Poirer 2001). As the disease progresses, it probably comes to an imbalance between too few good TH1 cells producing interferon and Interleukin 2, and too many allergy-mediating TH2 cells with an increased total IgE. In cases of unclear coughing, dyspnoea or recurrent bronchitis, the possibility of bronchial hyperreac-tivity, asthma or emphysema should be kept in mind.


The dyspnea, wheezing, and other symptoms of asthma are produced by an obstruction of air flow through the bronchioles that occurs in episodes, or attacks. This obstruction is caused by inflammation, mucous secretion, and bronchoconstriction. Inflammation of the airways is characteristic of asthma, and itself contributes to increased airway responsiveness to agents that promote bronchiolar constriction. Bronchoconstriction further increases airway resistance and makes breathing difficult. The increased airway resistance of asthma may be provoked by allergic These conditions result in the secretion of several substances by tissue mast cells and eosinophils (chapter 15). Chief among these are histamine and the leukotrienes (derived from the same parent molecule, arachidonic acid, as are the prostaglandins see chapter 11, fig. 11.34). Drugs that block leukotriene synthesis or action are among the newest compounds available for the treatment of asthma.

Current Promoted Uses

Physicians routinely used intravenous ephedrine for the prophylaxis and treatment of hypotension caused by spinal anesthesia particularly during cae-sarean section (9). In the past, ephedrine was used to treat Stokes-Adams attacks (complete heart block), and was also recommended as a treatment for narcolepsy. Over the years, ephedrine has been replaced by other, more effective agents (10), and the advent of highly selective -agonists has mostly eliminated the need to use ephedrine in treating asthma.

Pharmacological Effects

Ephedrine, the predominant alkaloid in ephedra, is both an a and P stimulant. It directly stimulates a2 and Px receptors and, because it also causes the release of norepinephrine from nerve endings, it also acts as a P2 stimulant. The resultant physiological changes are variable, depending on receptor distribution and receptor regulation (26). Tolerance to ephedrine's P agonist actions emerges rapidly, which is why ephedrine is no longer the preferred agent for treating asthma receptor downregulation quickly occurs and the bronchodilator effects are lost (27,28).

Clinical Studies 61 Bronchodilation

Banner et al. summarized studies where the effects of ephedrine and ephedra were compared to placebo in controlled studies in humans. None of the controlled trials disclosed any evidence of cardiovascular toxicity when ephedrine was given in doses as high as 1 mg kg, even when it was administered to severe asthmatics with known cardiac arrhythmias (57). The trial reported by Banner et al. studied the respiratory and circulatory effects of orally administered ephedrine sulfate, 25 mg, aminophylline, 400 mg, terbutaline sulfate, 5 mg, and placebo in 20 patients with ventricular arrhythmia by a double-blind crossover method. The study was comprised of 20 patients, with an average age of 60 years and a preexisting history of both asthma and heart disease (as evidence by the presence of frequent premature ventricular contractions). The bronchodilator effect of terbutaline was similar to that of aminophylline over 4 hours but superior to ephedrine at hour 4. Both terbutaline and ephedrine...

Increasing consumption what is being done

In several programmes, emphasis is placed on the education and involvement of children, because many of the processes linked to the development of chronic disease begin in childhood. Evidence from the Bogalusa Heart Study, tracking early risk of heart disease among American children, suggests that eating habits in childhood have a potential lifelong effect on cholesterol levels and on adult coronary heart disease.32 A study of British schoolchildren found that children who ate fruit more than once per day had better lung function compared with those who did not. The difference was evident even after controlling for possible confounding factors such as social class and passive smoking.33 A further study in Italy found that even low intakes of fruit can reduce wheezing and asthma with effects being most noticeable in children with a history of respiratory problems.34 Continued attention to increasing fruit and vegetable consumption in children is viewed as a practical and important way...

Firerelated Injuries And Fatalities

Asphyxia is always a risk when an individual is exposed to smoke. While many wildland firefighters use particulate masks, private citizens may be unprepared and have no form of airway protection. Wildland firefighters are not as likely to experience the extreme, acute exposures that structural firefighters encounter. However, they are more likely to have prolonged exposure to smoke. Common compounds found in the air of wildland fires include carbon monoxide, sulfur dioxide, particulate carbon and silica, polyaromatic hydrocarbons, aldehydes, and benzene. Of greatest concern are aldehydes and carbon monoxide. Aldehyde exposure results in local irritation, while carbon monoxide exposure is associated with nonspecific warning signs such as headache, and high levels can be potential fatal. While the long-term effects of respiratory contaminants are not fully known, studies have shown decreased short-term pulmonary function in wildland firefighters. Also of concern are exacerbations of...

Arthur A Stone and Saul S Shiffman

Asking people about their health, symptoms, attitudes, opinions, and behaviors is ubiquitous in the behavioral, social, and medical sciences (Stone et al, 2000). For many areas of inquiry in these fields, it is impossible to contemplate research programs without self-reports. Self-reports often serve as primary outcome measures, for instance, in assessing pain, fatigue, opinions, or attitudes self-reports are the accepted standard for these constructs and objective alternative measures usually are not available. Even when objective measures are possible in principle, we often rely on self-report data (e.g., smoking behavior, asthma attacks, social interactions), because the costs of objective data collection (via behavioral observations, for example) are prohibitive.

Significance to humans

Like many other groups of birds, hornbills are hunted for food and consumed for medicine. In Africa, parts of the ground-hornbill are eaten to improve health and sagacity, whereas in India, the great hornbill, the Indian pied hornbill, and the Indian gray hornbill are rendered into oils that supposedly aid in childbirth and relieve gout and joint pains. In Indonesia, the meat of the Sumba hornbill is roasted and eaten to relieve rheumatism and asthma. Because they are easily tamed, hornbills are captured and traded for pets or exhibition. Unlike any other group of birds, however, hornbills play special roles in the folklore and ceremonies of the countries where they occur. Long, elegant tail feathers are the most sought-after hornbill part, but heads and casques are also coveted. The Nishis people of Arunachal Pradesh, India, attach the upper beak of the great hornbill to rattan bopiah caps as traditional male headgear. Neighboring Wanchos of eastern Arunachal use the warm,...

Chronic Diseases and Neurocognition

Negative cognitive outcomes are also associated with type I and type II diabetes mellitus, pulmonary diseases such as chronic obstructive pulmonary disease and asthma, hepatic diseases such as cirrhosis, kidney diseases, autoimmune diseases such as systemic lupus erythematosus, various cancers, sleep disorders such as obstructive sleep apnea, and the human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome (AIDS) (see Bellia et al, 2007 Biessels et al, 2008 Borson et al, 2008 Kurella et al, 2005 Tarter et al, 2001 Zhang et al, 2007). Medical and surgical treatments for disease affect cognitive function though in inconsistent directions. For example, prospective investigations generally indicate better cognitive outcomes for those taking antihypertensive medication than untreated hypertensives (Murray et al, 2002). Yet, results of double-blind, placebo controlled trials of antihypertensive have yielded complex and conflicting findings. Statin use may also be...

Description and Prediction in Cross Sectional and Longitudinal Studies

Of studies predicting treatment adherence and health outcomes for multiple chronic conditions such as asthma (Horne and Weinman, 2002), diabetes (Searle et al, 2007), cardiovascular disease (Horne et al, 2000), rheumatic conditions (Moss-Morris and Chalder, 2003), and emotional disorders (Fortune et al, 2004). As one would expect, the five domains also define the properties of the prototypes underlying the representation of illness that an individual is actively managing. Although there may be exceptions (Bishop et al, 1987), the few studies that have assessed prototypes used scaling methods (e.g., multidimensional scaling) to identify groups or subsets of illnesses and have not focused on identifying the specific features of disease prototypes and whether they match the domains of illness representations.

Implementing Interventions

To ensure that patients are working with an illness representation that is biologically valid, it is critical to ascertain the prototype that appears to underlie the representation. The checks play a critical role in this process. An intervention for silent diseases must provide a simple and convincing illustration that the disease is present when the patient is asymptomatic. For example, to illustrate the inadequacy of symptoms to predict hypertensive status, patients could take their blood pressure upon arising from a good night sleep. In this situation the context (post-sleep) and check for a prototype of wellness (feeling rested) would be inconsistent with the elevated reading they are sure to get if they are hypertensive. For asthma, a chronic condition that manifests episodically, a simple, vivid analogy of inflammation would be valuable for explaining the episodic nature of a chronic condition (you may not feel a sore on your arm till I touch you when dust touches your lungs,...

Cardiovascular Effects

Because of effects noted with in vitro studies demonstrating that ginkgolides are capable of inhibiting platelet-activating factor (PAF), which is involved in platelet aggregation and inflammatory processes such as those seen in asthma, ulcerative colitis, and allergies (reviewed in 5,19,31), it has been suggested that bleeding parameters might be affected also. Several case reports of bleeding disorders among people receiving GB have been described (see Subheading 7.1.). However, at least in healthy volunteers, changes in platelet function or coagulation have not been substantiated. In a double-blind, placebo-controlled study of 32 healthy male volunteers receiving EGb 761 at three doses (120, 240, and 480 mg day) for 14 days, no changes in platelet function or coagulation were noted (32). Similarly, Kohler and colleagues studied the influence of the same GBE (EGb 761) on bleeding time and coagulation in healthy volunteers (33). This double-blind, placebo-controlled study was carried...

Respiratory Disorders

Chronic obstructive pulmonary diseases, including bronchitis, emphysema, asthma, and allied conditions, ranked fourth as causes of death in the United States in 1994, while pneumonia and influenza ranked sixth (Rosenberg et al., 1996). Over 100,000 people in this country died of obstructive pulmonary diseases, and over 80,000 died of pneumonia and influenza in that year. With the exception of deaths caused by asthma, which increase steadily until age 75 and then decline, deaths due to most respiratory disorders decline during childhood and then increase in frequency throughout adulthood. The death rate for chronic obstructive pulmonary diseases is slightly higher for males than females, but the reverse is true for deaths caused by pneumonia and influenza. Furthermore, the death rates for almost all respiratory diseases are higher for whites male and female than for blacks.

Additional Considerations

Include digoxin, lithium, phenytoin, theophylline, and warfarin. Because not all drugs subject to therapeutic drug concentration or pharmacodynamic monitoring are narrow therapeutic range drugs, the sponsors should contact the appropriate review division to determine whether a drug should be considered to have a narrow therapeutic range.

Intervention Research

Outcomes calls into question whether interventions to improve social support might benefit health. A review of 100 interventions of either group- or individual-level formats designed to modify perceptions of support availability and or skills related to seeking and receiving social support documented that a majority of interventions were successful in improving psychosocial (e.g., psychological well-being, perceptions of support availability, or receipt) and behavioral outcomes (e.g., adherence to medical treatments, maintenance of adopted health behaviors Hogan et al, 2002). However, a much smaller body of research has examined physical health impacts of social support interventions. Campbell (2003) noted that interventions for physical health conditions that involve family members, such as interventions which educate families about the target health condition and provide social support skills training, generally support the salutary benefits of family intervention for a number of...

Allergic Fungal Rhinosinusitis

Strong parallels have been made between AFRS and allergic bronchopulmonary aspergillosis (ABPA), a hypersensitivity disorder limited to the lungs and specific to A. fumigatus. ABPA is a late-phase allergic inflammatory response occurring in patients diagnosed with asthma or Cystic Fibrosis (Knutsen, 2003). In patients with ABPA, hyphal Aspergillus can be found in the airspaces and parenchyma of the lungs. Increased IgE levels, as well as systemic and pulmonary eosinophilia, characterize the disease. The disease can have a number of clinical presentations including hemoptysis (in which patients cough up large amounts of blood) as well as bronchietasis (a condition where large amounts of fibrous tissue are formed within the lungs). In humans the CD4+ T-cell population in ABPA

Ethical Issues in the Quality of Care

Minority preschoolers, blacks and Hispanics, receive lower-quality overall asthma care than white children. While emergency-room treatment and hospital length of stay are essentially equivalent, nonwhites are less likely to be prescribed nebulizers for home use and are less likely to have taken inhaled steroids or cromolyn sodium (Finkelstein, 1995).

Differential Diagnosis

The symptoms associated with nerve agent intoxication may be the result of other organophosphate compounds such as the carbamate insecticides. Cholinergic crisis can be the result of a variety of medication overdoses, including neostigmine, physostigmine, pyridostigmine bromide, PCP, phenothiazines, clonidine, and muscarinic mushrooms. In addition, CNS symptoms may be mimicked by stroke, seizure, or other neuromuscular disorders. Such clinical findings as rhinorrhea, lacrimation, and bronchospasm may also be present with exposure to riot-control agents.

Measurement of Neighborhoods

A more fundamental issue related to defining and operationalizing neighborhood boundaries is identifying the appropriate spatial scale. The different spatial scales represented in the literature are in part driven by data availability such that the most common option is the use of administrative sources with pre-specified boundaries at various spatial scales. However, the most relevant spatial scale for investigation depends on many other factors including (1) the processes through which area features are hypothesized to affect specific health outcome, (2) the neighborhood exposures being measured, and (3) the most appropriate spatial scale for intervention or policy-relevant solutions. Different spatial scales may be more or less relevant for specific health processes under investigation. For example, the immediate area (i.e., smaller neighborhood boundaries) may be important for understanding how environmental exposures (i.e., toxins) relate to asthma. Alternatively, larger areas...

Prevention strategies whole populations highrisk groups or selected individuals

Genetic studies on twins are valuable because they afford a degree of quasi-experimental control over the genetic variation that is, we can ''hold constant'' the full genotype (monozygotic twins) or half the genotype (dizygotic twins). It is much less easy to achieve control over local environmental conditions. Nevertheless, care is needed in the interpretation of twin studies and other genetic-epidemiological studies. For example, a recent British study of twins reported that 68 of the inter-individual variance in childhood asthma occurrence was due to genetic factors, while only 13 was due to shared environmental factors (Koeppen-Schomerus et al., 2000). The high proportion of risk here attributed to genes is misleading. First, whether the incidence of asthma within a given population is high or low, the extent of concordance between twins will be unchanged - and so the ''genetic'' component would be a constant. Yet any such variation in incidence depends on a non-constant factor...

Perfecting Case And Outbreak Detection

If and when diagnostic expert systems are embedded in the clinical information systems of every hospital (animal and human), long-term care facility, clinic, and laboratory in a region, they will be able to notify a health department or other biosurveillance organization of every fever, syndromic presentation, and reportable disease in individuals receiving medical or veterinary care. If diagnostic expert systems are made available to the public or to selected high-risk populations (e.g., postal employees or patients with preexisting conditions such as asthma or diabetes), case finding would be extended to an even larger fraction of the population, approximating the every-patient-every-day capabilities of an ideal case detection system.

Extent and Associations

Individuals with limited health literacy possess less health knowledge, access fewer preventive services, and have poorer self-management skills. Williams and colleagues (1998a) interviewed patients presenting to an urban hospital asthma clinic and or emergency department and found those with low health literacy had poorer asthma knowledge. In a similar study, lower literate patients with hypertension and diabetes were also reported to have poorer knowledge of disease (Williams et al, 1998b). Other research studies have since confirmed this relationship in a multitude of contexts. Among individuals living with HIV AIDS, those with limited literacy were less able to define CD4 lymphocyte count and viral load and to identify antiviral medications in their regimen even with the aid of pictures (Kalichman et al, 1999 Wolf et al, 2004). A great deal of attention has also highlighted the association between low health literacy and treatment misunderstanding, including medication names,...

Computerinterpretable Case Definitions

Case definitions, as currently written, are not well suited for automation. The authors of the SARS case definition intended it for use by physicians and epidemiologists, not computers. The clause findings of lower respiratory illness (e.g., cough, shortness of breath, difficulty breathing) does not enumerate all findings of lower respiratory illness. A computer requires a complete enumeration of all findings that it should count as evidence of lower respiratory illness (e.g., cough, shortness of breath, difficulty breathing, wheezing, cyanosis, tachypnea, dullness to percussion, fremitus, whispered pectoriloquy, rales, and rhonchi). The findings would also have to be described more precisely. For example, a physician or an epidemiologist would not count chronic cough or cough associated with asthma as a finding of lower respiratory illness when applying this case definition, but a computer would (unless told otherwise). Note that it is difficult, if not impossible, to enumerate all...


Cholinergic agonists, such as pilocarpine and carbachol, should be avoided in conditions where pupillary constriction and intraocular vascular congestion are undesirable, such as in acute iritis or visually significant lens changes. These agents should also be avoided where there is a history of, or predisposition to, retinal detachment, or a proven sensitivity to these agents, or, for the membrane delivery dosage form, the presence of acute infectious conjunctivitis or keratitis. Patients with severe asthma, bronchial obstruction, acute cardiac failure, active peptic ulcer, hyper-thyroidism, gastrointestinal spasm, urinary tract obstruction, Parkinsonism, recent myocardial infarction, and, perhaps, poorly controlled blood pressure disorders are at risk for having these conditions exacerbated by cholinergic agonists.3

Mast Cells and Basophils

Mast cells participate both in acquired (e.g., IgE-dependent) and innate immune responses and tend to be present in tissues that interface between the organism and its environment (e.g., skin, respiratory tract, gastrointestinal tract) (121,122). The IgE-dependent roles of mast cells in allergic reactions, hay fever, and asthma are well established (121-123). Allergens and Ags recognize and crosslink specific IgE bound to the cell surface high-affinity IgE receptor, FceRI, to trigger acute hypersensitivity reactions, late-phase reactions, and chronic inflammatory reactions by release of preformed mediators present in the cytoplasmic granules (biogenic amines, proteoglycans, neutral proteases, TNF-a) and de novo synthesized mediators (leukotrienes, prostaglandins, cytokines).

Heteropteryx dilatata

Jungle nymphs and people The droppings of jungle nymphs are dried and mixed with herbs in China as a cure for numerous ailments, such as asthma. Chinese families often rear them on guava leaves to keep a steady supply of droppings handy. This is also a popular species for live displays in zoos and butterfly houses around the world.

Reflection of Effects on Th1 Th2 and Treg Differentiation

Also Lactobacillus strains have been shown to confer differential effects on cytokine production and expression of surface markers on murine dendritic cells (85). Furthermore, lactobacilli induced in vitro, in a strain dependent manner, Treg-like low proliferating Th population producing TGF-b and IL-10 (86). TGF-b is the key cytokine in induction of T-cell differentiation towards Tregs (Fig. 2) (87). In a clinical study, improvement in atopic eczema symptoms following oral administration of lactobacilli was accompanied by increased serum concentrations of TGF-b (17). Interestingly, oral supplementation of lactobacilli in breast-feeding mothers was followed by increased TGF-b concentrations in breast-milk (88). This increase may have contributed to subsequently lower prevalence of atopic eczema in children. It should be noted, however, that allergic sensitization was not affected and allergic rhinitis and asthma may have increased in frequency (89). Nevertheless, these studies are not...

Examples of Prostaglandin Actions

Some prostaglandins cause constriction whereas others cause dilation of blood vessels in the lungs and of bronchiolar smooth muscle. The leukotrienes are potent bronchoconstrictors, and these compounds, together with PGF2a, may cause respiratory distress and contribute to bronchoconstriction in asthma.

Pulmonary Function Tests

Pulmonary function tests should be obtained as soon as the patient is stable. It is our practice to obtain complete pulmonary function tests (PFTs) as soon as the patient is ambulatory and no longer requiring supplemental oxygen. We obtain complete PFTs again at 3, 6, 12, and 24 months after exposure in the symptomatic patient. Spirometry frequently is normal in the presence of mild obstructive or restrictive disease from inhalation injury. Also pseudo-restriction (symmetrical reductions in forced vital capacity and forced expiratory volume at 1 s) may occur in obstructive airways disease due to air trapping. Therefore, measurement of a bronchodilator response and or lung volumes is necessary, especially when spirometry is abnormal or at the lower limits of normal. Airflow obstruction may be due to RADS, asthma, or anatomic airway narrowing. Bronchodilator response or methacholine challenge testing can be performed to confirm obstructive airways disease and airway hyperreactivity....

The choice between Thl and Th2 responses in humans nature versus nurture

Asthma and atopy have been linked to genes on chromosome 11q13 (FceRI), 5q31 (cytokine gene cluster) and 14q (TCR-a genes Sandford et al 1996). Total serum IgE links to markers in chromosome 5q31.1, where the genes of IL-3, -4, -5, -9, -13, interferon regulatory factor 1 (IRF-1) and the p chain of the IL-12 receptor are clustered (Marsh et al 1994). The occurrence of atopic disease is also regulated by environmental factors. The prevalence of asthma has doubled in the western world over the last two decades. Increased exposure to environmental allergens such as house dust mite may contribute to the asthma epidemic. Several studies indicate that childhood infections may regulate cytokine responses and confer a degree of protection to atopy, while modern vaccination strategies induce predominantly Th2 responses (Shirakawa et al 1997). In Third World populations chronic intestinal parasite infestation has been shown to induce Th2 immune deviation. Bentwich et al (1995) proposed that...

Secondary manifestations induced by the gasblood interface

It becomes increasingly permeable, causing oedema in the tissue, which in turn worsens the ischemia30. In the lungs, this can lead to ARDS due to non-cardiogenic pulmonary oedema31 or severe bronchospasm due to bronchial hyper-reactivity32. In the brain, the oedema effects intra-cranial pressure and impairs brain metabolism33.

Rectal Administration

Some drugs are administered rectally either in suppository or in solution form, e.g., retention enema. The solution yield better absorption provided that they are retained for a sufficient length of time in the rectum. The suppositories are the most commonly used dosage forms for both local and systemic effect. Examples of drugs administered rectally for systemic action include aspirin, acetaminophen, indomethacin, diazepam, theophylline, prochlorperazine, cyclizine, promethazine, and barbiturates.

Intravenous Administration

The intravenous route is especially suitable when a rapid response is required, as in the treatment of epileptic seizures, acute asthmatic attacks, cardiac arrhythmias, etc. The fluctuation of plasma concentration is generally very small if a drug is administered by slow intravenous infusion, as is employed for lidocaine, theophylline, and many antibiotics. A caution is needed for drugs with poor water solubility which can precipitate resulting in thrombosis, an removal of drug from circulation and deposition of the precipitate in various tissues resulting in reduced apparent bioavailability. In addition, drugs which bind to plasma proteins extensively may show altered response depending on rate of injection since the initial binding and concentration at site of action can vary significantly.

Physiologic Effects Of Acupuncture

Acupuncture has been utilized for treatment and prevention of multiple health conditions, such as chronic pain, nausea and vomiting, obesity, substance abuse, and asthma. Stress response and cardiovascular effects of pain have reportedly been attenuated by nonpharmacological techniques such as acupuncture it modulates the body's pain system, increases the release of endogenous opioids (53), and or decreases postoperative pain (54). In a feline cardiovascular model, the utilization of electro-acupuncture induced improvements in regional cardiac wall motion activity during myocardial ischemia (55). Furthermore, acupressure applied to females undergoing elective cesarean section with spinal anesthesia displayed a reduction in nausea and vomiting (56).

Maternal Investment and Fetal Priming Within an Evolutionary Framework

Along with the placental transfer of antibody, there is also a transmission of many anti-genic proteins, a second process that becomes important to appreciate when trying to understand why some human babies are born already sensitized to food allergens and plant pollens (Liobichler et al, 2002). The fetal response to these proteins that become embedded in placen-tal tissues or transfer into the fetal compartment helps one to predict which infants will go on to develop atopic dermatitis and asthma. Less frequently there may also be some problematic antibody from the mother transferred as well, which can result in maternal-fetal incompatibilities. One example is the maternal immune reaction against paternal antigens on fetal cells, such as to Rhesus factor. Another hypothesized problem is the transfer of maternal antibody that

The Link Between Birth Weight and Later Health

Obesity early in life thus seriously increases risk for many ailments, but especially for the Big Three metabolic syndrome, diabetes, and cardiovascular disease. It is perhaps less well known that large babies and overweight children are also more likely to develop allergies and asthma (Pekkanen et al, 2001). In fact, if one were to compare the odds ratios of developing asthma in small neonates versus in large babies over 10 pounds, the greater pediatric concern would have to be for the bigger infants, especially in the heaviest ones gestated beyond 40 weeks postconception.

During catheterisation of the right cardiac chambers

- during mechanical ventilation where the use of high pressures of insufflation can cause alveolar rupture with air passing into the interstitial tissue, the pleura, or the mediastinum and later into the vascular system. GE can be a complication of mechanical ventilation in status asthmaticus and acute respiratory distress syndromes in adults69 or children70. It frequently

The Risks Posed by Prenatal and Perinatal Infection

If infection with influenza during pregnancy can really be harmful to fetal brain development, it is a more serious concern when virulent strains circulate at pandemic levels (Harris, 1919). Even in a typical year, up to 11 of pregnant women are infected with influenza at some point during gestation (Irving et al, 2000). Moreover, the offspring of infected pregnant women who are asthmatic are at greater risk because they are more likely to progress on to bacterial pneumonia (Hartert et al, 2003). However, the jury is still out on whether the more benign strains of influenza that commonly circulate, which cause just a transient illness and fever, are of equivalent concern. One particularly active area of research right now is on the mediating role of the increased proinflammatory cytokine activity during infection, because it can adversely alter placental functioning (Dammann and Leviton, 1997). Some cytokines, such as interleukin-6, can also cross the placenta and reach the fetus or...

ErbB Proteins and Pathological Conditions

Due to their widespread expression and signaling potency, ErbB molecules are involved in a variety of physiological processes (e.g., myelination, implantation, wound healing, mammary development, angiogenesis) and pathological states (airway inflammation, asthma, ulcers, and other gastrointestinal tract diseases). However, the best studied is the oncogenic aspect of the ErbB network in human malignancies. ErbBs were first implicated in cancer upon the characterization of an aberrant form of EGFR encoded by the avian erythroblastosis tumor virus. EGFR and ErbB2 have since been implicated in various forms of human cancers. Abnormal activation of these receptors occurs through overexpression, gene amplification, constitutive activation of mutant receptors, or autocrine growth factor loops. ErbB2 has been used as a prognostic marker as its overexpression is associated with shorter overall and relapse-free survival of patients with breast or ovarian cancer 13 . Further, ErbB molecules...

Individual Level Child Health Behaviors

Adolescents growing up in low SES environments also experience greater stress in their lives (Goodman et al, 2005a), which may predispose low SES youth to certain negative psychological and physical health outcomes. Chen et al (2004) and Chen and Matthews (2003) showed that youth from low SES environments more readily make interpretations of threat when presented with ambiguous, but not negative, events, perhaps as a result of having grown up in a more hostile environment where there was greater exposure to chronic as well as acute daily stressors. These psychological traits have also been linked to physiological health outcomes, such that these youth also showed evidence of greater diastolic blood pressure and heart rate reactivity (Chen et al, 2004), as well as heightened levels of inflammatory markers implicated in asthma (Chen et al, 2006).

Biological Pathways

Finally, SES has also been associated with biological markers within samples of adolescents with a chronic illness. For example, Chen et al (2003) examined immune and neuroendocrine markers of asthma in a group of adolescents with asthma. Living in a low neighborhood was associated with greater stimulated production of the asthma-relevant cytokine interleukin 5 (IL-5), and marginally lower morning cortisol (a hormone with anti-inflammatory effects) among these adolescents. Likewise, another study with children and adolescents with asthma showed that those coming from low SES environments had a heightened production of the asthma-relevant cytokines IL-5 and IL-13, as well as higher eosinophil counts, a type of white blood cell involved in the inflammatory process of asthma. Taken together, these findings suggest that SES can have biological effects that have implications for the progression of chronic diseases and that low SES among adolescents is associated with a differential profile...

Clinical Manifestations

ACS is another common presentation of sickle cell crisis. Patients present with a new infiltrate on chest films, chest pain, fever, and tachypnea. The causes include infections (e.g., parvovirus), fat embolism from bone infarction, and surgery. This condition also causes chronic lung inflammation not unlike asthma in the early stages and restrictive lung diseases in the late stages (13).

Biomarkers of Disease State

Biological indicators of disease states include markers such as blood pressure in hypertension and as a risk factor for coronary heart disease (CHD) and stroke, glycated hemoglobin or blood glucose for the assessment of diabetes, and airways resistance in bronchial asthma. These biological measures are direct markers of the physiological dysfunction constituting the disease and can be related to social, emotional, and economic experience. Observational

Lung volume reduction

Patients likely to benefit from lung volume reduction surgery have relatively pure emphysema of a heterogenous nature. This means that they have a minimum of sputum production and easily controlled bronchospasm not requiring systemic steroids and that a ventilation-perfusion scan shows areas of mismatch between the lung being perfused and ventilated. These areas are usually at the lung apices and can be safely resected without reducing pulmonary function yet reducing the overall size of the lungs. Well selected patients should get several years of functional improvement before they once again deteriorate as their underlying loss of elasticity degenerates with age.

Aspirin nsaid hypersensitivity

Three manifestations of sensitivity to NSAIDs are of importance to the head and neck. They include urticaria angioedema, anaphylaxis, and rhinoconjunctivitis asthma. These appear to occur separately, and, in most instances, cross-reaction with other drugs in the class is common. By definition, NSAID hypersensitivity is present in patients who react adversely to the administration of this class of drug. It was originally described by Widal as a symptom complex of aspirin sensitivity, asthma, and nasal polyposis, and is now known to be associated with chronic pansinusitis and tissue and peripheral blood eosinophilia. Another group of patients react to the ingestion of these drugs with acute urticaria angioedema, or, more controversially, with exacerbation of underlying urticaria angioedema. Finally, a small group of patients have immediate anaphylactic reactions to the ingestion of this class of drug. Only in the latter group does selectivity for a particular agent within the class...

Agerelated Changes in Respiratory Mechanics

Respiratory muscle strength is also affected by nutritional status, often deficient in the elderly, and by the age-related decrease in muscle mass (sarcopenia) (Enright et al., 1994 Tolep et al., 1995 Polkey et al., 1997). Indeed, normal values for maximal inspiratory pressure in subjects aged over 80 are below the threshold defined in an adult population for clinically relevant respiratory dysfunction (Enright et al., 1994). Situations in which an additional load is placed on the respiratory muscles, such as decreased parenchymal compliance (pneumonia, congestive heart failure) or increased airway resistance (presence of tracheal or bronchial secretions and inflammation, asthma), may lead to hypoventilation and hypercapnic respiratory failure. Patients with preexisting structural changes in lung mechanics (such as COPD, interstitial lung disease, or Kyphoscoliosis) are, of course, at increased risk of hypercapnic respiratory failure.

Sensitivity Of Respiratory Centers And Clinical Symptoms

Lower sensitivity of respiratory centers to hypoxia or hypercapnia in older subjects results in a diminished venti-latory response in case of acute disease such as heart failure, infection, or airway obstruction, and thus delays important clinical symptoms and signs such as dyspnea and tachypnea, which are important for the diagnosis of pneumonia and appreciation of its severity (Kronenberg et al., 1973 Peterson et al., 1981). Aging is also associated with a decreased perception of added resistive loads, such as that induced by asthma or increased airway secretions. Indeed, older subjects have a lower perception of methacholine-induced bronchoconstriction when compared with younger subjects (Cuttitta et al., 2001).

Immediate Hypersensitivity

Immediate hypersensitivity can produce allergic rhinitis (chronic runny or stuffy nose) conjunctivitis (red eyes) allergic asthma atopic dermatitis (urticaria, or hives) and other symptoms. These symptoms result from the immune response to the allergen. In people who are not allergic, the allergen stimulates one type of helper T lymphocyte, the TH1 cells, to secrete interferon-y and inter-leukin-2. In people who are allergic, dendritic cells stimulate the other type of helper T lymphocytes, the TH2 cells, to secrete other lymphokines, including interleukin-4 and interleukin-13. These, in Hay fever, asthma, and most other allergic conditions The symptoms of hay fever (itching, sneezing, tearing, runny nose) are produced largely by histamine and can be treated effectively by antihistamine drugs that block the H1-histamine receptor. In asthma, the difficulty in breathing is caused by inflammation and smooth muscle constriction in the bronchioles as a result of chemicals released by mast...

Initial Medical Management

Beta blockers are contraindicated in patients with asthma, chronic obstructive pulmonary disease (COPD) or bradycardia. Systemic CAIs should be avoided in patients with a history of calcific kidney stones or potential problems with metabolic acidosis. Systemic CAIs may be used with caution in patients with a sulfa allergy.50 In a patient with a history of mild asthma or COPD, betaxolol provides a safer alternative. However, most studies have shown its efficacy in lowering IOP to be less than that of nonselective beta blockers.70 Furthermore, betaxolol has been associated with adverse pulmonary side effects in at-risk populations.71 Given the availability of alternate medications, the use of any beta blocker should be carefully considered in the presence of a relative contraindication.

HIV and Pulmonary Diseases

The spectrum of lung diseases in HIV-infected patients encompasses complications typical for HIV such as tuberculosis, bacterial pneumonia, lymphomas and HIV-associated pulmonary hypertension, but also includes typical everyday pulmonary problems like acute bronchitis, asthma, COPD and bronchial carcinomas (Table 1). Classical diseases such as PCP have become rarer as a result of HAART and chemoprophylaxis (Lazarous 2007), so that other complications are on the increase (Grubb 2006). None other than acute bronchitis is the most common cause of pulmonary problems in HIV patients (Wallace 1997). However, particularly in patients with advanced immune deficiency, it is vital to take all differential diagnoses into consideration. Anamnestic and clinical appearance are often essential clues when it comes to telling the difference between the banal and the dangerous.

Overview Of Biomarkers

Among the most studied cytochrome P450s with respect to polymorphism is CYP1A2, which has also been found to be associated with increased risk to human colorectal and bladder cancer (86). CYP1A2 catalyzes the N-oxidation of several aromatic and heterocyclic amines to DNA reactive species. Although no polymorphic sequences in the structural CYP1A2 gene have been found, the metabolic phenotype of the enzyme has been evaluated by using caffeine metabolism, phenacetin O-deethylation, and theophylline 1-demethylation (87). The use of urinary caffeine metabolites as a biomarker for the activity of the enzyme has been validated in several epidemiological studies. The rationale for developing this method was that the initial step in the biotransformation of caffeine (caffeine 3-demethylation) is catalyzed by CYP1A2. The ratio of either 1,7-dimethylxan-thine (17X) + 1,7-dimethylurate (17U) caffeine (137X) , examined in urine 4 to 5 hours after caffeine ingestion (88), or...

Adjunctive Medical Therapy

After diagnosing a patient with glaucoma, in the United States the clinician usually prescribes topical medication as the initial treatment regimen. Ophthalmologists are fortunate to have many drugs in their arsenal today that are effective at lowering intraocular pressure (IOP) while requiring less frequent dosing and causing fewer systemic and ocular side effects than previous generations of glaucoma medications. While this provides the clinician with more options, it can also cause confusion. The ophthalmologist must choose one from among more than a handful of drops as initial single therapy. This decision is more clear-cut when patients have relative contraindications to particular drugs, such as avoiding beta blockers in patients with asthma or heart block or trying alternatives to carbonic anhydrase inhibitors (CAIs) in patients who are sulfa allergic. Otherwise, decisions may often be based upon experience or the clinician's comfort level with a particular medication.

Pulmonary Disease States Associated With Advanced

Some disorders that involve remodeling of airways and distal lung parenchyma tend to appear with advanced age and become quite prevalent in elderly populations. These disorders include COPD and idiopathic pulmonary fibrosis (IPF). The prevalence of obstructive lung disease is increased in the elderly and may be greatly underestimated in certain elderly populations (Malik et al., 2004 Lundback et al., 2003). Both asthma and COPD Airflow obstruction is generally quite reversible in asthmatics with appropriate treatment, which stands in contrast to patients with COPD for whom obstruction is not generally reversible despite therapy. Asthma prevalence in elderly populations may range as high as 8 (Burrows et al., 1991 Parameswaran et al., 1998), and it can be difficult to differentiate from COPD. Older asthmatics with long-standing asthma may have considerable airway remodeling with a prominent component of irreversible airflow obstruction (Finucane et al., 1985), and these individuals...

Animal Models and Insights into Mechanisms of Lung Senescence

When observations that are currently available from animal models of lung aging are merged with observations of altered structure and physiology of the aging human lung, it becomes clear that the most prominent feature of lung aging is loss or altered composition of matrix tissue accompanied by rearrangement of distal airspace structure such that elastic recoil declines and ventilation to perfusion relationships are altered. These changes show many similarities to emphysema, although important differences separate the emphysematous lung from an aged lung. Emphysema is characterized by airway inflammation and expanded populations of inflammatory cells (macrophages, neutrophils, and lymphocytes) in distal airspaces or airway walls (Barnes, 2000 Saetta et al., 2001), and proteolytic and oxidative stress associated with the influx of inflammatory cells is thought to play a key role in the pathogenesis of emphysema. It is interesting that bronchoalveolar lavage (BAL) in aged C57BL 6 mice...

Adverse Effects and Toxicity

When taken within the recommended dosage range, the y-linolenic acid content of OEP is equivalent to that present in a normal diet (6). Thus, although adverse effects are rare at recommended doses, occasionally, mild gastrointestinal effects and headache may occur with oral use of OEP. The World Health Organization Programme for International Drug Monitoring reported that, in the period between 1968 and 1997, there were 193 adverse reactions reported mentioning OEP. The most critical of these OEP reports mentioned convulsions, aggravated convulsion, face edema, and asthma. The most noncritical OEP adverse effects included headache, nausea, itching, abdominal pain, and diarrhea (52). In the study by Guivernau et al. summarized in Subheading 5.6, they reported that OEP inhibited platelet aggregation and prolonged bleeding time in 12 males with hyperlipidemia taking 3 g of OEP daily (containing linoleic acid 2200 mg and y-linolenic acid 240 mg). Compared to placebo,

Chronic obstructive pulmonary disease COPD

Overlap between asthma and smoking-related COPD The distinction between asthma and COPD is not always easy. Both conditions are associated with symptoms of wheeze and breathlessness and both are characterized by the presence of airflow obstruction. Moreover, in long standing asthma there may be a loss of reversibility of airflow obstruction and smokers with bronchial hyper-reactivity are at greater risk of developing COPD. It has been suggested that the two conditions are part of the same disease spectrum, the so called ''Dutch hypothesis. There are however distinct differences in the pathophysiology of the two conditions both in the predominant type of inflammatory cell (CD4+ lymphocytes and eosinophils in asthma and CD8+ lymphocytes, macrophages and neutrophils in COPD) and the predominant site of inflammation (large and small airways in asthma and small airway and lung parenchyma in COPD) (Jeffery, 2001). Thus while the clinical features of asthma and COPD overlap, the differences...

Other Special Situations

Although studies of beta-adrenergic blocking agents in children have shown a minimum of side effects in short-term use, apnea has been reported in neonates. Parents should be cautioned to discontinue the medication if any side effects, such as asthmatic symptoms, develop. The selective beta-1 blockers, such as betaxolol, should have even fewer pulmonary side effects. Allergic responses, if mild, can sometimes be successfully treated with mast-cell stabilizers, such as olopatadine, cromolyn, lodoxamide, or low-dose corticosteroids, such as medrysone. Preservative-free preparations are available for pilocarpine, epinephrine, timolol, and apraclonidine. Some patients with adverse reactions due to benzalkonium chloride in certain drops may be treated with other drugs using alternative preservatives. In some cases of drug intolerance, dosages below those normally prescribed can sometimes be effective for example, latanoprost was shown similarly efficacious when given once daily or once...

Pharmacological Toxicological Effects 51 Pharmacology

The locations of the substituents on the phenylethylamine backbone play an integral role in determining the observed pharmacological effects of sym-pathomimetic molecules (Table 1). Substitution of a hydroxyl group on the P-carbon tends to increase activity toward both a and P receptors, but decreases activity in the central nervous system (CNS) (23). Substitution of hydroxyl groups in any place in the phenylethylamine structure increases the hydrophi-licity, and thus decreases the propensity of the molecule to enter the CNS (23). Ephedrine, for example, is a weaker CNS stimulant than amphetamine but is a stronger bronchodilator and has greater effect on increasing heart rate and blood pressure (23). The relatively polar epinephrine is essentially devoid of CNS activity aside from anxiety related to other systemic effects (23). Hydroxyl groups at both the 3 and 4 position provides the most a and P activity (23). Also, substitution at the amino position generally enhances the effect on...

Atopic dermatitis OMIM 603165

Atopic dermatitis (AD) is a clinical syndrome characterized by an itchy rash with a variety of morphological cutaneous features that change with age, in association with a positive family history and concomitant presence of other atopic diseases (atopic asthma, hay fever, and occasionally urticaria) (Williams, 1997). The atopic immunological state is characterized by a propensity to develop type 1 IgE mediated responses in response to certain antigens, but the cutaneous immuno-pathology of atopic dermatitis is characterized by the presence of a T cell and inflammatory cell infiltrate resembling the pattern seen in type IV hypersensitivity reactions (rather than the type 1-like response seen in urticaria). The onset of the rash is typically in early life, peaking at age four years and tending to improve with age, although a large proportion of subjects may develop other forms of eczema later in life (Williams, 1997). Drawing the boundary between mild atopic dermatitis and normality is...

Common Symptomatic Lung Sounds

The high-pitched whistling music type of sounds heard over large airways as well as over the chest are called wheezes. Fig. 7.4 shows a typical wheezing sound in the time and time-frequency domain. Wheezes can be caused by airway narrowing and the increased secretions. Wheezes are usually heard in congestive heart failure, asthma, pneumonia, chronic bronchitis and emphysema, bronchiectasis.

Rifampin or rifampicin

Rifampin increases metabolism of numerous drugs, reducing their efficacy if administered concurrently. These drugs include atovaquone, warfarin, barbiturates, benzodiazepines, beta-blockers, clarithromycin, contraceptives, steroids, oral antidiabetics, cyclosporine, dapsone, digitalis, doxycycline, erythromycin, haloperidol, ketoconazole, methadone, phenytoin, theophylline, trimethoprim, verapamil. Combination with ketoconazole or voriconazole is contraindicated. Antacids, opiates and anticholinergics reduce the bioavailability of orally administered rifampin if given simultaneously. To avoid this interaction, rifampin should be given several hours before these drugs.

Allergic Reactions And Other Toxicities

Acute allergic reactions to a number of cytotoxic agents used in the treatment of germ cell tumors have been documented these agents include bleomycin,60 paclitaxel,72-74 and (rarely) carboplatin or cisplatin.57,76 These can manifest as minor reactions such as flushing and rashes or as more severe symptoms such as urticaria, periorbital edema, bronchospasm, and hypotension. In the majority of cases, the hypersensi-tivity syndromes can be treated with corticosteroids and antihistamines, and the patient can be rechal-lenged after pretreatment with these medications.7476 Hypersensitivity reactions are so common during treatment with paclitaxel (up to 30 of patients) that patients are routinely treated prophylactically with corticosteroids, cimetidine, and antihistamines.46

Project Title Ultrafine Particulate Matter Cardiorespiratory Health

Summary (provided by applicant) Heart disease is the leading cause of death and hospitalization among the elderly population, which makes the identification of preventable causes for heart disease morbidity and mortality a major goal of epidemiologic research. Numerous studies have shown associations of outdoor particulate matter (PM) air pollution with cardiovascular hospital admissions and mortality. The causal pollutant components and physiologic mechanisms for these associations are not fully understood. There is evidence that airway inflammation resulting from airway deposition of ultrafine particles ( 0.1 fm in diameter) could lead to an increase in thrombogenic and inflammatory activity in the blood, and to a disturbance in cardiovascular function, resulting from oxidant stress responses at extra-pulmonary sites, including the vascular endothelium of the heart. This is expected to increase the risk of adverse cardiovascular outcomes, particularly in people with underlying...

Resolution Of The Acute Inflammatory Process

Although the rapid initiation of the protective immune response to invading pathogens is critically important to protect the host from infectious agents, it is equally important to terminate this immune response in order to protect host tissues from the harmful effects of prolonged exposure to the toxic mediators released from inflammatory cells. Clear evidence for the importance of this balanced immune response can be observed during the course of pulmonary inflammation secondary to trauma or sepsis. The initial moderate inflammatory reactions seen in the lungs can derail, become self-destructive, and can ultimately develop into lethal ARDS. Similarly, other clinical conditions such as tuberculosis, asthma, and glomerulonephritis are associated with a failure of the cellular immune response to terminate its inflammatory cascades, ultimately leading to chronic disease characterized by extensive tissue damage and scaring that can seriously impair organ system functions (Carding and...

Arachidonic Acid Metabolism

Three main branches of the lipoxygenase pathway give rise to specific products of AA, including leukotrienes (LTs) and hydroxyeicosatetraenonic acids (HETEs). Arachidonic acid can be metabolized by 5-lipoxygenase (5-LO) to LTs (key mediators of asthma and anaphylactic shock) or 5-HETE. 12-LO converts AA into 12-HETE. Metabolism of AA by 15-LO generates 15-HETE, which acts as a ligand for the growth controlling nuclear receptor PPARy (162). Both 5-HETE and 12-HETE act as a mitogen to cultured breast and prostate cancer cells (163). Interestingly, studies with colon cancer cells indicate that unlike 5-LO and 12-LO, 15-LO activity is antiproliferative (164). Tissue samples taken from breast cancer patients indeed show that 15-LO expression is decreased in tissues taken from patients with breast cancer as compared to paired normal tissues. Therefore, the application of phytochemicals that block the activities of 5-LO or 12-LO or both in combination may be useful in the treatment of...

Pulmonary Administration

Pulmonary administration has been used mainly for local therapy. For example, aerosols of epinephrine, isoproterenol, and dexamethasone are commonly used for acute asthmatic attacks, and antibiotics are sometimes incorporated for the treatment of complicated bronch-opulmonary infections. In some instances, the systemic absorption of drugs administered for local action may be appreciable. For example, isoproterenol in a 0.5 aerosol is an effective bronchodilator, but a l aerosol is apt to cause undesirable cardioacceleratory and hypertensive actions after only a few inhalations. The quick responses can, however, be beneficial in the treatment of anaphylactic episodes, as in the use of epinephrine. The problem of accurate dosing in pulmonary dosing in pulmonary administration remains a serious obstacle to greater use of this route. The use of metered dose devices is certainly an improvement and some products use the drug as a powder aerosol. The powder particles sizes range primarily...

Invasive Fungal Sinusitis

These patients typically suffer from a longstanding history of upper respiratory allergies, asthma, and nasal polyposis. The disease can take months or years to progress and symptoms include the erosion of barriers separating the paranasal cavities, as well as adjacent structures such as the orbits, brain, and pituitary gland (Stringer, 2000). Additionally patients suffer from mycotic aneurysms, carotid artery ruptures, erosion of the maxillary floor which results in palatal degradation, and erosion of the cribriform plate which results in chronic headaches, seizures, and decreased mental status. Etiological agents found in clinical cases are the same as those in the noninvasive and the acute invasive forms (Schell, 2000).

Liposcelis bostrychophila

Book lice are considered a nuisance when they infest stored foods and libraries. Their presence in the home may also set off allergy and asthma attacks. (Illustration by Barbara Duperron. Reproduced by permission.) Book lice and people Book lice are considered a nuisance when they infest stored foods and libraries. Their presence in the home may also set off allergy and asthma attacks. Book lice are considered a nuisance when they infest stored foods and libraries. Their presence in the home may also set off allergy and asthma attacks. (Illustration by Barbara Duperron. Reproduced by permission.)

Altered Notch Signaling in TALL

Thymic stromal lymphopoietin a new cytokine in asthma. Curr Opin Pharmacol. 2008 8 249-254. 55. Ying S, O'Connor B, Ratoff J, et al. Thymic stromal lymphopoietin expression is increased in asthmatic airways and correlates with expression of Th2-attracting chemokines and disease severity. J Immunol. 2005 174 8183-8190. 57. Zhang Z, Hener P, Frossard N, et al. Thymic stromal lymphopoietin overproduced by ker-atinocytes in mouse skin aggravates experimental asthma. Proc Natl Acad Sci USA. 2009 106 1536-1541.

Representations Create a Context for Management

The activation of a representation of a condition such as asthma, cancer, diabetes, or hypertension creates a framework within which individuals engage in a common-sense selection and appraisal of procedures to prevent, detect, control, and cure potential threats to health. These specific procedures can be selected from culturally prescribed nostrums, the shelf of family remedies, or be medically prescribed. Procedures are highly valued if they are perceived and believed to attack the disease at its location, address its mode of action, and or affect a perceptible target (e.g., a subjective symptom or objective reading), and do so quickly. The match between the procedure representations and the illness representation determines the relevance of the procedure for illness control if heart burn is the problem, ingesting an anti-acid makes good common sense if cancer is a growth or lump, then surgical removal makes good common sense (radiation less so as it leaves something in the body)....

Allergic rhinosinusitis

The most important and prevalent nonrhinitic symptoms expressed by patients with allergic rhinosinusitis are ocular, otic, and respiratory patients note itchy and watery eyes and manifest injection of the conjunctivae. The palpebral conjunctivae may demonstrate cobblestoning, indicating lymphocytic infiltration. Otic manifestations include patient-reported sensations of fullness or clicking sensations and decreased auditory acuity. Nonnasal respiratory effects are manifest as asthma with cough and wheezing dyspnea. While not all patients with allergic rhinosinusitis have asthma, most asthmatic patients experience rhinitis, and importantly, studies indicate that appropriate management of rhinosinusitis improves the efficacy of asthma treatment. The local head and neck manifestations of allergic rhinosinusitis include pale and boggy nasal mucosae and swollen turbinates, resulting in obstruction of airflow. Additionally, copious nasal secretions, generally described as watery, but often...

Allergy and Dermatitis

There is clear evidence that otitis media with effusion is highly related to an allergic diathesis. When this converts to chronic draining otitis media, the allergic component would seem to still be relevant, although direct evidence is scant (17-19). Therefore, the surgeon must consider allergy evaluation, based on a patient history of other allergic diatheses, especially of the unified respiratory epithelium. Patients with chronic draining ear and allergic rhinitis, chronic rhinosinusitis, and asthma are strong candidates for allergy workup before contemplating surgical treatment.

Cockroaches And People

Mans, but they can trigger allergic reactions among people who are especially sensitive to them. Researchers regularly working with cockroaches in laboratories may eventually become sensitive to them. In time they may experience allergy attacks, asthma, or skin irritations when exposed to cockroaches or the materials with which cockroaches have come into contact.

Pharmacological Toxicological Effects

Inflammation Asthma There are many articles that address the role of St. John's wort in inflammation. As previously mentioned, St. John's wort is an inhibitor of IL-6, which is an important cytokine involved in inflammation (14,15). Additionally, hyperforin was found to inhibit cyclooxygenase (COX)-1 and 5-lipoxygenase (5-LO), key enzymes in the formation of proinflammatory eicosanoids. Moreover, it inhibited both enzymes at IC50 concentrations of 0.09 to 3 pM, which is close to the plasma concentrations achieved with standard dosing. Hyperforin was three times more potent then aspirin in its ability to inhibit COX-1 and almost equipotent to zileuton in its ability to inhibit 5-LO. Hyperforin did not significantly inhibit COX-2, 12-LO, or 15-LO enzymes (32). St. John's wort's ability to act as a 5-LO inhibitor could lead to a future role in asthma.

Restrictive and Obstructive Disorders

Spirometry is useful in the diagnosis of lung diseases. On the basis of pulmonary function tests, lung disorders can be classified as restrictive or obstructive. In restrictive disorders, such as pulmonary fibrosis, the vital capacity is reduced to below normal. The rate at which the vital capacity can be forcibly exhaled, however, is normal. In disorders that are exclusively obstructive, by contrast, the vital capacity is normal because lung tissue is not damaged. In asthma for example, the vital capacity is normal, but expiration is more difficult and takes a longer time because bronchoconstriction increases the resistance to air flow. Obstructive disorders are therefore diagnosed by tests that measure the rate of expiration. One such test is the forced expiratory volume (FEV), in which the percentage of the vital capacity that can be exhaled in the first second (FEVi) is measured (fig. 16.17). An FEVi that is significantly less than 80 suggests the presence of obstructive pulmonary...


This is preferred by most anaesthetists for induction of anaesthesia in upper airway obstruction some also prefer it for induction in children. It may also be indicated in bronchopleural fistula or empyema and when i.v. access is problematic. Airway muscle tone and breathing are normally maintained. However, inhalational induction is slow, requires some patient cooperation and can be associated with coughing, laryngeal spasm and bronchospasm, especially in the excitement stages of anaesthesia, also making oxygenation difficult or impossible.


Its deleterious effects are mostly caused by a raised intrathoracic pressure. This decreases venous return which may cause a fall in cardiac output it may also further impair expiration, worsening air trapping in those with asthma and chronic obstructive airways disease.


The effects of IL-11 administration in preclinical models have been comprehensively reviewed (112,113). Genetic overexpression of human IL-11 was achieved in mice transplanted with marrow cells transduced with a retrovirus leading to IL-11 production (114,115) mice had high concentrations of serum IL-11, moderately increased platelet counts, increased splenic myeloid progenitor cell numbers, and evidence of system chronic IL-11 toxicity (loss of fat tissue, thymic atrophy, eyelid inflammation, and occasional hyperactivity). Several models of stable germline IL-11-expressing transgenes exist. An IL-11 transgene driven by the Mx promoter resulted in mice with constitutive expression on IL-11 in bone and bone marrow cells (this promoter was selected because its transcriptional activity can be upregulated by IFN) the major phenotype of these mice was increased bone formation (116). Transgenic mice with IL-11 expression restricted to the airways have been generated (117), including an...


Special attention may be required in the areas of chemical and thermal burn management. Acute and later chronic upper and lower respiratory pathology will occur, requiring treatments ranging from oxygen and bronchodilators to intubation. In the subacute and chronic phases following a volcanic incident, large numbers of people may be displaced from their homes, triggering numerous public health concerns from ensuing infections and disease.


Adenosine has a role in stimulating vasodilation when tissue becomes ischemic. Experiments using mi-crospheres to occlude microvessels demonstrate such a role. In these experiments, where vasomotor tone was intact, the obstruction of small vessels resulted in an increase of flow in the major coronary artery but a decrease of peak reactive hyperemic flow (Hori et al., 1986). This effect could be blocked by theophylline, an adenosine-blocking drug. Apparently, adenosine is produced to levels above threshold in the small areas where perfusion is blocked, and then diffuses to neighboring resistance vessels which dilate. Higher perfusion of neighboring areas may then result in higher tissue oxygen pressure, which will facilitate oxygen shunting to the poorly perfused area.

Lung Mechanics

The lung tissues and airways become hyperresponsive in asthma, which results in reversible increase in bronchial smooth muscle tone and variable amounts of inflammation of bronchial mucosa. Because of the increased smooth muscle tone during an asthma attack, the airways also tend to close at abnormally high lung volumes, trapping air behind occluded or narrowed small airways. Therefore, asthmatic people tend to breathe at high lung volume in order to counteract the increase in smooth muscle tension, which is the primary defect in an asthmatic attack. Because these patients breathe at such high lung volumes and at that high volume based on the pressure-volume curve (Fig. 1.5) lung compliance is at its minimum (Fig. 1.6), they must exert significant effort to create an extremely negative pleural pressure, and consequently fatigue easily.

Mast cells

Although functionally akin to basophils, they are long living and thought to belong to the tissue macrophage family. They are not phagocytic and do not present antigen to lymphocytes. Upon binding of foreign antigen to its membrane receptors, degranulation occurs with release of histamine, heparin and other vasoactive peptides. Activation also results in the release of leukotrienes (LT) from the surface membrane. Mast cells are important effector cells of many of the manifestations of hypersensitivity or allergic reactions, such as urticaria, rhinitis and bronchospasm.

Stress And Coping

Among the symptoms of prolonged stress are persisting anxiety, depression, irritability, fatigue, loss of appetite, headache, and backache. Continuing stress can affect the course and severity of physical disorders such as peptic ulcers, migraine headaches, skin conditions, chronic backache, and bronchial asthma.

Chlorine Cl2

Considerations in the differential diagnosis of chlorine exposure include other pulmonary irritants such as phosgene, asthma reactive airway disease (RAD), and other causes of acute lung injury (ALI) adult respiratory distress syndrome. Chlorine exposure is treated with supportive care with an emphasis on optimizing oxygen delivery. Care should be taken to ensure a patent airway, even if endotra-cheal intubation is required. Aerosolized bronchodilators may be required. There are insufficient data to support using parenteral steroids at this point. Treatment with aerosolized bicarbonate is controversial and has not been demonstrated to improve survival, but may provide symptomatic relief to those with mild symptoms. Skin burns are treated as thermal burns, with decontamination, wound care, and pain control. Eyes should be irrigated until a pH of 7.4 is reached and examined for signs of corneal abrasion as well as foreign particulate matter.

Phosgene Cocl2

Treatment again consists of airway support and oxygenation. Positive pressure may be warranted. Bronchodilators should be administered if the patients exhibit any signs of respiratory distress. Patients with known exposure should be observed for a prolonged period (i.e., up to 48 hours) due to the risk of delayed-onset ALI.


When solvate happens to be water, these are called hydrates wherein water is entrapped through hydrogen bonding inside the crystal and strengthens crystal structure and thereby invariably reduces the dissolution rate (Table 11). The water molecules can reside in the crystal either as isolate lattice where they are not in contact with each other, or lattice channel water where they fill space and metal coordinated water in salts of weak acids where meta ion coordinates with water molecule. Metal-ion coordinates may also fill channels such as in the case of nedocromil sodium trihydrate. Crystalline hydrates have been classified by structural aspects into three classes isolated lattice sites, lattice channels, and metal-ion coordinated water. There are three classes discernible by the commonly available analytical techniques.

Allergiesan Overview

Allergies are by definition immunological hypersensitivity reactions to substances (allergens), usually proteins, tolerated in defined dose by normal individuals (21). Allergic reactions are manifested in allergic diseases such as asthma, eczema, and rhinoconjuncti-vitis, each defined by a group of symptoms and signs. The life-impairing effect of these diseases varies from subtle to dominant. In addition to impairing physical health there may be an impact on social and emotional health, especially in childhood (22). Allergic symptoms can significantly disturb productivity in school and work where they are among the major causes of absenteeism. The personal and social economic burden is considerable (22-24). During the second half of the twentieth century the prevalence of allergic diseases has increased in epidemic proportions. The highest prevalence is in children and teenagers. With, on average, every fourth child affected, allergic diseases represent the most common chronic...


Prostaglandins are produced in almost every organ and have been implicated in a wide variety of regulatory functions. The study of prostaglandins can be confusing because of the diversity of their actions, and because different prostaglandins may exert antagonistic effects in some tissues. For example, the smooth muscle of blood vessels relaxes (producing vasodilation) in response to prostaglandin E2 (abbreviated PGE2) and PGF2a these effects promote reddening and heat during an inflammation reaction. In the smooth muscles of the bronchioles (airways of the lungs), however, PGF2a stimulates contraction, contributing to the symptoms of asthma.

Irritant Gases

Examine chest and consider early use of bronchodilators, mucomyst, and or inhaled corticosteroids. 7. Peak flow rates and or bedside spirometry may be helpful in diagnosing or documenting reversible bronchospasm. Full pulmonary function tests (volumes, diffusion, and or provokability) should be reversed for a later timepoint. When the patient is exposed to a low-soluble gas, like phosgene, upper-airway signs and symptoms are not expected and observation is required because it may take as long as 24 hours for reactive airways dysfunction syndrome or pulmonary edema to develop. The development of reactive airways dysfunction syndrome (RADS) or asthma after exposure to irritant gases is the most common long-term complication. Early treatment with inhaled bronchodilators and inhaled corticosteroids is a well-proven treatment approach for those with symptoms and reversible bronchospasm. Reversible bronchospasm can be confirmed by documenting improvement in flow rates after treatment with...

Smoke Inhalation

The most common clinical problems associated with smoke inhalation are (1) upper and or lower-airway inflammation and (2) carbon monoxide toxicity, although hydrogen cyanide toxicity has gained recent attention. Fiberoptic bronchoscopy is very useful in evaluation of burn patients for airway injury by demonstrating carbonaceous material, airway edema, erythema, ulcerations, hemorrhage, blisters, or ischemia. During bronchoscopy, intubation should be considered, preferably over the

Neighborhood Factors

Levels of pollution are yet another neighborhood factor with relevance to adolescents' health. Lee et al (2006) reported that low SES youth growing up in a major Korean city were exposed to greater levels of small airborne particles, sulfur, and nitrogen dioxide. This greater ambient air pollution in low SES neighborhoods is particularly relevant for youth with and at risk of asthma, one of the most common chronic illnesses among children and adolescents. A recent review article suggests that the accumulation of environmental risk factors across early life such as more polluted air and water and more crowded and poorer quality housing negatively influences the health of youth (Evans, 2004).

Allergic Reactions

Lepirudin administration during prospective studies in patients with HIT was associated with a low incidence of allergic events, as well as during the much larger clinical trials in patients with ACS. Among the adverse events reported were eczema, rash, pruritus, hot flushes, fever, chills, urticaria, bronchospasm, cough, stridor, dyspnea, angioedema (face, tongue, larynx), and injection-site reactions. Any causal relationship of lepirudin to these adverse events is unclear.

Pulmonary function

Pulmonary function should be measured before contemplating lung resection. In a fit patient, this need be no more than basic spirometry (Fig. 18.7). Smoking, which causes lung cancer, may also lead to a degree of emphysema, and these patients require full bronchospirometry with and without bronchodilators and an estimate of pulmonary diffusion. In marginal cases, a pulmonary exercise test measuring the oxygen uptake during exercise is also helpful and a ventilation-perfusion scan, particularly if it is quantified, gives an estimate of the relative contribution of each area of the lung to the overall function. This information is helpful in estimating the likely respiratory function after pulmonary resection. Clinical evidence of pulmonary hypertension is a contraindication to major pulmonary resection and if suspected can be confirmed by non-invasive means. Patients who have marginal pulmonary function improve if they cease smoking and are given an intensive regimen of bronchodilators...


Your looks are affected not by a single 'looks' gene, but by lots of them, and by non-genetic factors as well, fashion and free will prominently among them. Chromosome 5 is a good place to start muddying the genetic waters by trying to build a picture that is a little more complicated, a little more subtle and a little more grey than I have painted so far. But I shall not stray too far into this territory yet. I must take things one step at a time, so I will still talk about a disease, though not a very clear-cut one and certainly not a 'genetic' one. Chromosome 5 is the home of several of the leading candidates for the tide of the 'asthma gene'. But everything about them screams out pleiotropy a technical term for multiple effects of multiple genes. Asthma has proved impossible to pin down in the genes. It is maddeningly resistant to being simplified. It remains all things to all people. Almost everybody gets it or some other kind of allergy at...


During a newly begun course of treatment with abacavir, asthma could also be due to hypersensitivity. Dyspnea (13 ), cough (27 ) and pharyngitis (13 ) are common symptoms (Keiser 2003). Some patients even develop pulmonary infiltrates. Although smoking is more harmful to HIV-positive than to HIV-negative persons, it is still more common among HIV-positives (Royce 1990). All HIV-associated and HIV-independent pulmonary diseases are more common in smokers than in non-smokers. This starts with bacterial pneumonia and PCP, but also applies to asthma, COPD and pulmonary carcinomas (Hirschtick 1996). Smoking promotes the formation of a local immune deficit in the pulmonary compartment it reduces the number of alveolar CD4+ cells and the production of important pro-inflammatory cytokines such as IL-1 and TNF-a (Wewers 1998). Furthermore, smoking suppresses the phagocytosis capacity of alveolar macrophages. This effect is more pronounced in HIV patients than in HIV-negative patients. HIV...


Chronic bronchitis, asthma, and emphysema, the most common causes of respiratory failure, are together called chronic obstructive pulmonary disease (COPD). In addition to the more direct obstructive and restrictive aspects of these conditions, other pathological changes may occur. These include edema, inflammation, hyperplasia (an increase in the number of cells), zones of pulmonary fibrosis, pneumonia, pulmonary emboli (traveling blood clots), and heart failure. Patients with severe chronic bronchitis or

Coping with Asthma

Coping with Asthma

If you suffer with asthma, you will no doubt be familiar with the uncomfortable sensations as your bronchial tubes begin to narrow and your muscles around them start to tighten. A sticky mucus known as phlegm begins to produce and increase within your bronchial tubes and you begin to wheeze, cough and struggle to breathe.

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