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Sample records for acute asthma management

  1. The management of acute asthma.

    PubMed

    Cross, S

    1997-04-01

    Health professionals likely to come into contact with people experiencing an acute episode of asthma, such as school nurses, ambulance personnel and A&E staff, need clear guidelines on management. The British Thoracic Society guidelines, revised this year, advise on the categorisation of asthma, assessment and treatment.

  2. Self-management of acute asthma among low-income urban adults.

    PubMed

    George, Maureen; Campbell, Jacquelyn; Rand, Cynthia

    2009-08-01

    One approach to address asthma disparities has been to create evidence-based guidelines to standardize asthma care and education. However, the adoption of these recommendations has been suboptimal among many providers. As a result, low-income minority patients may not be receiving adequate instruction in asthma self-management. In addition, these patients may fail to follow guideline-based recommendations. We conducted 25 interviews to identify the extent to which urban low-income adults have received training in, and implement, self-management protocols for acute asthma. Twenty-five adults (92% female; 76% African American; mean age 39) were enrolled. Only one subject had received asthma self-management training and only 10 (40%) used short-acting beta-(2) agonist-based (SABA) self-management protocols for the early treatment of acute asthma. No subject used a peak flow meter or an asthma action plan. Most (52%) chose to initially treat acute asthma with complementary and alternative medicine (CAM) despite the availability of SABAs. Importantly, 21 (84%) preferred an integrated approach using both conventional and CAM treatments. Four themes associated with acute asthma self-management emerged from the qualitative analysis. The first theme safety reflected subjects' perception that CAM was safer than SABA. Severity addressed the calculation that subjects made in determining if SABA or CAM was indicated based on the degree of symptoms they were experiencing. The third theme speed and strength of the combination described subjects' belief in the superiority of integrating CAM and SABA for acute asthma self-management. The final themesense of identity spoke to the ability of CAM to provide a customized self-management strategy that subjects desired. It is unclear if subjects' greater use of CAM or delays in using SABA-based self-management protocols were functions of inadequate instruction or personal preference. Regardless, delays in, or under use of, conventional

  3. Self-Management of Acute Asthma among Low-Income Urban Adults

    PubMed Central

    George, Maureen; Campbell, Jacquelyn; Rand, Cynthia

    2009-01-01

    One approach to address asthma disparities has been to create evidence-based guidelines to standardize asthma care and education. However, the adoption of these recommendations has been suboptimal among many providers. As a result, low-income minority patients may not be receiving adequate instruction in asthma self-management. In addition, these patients may fail to follow guideline-based recommendations. We conducted 25 interviews to identify the extent to which urban low-income adults have received training in, and implement, self-management protocols for acute asthma. Twenty-five adults (92% female; 76% African American; mean age 39) were enrolled. Only one subject had received asthma self-management training and only 10 (40%) used short-acting beta-2 agonist-based (SABA) self-management protocols for the early treatment of acute asthma. No subject used a peak flow meter or an asthma action plan. Most (52%) chose to initially treat acute asthma with complementary and alternative medicine (CAM) despite the availability of SABAs. Importantly, 21 (84%) preferred an integrated approach using both conventional and CAM treatments. Four themes associated with acute asthma self-management emerged from the qualitative analysis. The first theme safety reflected subjects’ perception that CAM was safer than SABA. Severity addressed the calculation that subjects made in determining if SABA or CAM was indicated based on the degree of symptoms they were experiencing. The third theme speed and strength of the combination described subjects’ belief in the superiority of integrating CAM and SABA for acute asthma self-management. The final themesense of identity spoke to the ability of CAM to provide a customized self-management strategy that subjects desired. It is unclear if subjects’ greater use of CAM or delays in using SABA-based self-management protocols were functions of inadequate instruction or personal preference. Regardless, delays in, or under use of

  4. Intravenous magnesium for acute asthma?

    PubMed

    2003-10-01

    Each year in the UK, around 1,500 people die from asthma. Standard treatment has been based on bronchodilators (e.g. beta 2-stimulants) and anti-inflammatory drugs (corticosteroids). The recently revised British Guideline on the Management of Asthma suggests also using a single dose of i.v. magnesium sulphate in patients with acute severe asthma, an unlicensed indication. Here we discuss the rationale for giving i.v. magnesium and whether it offers any advantage for patients with acute severe asthma.

  5. Asthma in adults (acute)

    PubMed Central

    2011-01-01

    Introduction About 10% of adults have suffered an attack of asthma, and up to 5% of these have severe disease that responds poorly to treatment. Patients with severe disease have an increased risk of death, but patients with mild to moderate disease are also at risk of exacerbations. Most guidelines about the management of asthma follow stepwise protocols. This review does not endorse or follow any particular protocol, but presents the evidence about specific interventions. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for acute asthma? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 100 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: beta2 agonists (plus ipratropium bromide, pressured metered-dose inhalers, short-acting continuous nebulised, short-acting intermittent nebulised, short-acting iv, and inhaled formoterol); corticosteroids (inhaled); corticosteroids (single oral, combined inhaled, and short courses); education about acute asthma; generalist care; helium–oxygen mixture (heliox); magnesium sulphate (iv and adding isotonic nebulised magnesium to inhaled beta2 agonists); mechanical ventilation; oxygen supplementation (controlled 28% oxygen and controlled 100% oxygen); and specialist care. PMID:21463536

  6. Acute asthma management by a pediatric after-hours call center.

    PubMed

    Nelson, Kyle A; Freiner, Donna; Garbutt, Jane; Trinkaus, Kathryn; Bruns, Julie; Sterkel, Randal; Smith, Sharon R; Strunk, Robert C

    2009-01-01

    To describe an asthma management protocol used in a nurse-staffed pediatric After-Hours Call Center (AHCC) that incorporates severity-based home treatment recommendations and follow-up call assessments. Call records for asthma advice from January 1, 2004 to June 30, 2004 were identified retrospectively and reviewed. Descriptive statistics were used to report patient demographics, frequencies of symptom severity zones (Red, Yellow, or Green) at initial calls, frequencies of call dispositions designating care advice provided (including home treatment recommendations and seeking emergency department [ED] care), and changes in severity zones between initial calls and follow-up calls when nurses reassessed patients after recommended home treatment. During the study period, 3,632 asthma calls (2,439 initial; 1,193 follow-up) were managed by AHCC nurses. Initial calls were classified mostly as Red (28%) or Yellow (42%) severity zones; 27% were Green zone and 3% could not be categorized. Fifty-two percent of initial calls with Red or Yellow severity zones involved home treatment recommendations; 50% of those Red zone and 63% of those Yellow zone calls had improved severity zones at follow-up call assessments. Twenty-eight percent of patients with home treatment recommendations were referred to the ED at the time of follow-up call nurse reassessment. This telephone-based nurse-staffed pediatric acute asthma management protocol includes provision of severity-based home treatment recommendations and follow-up assessments, and improved symptoms for many children with acute exacerbations. This protocol may also be successful in other locations and may improve outcomes, such as reduction in ED visits.

  7. Acute asthma during pregnancy.

    PubMed Central

    Stenius-Aarniala, B. S.; Hedman, J.; Teramo, K. A.

    1996-01-01

    BACKGROUND: Acute asthma during pregnancy is potentially dangerous to the fetus. The aim of this study was to investigate the effect of an acute attack of asthma during pregnancy on the course of pregnancy or delivery, or the health of the newborn infant, and to identify undertreatment as a possible cause of the exacerbations. METHODS: Five hundred and four pregnant asthmatic subjects were prospectively followed and treated. The data on 47 patients with an attack of asthma during pregnancy were compared with those of 457 asthmatics with no recorded acute exacerbation and with 237 healthy parturients. RESULTS: Of 504 asthmatics, 177 patients were not initially treated with inhaled corticosteroids. Of these, 17% had an acute attack compared with only 4% of the 257 patients who had been on inhaled anti-inflammatory treatment from the start of pregnancy. There were no differences between the groups as to length of gestation, length of the third stage of labour, or amount of haemorrhage after delivery. No differences were observed between pregnancies with and without an exacerbation with regard to relative birth weight, incidence of malformations, hypoglycaemia, or need for phototherapy for jaundice during the neonatal period. CONCLUSIONS: Patients with inadequate inhaled anti-inflammatory treatment during pregnancy run a higher risk of suffering an acute attack of asthma than those treated with an anti-inflammatory agent. However, if the acute attack of asthma is relatively mild and promptly treated, it does not have a serious effect on the pregnancy, delivery, or the health of the newborn infant. PMID:8733495

  8. Audit of acute asthma management at the Paediatric Emergency Department at Wad Madani Children’s Hospital, Sudan

    PubMed Central

    Haroun, Huda M.; Ali, Hassan M.; Tag Eldeen, Imad Eldeen M.

    2012-01-01

    This audit of hospital care of acute wheeze and asthma aimed to assess the degree of adherence of the acute care of the asthma patients to the published international guidelines. Information was collected in six key areas: patient demographics; initial asthma severity assessment; in-hospital treatment; asthma prophylaxis; asthma education and emergency planning; and follow-up arrangements. The area of initial asthma severity assessment showed defciencies in the clinical measures currently used to verify case severity. In- hospital treatment on the other hand was consistent with recommendations in the use of the inhaled β-2 agonist salbutamol as bronchodilator, the discrete use of aminophylline and the small number of patients ordered chest X-ray. However, the treatment was incoherent with recommendations in the delivery method used for inhaled bronchodilator in relation to the age group of treated patients, absence of ipratropium bromide as a bronchodilator in the management and the large use of antibiotics. Assessment of the areas of asthma prophylaxis, asthma education and emergency- planning and follow-up arrangements illustrated that little efforts were made to assure safe discharge, although these measures have been shown to reduce morbidity after the exacerbation and reduce relapse rates and signifcantly reduce hospitalizations, unscheduled acute visits, missed work days, as well as improving quality of life. This audit emphasizes the need for the adoption of a management protocol for acute asthma care in the emergency department based on published international guidelines and the assurance of its implementation, monitoring and evaluation using the right tools to improve patient care. PMID:27493337

  9. Acute bronchial asthma.

    PubMed

    Grover, Sudhanshu; Jindal, Atul; Bansal, Arun; Singhi, Sunit C

    2011-11-01

    Acute asthma is the third commonest cause of pediatric emergency visits at PGIMER. Typically, it presents with acute onset respiratory distress and wheeze in a patient with past or family history of similar episodes. The severity of the acute episode of asthma is judged clinically and categorized as mild, moderate and severe. The initial therapy consists of oxygen, inhaled beta-2 agonists (salbutamol or terbutaline), inhaled budesonide (three doses over 1 h, at 20 min interval) in all and ipratropium bromide and systemic steroids (hydrocortisone or methylprednisolone) in acute severe asthma. Other causes of acute onset wheeze and breathing difficulty such as pneumonia, foreign body, cardiac failure etc. should be ruled out with help of chest radiography and appropriate laboratory investigations in first time wheezers and those not responding to 1 h of inhaled therapy. In case of inadequate response or worsening, intravenous infusion of magnesium sulphate, terbutaline or aminophylline may be used. Magnesium sulphate is the safest and most effective alternative among these. Severe cases may need ICU care and rarely, ventilatory support. PMID:21769523

  10. Management of acute asthma in Canada: an assessment of emergency physician behaviour.

    PubMed

    Grunfeld, A; Beveridge, R C; Berkowitz, J; FitzGerald, J M

    1997-01-01

    The study objective was to assess Canadian emergency physicians for their management preferences and their compliance with recently developed guidelines for treatment of acute asthma in adults. The design was a cross-sectional survey sent to members of the Canadian Association of Emergency Physicians (CAEP) and to the emergency department (ED) directors of all Canadian hospitals with more than 25 beds in November 1992. ED directors who had not responded were sent a second survey in January 1993. The response rates for the survey were 60.1% (362/602) for ED directors and 53.4% (302/586) for CAEP members. Respondents were more likely to be from larger hospitals and to have completed some training beyond general practice level (CCFP, CCFP-EM, ABEM, FRCPC). There were wide variations among respondents in the use of objective measurements of asthma severity (forced expiratory volume in 1 s [FEV1] and peak expiratory flow rates [PEFR]), dosing of bronchodilators, and utilization of systemic corticosteroids. Forty-six percent of respondents used the FEV1 "occasionally" (22.3%) or "never" (23.8%), and 26.7% used PEFR "occasionally" (15.8%) or "never" (10.9%) in asthma management. Ninety-seven percent used nebulized beta agonist "always" (71.3%) or "often" (25.6%), but only 48.5% used the metered dose inhaler (MDI) "always" (11%) or "often" (37.5%). More than a quarter of respondents (27.2%) used doses of beta agonists that were less than those recommended (> every 30-60 min). Oral corticosteroids were prescribed at discharge only "occasionally" (51.1%), "seldom" (18.9%), or "never" (6.5%) in 76.6% of physicians. Physicians with more training were more likely to assess and treat patients according to current asthma treatment guidelines. The survey shows that many Canadian emergency physicians did not follow published recommendations for the care of patients with acute asthma. This finding was especially so with regard to objective evaluation of airflow, aggressive use of

  11. Management of Acute Exacerbation of Asthma and Chronic Obstructive Pulmonary Disease in the Emergency Department.

    PubMed

    Suau, Salvador J; DeBlieux, Peter M C

    2016-02-01

    Acute asthma and chronic obstructive pulmonary disease (COPD) exacerbations are the most common respiratory diseases requiring emergent medical evaluation and treatment. Asthma and COPD are chronic, debilitating disease processes that have been differentiated traditionally by the presence or absence of reversible airflow obstruction. Asthma and COPD exacerbations impose an enormous economic burden on the US health care budget. In daily clinical practice, it is difficult to differentiate these 2 obstructive processes based on their symptoms, and on their nearly identical acute treatment strategies; major differences are important when discussing anatomic sites involved, long-term prognosis, and the nature of inflammatory markers. PMID:26614239

  12. Do accident and emergency senior house officers know the British guidelines on the management of acute asthma?

    PubMed

    Ulahannan, T; Hardern, R D; Hamer, D W

    1996-03-01

    Avoidable deaths from asthma continue, even in hospital. Since the management of acute severe asthma is often initiated in the Accident and Emergency department, it is crucial that staff there have adequate knowledge. An anonymous questionnaire, containing items based on chart 6 of the UK guidelines, was completed by 66 Accident and Emergency Senior House Officers from the Yorkshire region. The study aim was to establish these doctors' levels of knowledge about the recommended management of acute asthma in Accident and Emergency. The median score was 10 (out of a possible 24) and the interquartile range 8-13. Further efforts are required to implement these guidelines so that the best patient outcomes can be achieved.

  13. Medical emergencies: pulmonary embolism and acute severe asthma.

    PubMed

    Somasundaram, K; Ball, J

    2013-01-01

    In this, the second of two articles covering specific medical emergencies, we discuss the definitions, epidemiology, pathophysiology, acute and chronic management of pulmonary embolus and acute severe asthma. PMID:23210560

  14. Acute adult asthma--assessment of severity and management and comparison with British Thoracic Society Guidelines.

    PubMed

    Hart, S R; Davidson, A C

    1999-01-01

    To investigate the accuracy of clinical severity assessment of asthmatics and to compare emergency and subsequent ward management with British Thoracic Society (BTS) Guidelines, the records of all patients admitted for severe asthma (46) over a 5-month period to a District General Hospital were inspected. Variations from recommended management were revealed. Appropriate oxygen administration was often not provided in casually and patients frequently left hospital before their discharge criteria were attained: recommended diurnal variations in peak flow were exceeded in 26%. Eleven per cent of discharges were against medical advice, making provision of adequate management logistically difficult. Adherence to BTS guidelines on the need for arterial blood gas (ABG) analysis would have led to a failure to detect significant hypoxaemia in 25% of cases. This study identified substantial variations from BTS management guidelines. It is suggested that oximetry is necessary on arrival to guide selection for arterial blood gas analysis.

  15. Out-Patient Management of Bronchial Asthma

    PubMed Central

    Cockcroft, D.W.

    1989-01-01

    Asthma, seen primarily as an inflammatory disease with secondary airway hyper-responsiveness, causes symptoms through contraction of the airway's smooth muscles. The management of chronic asthma relies on bronchodilators for symptomatic relief of bronchospasm, while primary therapy is used to either prevent or reverse the inflammatory component of the disease. Anti-inflammatory therapeutic strategies include environmental control (where relevant), sodium cromoglycate (where appropriate), and both inhaled and oral glucocorticosteroids. Management of acute severe asthma is similar; bronchodilators are used to ”buy time” while systemic corticosteroids control the inflammatory process. PMID:21248908

  16. [Anesthetic management in bronchial asthma].

    PubMed

    Kozian, Alf; Schilling, Thomas; Hachenberg, Thomas

    2016-06-01

    In daily practice, acute and chronic pulmonary diseases are common issues presenting to the anesthetist. Respiratory physiology in general is affected by both general and regional anesthesia, which results in an increased number of perioperative complications in pulmonary risk patients. Therefore, anesthetic management of patients with bronchial asthma needs to address different clinical topics: the physical appearance of pulmonary disease, type and extent of surgical intervention as well as effects of therapeutic drugs, anesthetics and mechanical ventilation on respiratory function. The present work describes important precautions in preoperative scheduling of the asthmatic patient. In the operative course, airway manipulation and a number of anesthetics are able to trigger intraoperative bronchial spasm with possibly fatal outcome. It is essential to avoid these substances to prevent asthma attack. If asthmatic status occurs, appropriate procedures according to therapeutic standards have to be applied to the patient. Postoperatively, sufficient pain therapy avoids pulmonary complications and improves outcome. PMID:27359239

  17. Asthma management programs in managed care organizations.

    PubMed

    Hartmann, Christine W; Maio, Vittorio; Goldfarb, Neil I; Cobb, Nicole; Nash, David B

    2005-12-01

    The aim of this work was to investigate how managed care organizations (MCOs) currently approach asthma treatment and management and to determine factors affecting asthma outcomes. A Web-based survey was administered to a national sample of 351 medical directors of MCOs to investigate the asthma management program components in their organizations as well as gaps and barriers in the management of patients with asthma. All 134 (38.2%) responding medical directors reported that their organizations monitor asthma patients. Plans use a variety of asthma management activities, including general member education (90%), member education by mail (87%), self-management education (85%), and provider education (82%). Educational resources (89%) and telephone advice nurse (77%) were the most common self-management strategies offered. Among factors impeding the provision of effective asthma care, noncompliance with asthma treatment, the inappropriate use of medications, and the need for multiple medications were cited by virtually all respondents. Health plans rely on an array of strategies to manage asthma patients. Education encouraging patient self-management is a key component of asthma management programs. However, a considerable number of treatment approach barriers are impeding the achievement of proper asthma care. Without innovative approaches to care, it appears that current MCOs' asthma management efforts may not result in substantial improvements in asthma outcomes.

  18. Is ketamine a lifesaving agent in childhood acute severe asthma?

    PubMed Central

    Hendaus, Mohamed A; Jomha, Fatima A; Alhammadi, Ahmed H

    2016-01-01

    Children with acute severe asthma exacerbation are at risk of developing respiratory failure. Moreover, conventional aggressive management might be futile in acute severe asthma requiring intubation and invasive ventilation. The aim of this review is to detail evidence on the use of ketamine in childhood asthma exacerbations. A search of the MEDLINE, EMBASE, and Cochrane databases was performed, using different combinations of the following terms: ketamine, asthma, use, exacerbation, and childhood. In addition, we searched the references of the identified articles for additional articles. We then reviewed titles and included studies that were relevant to the topic of interest. Finally, the search was limited to studies published in English and Spanish from 1918 to June 2015. Due to the scarcity in the literature, we included all published articles. The literature reports conflicting results of ketamine use for acute severe asthma in children. Taking into consideration the relatively good safety profile of the drug, ketamine might be a reasonable option in the management of acute severe asthma in children who fail to respond to standard therapy. Furthermore, pediatricians and pediatric emergency clinicians administering ketamine should be knowledgeable about the unique actions of this drug and its potential side effects. PMID:26955277

  19. Strategies in managing asthma.

    PubMed Central

    Barker, A F

    1989-01-01

    The management of adult asthma involves a concerted effort to identify and remove or mollify inciting or triggering stimuli such as respiratory tract infections, gastric reflux, aspirin, beta-antagonists, and environmental agents; educate patients, using written treatment plans and pulmonary function monitoring; and properly use the antiasthmatic medications including beta-agonists, theophylline, anticholinergics, and corticosteroids, with an emphasis on aerosol delivery and the use of corticosteroids during exacerbations. This strategy is summarized with suggestions on therapy in emergency departments, during the transition from hospital to ambulatory care, before exercise, and during pregnancy. PMID:2660411

  20. Are doctors still failing to assess and treat asthma attacks? An audit of the management of acute attacks in a health district.

    PubMed

    Pinnock, H; Johnson, A; Young, P; Martin, N

    1999-06-01

    This audit aimed to observe the management of acute asthma by primary and secondary care within a Health District. Asthma attacks occurring during the first 6 weeks of 1996 to patients between the ages of 3 and 74 years in Canterbury and Thanet District were notified by general practitioners, out-of-hours co-operatives and hospitals. Data were obtained retrospectively from the patient records. A total of 378 episodes was registered: 342 (90%) to primary care. Of these 234 (76% of patients aged 6 years or over) had a peak flow recorded; 114 (30%) were given emergency bronchodilation: oxygen was not used in primary care; 204 (54%) were given systemic steroids; and 43 (11%) were referred for hospital care of whom 36 were admitted. Of the attacks, 212 (69% of the patients aged 6 years or over) could be classified by percentage predicted peak flow and management compared to the Guidelines published by the British Thoracic Society. Twenty-eight patients presented with 'life-threatening' asthma: 20 (71%) were given emergency bronchodilation; oxygen was used in only two; 24 (86%) were given systemic steroids; and six (21%) were referred for admission. In their confidential enquiry into the asthma deaths the British Thoracic Society identified a failure to appreciate the severity of the attack, resulting in inadequate emergency treatment and delay in referring to hospital. These data suggest that, 15 years later, these problems may still exist.

  1. The role of tiotropium in the management of asthma

    PubMed Central

    2012-01-01

    Asthma is a chronic respiratory disease characterized by reversible airway obstruction that is secondary to an allergic inflammation and excessive smooth muscle contraction. Cholinergic signals were known to contribute significantly to the pathophysiology of asthma. However, the use of anti-cholinergic agents in asthma has been justified only in acute asthma exacerbations, until tiotropium bromide, a long-acting anti-cholinergic agent was introduced. Recent reports showing a promising role of tiotropium in the treatment of asthma have aroused interest of the use of anti-cholinergic agent for the management of asthma. This report describes pharmacological characteristics, potential effects on inflammatory cells, and the current status of tiotropium in the treatment of asthma. PMID:22701860

  2. How is difficult asthma managed?

    PubMed

    Roberts, N J; Robinson, D S; Partridge, M R

    2006-11-01

    Most patients with asthma can be easily treated. Some have difficult asthma; in some because the diagnosis is erroneous, in others because of comorbidity or noncompliance. A European Respiratory Society Task Force has called for an integrated approach for these patients, and positive results have been reported using protocols. In the UK, there is no overall understanding of the size of this problem, or how these patients are managed. A postal survey of 683 consultant members of the British Thoracic Society designed to elicit respondents' views on how they would manage four clinical scenarios was conducted. There was a 50.4% response rate. Few reported a uniform approach to the investigation of such patients. The availability of allied healthcare professionals was variable. The 21 consultant respiratory physicans, reporting a special interest in difficult asthma, were significantly more likely to objectively assess compliance, perform skin-prick tests and to utilise a liaison psychiatrist than those without an expressed special interest in asthma. Many reported difficulty in accessing psychologists, liaison psychiatrists and social workers. Approaches to the diagnosis and management of "vocal cord dysfunction" were variable. The results of this postal survey of specialist thoracic physicians in the UK suggest that a protocol for difficult asthma is not in widespread use and that access to necessary allied healthcare professionals is not uniform. Pulmonologists with a declared special interest in difficult asthma may have configured their services and approaches more in line with that proposed by the European Respiratory Society Task Force.

  3. The intersection between asthma and acute chest syndrome in children with sickle-cell anaemia.

    PubMed

    DeBaun, Michael R; Strunk, Robert C

    2016-06-18

    Acute chest syndrome is a frequent cause of acute lung disease in children with sickle-cell disease. Asthma is common in children with sickle-cell disease and is associated with increased incidence of vaso-occlusive pain events, acute chest syndrome episodes, and earlier death. Risk factors for asthma exacerbation and an acute chest syndrome episode are similar, and both can present with shortness of breath, chest pain, cough, and wheezing. Despite overlapping risk factors and symptoms, an acute exacerbation of asthma or an episode of acute chest syndrome are two distinct entities that need disease-specific management strategies. Although understanding has increased about asthma as a comorbidity in sickle-cell disease and its effects on morbidity, substantial gaps remain in knowledge about best management. PMID:27353685

  4. The intersection between asthma and acute chest syndrome in children with sickle-cell anaemia.

    PubMed

    DeBaun, Michael R; Strunk, Robert C

    2016-06-18

    Acute chest syndrome is a frequent cause of acute lung disease in children with sickle-cell disease. Asthma is common in children with sickle-cell disease and is associated with increased incidence of vaso-occlusive pain events, acute chest syndrome episodes, and earlier death. Risk factors for asthma exacerbation and an acute chest syndrome episode are similar, and both can present with shortness of breath, chest pain, cough, and wheezing. Despite overlapping risk factors and symptoms, an acute exacerbation of asthma or an episode of acute chest syndrome are two distinct entities that need disease-specific management strategies. Although understanding has increased about asthma as a comorbidity in sickle-cell disease and its effects on morbidity, substantial gaps remain in knowledge about best management.

  5. Acute asthma in emergency room.

    PubMed

    Chugh, Krishan

    2003-03-01

    Acute asthmatic exacerbation is one of the commonest emergencies seen in the pediatric age group. Viral infections are the most important triggers which set up the inflammatory reaction in the bronchial mucosa. GINA 2002 guidelines for assessing the severity and management are very useful for day to day practice. There is evidence to support the view that metered dose inhaler alongwith spaceor with or without mask is as effective as the standard doses of beta-2 agonists given by nebulizer. Ipratrpium bromide adds to the benefits of short acting beta-2 agonists. Systemic steroids should be started early. Early introduction of l/v beta-2 agonists and trial of l/v magnesium sulfate in non-responders have been recently recommended. Intravenous aminophylline can be tried in addition to full dose beta-2 agonists in those who reach the PICU. A close watch on the patient by monitoring clinical parameters, pulse oximeter, arterial blood gases and peak flow rate help in deciding whether there is need to further step up the therapy. Non-conventional measures like ketamine should be tried only under constant monitoring.

  6. Managing Asthma at School.

    ERIC Educational Resources Information Center

    Madden, Julie A.

    2000-01-01

    School personnel must know which students have asthma, typical warning signs, and appropriate actions in an emergency. Administering appropriate medication and reducing environmental triggers are not enough. Policymaking in schools and workplaces and legislation to increase health care access and eliminate substandard housing and air pollution are…

  7. Management of paediatric asthma

    PubMed Central

    Grigg, J

    2004-01-01

    Paediatric asthma best practice not only includes prescribing the correct therapeutic mix based on consensus guidelines, but also reducing therapy once control has been achieved. Clinicians should also be aware that asthma in young children is a heterogeneous entity, and a beneficial response to bronchodilators and/or inhaled steroids is not inevitable. In general, preschool children and infants should not be prescribed inhaled corticosteroids above 200 µg beclometasone dipropionate equivalent twice a day, or regular oral steroids, or long acting ß2-adrenoceptor agonists. New therapies such as anti-IgE antibodies are on the horizon, but these are unlikely to replace the established drug combinations. More likely is that the delivery of established drugs will become more convenient (for example, once a day inhaled corticosteroids, or season dependent prophylactic therapy). PMID:15356355

  8. The disease management approach to controlling asthma.

    PubMed

    Haahtela, T

    2002-02-01

    Asthma has become an important public health issue worldwide and certain groups, such as children, are at particular risk of the disease. Often asthma remains under-diagnosed and under-treated. Despite these worrying trends, the disease management approach to asthma control can help most asthma patients achieve a 'normal' way of life. The increased prevalence and greater diagnostic awareness of asthma have placed increased demands on healthcare resources, but effective asthma control can minimize the personal, social and economic burdens of asthma. Early diagnosis and immediate anti-inflammatory treatment is the first step in gaining control of symptoms. A stepwise approach is then used to classify asthma severity and treatment, with the number and frequency of medications increasing (step up) as asthma severity increases and decreasing (step down) when asthma is under control. This stepwise approach to asthma management necessitates regular review of treatment once asthma is under control. However, effective asthma management is dependent on successful patient education, adherence to prescribed medication and good doctor patient partnerships. Current treatment guidelines recommend the use of a written asthma management plan that should be agreed between the doctor and patient. These plans should cover all aspects of asthma treatment, including prevention steps for long-term control and action steps to stop attacks once a worsening in asthma has been recognized. This comprehensive approach to asthma management increases the likelihood of achieving asthma control, which in turn reduces the need for emergency visits to the hospital or clinic and reduces the limitations on physical activity previously imposed by the condition.

  9. Chapter 14: Acute severe asthma (status asthmaticus).

    PubMed

    Shah, Rachna; Saltoun, Carol A

    2012-01-01

    Acute severe asthma, formerly known as status asthmaticus, is defined as severe asthma unresponsive to repeated courses of beta-agonist therapy such as inhaled albuterol, levalbuterol, or subcutaneous epinephrine. It is a medical emergency that requires immediate recognition and treatment. Oral or parenteral corticosteroids should be administered to all patients with acute severe asthma as early as possible because clinical benefits may not occur for a minimum of 6-12 hours. Approximately 50% of episodes are attributable to upper respiratory infections, and other causes include medical nonadherence, nonsteroidal anti-inflammatory exposure in aspirin-allergic patients, allergen exposure (especially pets) in severely atopic individuals, irritant inhalation (smoke, paint, etc.), exercise, and insufficient use of inhaled or oral corticosteroids. The patient history should be focused on acute severe asthma including current use of oral or inhaled corticosteroids, number of hospitalizations, emergency room visits, intensive-care unit admissions and intubations, the frequency of albuterol use, the presence of nighttime symptoms, exercise intolerance, current medications or illicit drug use, exposure to allergens, and other significant medical conditions. Severe airflow obstruction may be predicted by accessory muscle use, pulsus paradoxus, refusal to recline below 30°, a pulse >120 beats/min, and decreased breath sounds. Physicians' subjective assessments of airway obstruction are often inaccurate. More objective measures of airway obstruction via peak flow (or forced expiratory volume in 1 second) and pulse oximetry before oxygen administration usually are helpful. Pulse oximetry values >90% are less commonly associated with problems although CO(2) retention and a low Pao(2) may be missed. PMID:22794687

  10. Recent advances in understanding and managing asthma.

    PubMed

    Loo, Su-Ling; Wark, Peter A B

    2016-01-01

    This review highlights the important articles published in the area of asthma research from January 2015 to July 2016. In basic science, significant advances have been made in understanding the link between the innate immune response and type II acquired immune responses in asthma and the role of the airway epithelium. Novel information continues to emerge with regard to the pathogenesis and heterogeneity of severe asthma. There have been important translational clinical trials in the areas of childhood asthma, treatment of allergy to improve asthma outcomes, and improving drug delivery to optimize the management of asthma. In addition, there are increasing data concerning the application of biological agents to the management of severe asthma. This body of work discusses the most notable advances in the understanding and management of asthma. PMID:27610226

  11. Recent advances in understanding and managing asthma

    PubMed Central

    Loo, Su-Ling; Wark, Peter A.B.

    2016-01-01

    This review highlights the important articles published in the area of asthma research from January 2015 to July 2016. In basic science, significant advances have been made in understanding the link between the innate immune response and type II acquired immune responses in asthma and the role of the airway epithelium. Novel information continues to emerge with regard to the pathogenesis and heterogeneity of severe asthma. There have been important translational clinical trials in the areas of childhood asthma, treatment of allergy to improve asthma outcomes, and improving drug delivery to optimize the management of asthma. In addition, there are increasing data concerning the application of biological agents to the management of severe asthma. This body of work discusses the most notable advances in the understanding and management of asthma. PMID:27610226

  12. Recent advances in understanding and managing asthma

    PubMed Central

    Loo, Su-Ling; Wark, Peter A.B.

    2016-01-01

    This review highlights the important articles published in the area of asthma research from January 2015 to July 2016. In basic science, significant advances have been made in understanding the link between the innate immune response and type II acquired immune responses in asthma and the role of the airway epithelium. Novel information continues to emerge with regard to the pathogenesis and heterogeneity of severe asthma. There have been important translational clinical trials in the areas of childhood asthma, treatment of allergy to improve asthma outcomes, and improving drug delivery to optimize the management of asthma. In addition, there are increasing data concerning the application of biological agents to the management of severe asthma. This body of work discusses the most notable advances in the understanding and management of asthma.

  13. Childhood Asthma Management and Environmental Triggers.

    PubMed

    Hollenbach, Jessica P; Cloutier, Michelle M

    2015-10-01

    Asthma is the most common chronic disease among children. It cannot be prevented but can be controlled. Industrialized countries experience high lifetime asthma prevalence that has increased over recent decades. Asthma has a complex interplay of genetic and environmental triggers. Studies have revealed complex interactions of lung structure and function genes with environmental exposures such as environmental tobacco smoke and vitamin D. Home environmental strategies can reduce asthma morbidity in children but should be tailored to specific allergens. Coupled with education and severity-specific asthma therapy, tailored interventions may be the most effective strategy to manage childhood asthma.

  14. Childhood asthma management pre- and post-incident asthma hospitalization.

    PubMed

    Bianchi, Marina; Clavenna, Antonio; Sequi, Marco; Bortolotti, Angela; Fortino, Ida; Merlino, Luca; Bonati, Maurizio

    2013-01-01

    Many hospitalizations for asthma could potentially be avoided with appropriate management. The aim of this study was to analyze data on disease management of a paediatric population with a hospitalization for asthma. The study population comprised 6-17 year old subjects belonging to three local health units of the Lombardy Region, northern Italy. Regional administrative databases were used to collect data on: the number of children with an incident hospitalization for asthma during the 2004-2006 period, anti-asthma therapy, specialist visit referrals, and claims for spirometry, released in the 12 months before and after hospitalization. Each patient's asthma management profile was compared with GINA guideline recommendations. Among the 183 hospitalized subjects, 101 (55%) received therapy before hospitalization and 82 (45%) did not. 10% did not receive any therapy either before or after hospital admission and in 13% the therapy was discontinued afterward. Based on GINA guidelines, asthma management adhered to recommendations only for 55% of subjects. Results may suggest that for half of hospitalized subjects, inaccurate diagnosis, under-treatment/scarce compliance with asthma guidelines by physicians, and/or scarce compliance to therapy by patients/their parents occurred. In all these cases, hospitalization would be a proxy indicator of preventable poor control of disease, rather than a proxy indicator of severity.

  15. Progress in the management of childhood asthma

    PubMed Central

    Pensrichon, Rattana; Kurasirikul, Suruthai

    2012-01-01

    Asthma has become the most common chronic disease in childhood. Significant advances in epidemiological research as well as in therapy of pediatric asthma have been made over the past 2 decades. In this review, we look at certain aspects therapy of childhood asthma, both in the past and present. Literature review on allergen avoidance (including mites, cockroach and cat), intensive therapy with β2-agonists in acute asthma (administering via continuous nebulization and intravenous routes), a revisit of theophylline use and its action, the use of inhaled corticosteroids in various phases of childhood asthma and sublingual immunotherapy in asthma are examined. Recent facts and dilemmas of these treatments are identified along with expression of our opinions, particularly on points of childhood asthma in the Asia-Pacific, are made in this review. PMID:22348203

  16. [Severe acute asthma in the emergency room: amelioration of decreased peak flow rate is interpreted with difficulty].

    PubMed

    Bouvard, E; Bellocq, A; Bernier, C; Meyniel, D

    1999-09-01

    We report a severe acute asthma case whose course was marked by persistent hypoxemia whereas proximal flows were normalized. This discordance reveals a ventilation/perfusion mismatch. This data suggests that care must be taken in interpreting the peak flow improvement during acute severe asthma management.

  17. Development of a Novel Tool for Engaging Children and Parents in Asthma Self-Management

    PubMed Central

    Nkoy, Flory L.; Stone, Bryan L.; Fassl, Bernhard A.; Koopmeiners, Karmella; Halbern, Sarah; Kim, Eun H.; Poll, Justin; Hales, Joseph W.; Lee, Dillon; Maloney, Christopher G.

    2012-01-01

    This paper describes the development and evaluation of an innovative application designed to engage children and their parents in weekly asthma self-monitoring and self-management to prompt an early response to deteriorations in chronic asthma control, and to provide their physicians with longitudinal data to assess the effectiveness of asthma therapy and prompt adjustments. The evaluation included 2 iterative usability testing cycles with 6 children with asthma and 2 parents of children with asthma to assess user performance and satisfaction with the application. Several usability problems were identified and changes were made to ensure acceptability of the application and relevance of the content. This novel application is unique compared to existing asthma tools and may shift asthma care from the current reactive, acute care model to a preventive, proactive patient-centered approach where treatment decisions are tailored to patients’ individual patterns of chronic asthma control to prevent acute exacerbations. PMID:23304339

  18. Barriers to Asthma Management as Identified by School Nurses.

    PubMed

    Quaranta, Judith E; Spencer, Gale A

    2016-10-01

    Asthma rates are increasing in children. School nurses have opportunities to care for children with asthma but need to overcome barriers impacting their ability to manage asthma in the school setting. This study (a) assessed barriers present in the school setting, (b) determined the impact of barriers on performance of asthma management behaviors, and (c) determined the impact of barriers on importance ratings of asthma management behaviors, asthma self-efficacy, and asthma attitudes (N = 537). Results revealed 72% of the nurses reported at least one barrier. As numbers of barriers increased, performance of asthma management behaviors decreased. Significant relationships were found between specific asthma management behaviors and specific barriers. No significant relationships were found between barriers and asthma self-efficacy, asthma attitude, or importance ratings of asthma management behaviors. Removing barriers may allow the nurse to perform at greatest effectiveness, enhancing the positive outcomes that result from appropriate asthma management. PMID:27044669

  19. Summary of the 2008 BTS/SIGN British Guideline on the management of asthma.

    PubMed

    Levy, Mark L; Thomas, Mike; Small, Iain; Pearce, Linda; Pinnock, Hilary; Stephenson, Paul

    2009-01-01

    The 2008 BTS/SIGN British Guideline on the management of asthma provides comprehensive updated evidence-based guidance on asthma management for healthcare professionals. This primary care-focussed summary has been produced to aid dissemination and implementation of the key guideline messages into primary care. The section on diagnosis emphasises the new integrated symptom-based approach with clinicians using their deductive skills to determine the probability that the patient has asthma. The various tools used for monitoring asthma are discussed. There are sections on both non-pharmacological and pharmacological management of chronic asthma in adults and children. Treatment options for children are subdivided into the under-5s and children aged 5-12 years. Poor asthma control is manifested by exacerbations and acute asthma. Personalised asthma action plans for guided self management should be provided and used when levels of asthma control change. There are sections on difficult asthma and the treatment of exacerbations and acute severe asthma. Various outcome measures for auditing the quality of asthma care are discussed.

  20. The Saudi initiative for asthma – 2012 update: Guidelines for the diagnosis and management of asthma in adults and children

    PubMed Central

    Al-Moamary, Mohamed S.; Alhaider, Sami A.; Al-Hajjaj, Mohamed S.; Al-Ghobain, Mohammed O.; Idrees, Majdy M.; Zeitouni, Mohammed O.; Al-Harbi, Adel S.; Al Dabbagh, Maha M.; Al-Matar, Hussain; Alorainy, Hassan S.

    2012-01-01

    This an updated guidelines for the diagnosis and management of asthma, developed by the Saudi Initiative for Asthma (SINA) group, a subsidiary of the Saudi Thoracic Society. The main objective of SINA is to have updated guidelines, which are simple to understand and easy to use by non-asthma specialists, including primary care and general practice physicians. This new version includes updates of acute and chronic asthma management, with more emphasis on the use of Asthma Control Test in the management of asthma, and a new section on “difficult-to-treat asthma.” Further, the section on asthma in children was re-written to cover different aspects in this age group. The SINA panel is a group of Saudi experts with well-respected academic backgrounds and experience in the field of asthma. The guidelines are formatted based on the available evidence, local literature, and the current situation in Saudi Arabia. There was an emphasis on patient–doctor partnership in the management that also includes a self-management plan. The approach adopted by the SINA group is mainly based on disease control as it is the ultimate goal of treatment. PMID:23189095

  1. Managing Asthma in the Classroom

    ERIC Educational Resources Information Center

    Hamm, Ellen M.

    2004-01-01

    Asthma is the most common chronic disease of childhood, affecting nearly 5 million children under the age of 18. Children with asthma account for 3 million hospital visits and 200,000 hospitalizations yearly. This adds up to an estimated $2 billion annually in health care costs (American Academy of Pediatrics, 1999). A child with asthma has three…

  2. PSYCHOLOGICAL MANAGEMENT OF CHILDHOOD ASTHMA

    PubMed Central

    Selesnick, Sheldon T.; Friedman, David Belais; Augenbraun, Bernice

    1964-01-01

    Over-emphasis on physical factors in asthma probably has come about because psychological factors have seemed elusive, difficult to define and often misleading. Several concepts of classic causes of emotional disturbances that abet asthmatic attacks in children may be helpful in management of the patient and his environs. The first concept has to do with feelings of inadequacy in the mother which lead her to place the burden of decision-making upon the child. She is thus able to give the child very little support and communicates to him her anxiety. Often encouragement to the mother, through the physician's pointing out her very real capacities and achievements can be helpful to the child. The second concept has to do with the asthmatic child's character structure and his assumption of a pseudo-mature position. Among the things the physician can do is to advise the parents as to what is age-appropriate behavior for the child and instruct them in ways to make the child recognize his position of dependence. The third concept concerns threat of separation as a precipitant to the asthma attack. To deal with such a situation the physician may make a number of recommendations of methods for alleviating such a threat. In some families, the degree of disturbance is so great that the parents cannot respond to the physician's advice and may need psychiatric referral. Clues for recognizing such a situation are given along with recommendations on how to make a successful referral. PMID:14154286

  3. Occupational asthma: natural history, evaluation and management

    SciTech Connect

    Lam, S.; Chan-Yeung, M.

    1987-04-01

    A variety of occupational circumstances are capable of inducing asthma by specific exposure to airborne dusts, gases, vapors and fumes. The authors review the clinical history of the disease, including detection of exposures and diagnostic tests. The natural history of occupational asthma, its management and finally its prevention are then discussed.

  4. Critical care in the ED: potentially fatal asthma and acute lung injury syndrome

    PubMed Central

    Hodder, Rick

    2012-01-01

    Emergency department clinicians are frequently called upon to assess, diagnose, and stabilize patients who present with acute respiratory failure. This review describes a rapid initial approach to acute respiratory failure in adults, illustrated by two common examples: (1) an airway disease – acute potentially fatal asthma, and (2) a pulmonary parenchymal disease – acute lung injury/acute respiratory distress syndrome. As such patients are usually admitted to hospital, discussion will be focused on those initial management aspects most relevant to the emergency department clinician. PMID:27147862

  5. Barriers to Asthma Management for School Nurses: An Integrative Review

    ERIC Educational Resources Information Center

    Hanley Nadeau, Ellen; Toronto, Coleen E.

    2016-01-01

    Childhood asthma is a growing health concern. Asthma is the most common chronic illness of childhood and a leading cause of emergency room visits, hospitalizations, and school absenteeism. School nurses play a valuable role in asthma management. The purpose of this integrative review is to examine barriers to asthma management for school nurses in…

  6. Barriers to Asthma Management as Identified by School Nurses

    ERIC Educational Resources Information Center

    Quaranta, Judith E.; Spencer, Gale A.

    2016-01-01

    Asthma rates are increasing in children. School nurses have opportunities to care for children with asthma but need to overcome barriers impacting their ability to manage asthma in the school setting. This study (a) assessed barriers present in the school setting, (b) determined the impact of barriers on performance of asthma management behaviors,…

  7. Children's perception of breathlessness in acute asthma

    PubMed Central

    Male, I; Richter, H; Seddon, P

    2000-01-01

    AIM—To determine whether asthmatic children who present to hospital with hypoxia perceive breathlessness less well than non-hypoxic presenters.
METHODS—A total of 27 children aged 5-16 years (mean age 10) admitted with acute asthma had recordings of oxygen saturation (SaO2), clinical score, forced expiratory volume in one second (FEV1), and breathlessness score (HMP) at admission and at 5, 10, 24,48, and 72 hours after admission. Those defined as hypoxic (SaO2 <92%) at admission were compared with a non-hypoxic group.
RESULTS—Twelve children were hypoxic at admission. Compared with the non-hypoxic group they were younger (8.6 (SD 2.8) v 11.2 (2.8) y, p = 0.02), and had greater airway obstruction (FEV1 32.5 (10)% v 54.3 (26)%, p = 0.0073, 95% confidence interval (CI) −36.9 to −6.6) yet had a trend towards less breathlessness (median HMP 4 v 3, p = 0.062, CI −0.001 to 2.00) at admission. The hypoxic group had a smaller change in breathlessness from admission to discharge, despite a similar improvement in FEV1, reflected in a lower ratio of change in HMP to change in FEV1 (ΔHMP/ΔFEV1) (median ΔHMP/ΔFEV1 0.021%−1v 0.073%−1, p = 0.0081, CI −0.075 to −0.016). Linear regression analysis showed a strong relation between ΔHMP/ΔFEV1 and initial SaO2 (p = 0.004, r = 0.54).
CONCLUSIONS—Asthmatic children who present to hospital hypoxic tend to perceive themselves as less breathless than non-hypoxic children. This may predispose to a future life threatening attack.

 PMID:10999869

  8. A multidisciplinary team case management approach reduces the burden of frequent asthma admissions

    PubMed Central

    Burke, Hannah; Davis, Jenny; Evans, Sian; Flower, Laura; Tan, Andrew

    2016-01-01

    Up to 10% of asthmatics have “difficult asthma”; however, they account for 80% of asthma-related expenditure and run the highest risk of acute severe exacerbations. An estimated 75% of admissions for asthma are avoidable. Guidelines advise that these patients be managed by an experienced specialist multidisciplinary team (MDT). We aimed to assess the impact of a case management strategy delivered via specialist MDTs on acute healthcare utilisation of patients with frequent asthma admissions. An MDT (consultant, specialist nurse, physiotherapist and psychologist) case management strategy was introduced in 2010 at University Hospital Southampton Foundation Trust (Southampton, UK) to support patients with frequent asthma admissions during admission and then in clinic. To assess efficacy, we systematically searched the hospital database for patients acutely admitted for asthma on two or more occasions in 2010, 2011 and 2012. Data were collected retrospectively covering patient demographics, admission details, asthma severity and comorbidity. From 2010 to 2012, 84 patients were admitted on two or more occasions per year (80% female, mean body mass index 31 kg·m−2 and 55% psychological comorbidity). After introducing an MDT approach repeat asthma admissions fell by 33% from 127 in 2010 to 84 in 2012 (p=0.0004). In addition, bed days fell by 52% from 895 in 2010 to 430 in 2010 (p=0.015). An MDT case management approach significantly reduces hospitalisation in difficult asthma patients with prior frequent admission. PMID:27730207

  9. Asthma control questionnaires in the management of asthma in children: A review.

    PubMed

    Voorend-van Bergen, S; Vaessen-Verberne, A A; de Jongste, J C; Pijnenburg, M W

    2015-02-01

    Several self-administered questionnaires have been developed to assess childhood asthma control in a simple and standardized way. This review discusses the most commonly used questionnaires and explores their usefulness in asthma management in children. We conclude that the use of asthma control questionnaires in daily practice and in research contributes to the standardized evaluation of children with asthma and helps to track asthma symptoms, but validation studies in a wider range of settings are needed.

  10. Moving towards effective chronic illness management: asthma as an exemplar.

    PubMed

    Estes, Tracy S

    2011-01-01

    The United States health care system is at a pivotal point in its ability to manage chronic illness. The demands and philosophical differences between the management of acute and chronic illnesses suggest the need for different strategies for effective and efficient management of chronic illness. The purpose of this article is to discuss the Chronic Care Model and the collaborative approach to managing chronic illnesses. Asthma, as an exemplar, will be used to illustrate the need for the development of new models of collaborative care for the treatment of chronic illnesses.

  11. The Saudi Initiative for Asthma - 2016 update: Guidelines for the diagnosis and management of asthma in adults and children

    PubMed Central

    Al-Moamary, Mohamed S.; Alhaider, Sami A.; Idrees, Majdy M.; Al Ghobain, Mohammed O.; Zeitouni, Mohammed O.; Al-Harbi, Adel S.; Yousef, Abdullah A.; Al-Matar, Hussain; Alorainy, Hassan S.; Al-Hajjaj, Mohamed S.

    2016-01-01

    This is an updated guideline for the diagnosis and management of asthma, developed by the Saudi Initiative for Asthma (SINA) group, a subsidiary of the Saudi Thoracic Society. The main objective of SINA is to have guidelines that are up to date, simple to understand and easy to use by nonasthma specialists, including primary care and general practice physicians. SINA approach is mainly based on symptom control and assessment of risk as it is the ultimate goal of treatment. The new SINA guidelines include updates of acute and chronic asthma management, with more emphasis on the use of asthma control in the management of asthma in adults and children, inclusion of a new medication appendix, and keeping consistency on the management at different age groups. The section on asthma in children is rewritten and expanded where the approach is stratified based on the age. The guidelines are constructed based on the available evidence, local literature, and the current situation in Saudi Arabia. There is also an emphasis on patient–doctor partnership in the management that also includes a self-management plan. PMID:26933455

  12. Perceived triggers of asthma: key to symptom perception and management.

    PubMed

    Janssens, T; Ritz, T

    2013-09-01

    Adequate asthma management depends on an accurate identification of asthma triggers. A review of the literature on trigger perception in asthma shows that individuals vary in their perception of asthma triggers and that the correlation between self-reported asthma triggers and allergy tests is only modest. In this article, we provide an overview of psychological mechanisms involved in the process of asthma triggers identification. We identify sources of errors in trigger identification and targets for behavioural interventions that aim to improve the accuracy of asthma trigger identification and thereby enhance asthma control.

  13. Challenges of Asthma Management for School Nurses in Districts with High Asthma Hospitalization Rates

    ERIC Educational Resources Information Center

    Liberatos, Penny; Leone, Jennifer; Craig, Ann Marie; Frei, Elizabeth Mary; Fuentes, Natalie; Harris, India Marie

    2013-01-01

    Background: School nurses play a central role in assisting elementary school children in managing their asthma, especially those in higher-risk school districts that are at increased risk of uncontrolled asthma. Study purposes are to (1) identify barriers to asthma management by school nurses in higher-risk school districts; and (2) assess the…

  14. Living with Asthma: Part 2, Manual for Teaching Children the Self-Management of Asthma.

    ERIC Educational Resources Information Center

    National Heart, Lung, and Blood Inst. (DHHS/NIH), Bethesda, MD. Div. of Lung Diseases.

    The Living with Asthma Program is designed to teach asthma self-management skills to children (ages 8-12) with asthma and to give their parents the knowledge and behavior modification skills to help their children take over responsibility for managing the condition. Both groups receive training in problem solving and in ways to improve family…

  15. New approaches to managing asthma: a US perspective

    PubMed Central

    Berger, William E

    2008-01-01

    Despite remarkable advances in diagnosis and long-term management, asthma remains a serious public health concern. Newly updated expert guidelines emphasize the intra- and inter-individual variability of asthma and highlight the importance of periodic assessment of asthma control. These guidelines update recommendations for step-wise asthma treatment, address the burgeoning field of asthma diagnostics, and stress the importance of a patient and health care professional partnership, including written action plans and self monitoring. The field of asthma therapeutics is expanding rapidly, with promising new treatment options available or in development that may address some of the existing barriers to successful asthma management. These approaches simplify treatment, use combinations of agents in one delivery device that have complementary actions, or target specific pathways involved in asthma patho-physiology. Considerable activity is taking place in asthma pharmacogenetics. This review provides an overview of these new approaches to managing asthma, including their present status and future potential. PMID:18728834

  16. Continuing decline in acute asthma episodes in the community

    PubMed Central

    Sunderland, R; Fleming, D

    2004-01-01

    Aims and Methods: To report on trends in the incidence of asthma episodes in children reported to the WRS over the period 1980–2002. Results: Data confirm the steady upward trend from 1980 to 1993. The downward trend since 1993 was consistent in both male and female preschool and school age children, in all regions of the country simultaneously, and during all seasons until 1999 since when it has stabilised. No causative factor has been identified and no temporal association found between factors previously postulated as causing the increase in acute asthma. The decline in acute asthma episodes in children is consistent with observed declines in all other respiratory infections in this community. PMID:14977715

  17. Biomarkers in the Management of Difficult Asthma

    PubMed Central

    Schleich, Florence; Sophie, Demarche; Renaud, Louis

    2016-01-01

    Difficult asthma is a heterogeneous disease of the airways including various types of bronchial inflammation and various degrees of airway remodeling. Therapeutic response of severe asthmatics can be predicted by the use of biomarkers of Type2-high or Type2-low inflammation. Based on sputum cell analysis, four inflammatory phenotypes have been described. As induced sputum is time-consuming and expensive technique, surrogate biomarkers are useful in clinical practice. Eosinophilic phenotype is likely to reflect ongoing adaptive immunity in response to allergen. Several biomarkers of eosinophilic asthma are easily available in clinical practice (blood eosinophils, serum IgE, exhaled nitric oxyde, serum periostin). Neutrophilic asthma is thought to reflect innate immune system activation in response to pollutants or infectious agents while paucigranulocytic asthma is thought to be not inflammatory and characterized by smooth muscle dysfunction. We currently lack of user-friendly biomarkers of neutrophilic asthma and airway remodeling. In this review, we summarize the biomarkers available for the management of difficult asthma. PMID:26467509

  18. Asthma Risk Profiles of Children Participating in an Asthma Education and Management Program

    ERIC Educational Resources Information Center

    Wilson, Candice; Rapp, Kristi Isaac; Jack, Leonard, Jr.; Hayes, Sandra; Post, Robert; Malveaux, Floyd

    2015-01-01

    Background: Focused risk assessment is essential in the effective management of asthma. Purpose: This study identified and examined correlations among areas of pediatric asthma risk and determined associations between these risks and demographic characteristics. Methods: This exploratory study identified risk factors that affect asthma management…

  19. Asthma Management Disparities: A Photovoice Investigation with African American Youth

    ERIC Educational Resources Information Center

    Evans-Agnew, Robin

    2016-01-01

    Disparities in asthma management are a burden on African American youth. The objective of this study is to describe and compare the discourses of asthma management disparities (AMDs) in African American adolescents in Seattle to existing youth-related asthma policies in Washington State. Adolescents participated in a three-session photovoice…

  20. Asthma in pregnancy: Physiology, diagnosis, and management.

    PubMed

    Kelly, William; Massoumi, Ali; Lazarus, Angeline

    2015-05-01

    Asthma is a common, potentially serious, medical condition that affects an estimated 8% of pregnant patients, with 4% of all pregnant patients experiencing an exacerbation in the past year. Practitioners must be able to diagnose, educate, and treat such patients as they undergo significant physiological and immunologic change. But staying current can be challenging given over 3000 citations for "asthma and pregnancy" in a recent PubMed search, with 750 described as review articles. Patients have even more difficulty navigating information, with 29 million Google search results for this same query and 1.2 million alone for the question whether asthma medications are safe during pregnancy. This review provides brief answers to important management questions followed by supporting background literature.

  1. Asthma in pregnancy: Physiology, diagnosis, and management.

    PubMed

    Kelly, William; Massoumi, Ali; Lazarus, Angeline

    2015-05-01

    Asthma is a common, potentially serious, medical condition that affects an estimated 8% of pregnant patients, with 4% of all pregnant patients experiencing an exacerbation in the past year. Practitioners must be able to diagnose, educate, and treat such patients as they undergo significant physiological and immunologic change. But staying current can be challenging given over 3000 citations for "asthma and pregnancy" in a recent PubMed search, with 750 described as review articles. Patients have even more difficulty navigating information, with 29 million Google search results for this same query and 1.2 million alone for the question whether asthma medications are safe during pregnancy. This review provides brief answers to important management questions followed by supporting background literature. PMID:25702799

  2. Barriers to Asthma Management for School Nurses: An Integrative Review.

    PubMed

    Hanley Nadeau, Ellen; Toronto, Coleen E

    2016-04-01

    Childhood asthma is a growing health concern. Asthma is the most common chronic illness of childhood and a leading cause of emergency room visits, hospitalizations, and school absenteeism. School nurses play a valuable role in asthma management. The purpose of this integrative review is to examine barriers to asthma management for school nurses in the school setting. Findings revealed multiple barriers school nurses encounter in managing asthma. Six themes emerged that included lack of resources and support, insufficient time, communication challenges, limited knowledge, and lack of awareness of school nurses' expertise. Students, parents, primary care physicians, school administration, staff, and school nurses themselves all play a role in constructing barriers to asthma management. There is a need for school nurses and school nurse leaders to focus efforts to develop strategies to overcome barriers to ensure evidence-based, best practice management of asthma in the school setting. PMID:26656476

  3. Barriers to Asthma Management for School Nurses: An Integrative Review.

    PubMed

    Hanley Nadeau, Ellen; Toronto, Coleen E

    2016-04-01

    Childhood asthma is a growing health concern. Asthma is the most common chronic illness of childhood and a leading cause of emergency room visits, hospitalizations, and school absenteeism. School nurses play a valuable role in asthma management. The purpose of this integrative review is to examine barriers to asthma management for school nurses in the school setting. Findings revealed multiple barriers school nurses encounter in managing asthma. Six themes emerged that included lack of resources and support, insufficient time, communication challenges, limited knowledge, and lack of awareness of school nurses' expertise. Students, parents, primary care physicians, school administration, staff, and school nurses themselves all play a role in constructing barriers to asthma management. There is a need for school nurses and school nurse leaders to focus efforts to develop strategies to overcome barriers to ensure evidence-based, best practice management of asthma in the school setting.

  4. Environmental Management of Pediatric Asthma: Guidelines for Health Care Providers

    ERIC Educational Resources Information Center

    Roberts, James R.; McCurdy, Leyla Erk

    2005-01-01

    These guidelines are the product of a new Pediatric Asthma Initiative aimed at integrating environmental management of asthma into pediatric health care. This document outlines competencies in environmental health relevant to pediatric asthma that should be mastered by primary health care providers, and outlines the environmental interventions…

  5. School Asthma Screening and Case Management: Attendance and Learning Outcomes

    ERIC Educational Resources Information Center

    Moricca, Michelle L.; Grasska, Merry A.; BMarthaler, Marcia; Morphew, Tricia; Weismuller, Penny C.; Galant, Stanley P.

    2013-01-01

    Asthma is related to school absenteeism and underperformance in elementary students. This pilot study assessed whether school nurse case management (CM) in children identified with asthma impacts academic performance and school absenteeism in one school. A validated questionnaire was used to identify children at risk for asthma and CM was provided…

  6. Bank One's worksite-based asthma disease management program.

    PubMed

    Burton, W N; Connerty, C M; Schultz, A B; Chen, C Y; Edington, D W

    2001-02-01

    Non-occupational asthma is a common disease affecting approximately 6% of the US population. Asthma accounts for an estimated 3 million workdays lost each year in the United States and for reduced employee job productivity. Although asthma disease management programs are relatively common in managed care organizations, they generally have not been offered at the workplace. A total of 168 employees with asthma were identified, and 76 participated in a worksite asthma disease management program. Of them, 41 (53.9%) completed an Asthma Therapy Assessment Questionnaire (ATAQ) at baseline, post-program (2 months), 4 months, and 12 months. The total ATAQ Index declined from 3.59 at baseline to 2.76 at 12 months (p < 0.01). After the program, significantly more employees reported using controller medications (the desired behavior) rather than reliever medications. A worksite-based disease management program for asthma should reduce medical care costs and absenteeism and improve worker productivity.

  7. Asthma.

    PubMed Central

    Calverley, P. M.

    1996-01-01

    Bronchial asthma is now recognised to be a major cause of morbidity and even mortality in people of all ages. Two important ideas have changed our approach to asthma management. The first is understanding that asthma is a chronic inflammatory disorder which needs regular treatment with anti-inflammatory drugs such as inhaled corticosteroids to prevent further attacks. The second development is the availability of prescribable peak flow meters, which allows both confident diagnosis and early prediction of relapse. Asthma management guidelines provide a logical treatment framework for most patients, but a few difficult cases still consume large amounts of medical time. The commonest problem is one of compliance with treatment which may respond to patient education, although this is not universally so. Other problems include misdiagnosis, acid reflux and, rarely, true corticosteroid-resistant asthma. Several potentially important new treatments have been developed. These include longer acting anticholinergic drugs, drugs with bronchodilator and some anti-inflammatory properties which antagonise or inhibit the production of leukotrienes, sub-types of phosphodiesterase inhibitor with anti-inflammatory properties and immunosuppressive drugs such as cyclosporin. Ultimately these new treatments must be rigorously tested and integrated into a care plan that remains centred on patient education. PMID:8746278

  8. Diagnosis and management of eosinophilic asthma: a US perspective

    PubMed Central

    Walford, Hannah H; Doherty, Taylor A

    2014-01-01

    Eosinophilic asthma is now recognized as an important subphenotype of asthma based on the pattern of inflammatory cellular infiltrate in the airway. Eosinophilic asthma can be associated with increased asthma severity, atopy, late-onset disease, and steroid refractoriness. Induced sputum cell count is the gold standard for identifying eosinophilic inflammation in asthma although several noninvasive biomarkers, including fractional exhaled nitric oxide and periostin, are emerging as potential surrogates. As novel therapies and biologic agents become increasingly available, there is an increased need for specific phenotype-directed treatment strategies. Greater recognition and understanding of the unique immunopathology of this asthma phenotype has important implications for management of the disease and the potential to improve patient outcomes. The present review provides a summary of the clinical features, pathogenesis, diagnosis, and management of eosinophilic asthma. PMID:24748808

  9. Methylprednisolone pulse therapy in severe acute asthma.

    PubMed

    Pedersen, B K; Laursen, L C; Lervang, H H; Stjernebjerg, T; Weeke, B

    1987-02-01

    In a group comparative double blind pilot study six asthmatic patients with an acute exacerbation of their disease were randomly treated with either methylprednisolone pulse therapy (MPPT) (1000 mg daily for 3 days) (n = 2) followed by placebo tablets, or standard doses of methylprednisolone (MP) (50 mg daily gradually decreased to zero over 3 weeks) (n = 4). The results showed that the effect of MPPT did not differ from that of standard doses of MP. MPPT has, however, the potential of being preferable to standard treatment with MP, because of easy administration and optimal patient compliance. PMID:3296841

  10. Managing Asthma: A Guide for Schools.

    ERIC Educational Resources Information Center

    National Heart, Lung, and Blood Inst. (DHHS/NIH), Bethesda, MD.

    This guide was developed to provide school personnel with practical ways to help students with asthma participate fully in all school activities. It begins by noting the prevalence of asthma and stating that asthma is a leading cause of absenteeism among students. This is followed by a brief description of asthma as a chronic lung disease…

  11. Recognition and management of asthma in children and young people.

    PubMed

    Pinfield, Jenny; Gaskin, Kerry; Bentley, Jackie; Rouse, Jo

    2015-09-16

    Asthma is a common childhood disorder that has global significance. Developing an understanding of the aetiology, effects, diagnosis and management of the disorder enables healthcare practitioners to reduce the physical, psychological and social effects of asthma on children, families and healthcare systems. This article refers to the Scottish Intercollegiate Guidelines Network and British Thoracic Society guideline on the management of asthma, and enables the reader to incorporate this guidance into their practice.

  12. Partners in School Asthma Management: Evaluation of a Self-Management Program for Children with Asthma

    ERIC Educational Resources Information Center

    Bartholomew, L. Kay; Sockrider, Marianna M.; Abramson, Stuart L.; Swank, Paul R.; Czyzewski, Danita I.; Tortolero, Susan R.; Markham, Christine M.; Fernandez, Maria E.; Shegog, Ross; Tyrrell, Shellie

    2006-01-01

    The "Partners in School Asthma Management" program for inner-city elementary school children comprises (1) case finding; (2) linkage of school nurses, parents, and clinicians; (3) a computer-based tailored educational program; and (4) school environmental assessment and intervention. Case finding identified 1730 children in 60 elementary schools…

  13. Severe Acute Asthma Exacerbation in Children: A Stepwise Approach for Escalating Therapy in a Pediatric Intensive Care Unit

    PubMed Central

    Nievas, I. Federico Fernandez; Anand, Kanwaljeet J. S.

    2013-01-01

    OBJECTIVES An increasing prevalence of pediatric asthma has led to increasing burdens of critical illness in children with severe acute asthma exacerbations, often leading to respiratory distress, progressive hypoxia, and respiratory failure. We review the definitions, epidemiology, pathophysiology, and clinical manifestations of severe acute asthma, with a view to developing an evidence-based, stepwise approach for escalating therapy in these patients. METHODS Subject headings related to asthma, status asthmaticus, critical asthma, and drug therapy were used in a MEDLINE search (1980–2012), supplemented by a manual search of personal files, references cited in the reviewed articles, and treatment algorithms developed within Le Bonheur Children's Hospital. RESULTS Patients with asthma require continuous monitoring of their cardiorespiratory status via noninvasive or invasive devices, with serial clinical examinations, objective scoring of asthma severity (using an objective pediatric asthma score), and appropriate diagnostic tests. All patients are treated with β-agonists, ipratropium, and steroids (intravenous preferable over oral preparations). Patients with worsening clinical status should be progressively treated with continuous β-agonists, intravenous magnesium, helium-oxygen mixtures, intravenous terbutaline and/or aminophylline, coupled with high-flow oxygen and non-invasive ventilation to limit the work of breathing, hypoxemia, and possibly hypercarbia. Sedation with low-dose ketamine (with or without benzodiazepines) infusions may allow better toleration of non-invasive ventilation and may also prepare the patient for tracheal intubation and mechanical ventilation, if indicated by a worsening clinical status. CONCLUSIONS Severe asthma can be a devastating illness in children, but most patients can be managed by using serial objective assessments and the stepwise clinical approach outlined herein. Following multidisciplinary education and training, this

  14. Maternal complications and the management of asthma in pregnancy.

    PubMed

    Vanders, Rebecca L; Murphy, Vanessa E

    2015-03-01

    Pregnancy is a unique state requiring alterations in maternal physiology to accommodate the growing fetus. Whilst the maternal immune system is normally well adept at performing this task, the presence of immune disorders, such as asthma, often lead to pregnancy-related complications affecting both mother and baby. Australia has a high prevalence of asthma; with approximately 12% of pregnant women reported to have current asthma. Poor control of asthma is of far greater risk than the use of asthma medications. Being able to identify complications associated with asthma during pregnancy is of great importance in providing appropriate asthma management and medical care to these pregnant women, which may have lifelong consequences for their offspring.

  15. Original Research: Acute chest syndrome in sickle cell disease: Effect of genotype and asthma

    PubMed Central

    Pahl, Kristy

    2016-01-01

    Sickle cell disease is a severe hemoglobinopathy caused by mutations in the beta globin genes. The disorder has protean manifestations and leads to severe morbidity and early mortality. Acute chest syndrome (ACS) is a common complication and in the USA is the leading cause of death in patients with sickle cell disease. Care of patients with sickle cell disease is complex and typically involves both primary care physicians and hematology subspecialists. The purpose of this study was first to attempt to validate in a pediatric sickle cell patient cohort associations between ACS and sickle cell disease genotype and between ACS and asthma as a comorbidity. The second purpose of the study was to study in a typical community the frequency with which asthma associated with ACS was addressed in terms of electronic medical record integration, pulmonary subspecialty consultation for management of asthma, and completion of pulmonary function testing (PFTs). A retrospective study of the electronic medical record of a children’s hospital that provides most of the medical care for children in a portion of western New York state was performed. We found that ACS was more common in the sickle cell disease genotypes SS and S/beta-thalassemia-null, and that ACS was more frequent in patients treated for asthma. We also found that despite the use of a comprehensive electronic medical record, there was poor documentation of ACS and asthma episodes in the problem lists of patients with sickle cell disease, and that most patients with sickle cell disease with ACS or asthma failed to receive formal consultation services from pediatric pulmonary subspecialists. PMID:26936083

  16. Original Research: Acute chest syndrome in sickle cell disease: Effect of genotype and asthma.

    PubMed

    Pahl, Kristy; Mullen, Craig A

    2016-04-01

    Sickle cell disease is a severe hemoglobinopathy caused by mutations in the beta globin genes. The disorder has protean manifestations and leads to severe morbidity and early mortality. Acute chest syndrome (ACS) is a common complication and in the USA is the leading cause of death in patients with sickle cell disease. Care of patients with sickle cell disease is complex and typically involves both primary care physicians and hematology subspecialists. The purpose of this study was first to attempt to validate in a pediatric sickle cell patient cohort associations between ACS and sickle cell disease genotype and between ACS and asthma as a comorbidity. The second purpose of the study was to study in a typical community the frequency with which asthma associated with ACS was addressed in terms of electronic medical record integration, pulmonary subspecialty consultation for management of asthma, and completion of pulmonary function testing (PFTs). A retrospective study of the electronic medical record of a children's hospital that provides most of the medical care for children in a portion of western New York state was performed. We found that ACS was more common in the sickle cell disease genotypes SS and S/beta-thalassemia-null, and that ACS was more frequent in patients treated for asthma. We also found that despite the use of a comprehensive electronic medical record, there was poor documentation of ACS and asthma episodes in the problem lists of patients with sickle cell disease, and that most patients with sickle cell disease with ACS or asthma failed to receive formal consultation services from pediatric pulmonary subspecialists.

  17. The prevalence, management and burden of asthma - a Nigerian study.

    PubMed

    Oni, Alexander O; Erhabor, G E; Egbagbe, E E

    2010-03-01

    Inadequate attention given to the management of asthma and ways of improving treatment could be a significant factor for the increase morbidity and mortality from asthma despite major advances in our understanding of the pathophysiology of the disease. There seems to be paucity of data concerning the management pattern and burden of asthma in Africa. This study was under taken to determine the prevalence, management pattern and the burden of asthma. This study was a cross sectional design involving clinical and lung function assessment. The diagnosis of asthma was made using the clinical features of asthma and lung function parameters (Forced expiratory volume in one second, Peak expiratory flow rate, Reversibility tests). Totally, 120 asthma patients participated in this study. All subjects completed the clinical asthma control questionnaires. All items were rated with the calculation of their mean and percentages. Student t-test was used to calculate the difference between the mean of the lung function tests for subjects and control. The prevalence of asthma among respiratory unit patients was 6.6% and higher in the first three decades of life with female preponderance (F:M=1.5-1).There is a strong family history of asthma(81.7%). Associated allergies include rhinitis (75%), pharyngitis (54%), conjunctivitis (54%) and dermatitis (30%). Percentage of asthma patients treated with bronchodilators alone (70%), combined inhaled bronchodilators and steroid (28.3%). Impaired daily activities include sports (84%), Job career (60%), Physical activity (55%), Social activity (54%), Household chores (61%), Disturbed sleep (53%), Daytime symptoms (51%), Hospitalized(50%). Subjects had significant low lung function values when compared with control (P < 0.05). The burden of asthma is very high despite the advanced knowledge of the pathophysiology and management of asthma.

  18. The Acute Asthma Severity Assessment Protocol (AASAP) study: objectives and methods of a study to develop an acute asthma clinical prediction rule.

    PubMed

    Arnold, Donald H; Gebretsadik, Tebeb; Abramo, Thomas J; Sheller, James R; Resha, Donald J; Hartert, Tina V

    2012-06-01

    Acute asthma exacerbations are one of the most common reasons for paediatric emergency department visits and hospitalisations, and a relapse frequently necessitates repeat urgent care. While care plans exist, there are no acute asthma prediction rules (APRs) to assess severity and predict outcome. The primary objective of the Acute Asthma Severity Assessment Protocol study is to develop a multivariable APR for acute asthma exacerbations in paediatric patients. A prospective, convenience sample of paediatric patients aged 5-17 years with acute asthma exacerbations who present to an urban, academic, tertiary paediatric emergency department was enrolled. The study protocol and data analysis plan conform to accepted biostatistical and clinical standards for clinical prediction rule development. Modelling of the APR will be performed once the entire sample size of 1500 has accrued. It is anticipated that the APR will improve resource utilisation in the emergency department, aid in standardisation of disease assessment and allow physician and non-physician providers to participate in earlier objective decision making. The objective of this report is to describe the study objectives and detailed methodology of the Acute Asthma Severity Assessment Protocol study.

  19. Integrated Self-Management System for Improved Treatment of Asthma

    PubMed Central

    NGUYEN, Kristen T.; CULJAT, Martin O.; MIERZWA, Andrzej P.; SINGH, Rahul S.; FONG, Benson; VANLANDINGHAM, Rebecca

    2016-01-01

    A mobile, affordable product that provides clinicians and patients with comprehensive asthma assessment is needed to improve asthma control. Our solution is an integrated system consisting of a portable, inexpensive, easy-to-use spirometer and a mobile application that communicates wirelessly with the spirometer. Results demonstrated that the wireless asthma management solution meets recommended American Thoracic Society (ATS) and European Respiratory Society (ERS) standards. The device is expected to empower patients to accurately self-assess their asthma for better self-management at home, work, or leisure. PMID:27046589

  20. The role of the asthma nurse in treatment compliance and self-management following hospital admission.

    PubMed

    Morice, A H; Wrench, C

    2001-11-01

    Effective self-management and treatment compliance is important in achieving good symptom control in asthma. The aim of this study was to determine whether asthma nurse intervention during hospital admission could increase knowledge and improve self-management and whether this would influence the number of emergency call-out visits by Genera Practitioners (GPs) and hospital re-admissions. Patients with acute asthma (n=80) were assessed by the asthma nurse within 24 h of admission using a British Thoracic Society (BTS) guideline-based questionnaire. Main outcome measures were: know edge of inhalers, self-management plans, peak flow monitoring, recognition of worsening symptoms and appropriate emergency action, Following randomization, half received nurse intervention during hospitalization. All received a follow-up questionnaire 6 weeks post-discharge and again at 6 months (response rates 86% and 81% respectively). GPs were contacted by postal questionnaire after 4 months. Questionnaire responses indicated an increase in knowledge in the intervention group, along with an ability to identify appropriate action on worsening symptoms. Emergency GP call-outs were more frequent in the control group in the 4 months post-discharge. Hospital re-admission rates were similar in both groups. Asthma nurse intervention appeared to increase knowledge of asthma management, maintained throughout the study period, but had no significant impact on reducing re-admissions to hospital.

  1. Dyspnea in acute bronchial asthma in an emergency room.

    PubMed

    Kunitoh, H; Watanabe, K; Sajima, Y

    1994-03-01

    Pulmonary function, arterial blood gases, and pulse rate were prospectively compared with dyspnea perceived by patients before and after emergency room treatment for acute asthma in 83 episodes. Subjective degree of dyspnea was rated on a modified Borg scale. Before treatment, all spirometry (FVC, FEV1, and peak expiratory flow rate) and arterial blood gas (PaO2, PaCO2, and bicarbonate) data as well as pulse rate were significantly correlated with modified Borg scale, but only PaCO2 showed significant correlation (P < .001) in a multivariate analysis. After treatment, only PaO2 was significantly correlated with modified Borg scale (P = .008) in a multivariate analysis, and pulse rate showed correlation of borderline significance (P = .06). In another 37 episodes of relapsed acute asthma, the correlations between laboratory data and modified Borg scale were very weak, especially after treatment. We conclude that dyspnea expressed by asthmatic patients in an emergency room might be reflecting different mechanisms as treatment is performed. Although it should be one useful guide in emergency evaluation, it must be recognized that dyspnea in the same patient could mean different abnormalities.

  2. Asthma and other recurrent wheezing disorders in children (acute)

    PubMed Central

    2012-01-01

    Introduction Acute childhood asthma is a common clinical emergency presenting across a range of ages and with a range of severities. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for acute asthma in children? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 35 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: beta2 agonists (high-dose nebulised, metered-dose inhaler plus spacer device versus nebuliser, intravenous), corticosteroids (systemic, high-dose inhaled), ipratropium bromide (single- or multiple-dose inhaled), magnesium sulphate, oxygen, and theophylline or aminophylline. PMID:24807832

  3. Managing Asthma: Learning to Breathe Easier

    MedlinePlus

    ... even narrower. Common asthma triggers include cigarette smoke, air pollution, mold, house dust mites, and furry animal dander. ... your asthma worse—such as dust mites, mold, air pollution, or secondhand tobacco smoke—and try to avoid ...

  4. Using the Health Belief Model to Understand School Nurse Asthma Management.

    PubMed

    Quaranta, Judith E; Spencer, Gale A

    2015-12-01

    Ten million children in the United States have asthma. Since children are in school about 6 hr a day, school nurses are positioned to intervene and influence asthma outcomes. A descriptive correlational study was designed to investigate performance of school nurses' asthma management behaviors in relationship to asthma knowledge, asthma attitude, asthma self-efficacy, and rating of importance of asthma management behaviors. Results indicated that asthma attitude, asthma self-efficacy, and rating of importance of asthma management behaviors were associated with performance of asthma management behaviors. The higher the rating of importance of asthma management behaviors, the more likely school nurses were to perform the behaviors (p < .05). Higher levels of asthma self-efficacy were associated with performance of asthma management behaviors, indicating the importance of strengthening school nurses' asthma self-efficacy in asthma management. By understanding factors influencing performance of asthma management behaviors by school nurses, interventions can be implemented to increase asthma management behaviors, leading to improved outcomes for students with asthma. PMID:26324467

  5. Managing Asthma in the Early Childhood Setting

    ERIC Educational Resources Information Center

    Graville, Iris

    2011-01-01

    Asthma, one of the most common chronic disorders in childhood, affects more than seven million children in the United States, and is the third leading cause of hospitalization for children. Statistics like these make planning and preparing for asthma in the early childhood setting a high priority. With the high rates of asthma in the U.S. today,…

  6. An Online Simulation in Pediatric Asthma Management

    ERIC Educational Resources Information Center

    Hopper, Keith B.

    2004-01-01

    The Centers for Disease Control (CDC) estimates that nearly 20 million Americans suffer from asthma, 6.3 million of which are children (Centers for Disease Control and Prevention, 2004). It is not merely an annoyance disease, as is commonly believed. Asthma kills. It takes more than 5,000 American lives each year (Asthma Statistics in America,…

  7. IAQ Tools for Schools: Managing Asthma in the School Environment.

    ERIC Educational Resources Information Center

    Environmental Protection Agency, Washington, DC. Office of Radiation and Indoor Air.

    This manual provides tips on improving indoor air quality within the school environment by removing the elements that trigger asthma attacks in children, and presents a list of organizations where asthma resource information can be obtained. Air quality management tips cover removing of animal and cockroach allergens, cleaning up mold and…

  8. Advocate's disease management program reduces readmissions for CHF and asthma.

    PubMed

    2003-03-01

    Advocate's disease management program reduces readmissions for congestive heart failure (CHF) and asthma. Educating CHF and asthma patients while they are in the hospital, using standing orders that reflect national guidelines, and then providing nurse specialists to follow up with patients while they are in the outpatient setting is proving to be a winning combination for Advocate Health Care.

  9. Examining Household Asthma Management Behavior through a Microeconomic Framework

    ERIC Educational Resources Information Center

    Magzamen, Sheryl; Brandt, Sylvia J.; Tager, Ira B.

    2014-01-01

    National guidelines on the effective management of pediatric asthma have been promoted for over 20 years, yet asthma-related morbidity among low-income children remains disproportionately high. To date, household and clinical interventions designed to remediate these differences have been informed largely by a health behavior framework. However,…

  10. Early prediction of poor outcome in patients with acute asthma in the emergency room.

    PubMed

    Mallmann, F; Fernandes, A K; Avila, E M; Nogueira, F L; Steinhorst, A M P; Saucedo, D Z; Machado, F J; Raymundi, M G; Dalcin, P T R; Menna Barreto, S S

    2002-01-01

    Early identification of patients who need hospitalization or patients who should be discharged would be helpful for the management of acute asthma in the emergency room. The objective of the present study was to examine the clinical and pulmonary functional measures used during the first hour of assessment of acute asthma in the emergency room in order to predict the outcome. We evaluated 88 patients. The inclusion criteria were age between 12 and 55 years, forced expiratory volume in the first second below 50% of predicted value, and no history of chronic disease or pregnancy. After baseline evaluation, all patients were treated with 2.5 mg albuterol delivered by nebulization every 20 min in the first hour and 60 mg of intravenous methylprednisolone. Patients were reevaluated after 60 min of treatment. Sixty-five patients (73.9%) were successfully treated and discharged from the emergency room (good responders), and 23 (26.1%) were hospitalized or were treated and discharged with relapse within 10 days (poor responders). A predictive index was developed: peak expiratory flow rates after 1 h < or =0% of predicted values and accessory muscle use after 1 h. The index ranged from 0 to 2. An index of 1 or higher presented a sensitivity of 74.0, a specificity of 69.0, a positive predictive value of 46.0, and a negative predictive value of 88.0. It was possible to predict outcome in the first hour of management of acute asthma in the emergency room when the index score was 0 or 2.

  11. A woman with asthma: a whole systems approach to supporting self-management

    PubMed Central

    Pinnock, Hilary; Ehrlich, Elisabeth; Hoskins, Gaylor; Tomlins, Ron

    2014-01-01

    A 35-year-old lady attends for review of her asthma following an acute exacerbation. There is an extensive evidence base for supported self-management for people living with asthma, and international and national guidelines emphasise the importance of providing a written asthma action plan. Effective implementation of this recommendation for the lady in this case study is considered from the perspective of a patient, healthcare professional, and the organisation. The patient emphasises the importance of developing a partnership based on honesty and trust, the need for adherence to monitoring and regular treatment, and involvement of family support. The professional considers the provision of asthma self-management in the context of a structured review, with a focus on a self-management discussion which elicits the patient’s goals and preferences. The organisation has a crucial role in promoting, enabling and providing resources to support professionals to provide self-management. The patient’s asthma control was assessed and management optimised in two structured reviews. Her goal was to avoid disruption to her work and her personalised action plan focused on achieving that goal. PMID:25321880

  12. Asthma

    MedlinePlus

    ... that you have asthma. Your doctor will diagnose asthma based on lung function tests, your medical history, and a physical exam. You may also have allergy tests. When your asthma symptoms become worse than usual, it's called an ...

  13. Asthma

    MedlinePlus

    ... Got Homework? Here's Help White House Lunch Recipes Asthma KidsHealth > For Kids > Asthma Print A A A ... it can take several days. continue Who Gets Asthma? No one really knows why one person's airways ...

  14. Using the Health Belief Model to Understand School Nurse Asthma Management

    ERIC Educational Resources Information Center

    Quaranta, Judith E.; Spencer, Gale A.

    2015-01-01

    Ten million children in the United States have asthma. Since children are in school about 6 hr a day, school nurses are positioned to intervene and influence asthma outcomes. A descriptive correlational study was designed to investigate performance of school nurses' asthma management behaviors in relationship to asthma knowledge, asthma attitude,…

  15. Disparities in Asthma Care, Management, and Education Among Children With Asthma

    PubMed Central

    Holsey, Chanda N.; Collins, Pamela; Zahran, Hatice

    2016-01-01

    Health disparities are pervasive in the United States. Health and health care disparities are the differences or gaps in health (eg, life expectancy, morbidity, risk factors, and quality of life) and health care access and quality between segments of the United States population as related to race/ethnicity and socioeconomic status (eg, income, education). Multiple factors are associated with such disparities in asthma management and education. This article explores some of those factors and summarizes the strategies developed and interventions implemented to address disparities associated with asthma care and education among racial and ethnic minority children. It also discusses the need for further research to identify effective asthma education approaches for improving the management of asthma among racial and ethnic minority children. More exploration of the root causes of health care disparities, including policy studies in the area of social determinates of health and health equity, is also needed. PMID:27570439

  16. Asthma Prevalence, Management, and Education in New York State Elementary Schools: A Survey of School Nurses

    ERIC Educational Resources Information Center

    Kielb, Christine; Lin, Shao; Hwang, Syni-an

    2007-01-01

    A survey of school nurses was conducted in New York State elementary schools to assess asthma and asthma management in students. The survey contained questions about asthma morbidity, management and education, obstacles to management, and school indoor air quality. The reported prevalence of asthma among students was 8.5%. Of the students with…

  17. Asthma Management: Part I: An Overview of the Problem and Current Trends.

    ERIC Educational Resources Information Center

    Baker, Valerie O'Toole; Friedman, Janet; Schmitt, Rita

    2002-01-01

    Describes the pathophysiology of asthma and the types, risk factors, and current trends in management of the disease. The role of the school nurse in asthma management is outlined, including identifying children with asthma, evaluating the child's response to the asthma management plan, and controlling environmental factors that precipitate asthma…

  18. Internet telehealth for pediatric asthma case management: integrating computerized and case manager features for tailoring a Web-based asthma education program.

    PubMed

    Wise, Meg; Gustafson, David H; Sorkness, Christine A; Molfenter, Todd; Staresinic, Anthony; Meis, Tracy; Hawkins, Robert P; Shanovich, Kathleen Kelly; Walker, Nola P

    2007-07-01

    This article reports on the development of a personalized, Web-based asthma-education program for parents whose 4- to 12-year-old children have moderate to severe asthma. Personalization includes computer-based tailored messages and a human coach to build asthma self-management skills. Computerized features include the Asthma Manager, My Calendar/Reminder, My Goals, and a tailored home page. These are integrated with monthly asthma-education phone calls from an asthma-nurse case manager. The authors discuss the development process and issues and describe the current randomized evaluation study to test whether the year-long integrated intervention can improve adherence to a daily asthma controller medication, asthma control, and parent quality of life to reduce asthma-related healthcare utilization. Implications for health education for chronic disease management are raised.

  19. Concise guidance: diagnosis, management and prevention of occupational asthma.

    PubMed

    Nicholson, Paul J; Cullinan, Paul; Burge, Sherwood

    2012-04-01

    This concise guidance, prepared for physicians, summarises the British Occupational Health Research Foundation guideline for the prevention, identification and management of occupational asthma. Approximately one in six people of working age who develop asthma have work-related asthma, where work has either caused or aggravated their disease. Physicians who assess working adults with asthma need to ask the patient about their job and the materials they work with, and be aware of those that carry particular risks; they should also ask whether symptoms improve regularly on days away from work. A diagnosis of occupational asthma (ie asthma caused by work) should not be made on the basis of history alone, but be supported by immunological and physiological investigations of proven diagnostic benefit. Following a validated diagnosis of occupational asthma, physicians should recommend early avoidance of further exposure, because this offers the best chance of complete recovery. If appropriate and timely interventions are not taken, the prognosis of occupational asthma is poor, with only approximately one-third of workers achieving full symptomatic recovery.

  20. Optimising the management of patients with difficult asthma.

    PubMed

    Palmer, Evelyn; Higgins, Bernard

    2015-11-01

    Asthma affects 5.4 million people in the UK, around 1 in 12 of the population. Between 5 and 10% of asthma (depending on the definition used) is categorised as difficult asthma, a term which generally refers to patients who continue to experience symptoms and frequent exacerbations despite the prescription of high-dose asthma therapy. Difficult asthma is an indication for specialist review by an appropriate respiratory physician, but close liaison between primary, secondary and tertiary care is critical and it is therefore important that primary care health professionals should be aware of the principles of management. One of the most important questions to ask is whether the individual with difficult asthma is taking their treatment Identifying this, however, is not easy. GPs could assess prescription uptake, looking for low use of preventers and excess use of short-acting bronchodilators. Newer means of assessing adherence have been developed. Inhaler devices that can monitor completion and timing of actuations have been produced. Meters that measure FeNO are available. A recent UK study found that 12 out of 100 patients referred for difficult asthma did not have reversible airflow obstruction or a history suggestive of asthma. Diagnoses included COPD, cystic fibrosis, cardiomyopathy, respiratory muscle dysfunction and severe anxiety with vocal cord dysfunction. PMID:26753269

  1. Optimising the management of patients with difficult asthma.

    PubMed

    Palmer, Evelyn; Higgins, Bernard

    2015-11-01

    Asthma affects 5.4 million people in the UK, around 1 in 12 of the population. Between 5 and 10% of asthma (depending on the definition used) is categorised as difficult asthma, a term which generally refers to patients who continue to experience symptoms and frequent exacerbations despite the prescription of high-dose asthma therapy. Difficult asthma is an indication for specialist review by an appropriate respiratory physician, but close liaison between primary, secondary and tertiary care is critical and it is therefore important that primary care health professionals should be aware of the principles of management. One of the most important questions to ask is whether the individual with difficult asthma is taking their treatment Identifying this, however, is not easy. GPs could assess prescription uptake, looking for low use of preventers and excess use of short-acting bronchodilators. Newer means of assessing adherence have been developed. Inhaler devices that can monitor completion and timing of actuations have been produced. Meters that measure FeNO are available. A recent UK study found that 12 out of 100 patients referred for difficult asthma did not have reversible airflow obstruction or a history suggestive of asthma. Diagnoses included COPD, cystic fibrosis, cardiomyopathy, respiratory muscle dysfunction and severe anxiety with vocal cord dysfunction.

  2. Compliance amongst asthma patients registered for an asthma disease risk-management programme in South Africa.

    PubMed

    Opedun, Ntombombuso; Ehlers, Valerie J; Roos, Janetta H

    2011-09-27

    The study attempted to identify the factors that influence compliance amongst 1039 members and their dependants of a particular medical aid scheme in South Africa who were registered for an asthma disease risk-management (DRM) programme. The sample consisted of 200 systematically selected individuals or their dependants. A quantitative, exploratory, and descriptive study was undertaken. Questionnaires for completion were posted to the individuals or their dependants. The Statistica 7.1 computer program was used to analyse the data.Most asthma patients did not comply with the DRM programme because they lacked knowledge of the programme. Asthma patients' compliance with the DRM programme can be enhanced by the sustained, positive attitudes of their health providers and case managers; better promotion of the programme; and by involving the patients to a greater extent in the long-term management of their disease.Asthma patients require education about healthy lifestyles that would empower them to successfully manage their condition, which would prevent or at least reduce asthma attacks and/or hospital admissions.

  3. Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007.

    PubMed

    2007-11-01

    instructions for daily treatment and ways to recognize and handle worsening asthma. New recommendations encourage expanding educational opportunities to reach patients in a variety of settings, such as pharmacies, schools, community centers, and patients' homes. A new section addresses the need for clinician education programs to improve communication with patients and to use system-wide approaches to integrate the guidelines into health care practice. The guidelines describe new evidence for using multiple approaches to limit exposure to allergens and other substances that can worsen asthma; research shows that single steps are rarely sufficient. EPR-3 also expands the section on common conditions that can affect asthma and notes that management of these conditions may help to improve asthma control. Expert Panel Report 3 continues the use of a stepwise approach to control asthma. When assessing the level of asthma control to determine the need for adjusting therapy, EPR-3 reconfirms the importance of assessing patient adherence to medication, inhaler technique, and environmental control measures before making a step up in therapy. The stepwise approach expands from 4 steps to 6 steps of care. Medications have been repositioned within these 6 steps. Recommendations on medications are updated to reflect the latest evidence on effectiveness and safety. EPR-3 reaffirms that patients with persistent asthma need both long-term control medications to control asthma and prevent exacerbations and quick-relief medication for symptoms, as needed. EPR-3 also reaffirms that inhaled corticosteroids are the most effective long-term control medication across all age groups. New recommendations on treatment options such as leukotriene receptor antagonists and cromolyn for long-term control; long-acting beta-agonists as adjunct therapy with inhaled corticosteroids; omalizumab for severe asthma; and albuterol, levalbuterol, and corticosteroids for acute exacerbations are included. PMID

  4. Management of asthma: the current US and European guidelines.

    PubMed

    Reddy, Ashwini P; Gupta, Meera R

    2014-01-01

    Asthma management guidelines aim to improve the implementation of current knowledge into daily clinical practice by establishing a consensus of scientific practices for the management of asthma. Initial guidelines were based on consensus of expert opinion in order to employ a severity-based classification system as a guide to treatment. However, advances in asthma research led to the development of evidence-based guidelines and a major paradigm shift to control-based asthma management. Control-based management is central to the published guidelines developed by The National Heart, Lung, and Blood Institute (NHLBI), The Global Initiative for Asthma (GINA), and The British Thoracic Society (BTS), each one using the same volume of evidence but emphasizing aspects particular to their specific patient populations and socioeconomic needs. This chapter summarizes the evolution of these guidelines and summarizes the key points and evidence used in the recommendations for the assessment, monitoring, and management of asthma in all ages, with particular emphasis on the NHLBI guidelines.

  5. Management of critical asthma syndrome during pregnancy.

    PubMed

    Chan, Andrew L; Juarez, Maya M; Gidwani, Nisha; Albertson, Timothy E

    2015-02-01

    One-third of pregnant asthmatics experience a worsening of their asthma that may progress to a critical asthma syndrome (CAS) that includes status asthmaticus (SA) and near-fatal asthma (NFA). Patients with severe asthma before pregnancy may experience more exacerbations, especially during late pregnancy. Prevention of the CAS includes excellent asthma control involving targeted early and regular medical care of the pregnant asthmatic, together with medication compliance. Spontaneous abortion risk is higher in pregnant women with uncontrolled asthma than in non-asthmatics. Should CAS occur during pregnancy, aggressive bronchodilator therapy, montelukast, and systemic corticosteroids can be used in the context of respiratory monitoring, preferably in an Intensive Care Unit (ICU). Systemic epinephrine should be avoided due to potential teratogenic side-effects and placental/uterine vasoconstriction. Non-invasive ventilation has been used in some cases. Intratracheal intubation can be hazardous and rapid-sequence intubation by an experienced physician is recommended. Mechanical ventilation parameters are adjusted based on changes to respiratory mechanics in the pregnant patient. An inhaled helium-oxygen gas admixture may promote laminar airflow and improve gas exchange. Permissive hypercapnea is controversial, but may be unavoidable. Sedation with propofol which itself has bronchodilating properties is preferred to benzodiazepines. Case reports delineating good outcomes for both mother and fetus despite intubation for SA suggest that multidisciplinary ICU care of the pregnant asthmatic with critical asthma are feasible especially if hypoxemia is avoided.

  6. Management of critical asthma syndrome during pregnancy.

    PubMed

    Chan, Andrew L; Juarez, Maya M; Gidwani, Nisha; Albertson, Timothy E

    2015-02-01

    One-third of pregnant asthmatics experience a worsening of their asthma that may progress to a critical asthma syndrome (CAS) that includes status asthmaticus (SA) and near-fatal asthma (NFA). Patients with severe asthma before pregnancy may experience more exacerbations, especially during late pregnancy. Prevention of the CAS includes excellent asthma control involving targeted early and regular medical care of the pregnant asthmatic, together with medication compliance. Spontaneous abortion risk is higher in pregnant women with uncontrolled asthma than in non-asthmatics. Should CAS occur during pregnancy, aggressive bronchodilator therapy, montelukast, and systemic corticosteroids can be used in the context of respiratory monitoring, preferably in an Intensive Care Unit (ICU). Systemic epinephrine should be avoided due to potential teratogenic side-effects and placental/uterine vasoconstriction. Non-invasive ventilation has been used in some cases. Intratracheal intubation can be hazardous and rapid-sequence intubation by an experienced physician is recommended. Mechanical ventilation parameters are adjusted based on changes to respiratory mechanics in the pregnant patient. An inhaled helium-oxygen gas admixture may promote laminar airflow and improve gas exchange. Permissive hypercapnea is controversial, but may be unavoidable. Sedation with propofol which itself has bronchodilating properties is preferred to benzodiazepines. Case reports delineating good outcomes for both mother and fetus despite intubation for SA suggest that multidisciplinary ICU care of the pregnant asthmatic with critical asthma are feasible especially if hypoxemia is avoided. PMID:24258096

  7. Managing asthma with mobile phones: a feasibility study.

    PubMed

    Holtz, Bree; Whitten, Pamela

    2009-11-01

    Asthma is a chronic disease and a growing health problem worldwide. The objective of this pilot study was to test the feasibility and utilization of tracking asthma symptoms through an innovative mobile phone application. The subjects for this research project consisted of 4 individuals who are currently receiving treatment for asthma from a primary care physician in Ingham County, Michigan. Participants took their peak flow reading each day and used the short message service (SMS) function on their phone and sent it to a Web server. If they did not send it by 11 AM, they received a reminder via an automated SMS to their phone. The resulting data suggest that this method of management is feasible. The data also demonstrate participants' satisfaction in monitoring their asthma in this manner. Using mobile phones for asthma management could improve compliance with asthma action plans and reduce adverse asthma events. Future research could further demonstrate that mobile phones are a new and effective method for providing healthcare.

  8. Fathers and Asthma Care: Paternal Involvement, Beliefs, and Management Skills

    PubMed Central

    Masek, Bruce; Barreto, Esteban; Baer, Lee; Lapey, Allen; Budge, Eduardo; McQuaid, Elizabeth L.

    2015-01-01

    Objective To compare asthma care roles of maternal and paternal caregivers, and examine associations between caregiver involvement and the outcomes of adherence, morbidity, and parental quality of life (QoL). Methods Mothers and fathers in 63 families of children, ages 5–9 years, with persistent asthma completed semistructured interviews and questionnaires. Adherence was measured via electronic monitoring. Paired t tests compared parental asthma care roles, and analysis of covariance, controlling for socioeconomic status, evaluated associations of asthma outcomes with caregiver involvement scores. Results Mothers had higher scores on measures of involvement, beliefs in medication necessity, and on four subscales of the Family Asthma Management System Scale interview (Asthma Knowledge, Relationship with Provider, Symptom Assessment, and Response to Symptoms). Maternal QoL was lowest when both maternal and paternal involvement was high. Paternal involvement was associated with increased morbidity. Conclusions There is room for enhancement of fathers’ asthma care roles. Higher levels of paternal involvement may be driven by family need. PMID:25922295

  9. Asthma

    MedlinePlus

    ... Month with a Google+ Hangout on Air for parents and caregivers to learn how to help control a child's asthma so that they can breathe ... parents build up their asthma team. Jose, his parents, a doctor and a nurse, ... forces to help Jose control his asthma. The video is recorded in Spanish ...

  10. Reducing asthma disparities by addressing environmental inequities: a case study of regional asthma management and prevention's advocacy efforts.

    PubMed

    Lamb, Anne Kelsey; Ervice, Joel; Lorenzen, Kathryn; Prentice, Bob; White, Shannon

    2011-01-01

    Regional Asthma Management and Prevention describes its collaborative approach to address a social determinant of health--air quality--and the associated inequities that have led to asthma disparities impacting African American and Latino communities in the San Francisco Bay Area. The strategies, aimed at decreasing diesel pollution in disproportionately impacted communities, span the levels of the socioecological model, with an emphasis on policy outcomes. Regional Asthma Management and Prevention describes how this work fits within a larger comprehensive approach to address asthma disparities encompassing several components, ranging from clinical management to environmental protection. PMID:21160331

  11. [Lactic acidosis in a child with acute severe asthma].

    PubMed

    Perrin, C; Savy, N; Lang, M; Caron, N; Labbé, A

    2014-10-01

    Lactic acidosis is a recognized event in adult patients with acute severe asthma (ASA). Only a few cases have been reported in children. Hereinafter is reported the case of a 2-year-old girl hospitalized in the pediatric intensive care unit for ASA, which was treated with high-flow oxygen therapy and intravenous methylprednisolone and salbutamol. During hospitalization, she had metabolic acidosis with a 7.29 pH, a 26mmHg hypocapnia, and a decrease in bicarbonates to 12 mmol/L. The anion gap was increased to 20 mmol/L and lactates to 8 mmol/L. The work-up for a congenital metabolic disease was normal. Progression was propitious with spontaneous improvement of lactic acidosis, and the child was discharged from the intensive care unit after 72 h. The origin of lactic acidosis during ASA seems to be multifactorial. Although its recovery can be spontaneous, it is important to know how to identify it because it can worsen respiratory symptoms and can lead to incongruous therapeutic escalation.

  12. [Preoperative Management of Patients with Bronchial Asthma or Chronic Bronchitis].

    PubMed

    Hagihira, Satoshi

    2015-09-01

    Bronchial asthma is characterized by chronic airway inflammation. The primary goal of treatment of asthma is to maintain the state of control. According to the Japanese guidelines (JGL2012), long-term management consists of 4 therapeutic steps, and use of inhaled corticosteroids (ICS) is recommended at all 4 steps. Besides ICS, inhalation of long-acting β2-agonist (LABA) is also effective. Recently, omalizumab (a humanized antihuman IgE antibody) can be available for patients with severe allergic asthma. Although there is no specific strategy for preoperative treatment of patients with asthma, preoperative systemic steroid administration seemed to be effective to prevent asthma attack during anesthesia. The most common cause of chronic bronchitis is smoking. Even the respiratory function is within normal limits, perioperative management of patients with chronic bronchitis is often troublesome. The most common problem is their sputum. To minimize perioperative pulmonary complication in these patients, smoking cessation and pulmonary rehabilitation are essential. It is known that more than 1 month of smoking cessation is required to reduce perioperative respiratory complication. However, even one or two weeks of smoking cessation can decrease sputum secretion. In summary, preoperative optimization is most important to prevent respiratory complication in patients with bronchial asthma or chronic bronchitis. PMID:26466493

  13. National Athletic Trainers' Association Position Statement: Management of Asthma in Athletes

    PubMed Central

    Miller, Michael G; Weiler, John M; Baker, Robert; Collins, James; D'Alonzo, Gilbert

    2005-01-01

    Objective: To present guidelines for the recognition, prophylaxis, and management of asthma that lead to improvement in the quality of care certified athletic trainers and other heath care providers can offer to athletes with asthma, especially exercise-induced asthma. Background: Many athletes have difficulty breathing during or after athletic events and practices. Although a wide variety of conditions can predispose an athlete to breathing difficulties, the most common cause is undiagnosed or uncontrolled asthma. At least 15% to 25% of athletes may have signs and symptoms suggestive of asthma, including exercise-induced asthma. Athletic trainers are in a unique position to recognize breathing difficulties caused by undiagnosed or uncontrolled asthma, particularly when asthma follows exercise. Once the diagnosis of asthma is made, the athletic trainer should play a pivotal role in supervising therapies to prevent and control asthma symptoms. It is also important for the athletic trainer to recognize when asthma is not the underlying cause for respiratory difficulties, so that the athlete can be evaluated and treated properly. Recommendations: The recommendations contained in this position statement describe a structured approach for the diagnosis and management of asthma in an exercising population. Athletic trainers should be educated to recognize asthma symptoms in order to identify patients who might benefit from better management and should understand the management of asthma, especially exercise-induced asthma, to participate as active members of the asthma care team. PMID:16284647

  14. Acute severe asthma. A prospective study of the precipitating factors in 40 children.

    PubMed

    Potter, P C; Weinberg, E; Shore, S C

    1984-09-15

    A prospective study was undertaken to determine the factors precipitating acute severe asthma in children attending the Red Cross War Memorial Children's Hospital, Cape Town. A comparison in terms of recent exposure to possible precipitating factors was made between 40 known asthmatics presenting with acute severe asthma and 40 known asthmatics who were clinically well. Exposure to known allergens had occurred in 7 cases. The time of onset of symptoms bore no relationship to meteorological changes in temperature, humidity or average pressure. Drug compliance in both groups was of the order of 50%. The majority of severe asthma attacks were associated with infection of the respiratory tract. The importance of infection as a precipitating factor in a severe asthma attack is discussed with reference to the cholinergic, adrenergic and immunological mechanisms.

  15. Management of acute sunburn.

    PubMed

    Han, Amy; Maibach, Howard I

    2004-01-01

    Current literature documents the use of many pharmacologic agents in the management of acute sunburn. While numerous studies have been undertaken, there is no consensus on an algorithm for such treatment. We review the literature for an evidence-based approach to the management of sunburn. A MEDLINE search was conducted whereby all published articles related to sunburn or ultraviolet (UV)-induced erythema from 1966-2001 were evaluated. Studies and reviews were excluded if they were not conducted in human beings. The results of these studies are varying and often conflicting in terms of clinical effectiveness or feasibility. A total of 40 studies were reviewed. Fourteen out of the 40 studies addressed the actual treatment of sunburn (i.e. the application of a substance after the development of signs or symptoms). The majority concluded that either corticosteroids, NSAIDs, antioxidants, antihistamines or emollients were ineffective at decreasing recovery time. The remaining studies showed mild improvement with such treatments, but study designs or methods were flawed. Furthermore, regardless of the treatment modality, the damage to epidermal cells is the same. Given the lack of convincing data and consensus of opinion regarding sunburn management, the most effective and practical approach to acute sunburn is symptomatic treatment of UV light-induced symptoms, including erythema, pain and pruritus.

  16. Tips to help parents manage their child's asthma every day | NIH MedlinePlus the Magazine

    MedlinePlus

    ... Breathing Easier Tips to Help Parents Manage Their Child's Asthma Every Day Past Issues / Fall 2013 Table ... doctor, to write down how to manage your child's asthma, routinely on a daily basis and during ...

  17. Ketamine versus aminophylline for acute asthma in children: A randomized, controlled trial

    PubMed Central

    Tiwari, Abhimanyu; Guglani, Vishal; Jat, Kana Ram

    2016-01-01

    BACKGROUND: There is a lack of consensus regarding second-line therapy in children with acute asthma who fail to the standard therapy. Ketamine had bronchodilator property and may be useful in the treatment of acute asthma. OBJECTIVE: The objective of this study was to evaluate the efficacy and safety of ketamine as compared to aminophylline in children with acute asthma who respond poorly to the standard therapy. METHODS: This randomized controlled trial included patients with acute asthma having Pediatric Respiratory Assessment Measure (PRAM) score ≥5 at 2 h of standard therapy. The enrolled patients received either intravenous (IV) ketamine or IV aminophylline. Primary outcome measure was change in PRAM score at the end of intervention. Secondary outcome measures included adverse effects, change in PO2and PCO2, need for mechanical ventilation, and duration of hospital stay. RESULTS: The trial included 24 patients each in ketamine and aminophylline groups. The baseline parameters were similar between the groups. The primary outcome was similar in both the groups with a change in PRAM score of 4.00 ± 1.25 and 4.17 ± 1.68 (P = 0.699) in ketamine and aminophylline groups, respectively. The secondary outcomes were not different between the groups. CONCLUSION: Ketamine and aminophylline were equally effective for children with acute asthma who responded poorly to the standard therapy. PMID:27803755

  18. Canadian Thoracic Society 2012 guideline update: Diagnosis and management of asthma in preschoolers, children and adults

    PubMed Central

    Lougheed, M Diane; Lemiere, Catherine; Ducharme, Francine M; Licskai, Chris; Dell, Sharon D; Rowe, Brian H; FitzGerald, Mark; Leigh, Richard; Watson, Wade; Boulet, Louis-Philippe

    2012-01-01

    BACKGROUND: In 2010, the Canadian Thoracic Society (CTS) published a Consensus Summary for the diagnosis and management of asthma in children six years of age and older, and adults, including an updated Asthma Management Continuum. The CTS Asthma Clinical Assembly subsequently began a formal clinical practice guideline update process, focusing, in this first iteration, on topics of controversy and/or gaps in the previous guidelines. METHODS: Four clinical questions were identified as a focus for the updated guideline: the role of noninvasive measurements of airway inflammation for the adjustment of anti-inflammatory therapy; the initiation of adjunct therapy to inhaled corticosteroids (ICS) for uncontrolled asthma; the role of a single inhaler of an ICS/long-acting beta2-agonist combination as a reliever, and as a reliever and a controller; and the escalation of controller medication for acute loss of asthma control as part of a self-management action plan. The expert panel followed an adaptation process to identify and appraise existing guidelines on the specified topics. In addition, literature searches were performed to identify relevant systematic reviews and randomized controlled trials. The panel formally assessed and graded the evidence, and made 34 recommendations. RESULTS: The updated guideline recommendations outline a role for inclusion of assessment of sputum eosinophils, in addition to standard measures of asthma control, to guide adjustment of controller therapy in adults with moderate to severe asthma. Appraisal of the evidence regarding which adjunct controller therapy to add to ICS and at what ICS dose to begin adjunct therapy in children and adults with poor asthma control supported the 2010 CTS Consensus Summary recommendations. New recommendations for the adjustment of controller medication within written action plans are provided. Finally, priority areas for future research were identified. CONCLUSIONS: The present clinical practice guideline

  19. Diagnosis and management of asthma in preschoolers: A Canadian Thoracic Society and Canadian Paediatric Society position paper

    PubMed Central

    Ducharme, Francine M; Dell, Sharon D; Radhakrishnan, Dhenuka; Grad, Roland M; Watson, Wade TA; Yang, Connie L; Zelman, Mitchell

    2015-01-01

    Asthma often starts before six years of age. However, there remains uncertainty as to when and how a preschool-age child with symptoms suggestive of asthma can be diagnosed with this condition. This delays treatment and contributes to both short- and long-term morbidity. Members of the Canadian Thoracic Society Asthma Clinical Assembly partnered with the Canadian Paediatric Society to develop a joint working group with the mandate to develop a position paper on the diagnosis and management of asthma in preschoolers. In the absence of lung function tests, the diagnosis of asthma should be considered in children one to five years of age with frequent (≥8 days/month) asthma-like symptoms or recurrent (≥2) exacerbations (episodes with asthma-like signs). The diagnosis requires the objective document of signs or convincing parent-reported symptoms of airflow obstruction (improvement in these signs or symptoms with asthma therapy), and no clinical suspicion of an alternative diagnosis. The characteristic feature of airflow obstruction is wheezing, commonly accompanied by difficulty breathing and cough. Reversibility with asthma medications is defined as direct observation of improvement with short-acting ß2-agonists (SABA) (with or without oral corticosteroids) by a trained health care practitioner during an acute exacerbation (preferred method). However, in children with no wheezing (or other signs of airflow obstruction) on presentation, reversibility may be determined by convincing parental report of a symptomatic response to a three-month therapeutic trial of a medium dose of inhaled corticosteroids with as-needed SABA (alternative method), or as-needed SABA alone (weaker alternative method). The authors provide key messages regarding in whom to consider the diagnosis, terms to be abandoned, when to refer to an asthma specialist and the initial management strategy. Finally, dissemination plans and priority areas for research are identified. PMID:25893310

  20. Diagnosis and management of asthma in preschoolers: A Canadian Thoracic Society and Canadian Paediatric Society position paper

    PubMed Central

    Ducharme, Francine M; Dell, Sharon D; Radhakrishnan, Dhenuka; Grad, Roland M; Watson, Wade TA; Yang, Connie L; Zelman, Mitchell

    2015-01-01

    Asthma often starts before six years of age. However, there remains uncertainty as to when and how a preschool-age child with symptoms suggestive of asthma can be diagnosed with this condition. This delays treatment and contributes to both short- and long-term morbidity. Members of the Canadian Thoracic Society Asthma Clinical Assembly partnered with the Canadian Paediatric Society to develop a joint working group with the mandate to develop a position paper on the diagnosis and management of asthma in preschoolers. In the absence of lung function tests, the diagnosis of asthma should be considered in children one to five years of age with frequent (≥8 days/month) asthma-like symptoms or recurrent (≥2) exacerbations (episodes with asthma-like signs). The diagnosis requires the objective document of signs or convincing parent-reported symptoms of airflow obstruction (improvement in these signs or symptoms with asthma therapy), and no clinical suspicion of an alternative diagnosis. The characteristic feature of airflow obstruction is wheezing, commonly accompanied by difficulty breathing and cough. Reversibility with asthma medications is defined as direct observation of improvement with short-acting ß2-agonists (SABA) (with or without oral corticosteroids) by a trained health care practitioner during an acute exacerbation (preferred method). However, in children with no wheezing (or other signs of airflow obstruction) on presentation, reversibility may be determined by convincing parental report of a symptomatic response to a three-month therapeutic trial of a medium dose of inhaled corticosteroids with as-needed SABA (alternative method), or as-needed SABA alone (weaker alternative method). The authors provide key messages regarding in whom to consider the diagnosis, terms to be abandoned, when to refer to an asthma specialist and the initial management strategy. Finally, dissemination plans and priority areas for research are identified. PMID:26526095

  1. Successful use of extracorporeal life support after double traumatic tracheobronchial injury in a patient with severe acute asthma.

    PubMed

    Valette, Xavier; Desjouis, Aurélie; Massetti, Massimo; Hanouz, Jean-Luc; Icard, Philippe

    2011-01-01

    We report the case of an asthmatic patient with blunt trachea and left main bronchus injuries who developed acute severe asthma after surgical repair. Despite medical treatment and ventilatory support, asthma persisted with high airway pressures and severe respiratory acidosis. We proposed venovenous extracorporeal life support for CO(2) removal which allowed arterial blood gas normalization and airway pressures decrease. Extracorporeal life support was removed on day five after medical treatment of acute severe asthma. So we report the successful use of extracorporeal life support for operated double blunt tracheobronchial injury with acute severe asthma. PMID:22135742

  2. Examining household asthma management behavior through a microeconomic framework.

    PubMed

    Magzamen, Sheryl; Brandt, Sylvia J; Tager, Ira B

    2014-12-01

    National guidelines on the effective management of pediatric asthma have been promoted for over 20 years, yet asthma-related morbidity among low-income children remains disproportionately high. To date, household and clinical interventions designed to remediate these differences have been informed largely by a health behavior framework. However, these programs have not resulted in consistent sustained improvements in targeted populations. The continued funding and implementation of programs based on the health behavior framework leads us to question if traditional behavioral models are sufficient to understand and promote adaptation of positive health management behaviors. We introduce the application of the microeconomic framework to investigate potential mechanisms that can lead to positive management behaviors to improve asthma-related morbidity. We provide examples from the literature on health production, preferences, trade-offs and time horizons to illustrate how economic constructs can potentially add to understanding of disease management. The economic framework, which can be empirically observed, tested, and quantified, can explicate the engagement in household-level activities that would affect health and well-being. The inclusion of a microeconomic perspective in intervention research may lead to identification of mechanisms that lead to household decisions with regard to asthma management strategies and behavior. The inclusion of the microeconomic framework to understand the production of health may provide a novel theoretical framework to investigate the underlying causal behavioral mechanisms related to asthma management and control. Adaptation of an economic perspective may provide new insight into the design and implementation of interventions to improve asthma-related morbidity in susceptible populations.

  3. The size of the problem of managing asthma.

    PubMed

    Barnes, Peter J

    2004-10-01

    Asthma is now the commonest chronic disease in industrialised countries and its prevalence is rising throughout the world. However, despite the availability of very effective treatments many patients with asthma have poorly controlled symptoms and frequent exacerbations, some of which require hospital admission. Important factors contributing to poor asthma control are failure to recognise asthma as a diagnosis, non-implementation of asthma management guidelines and patient non-compliance with therapy. The guidelines themselves have many inherent limitations. Chief among these is that the evidence upon which they are based may be misleading. The evidence used to support recommendations in guidelines is derived from double-blind, placebo-controlled studies in very carefully selected patients who are usually compliant with therapy and instructed in the use of inhalers. In the 'real world' things are very different and patients frequently fail to understand how to use their therapy and are often non-compliant. Reasons for non-compliance are complex and include complicated drug and dosing regimens and inability to use inhaler devices correctly; particularly pressurised metered dose inhalers (pMDIs) due to difficulty co-ordinating device activation and inhalation. Dry powder inhalers (DPIs) preclude the need to co-ordinate inspiration with activation, are easy and convenient to use and are environmentally friendly. There is no doubt that the type of inhaler is just as important as the class of drug in the long-term management of asthma. Improvements in inhaled drug delivery will continue to be important in improving asthma management.

  4. Acute Oral Ethanol Exposure Triggers Asthma In Cockroach Allergen–Sensitized Mice

    PubMed Central

    Bouchard, Jacqueline C.; Kim, Jiyoun; Beal, Dominic R.; Vaickus, Louis J.; Craciun, Florin L.; Remick, Daniel G.

    2013-01-01

    Asthma may be triggered by multiple mediators, including allergen-IgE cross-linking and non-IgE mechanisms. Several clinical studies have shown acute ethanol consumption exacerbates asthma, yet no animal model exists to study this process. We developed a model of ethanol-triggered asthma in allergen-sensitized mice to evaluate the mechanisms of ethanol inducing asthma-like responses. Outbred mice were exposed to cockroach allergens on Days 0 and 14; and on Day 21, mice received ethanol by oral gavage. Tracer studies confirmed alcohol aspiration did not occur. Within 30 minutes, alcohol induced degranulation of over 74% of mast cells, and multiple parameters of asthma-like pulmonary inflammation were triggered. Ethanol-gavaged mice had a fivefold increased production of eotaxin-2 (534 pg/mL) and a sevenfold increase in bronchoalveolar eosinophils (70,080 cells). Ethanol induced a 10-fold increase in IL-13, from 84 pg/mL in sensitized mice to 845 pg/mL in ethanol-gavaged sensitized mice. In cockroach allergen–sensitized mice, ethanol triggered asthma-like changes in respiratory physiology and a significant fivefold increase in airway mucin production. Importantly, none of these asthmatic exacerbations were observed in normal mice gavaged with ethanol. Cromolyn sodium effectively stabilized mast cells, yet increased mucin production and bronchoalveolar eosinophil recruitment. Together, these data show a single oral alcohol exposure will trigger asthma-like pulmonary inflammation in allergen-sensitized mice, providing a novel asthma model. PMID:22796441

  5. Effects of oral montelukast on airway function in acute asthma.

    PubMed

    Cýllý, A; Kara, A; Ozdemir, T; Oğüş, C; Gülkesen, K H

    2003-05-01

    Montelukast, a specific cysteinyl leukotriene receptor antagonist, has been shown to improve pulmonary function within 1 h of ingestion. This study was undertaken to compare the effects on peak expiratory flow rate (PEFR) of oral montelukast added to intravenous steroid, intravenous steroid alone and placebo during the 24 h period following administration. Seventy asthmatic patients (FEV1 40-80% predicted and > or = 15% improvement after inhaled beta agonist) were enrolled in a single blind study to receive oral montelukast (10 mg) plus intravenous prednisolone (1 mg/kg), intravenous prednisolone (1 mg/kg) or placebo in a randomised fashion. The patients received one ofthe above three groups of medication before any other treatments. This was immediately followed by the aerosol treatments of 100 mcg of terbutaline sulphate divided into three doses during 1 h as described in the consensus statement. Thereafter, patients were observed for 24 h to document the effects on PEFR, Borg dyspnoea score and need for rescue medication. The primary end point was percentage change at different time points. Secondary end points were Borg dyspnoea score and use of rescue medication. Compared with placebo, montelukast added to the prednisolone group and the prednisolone alone group had significant percentage change from baseline in PEFR in the entire 24 h period (P<0.05). The difference in PEFR between montelukast plus prednisolone group and prednisolone group favoured the montelukast plus prednisolone group but did not reach statistical significance. Furthermore, montelukast plus prednisolone group required less inhaled short-acting beta agonistthan other two groups. The results of this study indicate that adding montelukast to steroid in acute asthma may have some additive improvement in lung functions. PMID:12735671

  6. An Exploration of Parent-Child Dyadic Asthma Management Influences on Quality of Life

    PubMed Central

    Horner, Sharon D.; Brown, Adama

    2015-01-01

    Most studies of childhood asthma management use data from a single family reporter and fail to capture the parent-child dyadic influences. In this descriptive exploratory study with 183 parent-child dyads, data were collected from both parents and children. Using structural equation modeling, the relationships of parents’ and children’s asthma knowledge, self-efficacy to manage asthma, and asthma management on the child’s quality of life were examined. Direct significant relationships from knowledge to self-efficacy to asthma management were found for each member of the dyad. The associations between parents’ and children’s self-efficacy and asthma management were not statistically significant. Only the children’s self-efficacy to manage asthma was significantly associated with children’s asthma-related quality of life. PMID:25822510

  7. Asthma self-management model: randomized controlled trial.

    PubMed

    Olivera, Carolina M X; Vianna, Elcio Oliveira; Bonizio, Roni C; de Menezes, Marcelo B; Ferraz, Erica; Cetlin, Andrea A; Valdevite, Laura M; Almeida, Gustavo A; Araujo, Ana S; Simoneti, Christian S; de Freitas, Amanda; Lizzi, Elisangela A; Borges, Marcos C; de Freitas, Osvaldo

    2016-10-01

    Information for patients provided by the pharmacist is reflected in adhesion to treatment, clinical results and patient quality of life. The objective of this study was to assess an asthma self-management model for rational medicine use. This was a randomized controlled trial with 60 asthmatic patients assigned to attend five modules presented by a pharmacist (intervention group) and 59 patients in the control group. Data collection was performed before and after this 4-month intervention and included an evaluation of asthma knowledge, lifestyle, inhaler techniques, adhesion to treatment, pulmonary function and quality of life. An economic viability analysis was also performed. The intervention group obtained an increase in asthma knowledge scores of 58.3-79.5% (P < 0.001). In this group, there was also an increase in the number of individuals who practiced physical exercise (36-43%), in the number of correct replies regarding the use of inhalers, in the percentage of adherent patients, and in quality of life scores for all domains. We concluded that this asthma self-management model was effective in improving the quality of life of asthma patients. PMID:27473571

  8. Asthma.

    PubMed

    Bergmann, Karl-Christian

    2014-01-01

    'Asthma' is derived from the Greek root ασθμαινω, meaning 'gasp for breath'. The term originally did not define a disease, but was employed to describe respiratory symptoms of a variety of pulmonary conditions. Over the centuries, several models have been proposed to understand the pathophysiologic abnormalities of asthma. By the beginning of the 20th century, asthma was seen to be a unique illness characterized by 'spasmodic afflictions of the bronchial tubes'. Consistent with the nature of asthma as a complex disease, the models for asthma pathogenesis have become increasingly complex. Research has moved from antiquated ideas to a descriptive functional approach to one that relies on pathophysiology in cellular and molecular biology, immunology, microbiology and genetics/genomics. As more advanced technologies for measuring lung function were developed, the features of asthma were steadily unraveled and its pathophysiology clarified. Asthma was shown to be associated with transient increases in airway resistance, reductions in forced expiratory volumes and flows, hyperinflation of the lungs and increased work of breathing, as well as abnormalities in the distribution of ventilation, perfusion and arterial blood gases. Today, asthma is seen as a chronic inflammatory disease which is not yet fully understood in its pathophysiology; therefore, therapy is still on the path to becoming optimal. PMID:24925386

  9. Asthma.

    PubMed

    Bergmann, Karl-Christian

    2014-01-01

    'Asthma' is derived from the Greek root ασθμαινω, meaning 'gasp for breath'. The term originally did not define a disease, but was employed to describe respiratory symptoms of a variety of pulmonary conditions. Over the centuries, several models have been proposed to understand the pathophysiologic abnormalities of asthma. By the beginning of the 20th century, asthma was seen to be a unique illness characterized by 'spasmodic afflictions of the bronchial tubes'. Consistent with the nature of asthma as a complex disease, the models for asthma pathogenesis have become increasingly complex. Research has moved from antiquated ideas to a descriptive functional approach to one that relies on pathophysiology in cellular and molecular biology, immunology, microbiology and genetics/genomics. As more advanced technologies for measuring lung function were developed, the features of asthma were steadily unraveled and its pathophysiology clarified. Asthma was shown to be associated with transient increases in airway resistance, reductions in forced expiratory volumes and flows, hyperinflation of the lungs and increased work of breathing, as well as abnormalities in the distribution of ventilation, perfusion and arterial blood gases. Today, asthma is seen as a chronic inflammatory disease which is not yet fully understood in its pathophysiology; therefore, therapy is still on the path to becoming optimal.

  10. The Efficacy of Asthma Case Management in an Urban School District in Reducing School Absences and Hospitalizations for Asthma

    ERIC Educational Resources Information Center

    Levy, Marian; Heffner, Brenda; Stewart, Tara; Beeman, Gail

    2006-01-01

    Pediatric asthma rates are reaching epidemic proportions, adversely affecting children's quality of life, educational potential, and health care costs, especially those in the inner city. This study evaluated the effectiveness of a school-based asthma case management (CM) approach with medically undeserved inner-city children attending Memphis…

  11. Outcomes for a Comprehensive School-Based Asthma Management Program

    ERIC Educational Resources Information Center

    Gerald, Lynn B.; Redden, David; Wittich, Angelina R.; Hains, Coralie; Turner-Henson, Anne; Hemstreet, Mary P.; Feinstein, Ronald; Erwin, Sue; Bailey, William C.

    2006-01-01

    This article describes the evaluation of a comprehensive school-based asthma management program in an inner-city, largely African-American school system. All 54 elementary schools (combined enrollment 13,247 students) from a single urban school system participated in this study. Schools were randomly divided between immediate and delayed…

  12. The effect of sand storms on acute asthma in Riyadh, Saudi Arabia

    PubMed Central

    Alangari, Abdullah A.; Riaz, Muhammad; Mahjoub, Mohamed Osman; Malhis, Nidal; Al-Tamimi, Saleh; Al-Modaihsh, Abdullah

    2015-01-01

    OBJECTIVE: Major sand storms are frequent in the Middle East. This study aims to investigate the role of air particulate matter (PM) level in acute asthma in children in Riyadh, Saudi Arabia. METHODS: An aerosol spectrometer was used to evaluate PM < 10μm in diameter (PM10) and PM < 2.5 μm in diameter (PM2.5) concentrations in the air every 30 minutes throughout February and March 2012 in Riyadh. Data on children 2-12 years of age presenting to the emergency department of a major children's hospital with acute asthma during the same period were collected including their acute asthma severity score. RESULTS: The median with interquartile range (IQR) levels of PM10 and PM2.5 were 454 μg/m3 (309,864) and 108 μg/m3 (72,192) respectively. There was no correlation between the average daily PM10 levels and the average number of children presenting with acute asthma per day (r = -0.14, P = 0.45), their daily asthma score (r = 0.014, P = 0.94), or admission rate ( r= -0.08, P = 0.65). This was also true for average daily PM2.5 levels. In addition, there was no difference in these variables between days with PM10 >1000 μg/m3, representing major sand storms, plus the following 5 days and other days with PM10< 1000 μg/m3. CONCLUSION: Sand storms, even major ones, had no significant impact on acute asthma exacerbations in children in Riyadh, Saudi Arabia. The very high levels of PM, however, deserve further studying especially of their long-term effects. PMID:25593604

  13. Asthma Quiz

    MedlinePlus

    ... Asthma is a chronic disease that requires ongoing management. Personalized plans for treatment may include medications, an asthma action plan, and environmental control measures to avoid your child's asthma triggers. ...

  14. Monitoring asthma in childhood: management-related issues.

    PubMed

    Rottier, Bart L; Eber, Ernst; Hedlin, Gunilla; Turner, Steve; Wooler, Edwina; Mantzourani, Eva; Kulkarni, Neeta

    2015-06-01

    Management-related issues are an important aspect of monitoring asthma in children in clinical practice. This review summarises the literature on practical aspects of monitoring including adherence to treatment, inhalation technique, ongoing exposure to allergens and irritants, comorbid conditions and side-effects of treatment, as agreed by the European Respiratory Society Task Force on Monitoring Asthma in Childhood. The evidence indicates that it is important to discuss adherence to treatment in a non-confrontational way at every clinic visit, and take into account a patient's illness and medication beliefs. All task force members teach inhalation techniques at least twice when introducing a new inhalation device and then at least annually. Exposure to second-hand tobacco smoke, combustion-derived air pollutants, house dust mites, fungal spores, pollens and pet dander deserve regular attention during follow-up according to most task force members. In addition, allergic rhinitis should be considered as a cause for poor asthma control. Task force members do not screen for gastro-oesophageal reflux and food allergy. Height and weight are generally measured at least annually to identify individuals who are susceptible to adrenal suppression and to calculate body mass index, even though causality between obesity and asthma has not been established. In cases of poor asthma control, before stepping up treatment the above aspects of monitoring deserve closer attention.

  15. Korean Asthma Guideline 2014: Summary of Major Updates to the Korean Asthma Guideline 2014.

    PubMed

    Kim, Deog Kyeom; Park, Yong Bum; Oh, Yeon-Mok; Jung, Ki-Suck; Yoo, Ji Hong; Yoo, Kwang-Ha; Kim, Kwan Hyung

    2016-07-01

    Asthma is a prevalent and serious health problem in Korea. Recently, the Korean Asthma Guideline has been updated by The Korean Academy of Tuberculosis and Respiratory Diseases (KATRD) in an effort to improve the clinical management of asthma. This guideline focuses on adult patients with asthma and aims to deliver up to date scientific evidence and recommendations to general physicians for the management of asthma. For this purpose, this guideline was updated following systematic review and meta-analysis of recent studies and adapting some points of international guidelines (Global Initiative for Asthma [GINA] report 2014, National Asthma Education and Prevention Program [NAEPP] 2007, British Thoracic Society [BTS/SIGN] asthma guideline 2012, and Canadian asthma guideline 2012). Updated issues include recommendations derived using the population, intervention, comparison, and outcomes (PICO) model, which produced 20 clinical questions on the management of asthma. It also covers a new definition of asthma, the importance of confirming various airflow limitations with spirometry, the epidemiology and the diagnostic flow of asthma in Korea, the importance and evidence for inhaled corticosteroids (ICS) and ICS/formoterol as a single maintenance and acute therapy in the stepwise management of asthma, assessment of severity of asthma and management of exacerbation, and an action plan to cope with exacerbation. This guideline includes clinical assessments, and treatment of asthma-chronic obstructive pulmonary disease overlap syndrome, management of asthma in specific conditions including severe asthma, elderly asthma, cough variant asthma, exercise-induced bronchial contraction, etc. The revised Korean Asthma Guideline is expected to be a useful resource in the management of asthma.

  16. Korean Asthma Guideline 2014: Summary of Major Updates to the Korean Asthma Guideline 2014.

    PubMed

    Kim, Deog Kyeom; Park, Yong Bum; Oh, Yeon-Mok; Jung, Ki-Suck; Yoo, Ji Hong; Yoo, Kwang-Ha; Kim, Kwan Hyung

    2016-07-01

    Asthma is a prevalent and serious health problem in Korea. Recently, the Korean Asthma Guideline has been updated by The Korean Academy of Tuberculosis and Respiratory Diseases (KATRD) in an effort to improve the clinical management of asthma. This guideline focuses on adult patients with asthma and aims to deliver up to date scientific evidence and recommendations to general physicians for the management of asthma. For this purpose, this guideline was updated following systematic review and meta-analysis of recent studies and adapting some points of international guidelines (Global Initiative for Asthma [GINA] report 2014, National Asthma Education and Prevention Program [NAEPP] 2007, British Thoracic Society [BTS/SIGN] asthma guideline 2012, and Canadian asthma guideline 2012). Updated issues include recommendations derived using the population, intervention, comparison, and outcomes (PICO) model, which produced 20 clinical questions on the management of asthma. It also covers a new definition of asthma, the importance of confirming various airflow limitations with spirometry, the epidemiology and the diagnostic flow of asthma in Korea, the importance and evidence for inhaled corticosteroids (ICS) and ICS/formoterol as a single maintenance and acute therapy in the stepwise management of asthma, assessment of severity of asthma and management of exacerbation, and an action plan to cope with exacerbation. This guideline includes clinical assessments, and treatment of asthma-chronic obstructive pulmonary disease overlap syndrome, management of asthma in specific conditions including severe asthma, elderly asthma, cough variant asthma, exercise-induced bronchial contraction, etc. The revised Korean Asthma Guideline is expected to be a useful resource in the management of asthma. PMID:27433170

  17. Stable admission rate for acute asthma in Danish children since 1977.

    PubMed

    Sevelsted, Astrid; Pipper, Christian Bressen; Bisgaard, Hans

    2016-03-01

    Childhood asthma is consistently reported to have increased in recent decades in most westernized countries, but it is unknown if this increase is similar across severities. We aimed to study the time-trend of acute hospital admission and readmission for asthma of school-aged children in the recent 35 years in Denmark. We analyzed time-trends in the national incidence rate of hospitalization for acute severe asthma in children aged 5-15 in Denmark during the 35-year period 1977-2012 in the Danish national registry. Only in-patient admissions with a principal diagnosis of asthma (ICD-8: 493** or ICD-10: J45** or J46**) were included. Among children with asthma hospitalizations, we investigated the risk of readmission beyond 1 month of first admission. Admissions were summarized as rates per thousand person years at risk. The overall time-trend is stable with a rate of one admission per year per thousand children at risk and a per-year incidence rate ratio 0.999 [95 % CI 0.997-1.001]. The rate of any readmission decreased from approximately 20 per thousand children in the eighties to less than 10 in the early nineties before stabilizing at around 10 per thousand children from mid-nineties and onwards. During 35 years of nation-wide follow-up, we find a highly stable incidence rate of first hospital admission for acute severe asthma in children. Moreover, rates of readmission halved during the seventies and stabilized in the last twenty years. In conclusion, our data suggest that the reported increase in childhood asthma is mainly due to less severe cases.

  18. Towards tailored and targeted adherence assessment to optimise asthma management.

    PubMed

    van Boven, Job F M; Trappenburg, Jaap C A; van der Molen, Thys; Chavannes, Niels H

    2015-01-01

    In this paper, we aim to emphasise the need for a more comprehensive and tailored approach to manage the broad nature of non-adherence, to personalise current asthma management. Although currently several methods are available to measure the extent of asthma patients' adherence, the vast majority do not incorporate confirmation of the actual inhalation, dose and inhalation technique. Moreover, most current measures lack detailed information on the individual consequences of non-adherence and on when and how to take action if non-adherence is identified. Notably, one has to realise there are several forms of non-adherence (erratic non-adherence, intelligent non-adherence and unwitting non-adherence), each requiring a different approach. To improve asthma management, more accurate methods are needed that integrate measures of non-adherence, asthma disease control and patient preferences. Integrating information from the latest inhaler devices and patient-reported outcomes using mobile monitoring- and feedback systems ('mHealth') is considered a promising strategy, but requires careful implementation. Key issues to be considered before large-scale implementation include patient preferences, large heterogeneity in patient and disease characteristics, economic consequences, and long-term persistence with new digital technologies.

  19. Towards tailored and targeted adherence assessment to optimise asthma management

    PubMed Central

    van Boven, Job FM; Trappenburg, Jaap CA; van der Molen, Thys; Chavannes, Niels H

    2015-01-01

    In this paper, we aim to emphasise the need for a more comprehensive and tailored approach to manage the broad nature of non-adherence, to personalise current asthma management. Although currently several methods are available to measure the extent of asthma patients’ adherence, the vast majority do not incorporate confirmation of the actual inhalation, dose and inhalation technique. Moreover, most current measures lack detailed information on the individual consequences of non-adherence and on when and how to take action if non-adherence is identified. Notably, one has to realise there are several forms of non-adherence (erratic non-adherence, intelligent non-adherence and unwitting non-adherence), each requiring a different approach. To improve asthma management, more accurate methods are needed that integrate measures of non-adherence, asthma disease control and patient preferences. Integrating information from the latest inhaler devices and patient-reported outcomes using mobile monitoring- and feedback systems (‘mHealth’) is considered a promising strategy, but requires careful implementation. Key issues to be considered before large-scale implementation include patient preferences, large heterogeneity in patient and disease characteristics, economic consequences, and long-term persistence with new digital technologies. PMID:26181850

  20. Mobile phone technology in the management of asthma.

    PubMed

    Ryan, D; Cobern, W; Wheeler, J; Price, D; Tarassenko, L

    2005-01-01

    Peak flow monitoring is widely recommended as part of a self-management plan for asthma. We conducted an observational study using electronic peak flow monitoring and mobile phone technology in a UK general practice population over a nine-month period. Patients between 12 and 55 years of age who required treatment with regular inhaled steroids and (as needed) bronchodilators were recruited from nine general practices. Patients were included if their asthma was considered stable (i.e. no exacerbation in the previous three months). No therapeutic intervention was proposed. The primary outcome measure was compliance. In all, 69% of the 46 participants who filled in the post-study questionnaire were 'satisfied' or 'very satisfied' by the study, citing the ease of use and the increased autonomy and understanding of asthma as the main advantages. In total, 74% indicated that the system had helped to improve their ability to manage their symptoms. The most positive features of the telemedicine system were described as follows: increased awareness and information about asthma, improved ability to monitor/manage the condition with the feedback screens on the mobile phone and ease of use.

  1. Work-related asthma: a case-based approach to management.

    PubMed

    Pacheco, Karin A; Tarlo, Susan M

    2011-11-01

    The management of work-related asthma has some differences from management of other asthma. Components of management include not only making as accurate a diagnosis as possible, identifying the causative agent or triggers at work, and managing the asthma with pharmacologic treatment as for other patients with asthma, but also advising on the appropriate work changes that may be needed, assisting the worker with appropriate compensation claims, and supporting protective measures for coworkers. This article discusses the approaches that may be taken for patients with different forms of work-related asthma.

  2. [Guidelines for the diagnosis and management of bronchial asthma--a comparison of the Japanese guidelines for the adult asthma with GINA and ICR].

    PubMed

    Kabe, J

    1996-11-01

    Although the concept of asthma management of the Japanese Guidelines is basically similar in the other guidelines including GINA, ICR, of British Thoracic Society, and of the other countries, assuming that asthma is a chronic inflammatory disorder of the airway, the program of stepwise pharmacologic therapy is not the same in various points. Therapy suggested in the Japanese Guidelines is different in 1) oral antiallergic drugs are widely used, 2) patients prefer oral bronchodilators to inhaled bronchodilators, 3) sustained released theophylline in the long term management and intravenous infusion of aminophylline for the treatment of acute exacerbation are accepted and frequently used by the physicians. Also the differences in the choice of medication between GINA, which is characterized by concept of cost, and other guidelines are discussed.

  3. Development and internal validation of a pediatric acute asthma prediction rule for hospitalization

    PubMed Central

    Arnold, Donald H; Gebretsadik, Tebeb; Moons, Karel GM; Harrell, Frank E; Hartert, Tina V

    2014-01-01

    Background Clinicians have difficulty predicting need for hospitalization in children with acute asthma exacerbations. Objective To develop and internally validate a multivariable Asthma Prediction Rule (APR) to inform hospitalization decision-making in children ages 5-17 years with acute asthma exacerbations. Methods Between April, 2008 and February, 2013 we enrolled a prospective cohort of patients ages 5-17 years with asthma who presented to our pediatric emergency department with acute exacerbations. Predictors for APR modeling included 15 demographic characteristics, asthma chronic control measures, and pulmonary examination findings in participants at the time of triage and before treatment. The primary outcome variable for APR modeling was need for hospitalization (length-of-stay > 24 hr for those admitted to hospital or relapse for those discharged). A secondary outcome was the hospitalization decision of the clinical team. We used penalized maximum likelihood multiple logistic regression modeling to examine the adjusted association of each predictor variable with the outcome. Backward step-down variable selection techniques were used to yield reduced-form models. Results Data from 928 of 933 participants was used for prediction rule modeling, with median [IQR] age 8.8 [6.9, 11.2] years, 61% male, and 59% African-American race. Both full (penalized) and reduced-form models for each outcome calibrated well, with bootstrap-corrected c-indices of 1.74 and 0.73 for need for hospitalization and 0.81 in each case for hospitalization decision. Conclusion The APR predicts the need for hospitalization of children with acute asthma exacerbations using predictor variables available at the time of presentation to an emergency department. PMID:25609324

  4. Asthma

    MedlinePlus

    ... for Parents for Kids for Teens Teens Home Body Mind Sexual Health Food & Fitness Diseases & Conditions Infections Q& ... exercise. It's a great way to keep the body and mind healthy, so if you get exercise-induced asthma ...

  5. A systematic review of explanatory factors of barriers and facilitators to improving asthma management in South Asian children

    PubMed Central

    2014-01-01

    Background South Asian children with asthma are less likely to receive prescriptions and more likely to suffer uncontrolled symptoms and acute asthma admissions compared with White British children. Understanding barriers are therefore vital in addressing health inequalities. We undertook a systematic review identifying explanatory factors for barriers and facilitators to asthma management in South Asian children. South Asians were defined as individuals of Indian, Pakistani or Bangladeshi descent. Methods Data Sources - Medline, HMIC, EMBASE, ASSIA, Web of Science, BNI, CINAHL, PsycINFO, OpenSIGLE, CRD, Scopus, NHS Evidence, Cochrane Library, Campbell Collaboration, RCPCH, ATS, ERS, Asthma UK, Google Scholar & Asthma Guidelines (BTS, GINA, ATS, Monash, NAEPP, Singapore & New Zealand) to August 2013. Inclusion Criteria – Qualitative, quantitative or mixed methods research with primary focus on identifying explanations for barriers and/or facilitators to asthma management in South Asian children aged 0–18 years with diagnosed/suspected asthma and/or carers and/or healthcare professionals. Data Extraction – Three authors independently reviewed, selected & extracted eligible articles with disagreements resolved by research team discussion. Results 15 studies encompassing 25,755 children, 18,483 parents/carers and 239 healthcare professionals were included. Barriers and explanatory factors identified were: 1. Lack of asthma knowledge in families and healthcare professionals. 2. Under-use of preventer medications. 3. Non-acceptance/denial of asthma. 4. Over-reliance on Emergency Department management. 5. Communication problems. 6. Non-adherence to medication. 7. Use of complementary therapies. Little facilitators regarding asthma management were identified. Conclusions Several key issues were identified as likely to be ethnic-specific to South Asian families, rather than a reflection of minority status: impact of parental and professional knowledge and beliefs

  6. Korean Asthma Guideline 2014: Summary of Major Updates to the Korean Asthma Guideline 2014

    PubMed Central

    Kim, Deog Kyeom; Park, Yong Bum; Oh, Yeon-Mok; Jung, Ki-Suck; Yoo, Ji Hong

    2016-01-01

    Asthma is a prevalent and serious health problem in Korea. Recently, the Korean Asthma Guideline has been updated by The Korean Academy of Tuberculosis and Respiratory Diseases (KATRD) in an effort to improve the clinical management of asthma. This guideline focuses on adult patients with asthma and aims to deliver up to date scientific evidence and recommendations to general physicians for the management of asthma. For this purpose, this guideline was updated following systematic review and meta-analysis of recent studies and adapting some points of international guidelines (Global Initiative for Asthma [GINA] report 2014, National Asthma Education and Prevention Program [NAEPP] 2007, British Thoracic Society [BTS/SIGN] asthma guideline 2012, and Canadian asthma guideline 2012). Updated issues include recommendations derived using the population, intervention, comparison, and outcomes (PICO) model, which produced 20 clinical questions on the management of asthma. It also covers a new definition of asthma, the importance of confirming various airflow limitations with spirometry, the epidemiology and the diagnostic flow of asthma in Korea, the importance and evidence for inhaled corticosteroids (ICS) and ICS/formoterol as a single maintenance and acute therapy in the stepwise management of asthma, assessment of severity of asthma and management of exacerbation, and an action plan to cope with exacerbation. This guideline includes clinical assessments, and treatment of asthma–chronic obstructive pulmonary disease overlap syndrome, management of asthma in specific conditions including severe asthma, elderly asthma, cough variant asthma, exercise-induced bronchial contraction, etc. The revised Korean Asthma Guideline is expected to be a useful resource in the management of asthma. PMID:27433170

  7. A case of severe acute exacerbation of Yokkaichi asthma treated with a vibrating mesh nebulizer.

    PubMed

    Yano, Takeshi; Yonaha, Tetsu; Hidaka, Koutaro; Nagahama, Masumi; Koshida, Tomohiro; Matsuoka, Hiroshi; Taniguchi, Masahiko; Tsuneyoshi, Isao

    2016-01-01

    Yokkaichi asthma was one of the most common environmental pollution diseases in Japan in the 1960s and 1970s. The problem of air pollution in Yokkaichi was solved in the 1970s. However, mortality and life expectancy were still affected by the late effects of air pollution in patients with Yokkaichi asthma even in the 2000s. In this case report, we described the experience of successful treatment of a patient with severe asthmatic status due to Yokkaichi asthma. A 40s-year-old man, who was officially certified as a patient with Yokkaichi asthma from his infancy, was admitted to hospital due to acute exacerbation of asthma. Mechanical ventilation, intravenous administration of aminophylline and dexamethasone, enteral administration of montelukast, and a transdermal patch of tulobuterol were started. However, because of the lack of improvement in clinical status, inhalation of procaterol using vibrating mesh nebulizer systems was started. Inhalation of procaterol was used three times a day. After using the vibrating mesh nebulizer, respiratory system compliance and hypercapnia rapidly improved. Bilateral expiratory wheezing was diminished. Weaning from mechanical ventilation was initiated, and on the eighth day of mechanical ventilation, the patient was extubated. Although intractable respiratory failure with decreased respiratory system compliance resulting from the late effects of air pollution and a long-time asthmatic inflammatory condition was observed, the use of a vibrating mesh nebulizer for the inhaled administration of procaterol was useful to relieve severe bronchospasm due to Yokkaichi asthma. PMID:27547723

  8. In-school asthma management and physical activity: children’s perspectives

    PubMed Central

    Walker, Timothy J.; Reznik, Marina

    2014-01-01

    OBJECTIVE Regular physical activity (PA) is an important component of pediatric asthma management. No studies have examined how in-school asthma management influences PA from children’s perspectives. The aim of this study was to explore children’s perceptions of the impact of in-school asthma management on PA. METHODS Qualitative interviews with 23 inner-city minority children with asthma (ages 8–10 yrs; 12 girls, 11 boys) were conducted in 10 Bronx, New York elementary schools. Sampling continued until saturation was reached. Interviews were recorded, transcribed and independently coded for common themes. RESULTS Interviews produced five themes representing students’ perceptions about 1) asthma symptoms during in-school PA; 2) methods to control asthma episodes during school PA; 3) methods to prevent asthma episodes during school; 4) limited accessibility of asthma medications; and 5) negative feelings about asthma and medication use. The majority of students experienced asthma symptoms while performing PA during school. Primary methods of managing asthma symptoms were sitting out during activity, drinking water, and visiting the nurse. Students lacked awareness or adherence to action plans to prevent or control asthma. Students reported limited access to medication during school and feelings of embarrassment and/or concerns of teasing when medicating in front of others. CONCLUSIONS Our results indicate inappropriate in-school management of asthma symptoms, poor asthma control, lack of accessible medication, and stigma around publicly using asthma medication. Thus, students often missed or were withheld from PA. Interventions to improve in-school asthma care must consider ways to address these issues. PMID:24796650

  9. A Comparison of an Individually Tailored and a Standardized Asthma Self-Management Education

    ERIC Educational Resources Information Center

    Shackelford, Judy; Bachman, Jean H.

    2009-01-01

    Background: Asthma is one of the most prevalent chronic diseases in the United States and can be life-threatening. There are a rising number of adults with asthma that cannot be prevented or cured but may be controlled. Self-management education is essential for long-term asthma control; however, the most effective type of education is unknown.…

  10. Didgeridoo Playing and Singing to Support Asthma Management in Aboriginal Australians

    ERIC Educational Resources Information Center

    Eley, Robert; Gorman, Don

    2010-01-01

    Context: Asthma affects over 15% of Australian Aboriginal people. Compliance in asthma management is poor. Interventions that will increase compliance are required. Purpose: The purpose of the study was to determine whether Aboriginal children, adolescents and adults would engage in music lessons to increase their knowledge of asthma and support…

  11. Methylprednisolone pulse therapy in acute severe asthma. A randomized, double-blind study.

    PubMed

    Engel, T; Dirksen, A; Frølund, L; Heinig, J H; Svendsen, U G; Pedersen, B K; Weeke, B

    1990-04-01

    Methylprednisolone pulse therapy (MPPT) has been shown to possess a long-lasting effect in other immune-inflammatory diseases without the well-known side effects caused by long-term treatment with glucocorticosteroids. In an attempt to reduce the long-term use of oral steroids in asthmatics, we conducted this double-blind, double-dummy study to compare the use of MPPT (1 g of methylprednisolone intravenously) (8 patients) with a short course of oral prednisolone (10 patients) in asthmatics presenting with acute severe asthma. Both treatments were effective in relieving the acute attack of asthma. The MPPT-treated patients did not show a faster resolution than did the orally treated group. No patients needed assisted ventilation, and no deaths occurred. One week after the treatment FEV1 tended to decrease in the methylprednisolone group compared with the oral prednisolone group (P = 0.06). The patients initially receiving MPPT needed supplementary prednisolone earlier and in higher doses than did the patients receiving oral prednisolone as initial treatment. At the end of the 12 weeks' study period, the groups reached identical FEV1. In conclusion, we did not find intravenous methylprednisolone superior to oral prednisolone in the treatment of acute attacks of severe asthma, but methylprednisolone pulse therapy had a shorter duration as regards protection against future asthma attacks. PMID:2183645

  12. Early use of inhaled nedocromil sodium in children following an acute episode of asthma

    PubMed Central

    Edwards, A; Lyons, J; Weinberg, E; Weinberg, F; Gillies, J; Reid, G; Robertson, C; Robinson, P; Dalton, M; Van Asperen, P; Wilson, C; Mullineux, J; Mullineux, A; Sly, P; Cox, M; Isles, A

    1999-01-01

    BACKGROUND—Current guidelines on the treatment of childhood asthma recommend the introduction of an anti-inflammatory drug in children who have persistent symptoms and require regular treatment with a bronchodilator. The efficacy and safety of inhaled nedocromil sodium (Tilade Mint aerosol) administered using a Fisonair spacer at a dose of 4 mg three times daily was compared with placebo in the treatment of asthmatic children aged 6-12 years who are symptomatic and recovering from an acute exacerbation of asthma.
METHODS—A group comparative, double blind, placebo controlled trial was performed in children who were recovering from an acute episode of asthma following treatment in the emergency department of the hospital or in children referred from their general practitioner following a wheezing episode and documented evidence of at least two previous episodes of wheezing. A two week baseline period on existing bronchodilator treatment was followed by a 12 week treatment period on either nedocromil sodium (2 mg/puff) or placebo. Both treatments were administered using a Fisonair spacer at a dose of two puffs three times daily. Changes from baseline values in daytime asthma and night time asthma symptom scores, usage of rescue bronchodilators, mean peak expiratory flow (PEF) recorded twice daily on diary cards, patients' opinion of treatment, and withdrawals due to treatment failure were measured during the primary treatment period (last six weeks of treatment).
RESULTS—One hundred and forty two children aged 6-12 years entered the baseline period. Sixty three were withdrawn due to failure to meet the entry criteria (18) or the criteria for asthma symptom severity (15) or reversibility (9), because they developed uncontrolled asthma (2), because they took disallowed treatment (2), or for other non-trial related reasons (17). Seventy nine patients (46boys) of mean age 8.8 years entered the treatment period. There were significant differences in the changes

  13. Early management of acute pancreatitis.

    PubMed

    Schepers, Nicolien J; Besselink, Marc G H; van Santvoort, Hjalmar C; Bakker, Olaf J; Bruno, Marco J

    2013-10-01

    Acute pancreatitis is the most common gastro-intestinal indication for acute hospitalization and its incidence continues to rise. In severe pancreatitis, morbidity and mortality remains high and is mainly driven by organ failure and infectious complications. Early management strategies should aim to prevent or treat organ failure and to reduce infectious complications. This review addresses the management of acute pancreatitis in the first hours to days after onset of symptoms, including fluid therapy, nutrition and endoscopic retrograde cholangiography. This review also discusses the recently revised Atlanta classification which provides new uniform terminology, thereby facilitating communication regarding severity and complications of pancreatitis.

  14. Comparison of oral montelukast with oral zileuton in acute asthma: A randomized, double-blind, placebo-controlled study

    PubMed Central

    Magazine, Rahul; Shahul, Hameed Aboobackar; Chogtu, Bharti; Kamath, Asha

    2016-01-01

    Background: Leukotriene modifiers have an established role in the management of chronic asthma but their role in acute asthma is still under evaluation. Objective: To study and compare the effects of oral montelukast with oral zileuton in acute asthma. Materials and Methods: This study included 120 asthmatics and was conducted from September 2012 to March 2014. Patients were randomized into three different groups to receive montelukast or zileuton or placebo in addition to standard treatment for asthma exacerbation. Peak expiratory flow rate (PEFR) values, details of rescue medication and vital signs were recorded at 6 h, 12 h, 24 h, and 48 h of drug or placebo administration and at discharge. Additional recording was done in the morning (8–10 am) following admission. The primary endpoint was the mean PEFR of each group at these time points; the secondary end point being the need for rescue medications. Results: The mean PEFR recordings of the three study groups – placebo, montelukast, and zileuton – respectively, at various time points were as follows: at 6 h (223.25 ± 90.40, 199.00 ± 82.52, 233.75 ± 84.05; P = 0.240); at 12 h (271.00 ± 109.38, 251.50 ± 101.44, 309.50 ± 129.63; P = 0.048); at 24 h (288.25 ± 114.26, 269.00 ± 107.51, 324.50 ± 127.88; P = 0.080); and at 48 h (295.00 ± 114.80, 293.50 ± 113.24, 344.75 ± 119.91; P = 0.015); discharge (305.00 ± 118.56, 305.25 ± 119.51, 361.25 ± 119.70; P = 0.010). The mean PEFR for the three study groups at 8–10 am on the morning following admission was 268.75 ± 111.43, 252.50 ± 99.99, 306.75 ± 114.44; P = 0.047. Total rescue doses needed were 10, 1, and 0, respectively (P = 0.049). Conclusion: Zileuton is better than montelukast as an additional drug in acute asthma and results in significant improvement in lung function, and reduction in the need for rescue medications. PMID:27185992

  15. Ionisers in the management of bronchial asthma.

    PubMed Central

    Nogrady, S G; Furnass, S B

    1983-01-01

    Because of recent interest in the possible benefits to asthmatic patients of negative ion generators and the largely uncontrolled and inconclusive nature of earlier studies a double blind crossover study of this treatment was carried out in 20 subjects with stable asthma over six months. After an initial two week period without an ioniser, active or placebo ionisers were installed in subjects' bedrooms for two eight week periods separated by a four week "washout" period when no ioniser was present. The study was completed by a final four week period when no ioniser was present. Subjects were randomly allocated to receive an active or a placebo ioniser first. Subjects recorded their peak expiratory flow rate (PEFR) twice daily, completed a daily symptom score questionnaire, and noted any treatment they took on a diary card. Recordings were completed throughout the trial. Ion counts and dust concentrations were measured in subjects' bedrooms during the study. Mean ion counts rose considerably when ionisers were activated (p less than 0.001). There were no significant differences in PEFR, symptom score, or consumption of medication between the periods that active ionisers and either no ionisers or placebo ionisers were in operation. This study has failed to show a statistically significant benefit in asthmatic subjects from the use of negative ion generators. PMID:6364442

  16. Gestational age-specific associations between infantile acute bronchiolitis and asthma after age five

    PubMed Central

    Strickland, Matthew J.; Marsh, Caitlin A.; Darrow, Lyndsey A.

    2014-01-01

    Background Infantile acute bronchiolitis is a risk factor for the development of pediatric asthma. The associations might differ according to gestational age. Methods Datasets of emergency department (ED) visits (Jan 2002 to June 2010) and live birth records (Jan 2002 to Dec 2004) from the state of Georgia were linked for all children who survived one year. Exposure was an ED visit for acute bronchiolitis during infancy (AB), and the outcome was an ED visit for asthma after age five years. The risk of asthma among children with AB (n = 11,564) was compared with the risk of asthma among children who did not have an ED visit for AB but who utilized the ED for another reason during infancy (n = 131,694). Associations were estimated using log-binomial regression models that controlled for several plausible confounders. Effect measure modification of the risk ratio by gestational age was investigated. Results Crude asthma risks (per 100 children) through June 2010 were 4.5 for children with AB and 2.3 for children without AB. The adjusted risk ratio for the overall association was 1.89 (95% confidence interval (CI) 1.73, 2.108). We did not observe effect modification of the risk ratio by gestational age. Conclusion A positive association was observed between ED visits for AB and subsequent asthma ED visits after age five; associations did not vary meaningfully by gestational age. Sensitivity analyses did not suggest large biases due to differences in ED utilization across socio-demographic groups or loss to follow-up from residential migration. PMID:25256755

  17. Current guidelines for the management of asthma in young children

    PubMed Central

    2010-01-01

    The diagnosis and management of asthma in young children is difficult, since there are many different wheezy phenotypes with varying underlying aetiologies and outcomes. This review discusses the different approaches to managing young children with wheezy illnesses presented in recently published global guidelines. Four major guidelines published since 2007 are considered. Helpful approaches are presented to assist the clinician to decide whether a clinical diagnosis of asthma can, or should be made in a young child with a recurrent wheezy illness and which treatments would be appropriate, dependent on risk factors, age of presentation, response to initial treatment and safety considerations. Each of the guidelines provide useful information for clinicians assessing young children with recurrent wheezy illnesses. There are differences in classification of the disease and treatment protocols. Although a firm diagnosis of asthma may only be made retrospectively in some cases and there are several effective guidelines to initiating treatment. Consistent review of the need for ongoing treatment with a particular pharmacological modality is essential, since many children with recurrent wheezing in infancy go into spontaneous remission. It is probable that newer biomarkers of airway inflammation will assist the clinician as to when to initiate and when to continue pharmacological treatment in the future. PMID:20224672

  18. [Management of acute tendinitis].

    PubMed

    Rapp, H J; Heisse, K; Becker, M; Stechele, M

    1992-12-01

    Ultrasonography must be used in combination with physical examination for the appropriate diagnosis of acute tendon injuries. Therapy should be designed to return the tendon to its normal function and appearance. Local and systemic anti-inflammatory agents, cold hydrotherapy and massage minimize excessive scar formation and progressively increasing tensile forces directs scar tissue to replace the tendon function.

  19. Update in paediatric asthma management: where is evidence challenging current practice?

    PubMed

    Robinson, Paul D; Van Asperen, Peter

    2013-05-01

    Extrapolation of management strategies based on results from predominantly adult asthma studies frequently occurs in paediatric asthma despite increasing evidence that paediatric asthma and, in particular, pre-school recurrent wheeze are very different disease entities. Response to medications in paediatric subjects is often different from that seen in their older adolescent and adult counterparts. In this update, we discussed recent studies that have had important implications for future paediatric asthma management. The overuse of combination inhaled steroid and long-acting beta2 agonist inhalers in paediatric asthma despite ongoing safety concerns is an increasing trend in paediatric asthma, and recent evidence has helped clarify how they should be used in children. Other aspects discussed include the role of oral corticosteroids in pre-school viral-induced wheeze and the utility of leukotriene receptor antagonists in exercise-induced asthma.

  20. Acute pain management.

    PubMed

    Hansen, B

    2000-07-01

    We encounter patients with acute pain many times each day, and few aspects of veterinary practice offer such an opportunity to help so many in such a profoundly rewarding way. As emphasized here and elsewhere, we now have excellent tools with which to help these animals, and the biggest impediment to optimal treatment of their pain is often our own difficulty in recognizing its presence. Perhaps the single most important aspect of treating acute pain is to cultivate an ability to see past our personal biases and expectations which may limit treatment and to rediscover the common sense we had about pain before we entered the profession. By rededicating ourselves to seeking out, preventing, and relieving pain, we not only perform a vital service for our patients but also elevate our profession even as we reap financial and spiritual rewards for our efforts. What could be better? PMID:10932832

  1. Update on perioperative management of the child with asthma.

    PubMed

    Dones, Francesco; Foresta, Grazia; Russotto, Vincenzo

    2012-04-01

    Asthma represents the leading cause of morbidity from a chronic disease among children. Dealing with this disease during the perioperative period of pediatric surgical procedures is, therefore, quite common for the anesthesiologist and other professionalities involved. Preoperative assessment has a key role in detecting children at increased risk of perioperative respiratory complications. For children without an optimal control of symptoms or with a recent respiratory tract infection elective surgery should be postponed, if possible, after the optimization of therapy. According to clinical setting, loco-regional anesthesia represents the desirable option since it allows to avoid airway instrumentation. Airway management goals are preventing the increase of airflow resistance during general anesthesia along with avoiding triggers of bronchospasm. When their use is possible, face mask ventilation and laringeal mask are considered more reliable than tracheal intubation for children with asthma. Sevoflurane is the most commonly used anesthetic for induction and manteinance. Salbutamol seems to be useful in preventing airflow resistance rise after endotracheal intubation. Mechanical ventilation should be tailored according to pathophysiology of asthma: an adequate expiratory time should be setted in order to avoid a positive end-expiratory pressure due to expiratory airflow obstruction. Pain should be prevented and promptly controlled with a loco-regional anesthesia technique when it is possible. Potential allergic reactions to drugs or latex should always be considered during the whole perioperative period. Creating a serene atmosphere should be adopted as an important component of interventions in order to guarantee the best care to the asthmatic child.

  2. Update on perioperative management of the child with asthma.

    PubMed

    Dones, Francesco; Foresta, Grazia; Russotto, Vincenzo

    2012-04-01

    Asthma represents the leading cause of morbidity from a chronic disease among children. Dealing with this disease during the perioperative period of pediatric surgical procedures is, therefore, quite common for the anesthesiologist and other professionalities involved. Preoperative assessment has a key role in detecting children at increased risk of perioperative respiratory complications. For children without an optimal control of symptoms or with a recent respiratory tract infection elective surgery should be postponed, if possible, after the optimization of therapy. According to clinical setting, loco-regional anesthesia represents the desirable option since it allows to avoid airway instrumentation. Airway management goals are preventing the increase of airflow resistance during general anesthesia along with avoiding triggers of bronchospasm. When their use is possible, face mask ventilation and laringeal mask are considered more reliable than tracheal intubation for children with asthma. Sevoflurane is the most commonly used anesthetic for induction and manteinance. Salbutamol seems to be useful in preventing airflow resistance rise after endotracheal intubation. Mechanical ventilation should be tailored according to pathophysiology of asthma: an adequate expiratory time should be setted in order to avoid a positive end-expiratory pressure due to expiratory airflow obstruction. Pain should be prevented and promptly controlled with a loco-regional anesthesia technique when it is possible. Potential allergic reactions to drugs or latex should always be considered during the whole perioperative period. Creating a serene atmosphere should be adopted as an important component of interventions in order to guarantee the best care to the asthmatic child. PMID:22802997

  3. A review of omalizumab for the management of severe asthma.

    PubMed

    Lin, Ching-Hsiung; Cheng, Shih-Lung

    2016-01-01

    Despite the expansion of the understanding in asthma pathophysiology and the continual advances in disease management, a small subgroup of patients remain partially controlled or refractory to standard treatments. Upon the identification of immunoglobulin E and other inflammatory mediators, investigations and developments of targeted agents have thrived. Omalizumab is a humanized monoclonal antibody that specifically targets the circulating immunoglobulin E, which in turn impedes and reduces subsequent releases of the proinflammatory mediators. In the past decade, omalizumab has been proven to be efficacious and well-tolerated in the treatment of moderate-to-severe asthma in both trials and real-life studies, most notably in reducing exacerbation rates and corticosteroid use. While growing evidence has demonstrated that omalizumab may be potentially beneficial in treating other allergic diseases, its indication remains confined to treating severe allergic asthma and chronic idiopathic urticaria. Future efforts may be focused on determining the optimal length of omalizumab treatment, seeking biomarkers that could better predict treatment response, as well as extending its indications. PMID:27528798

  4. A review of omalizumab for the management of severe asthma

    PubMed Central

    Lin, Ching-Hsiung; Cheng, Shih-Lung

    2016-01-01

    Despite the expansion of the understanding in asthma pathophysiology and the continual advances in disease management, a small subgroup of patients remain partially controlled or refractory to standard treatments. Upon the identification of immunoglobulin E and other inflammatory mediators, investigations and developments of targeted agents have thrived. Omalizumab is a humanized monoclonal antibody that specifically targets the circulating immunoglobulin E, which in turn impedes and reduces subsequent releases of the proinflammatory mediators. In the past decade, omalizumab has been proven to be efficacious and well-tolerated in the treatment of moderate-to-severe asthma in both trials and real-life studies, most notably in reducing exacerbation rates and corticosteroid use. While growing evidence has demonstrated that omalizumab may be potentially beneficial in treating other allergic diseases, its indication remains confined to treating severe allergic asthma and chronic idiopathic urticaria. Future efforts may be focused on determining the optimal length of omalizumab treatment, seeking biomarkers that could better predict treatment response, as well as extending its indications. PMID:27528798

  5. Update on perioperative management of the child with asthma

    PubMed Central

    Dones, Francesco; Foresta, Grazia; Russotto, Vincenzo

    2012-01-01

    Asthma represents the leading cause of morbidity from a chronic disease among children. Dealing with this disease during the perioperative period of pediatric surgical procedures is, therefore, quite common for the anesthesiologist and other professionalities involved. Preoperative assessment has a key role in detecting children at increased risk of perioperative respiratory complications. For children without an optimal control of symptoms or with a recent respiratory tract infection elective surgery should be postponed, if possible, after the optimization of therapy. According to clinical setting, loco-regional anesthesia represents the desirable option since it allows to avoid airway instrumentation. Airway management goals are preventing the increase of airflow resistance during general anesthesia along with avoiding triggers of bronchospasm. When their use is possible, face mask ventilation and laringeal mask are considered more reliable than tracheal intubation for children with asthma. Sevoflurane is the most commonly used anesthetic for induction and manteinance. Salbutamol seems to be useful in preventing airflow resistance rise after endotracheal intubation. Mechanical ventilation should be tailored according to pathophysiology of asthma: an adequate expiratory time should be setted in order to avoid a positive end-expiratory pressure due to expiratory airflow obstruction. Pain should be prevented and promptly controlled with a loco-regional anesthesia technique when it is possible. Potential allergic reactions to drugs or latex should always be considered during the whole perioperative period. Creating a serene atmosphere should be adopted as an important component of interventions in order to guarantee the best care to the asthmatic child. PMID:22802997

  6. An Internet Intervention to Improve Asthma Management: Rationale and Protocol of a Randomized Controlled Trial

    PubMed Central

    Lau, Annie YS; Dennis, Sarah; Liaw, Siaw-Teng; Coiera, Enrico

    2013-01-01

    Background Many studies have shown the effectiveness of self-management for patients with asthma. In particular, possession and use of a written asthma action plan provided by a doctor has shown to significantly improve patients’ asthma control. Yet, uptake of a written asthma action plan and preventative asthma management is low in the community, especially amongst adults. Objective A Web-based personally controlled health management system (PCHMS) called Healthy.me will be evaluated in a 2010 CONSORT-compliant 2-group (static websites verse PCHMS) parallel randomized controlled trial (RCT) (allocation ratio 1:1). Methods The PCHMS integrates an untethered personal health record with consumer care pathways and social forums. After eligibility assessment, a sample of 300 adult patients with moderate persistent asthma will be randomly assigned to one of these arms. After 12 months of using either Healthy.me or information websites (usual care arm), a post-study assessment will be conducted. Results The primary outcome measure is possession of or revision of an asthma action plan during the study. Secondary outcome measures include: (1) adherence to the asthma action plan, (2) rate of planned and unplanned visits to healthcare providers for asthma issues, (3) usage patterns of Healthy.me and attrition rates, (4) asthma control and asthma exacerbation scores, and (5) impact of asthma on life and competing demands, and days lost from work. Conclusions This RCT will provide insights into whether access to an online PCHMS will improve uptake of a written asthma action plan and preventative asthma actions. Trial Registration Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12612000716864; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=362714 (Archived by WebCite at http://www.webcitation.org/6IYBJGRnW). PMID:23942523

  7. Guidelines for asthma management: a review and comparison of 5 current guidelines.

    PubMed

    Myers, Timothy R

    2008-06-01

    The first clinical practice guidelines for the assessment and management of asthma were published over 20 years ago in New Zealand and Australia. During the same period, British and Scottish groups were collaborating on a United Kingdom version of asthma guidelines. Shortly after the introduction of the New Zealand and Canadian guidelines, the National Heart, Lung, and Blood Institute of the United States National Institutes of Health participated in 2 additional asthma guideline endeavors, which were published in the early 1990s. The National Heart, Lung, and Blood Institute formed the National Asthma Education and Prevention Program to develop asthma guidelines for the United States, and participated with an international task force to develop guidelines for the treatment of asthma in all countries, which resulted in the formation of the Global Initiative for Asthma in the mid-1990s. The asthma guidelines issued by professional societies and other groups prior to the late 1990s were primarily based on consensus or expert opinion in each guideline committee, though those opinions were based on the available studies. The early guidelines played a vital role in bridging the gap between various treatment options and recent discoveries in basic science, and served as the vehicle to implementation into daily clinical practice. Asthma guidelines have been published and revised in dozens of countries around the world and have become reputable directives or "road maps" in asthma diagnosis, treatment, and management for patients of all ages. The guidelines have similar formats. The dissemination and implementation of the early guidelines was inconsistent, and they were criticized for not being evidence-based. As the knowledge of asthma pathophysiology continues to expand, along with basic science research on asthma diagnosis, treatment, and management, as well as education of the asthma patient, it is essential that the asthma guidelines be frequently updated and based on

  8. Definition of critical asthma syndromes.

    PubMed

    Kenyon, Nicholas; Zeki, Amir A; Albertson, Timothy E; Louie, Samuel

    2015-02-01

    Urgent visits to the clinic and emergency department for acute severe asthma exacerbations are all too frequent. Existing national guidelines do not present consistent or specific recommendations for the evaluation and treatment of individual asthma patients in respiratory distress. In this vein, we propose the term "critical asthma syndrome" (CAS) to describe any child or adult who is at high risk for fatal asthma. Acute severe asthma, refractory asthma, status asthmaticus, and near-fatal asthma all describe CAS where physical exhaustion from the overwhelming work of breathing leads to respiratory arrest and death from hypoxia or related complications. The authors of this supplement seek to emphasize the importance of early recognition, prompt and coordinated evaluation, and treatment of CAS in the emergency department, hospital, and intensive care units by experienced healthcare provider teams. CAS is not severe persistent asthma where control of symptoms and prevention of exacerbations are targets of chronic disease management in the outpatient setting. The authors address the distinctions between the two entities throughout the supplement, and elaborate on the considerations important in the care of a critically ill patient, including the common errors to avoid. In addition, gaps in knowledge and clinical experience in regards to critical asthma are highlighted. Knowledge gaps include a lack of understanding of how to recognize CAS, how to coordinate and integrate hospital and outpatient resources, when to further phenotype patients with critical asthma in order to facilitate effective treatment, and how to prevent future acute exacerbations. Lastly, CAS is complicated by the fact that asthma care in diverse healthcare settings is haphazard. We recommend that primary care physicians refer patients promptly to an asthma specialist for consultation to reduce the frequency of acute exacerbations and prevent the development of CAS.

  9. Effective argon-FRC with a rebreathing technique in children with acute asthma.

    PubMed

    Yiallouros, P K; Milner, A D

    1995-01-01

    In children with asthma the measurement of functional residual capacity (FRC) with standard dilution techniques requires long rebreathing times of the inert gas, i.e., helium, to reach alveolar units with long time constants. A modification of the argon-freon-22 rebreathing technique enables argon to dilute in the readily accessible lung volume and potentially can give a measurement of FRC. However, the rebreathing tests cannot be prolonged for more than 1 min thus allowing argon to reach only the rapidly accessible lung units which are grossly useful in gas exchange (effective FRC, EFRC). The aim of this study was to measure the EFRC and standard lung function in children with acute severe asthma, assess their response to nebulized salbutamol, and evaluate the relations of the EFRC response to baseline spirometric measurements. Twenty-four asthmatic children who were admitted to the hospital with an acute asthma attack had spirometry and triplicate EFRC measurements before and after treatment with nebulized salbutamol. Eighteen patients had repeated the respiratory tests 50 days later when they had fully recovered. A significant proportion (28.9%) of the argon traces obtained at baseline before treatment did not equilibrate. However, in the great majority of these tests the oscillation of the argon traces over the last 3 breaths of the test was < 5% of the simultaneous argon concentration. The EFRC values derived from the argon traces with minimal oscillation (< 5%) were reduced during the acute asthma attack when compared with the paired values obtained after recovery (P = 0.03). The administration of salbutamol caused a fall from the baseline EFRC (P = 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

  10. A qualitative exploration of asthma self-management beliefs and practices in Puerto Rican families.

    PubMed

    Martin, Molly; Beebe, Jessie; Lopez, Lolita; Faux, Sandra

    2010-05-01

    Puerto Rican children suffer higher asthma morbidity than children of any other racial/ethnic group in the U.S. This study was intended to describe asthma self-management behaviors in Puerto Rican youth. Key informant interviews (n=5) and focus groups (n=4) were conducted. Informants were community pediatricians and community-based organization employees. The focus groups included Puerto Rican parents of children with asthma, children with asthma in grades 4-8, and adolescents with asthma in grades 9-12 (32 participants total). Data were audio-recorded, transcribed, and translated. Two separate analysts performed theme extraction using naturalistic inquiry. Children were assuming asthma self-management responsibilities at very young ages. The adolescents felt they needed more parental assistance with their asthma. Asthma management techniques that involved manipulation of the environment or emotions were the most popular. Fear of asthma, need for more general education and smoking cessation resources, and community supports for asthma were discussed. These findings have important implications for future interventions.

  11. Schools' capacity to help low-income, minority children to manage asthma.

    PubMed

    Anderson, Elizabeth W; Valerio, Melissa; Liu, Manlan; Benet, Dana Jones; Joseph, Christine; Brown, Randall; Clark, Noreen M

    2005-08-01

    This article describes the challenges and strengths of asthma management in 14 low-income, predominantly African American urban elementary schools serving more than 5,000 students. Asthma prevalence was 24.5%. Teachers, school principals, parents, and children described how asthma was managed at school. Data from classmates of students with asthma showed that they had moderate to high levels of information about the disease. Data from teachers indicated the great need for practical instruction on how they might effectively support a child with asthma in the classroom and on the playground. Principals raised concerns about expectations for the functioning of school staff and implementation of school policies especially related to asthma emergencies. Parents reported a range of problems their children face at school. Data from children with asthma showed that 75% believed asthma affected their school work. Findings from this study should be useful to school personnel, health providers, and others who assist children and their families to manage asthma at school. Data suggest that making school nursing services available is warranted, given the impact of asthma on the school community.

  12. Cortisol response to acute stress in asthma: Moderation by depressive mood.

    PubMed

    Trueba, Ana F; Simon, Erica; Auchus, Richard J; Ritz, Thomas

    2016-05-15

    Both individuals with asthma and depression show signs of a dysregulated hypothalamus-pituitary-adrenal axis. However, little is known about the cortisol response to stress in the context of co-occurring asthma and depressive mood. Thirty-nine individuals with asthma and 41 healthy controls underwent a combined speech and mental arithmetic stressor. During the course of the laboratory session, salivary cortisol was collected 5 times, with 1 sample at 0min before the stressor and 4 samples at 0, 15, 30 and 45min after the stressor. Depressive mood in the past week was assessed with the Hospital Anxiety and Depression Scale at the beginning of the session. Depressive symptoms moderated cortisol response to the acute stressor, but only among asthmatic patients. Higher depressive mood was associated with a significant increase in cortisol, whereas low depressive mood was associated with no cortisol response. In healthy participants, depressive mood had no substantial effect on cortisol response to the stressor. These findings suggest that depressive mood and chronic inflammatory diseases such as asthma can interact to augment cortisol response to stress.

  13. Recurrent accident and emergency department attendance for acute asthma in children.

    PubMed Central

    O'Halloran, S M; Heaf, D P

    1989-01-01

    Asthmatic children aged over 5 years making repeated visits to the accident and emergency department of a children's hospital were compared prospectively, on the basis of a clinical questionnaire and pulmonary function tests, with a control group of outpatients with asthma to find the reasons for their repeated attendance. Recurrent attenders (n = 145) had more severe asthma than control subjects (n = 118), with greater airway obstruction at rest (FEV1 79% v 85% predicted) and bronchial lability (47% v 38%). Significantly more of the "emergency" group used pressurised aerosols and fewer dry powder inhalers to administer bronchodilators. There were no differences in prophylactic treatment. Seventy one per cent of parents in the emergency group had feared that their child would die during an attack, compared with 56% of control subjects. Eighty one per cent of children were self referred to the accident and emergency department. Most parents had found hospital to be the quickest means of obtaining treatment in an emergency. There were no differences between the two groups in parents' knowledge about asthma, home conditions, or social disadvantage. Although children who repeatedly attend hospital accident and emergency departments for treatment of acute attacks have more severe asthma than controls and show some deficiencies in treatment, the major determinant of attendance appeared to be the parents' conviction that appropriate treatment could not be obtained elsewhere. PMID:2799741

  14. Proposed Design of a Clinical Information System for the Management of Bronchial Asthma

    PubMed Central

    Huq, S; Karras, BT; Wright, J; Lober, WB; Lozano, P; Zimmerman, FJ

    2002-01-01

    This poster categorizes the various applications to aid the management of Pediatric Bronchial Asthma. An attempt is made at classifying the various informatics approaches in this domain. Later, the approach of the proposed Asthma CAMS (Computer Aided Management System) project, being developed by the Child Health Institute and Clinical Informatics Research Group www.cirg.washington.edu at the University of Washington, is discussed.

  15. Cervical lung herniation complicating a case of acute asphyxial asthma in a child.

    PubMed

    Martchek, Melissa A; Padilla, Benjamin E; Zonfrillo, Mark R; Friedlaender, Eron Y

    2015-04-01

    The abrupt onset of respiratory failure secondary to asthma, known as acute asphyxial asthma (AAA) in adults, is uncommonly reported in children. Here, we report a case of a child with the acute onset of respiratory failure consistent with AAA complicated by the finding of a neck mass during resuscitation. This 11-year-old boy with a history of asthma initially presented in respiratory failure with altered mental status after the complaint of difficulty in breathing minutes before collapsing at home. Initially, his respiratory failure was thought to be secondary to status asthmaticus, and treatment was initiated accordingly. However, a neck mass noted during the resuscitation was cause for concern, and other etiologies for his respiratory failure were considered, including an airway obstructing neck mass. After pediatric surgery and anesthesia consultation for intubation and possible tracheostomy placement, general anesthesia was induced in the operating room with an inhaled anesthetic, with prompt resolution of the bronchspasm and decompression of the neck mass. Review of the imaging and clinical course ultimately yielded a diagnosis of cervical lung herniation as the etiology of his neck mass. We report this case of AAA and cervical lung herniation and a review of the literature of these 2 uncommon phenomena in children. PMID:25831031

  16. Home-based asthma self-management education for inner city children.

    PubMed

    Butz, Arlene M; Syron, Laura; Johnson, Betty; Spaulding, Joanne; Walker, Melissa; Bollinger, Mary Elizabeth

    2005-01-01

    Optimal home self-management in young children with asthma includes accurate symptom identification followed by timely and appropriate treatment. The objective of this study was to evaluate a home-based asthma educational intervention targeting symptom identification for parents of children with asthma. Two hundred twenty-one children with asthma were enrolled into an ongoing home-based clinical trial and randomized into either a standard asthma education (SAE) or a symptom/nebulizer education intervention (SNEI). Data included home visit records and parent's self-report on questionnaires. Symptom identification and self-management skills significantly improved from preintervention to postintervention for parents in both groups with the exception of checking medications for expiration dates and the frequency of cleaning nebulizer device and equipment. However, significantly more parents of children in the SNEI group reported treating cough symptoms as compared with the SAE group (p = 0.05). Of concern is that only 38% of all parents reported having an asthma action plan in the home. A targeted home-based asthma education intervention can be effective for improving symptom identification and appropriate use of medications in children with asthma. Home asthma educational programs should address accurate symptom identification and a demonstration of asthma medication delivery devices. PMID:15982192

  17. Comparison of the process of care of acute severe asthma in adults admitted to hospital before and 1 yr after the publication of national guidelines.

    PubMed

    Pearson, M G; Ryland, I; Harrison, B D

    1996-10-01

    This study set out to assess the effect of publication of the British Guidelines on Asthma Management on the processes and outcomes of the inpatient care of acute severe asthma in the U.K. A criterion-based audit of all acute asthma admissions during August and September 1990 (immediately before) and in 1991 (1 yr after publication of the Guidelines) using eight criteria of process and outcome was performed. Thirty-six teaching and district general hospitals in England, Scotland and Wales took part. In total, 766 patients admitted in 1990, and 900 patients admitted in 1991, were studied. The 1990 and 1991 cohorts were very similar demographically and had asthma of comparable severity. Respiratory physicians achieved similar high performance rates of between 75 and 91% for seven of the eight criteria for both years. Respiratory physicians were significantly more likely to provide patients with a written management plan in 1991. General physicians' performance was significantly lower in both years, but overall there was a very small, but just significant, improvement in their performance in 1991. Some hospitals performed consistently well in both years. It is concluded that respiratory physicians consistently provide better asthma care than general physicians. Though statistically significant, the small degree of improvement was disappointing. Possible reasons include: insufficient time for the Guidelines to be incorporated into practice; inaccessibility of the Guidelines to general physicians; failure to accept responsibility for implementing the good practice reflected in the Guidelines; and an explicit need for strategies to implement the Guidelines beyond publication in a widely-read general medical journal.

  18. Global strategy for the diagnosis and management of asthma in children 5 years and younger.

    PubMed

    Pedersen, Soren Erik; Hurd, Suzanne S; Lemanske, Robert F; Becker, Allan; Zar, Heather J; Sly, Peter D; Soto-Quiroz, Manuel; Wong, Gary; Bateman, Eric D

    2011-01-01

    Asthma is the most common chronic disease of childhood and the leading cause of childhood morbidity from chronic disease as measured by school absences, emergency department visits, and hospitalisation. During the past two decades, many scientific advances have improved our understanding of asthma and our ability to manage and control it effectively. However, in children 5 years and younger, the clinical symptoms of asthma are variable and non-specific. Furthermore, neither airflow limitation nor airway inflammation, the main pathologic hallmarks of the condition, can be assessed routinely in this age group. For this reason, to aid in the diagnosis of asthma in young children, a symptoms-only descriptive approach that includes the definition of various wheezing phenotypes has been recommended. In 1993, the Global Initiative for Asthma (GINA) was implemented to develop a network of individuals, organizations, and public health officials to disseminate information about the care of patients with asthma while at the same time assuring a mechanism to incorporate the results of scientific investigations into asthma care. Since then, GINA has developed and regularly revised a Global Strategy for Asthma Management and Prevention. Publications based on the Global Strategy for Asthma Management and Prevention have been translated into many different languages to promote international collaboration and dissemination of information. In this report, Global Strategy for Asthma Management and Prevention in Children 5 Years and Younger, an effort has been made to present the special challenges that must be taken into account in managing asthma in children during the first 5 years of life, including difficulties with diagnosis, the efficacy and safety of drugs and drug delivery systems, and the lack of data on new therapies. Approaches to these issues will vary among populations in the world based on socioeconomic conditions, genetic diversity, cultural beliefs, and differences in

  19. Global strategy for the diagnosis and management of asthma in children 5 years and younger.

    PubMed

    Pedersen, Soren Erik; Hurd, Suzanne S; Lemanske, Robert F; Becker, Allan; Zar, Heather J; Sly, Peter D; Soto-Quiroz, Manuel; Wong, Gary; Bateman, Eric D

    2011-01-01

    Asthma is the most common chronic disease of childhood and the leading cause of childhood morbidity from chronic disease as measured by school absences, emergency department visits, and hospitalisation. During the past two decades, many scientific advances have improved our understanding of asthma and our ability to manage and control it effectively. However, in children 5 years and younger, the clinical symptoms of asthma are variable and non-specific. Furthermore, neither airflow limitation nor airway inflammation, the main pathologic hallmarks of the condition, can be assessed routinely in this age group. For this reason, to aid in the diagnosis of asthma in young children, a symptoms-only descriptive approach that includes the definition of various wheezing phenotypes has been recommended. In 1993, the Global Initiative for Asthma (GINA) was implemented to develop a network of individuals, organizations, and public health officials to disseminate information about the care of patients with asthma while at the same time assuring a mechanism to incorporate the results of scientific investigations into asthma care. Since then, GINA has developed and regularly revised a Global Strategy for Asthma Management and Prevention. Publications based on the Global Strategy for Asthma Management and Prevention have been translated into many different languages to promote international collaboration and dissemination of information. In this report, Global Strategy for Asthma Management and Prevention in Children 5 Years and Younger, an effort has been made to present the special challenges that must be taken into account in managing asthma in children during the first 5 years of life, including difficulties with diagnosis, the efficacy and safety of drugs and drug delivery systems, and the lack of data on new therapies. Approaches to these issues will vary among populations in the world based on socioeconomic conditions, genetic diversity, cultural beliefs, and differences in

  20. Do United States' Teachers Know and Adhere to the National Guidelines on Asthma Management in the Classroom? A Systematic Review

    PubMed Central

    2015-01-01

    Proper asthma management in schools is important in achieving optimum asthma control in children with asthma. The National Heart, Lung, and Blood Institute (NHLBI) has developed guidelines on classroom asthma management. We conducted a systematic review to examine teacher knowledge of the NHLBI guidelines on asthma management in the classroom. We searched PubMed and EMBASE using search terms “asthma management,” “teacher(s),” “school teacher,” and “public school.” The inclusion criteria were articles published in English from 1994 to May 2014 that focus on schools in the United States (US). From 535 titles and abstracts, 9 studies met inclusion criteria. All studies reported that school teachers did not know the policies and procedures of asthma management. Teachers relied on school nurses to handle medical emergencies. Some studies identified that lack of full-time school nurses was a barrier to asthma management. Only one study showed directly that classroom teachers were not following the NHLBI guidelines on asthma management. Our literature review revealed that US teachers do not know the NHLBI guidelines on asthma management in the classroom. Future research should focus on interventions targeted toward training classroom teachers on asthma management as per NHLBI guidelines to ultimately improve asthma management in schools. PMID:25729770

  1. Do United States' teachers know and adhere to the national guidelines on asthma management in the classroom? A systematic review.

    PubMed

    Jaramillo, Yudilyn; Reznik, Marina

    2015-01-01

    Proper asthma management in schools is important in achieving optimum asthma control in children with asthma. The National Heart, Lung, and Blood Institute (NHLBI) has developed guidelines on classroom asthma management. We conducted a systematic review to examine teacher knowledge of the NHLBI guidelines on asthma management in the classroom. We searched PubMed and EMBASE using search terms "asthma management," "teacher(s)," "school teacher," and "public school." The inclusion criteria were articles published in English from 1994 to May 2014 that focus on schools in the United States (US). From 535 titles and abstracts, 9 studies met inclusion criteria. All studies reported that school teachers did not know the policies and procedures of asthma management. Teachers relied on school nurses to handle medical emergencies. Some studies identified that lack of full-time school nurses was a barrier to asthma management. Only one study showed directly that classroom teachers were not following the NHLBI guidelines on asthma management. Our literature review revealed that US teachers do not know the NHLBI guidelines on asthma management in the classroom. Future research should focus on interventions targeted toward training classroom teachers on asthma management as per NHLBI guidelines to ultimately improve asthma management in schools.

  2. Do United States' teachers know and adhere to the national guidelines on asthma management in the classroom? A systematic review.

    PubMed

    Jaramillo, Yudilyn; Reznik, Marina

    2015-01-01

    Proper asthma management in schools is important in achieving optimum asthma control in children with asthma. The National Heart, Lung, and Blood Institute (NHLBI) has developed guidelines on classroom asthma management. We conducted a systematic review to examine teacher knowledge of the NHLBI guidelines on asthma management in the classroom. We searched PubMed and EMBASE using search terms "asthma management," "teacher(s)," "school teacher," and "public school." The inclusion criteria were articles published in English from 1994 to May 2014 that focus on schools in the United States (US). From 535 titles and abstracts, 9 studies met inclusion criteria. All studies reported that school teachers did not know the policies and procedures of asthma management. Teachers relied on school nurses to handle medical emergencies. Some studies identified that lack of full-time school nurses was a barrier to asthma management. Only one study showed directly that classroom teachers were not following the NHLBI guidelines on asthma management. Our literature review revealed that US teachers do not know the NHLBI guidelines on asthma management in the classroom. Future research should focus on interventions targeted toward training classroom teachers on asthma management as per NHLBI guidelines to ultimately improve asthma management in schools. PMID:25729770

  3. Childhood Asthma

    MedlinePlus

    ... Share your child's asthma management plan with the school nurse and any coaches who oversee your child. With the approval of physicians and parents, school-age children with asthma should be allowed to ...

  4. [Moderate asthma in adults: diagnosis and management in general medical practice].

    PubMed

    Vernejoux, J M; Tunon De Lara, J M; Guizard, A V; Villanueva, P; Taytard, A

    1996-10-01

    Moderate asthma is a frequent disorder in general medicine. In 1990, the British Thoracic Society published their first guidelines on the management of asthma. Three years later, we have studied, using a questionnaire, the diagnosis and therapeutic criteria of moderate asthma used by general physicians, and comparing these to the guideline recommendations. Out of 46 physicians questioned in Bordeaux, 40 (87 per cent) agreed to participate in the study. Thirty two physicians (80 per cent) described as moderate an asthma which was mild according to the guidelines; eight physicians (20 per cent) described a moderate asthma according to the guidelines; twenty five (63 per cent) considered as severe a moderate asthma according to the recommendations, although eleven (28 per cent) considered it as moderate and four (10 per cent) did not give an opinion. In total, four (10 per cent) judged asthma severity according to the guidelines (Group R), twenty one (52 per cent) over-estimated the severity of moderate asthma (Group S), and fifteen (37 per cent) gave an inconsistent assessment (Group 1). Twenty six (65 per cent) prescribed an association of beta-2-agonists and inhaled corticosteroids for moderate asthma. Although most of the questioned physicians gave an appropriate treatment for moderate asthma treatment adapted to the severity of the situation, their therapeutic approach did not seem to be based upon the same criteria than that recommended in the guidelines.

  5. Interstitial collagen turnover during airway remodeling in acute and chronic experimental asthma

    PubMed Central

    González-Avila, Georgina; Bazan-Perkins, Blanca; Sandoval, Cuauhtémoc; Sommer, Bettina; Vadillo-Gonzalez, Sebastian; Ramos, Carlos; Aquino-Galvez, Arnoldo

    2016-01-01

    Asthma airway remodeling is characterized by the thickening of the basement membrane (BM) due to an increase in extracellular matrix (ECM) deposition, which contributes to the irreversibility of airflow obstruction. Interstitial collagens are the primary ECM components to be increased during the fibrotic process. The aim of the present study was to examine the interstitial collagen turnover during the course of acute and chronic asthma, and 1 month after the last exposure to the allergen. Guinea pigs sensitized to ovalbumin (OVA) and exposed to 3 further OVA challenges (acute model) or 12 OVA challenges (chronic model) were used as asthma experimental models. A group of animals from either model was sacrificed 1 h or 1 month after the last OVA challenge. Collagen distribution, collagen content, interstitial collagenase activity and matrix metalloproteinase (MMP)-1, MMP-13 and tissue inhibitor of metalloproteinase (TIMP)-1 protein expression levels were measured in the lung tissue samples from both experimental models. The results revealed that collagen deposit in bronchiole BM, adventitial and airway smooth muscle layers was increased in both experimental models as well as lung tissue collagen concentration. These structural changes persisted 1 month after the last OVA challenge. In the acute model, a decrease in collagenase activity and in MMP-1 concentration was observed. Collagenase activity returned to basal levels, and an increase in MMP-1 and MMP-13 expression levels along with a decrease in TIMP-1 expression levels were observed in animals sacrificed 1 month after the last OVA challenge. In the chronic model, there were no changes in collagenase activity or in MMP-13 concentration, although MMP-1 expression levels increased. One month later, an increase in collagenase activity was observed, although MMP-1 and TIMP-1 levels were not altered. The results of the present study suggest that even when the allergen challenges were discontinued, and collagenase

  6. The efficacy of nebulized magnesium sulfate alone and in combination with salbutamol in acute asthma

    PubMed Central

    Sarhan, Hatem A; EL-Garhy, Omar H; Ali, Mohamed A; Youssef, Nouran A

    2016-01-01

    Objective Evaluation of the efficacy of nebulized magnesium sulfate (MgSO4) alone and in combination with salbutamol in acute asthma. Methods A double-blind randomized controlled study was conducted in Chest and Emergency Departments. Thirty patients of acute attack of bronchial asthma were randomized into three groups: MgSO4 nebulization (group A), salbutamol nebulization (group B), and their combination (group C). All patients were monitored before and after nebulization (each 20 minutes) for peak expiratory flow rate (PEFR), respiratory rate (RR), heart rate (HR), blood pressure, pulsus paradoxus, oxygen saturation, clinical examination, and Fischl index. Results A highly significant improvement in PEFR, PEFR percentage, and Fischl index and significant decrease in RR and HR was observed in all groups. A similar improvement in PEFR was observed in group A and group B (P=0.389). The difference in peak expiratory flow (PEF) improvement was insignificant between group B and group C (P=0.101), while there was a significant difference between group A and group C (P=0.014) in favor of group C. Conclusion Nebulized MgSO4 alone or combined with salbutamol has a clinically significant bronchodilator effect in acute asthma and leads to clinical improvement, increase in PEFR, reduction in HR, and reduction in RR. The response to nebulized MgSO4 alone (PEFR improvement 54±35.6 L/min, P=0.001) is comparable (P=0.389) to that of nebulized salbutamol (PEFR improvement 67.0±41.9 L/min, P=0.001) and is significantly less than (P=0.014) that of nebulized combination (PEFR improvement 92.0±26.9 L/min, P=0.000). PMID:27354766

  7. Interstitial collagen turnover during airway remodeling in acute and chronic experimental asthma

    PubMed Central

    González-Avila, Georgina; Bazan-Perkins, Blanca; Sandoval, Cuauhtémoc; Sommer, Bettina; Vadillo-Gonzalez, Sebastian; Ramos, Carlos; Aquino-Galvez, Arnoldo

    2016-01-01

    Asthma airway remodeling is characterized by the thickening of the basement membrane (BM) due to an increase in extracellular matrix (ECM) deposition, which contributes to the irreversibility of airflow obstruction. Interstitial collagens are the primary ECM components to be increased during the fibrotic process. The aim of the present study was to examine the interstitial collagen turnover during the course of acute and chronic asthma, and 1 month after the last exposure to the allergen. Guinea pigs sensitized to ovalbumin (OVA) and exposed to 3 further OVA challenges (acute model) or 12 OVA challenges (chronic model) were used as asthma experimental models. A group of animals from either model was sacrificed 1 h or 1 month after the last OVA challenge. Collagen distribution, collagen content, interstitial collagenase activity and matrix metalloproteinase (MMP)-1, MMP-13 and tissue inhibitor of metalloproteinase (TIMP)-1 protein expression levels were measured in the lung tissue samples from both experimental models. The results revealed that collagen deposit in bronchiole BM, adventitial and airway smooth muscle layers was increased in both experimental models as well as lung tissue collagen concentration. These structural changes persisted 1 month after the last OVA challenge. In the acute model, a decrease in collagenase activity and in MMP-1 concentration was observed. Collagenase activity returned to basal levels, and an increase in MMP-1 and MMP-13 expression levels along with a decrease in TIMP-1 expression levels were observed in animals sacrificed 1 month after the last OVA challenge. In the chronic model, there were no changes in collagenase activity or in MMP-13 concentration, although MMP-1 expression levels increased. One month later, an increase in collagenase activity was observed, although MMP-1 and TIMP-1 levels were not altered. The results of the present study suggest that even when the allergen challenges were discontinued, and collagenase

  8. Changing clinical practice: views about the management of adult asthma

    PubMed Central

    Dawson, S.; Sutherland, K.; Dopson, S.; Miller, R.

    1999-01-01

    A case study of clinical practice in adult asthma is presented. The case is part of a larger project, funded by the North Thames NHS Executive Research and Development Programme, that sought to explore the part played by clinicians in the implementation of research and development into practice in two areas: adult asthma and glue ear in children. The first case of glue ear in children was reported in a previous issue of this journal (Quality in Health Care 1999;8:99-107). Background information from secondary sources on the condition, treatment, and organisation and location of care is followed by an account of the results of semistructured interviews with 159 clinicians. The findings are reported in two sections: clinical management and the organisation of care, and clinicians' accounts of what, why, and how they introduce changes into their practice. The way clinicians talk about their learning, their expressed views on acceptable practice, and their willingness to change were shown to be informed by construction of legitimate and sufficient evidence, respected colleagues, and accumulated individual experience. There was little open acknowledgment of the influence of organisational factors in influencing practice. To investigate whether relationships between task performance and organisational arrangements found in other sectors apply to UK health, more robust measures by which performance can be evaluated are needed. PMID:10847888

  9. Effects of the tulobuterol patch on the treatment of acute asthma exacerbations in young children.

    PubMed

    Katsunuma, Toshio; Ohya, Yukihiro; Fujisawa, Takao; Akashi, Kenichi; Imamura, Naoto; Ebisawa, Motohiro; Daikoku, Kazunari; Kondo, Naomi; Terada, Akihiko; Doi, Satoru; Nishimuta, Toshiyuki; Noma, Takeshi; Hamasaki, Yuhei; Kurihara, Kazuyuki; Masuda, Kei; Yamada, Takashi; Yamada, Masanori; Yoshihara, Shigemi; Watanabe, Kazuhiko; Watanabe, Tohru; Kitabayashi, Taeru; Morikawa, Akihiro; Nishima, Sankei

    2012-01-01

    The tulobuterol patch (TP) is a beta(2)-adrenergic agonist with a favorable pharmacokinetic profile used for asthma management in Japan. Because it contains tulobuterol in a molecular, crystallized form that is gradually absorbed percutaneously, TP exerts a prolonged bronchodilator effect exceeding 24 hours. Although it is a well-established treatment for asthma and wheezing, few studies have investigated whether it can reduce or prevent the symptoms associated with upper respiratory tract infections (URTIs) in young children. This study evaluated the effect of TP on the long-term management of asthma in young children. In this 1-year, randomized, multicenter, double-blind, placebo-controlled study, children aged 0.5-3 years old with mild-to-moderate persistent asthma were treated with either TP or placebo patch. The parents/guardians applied the TP or placebo patch to their children after URTI symptoms appeared. Respiratory symptoms were recorded daily during the 1-year observation period. Overall, 86 patients were enrolled and 80 were treated and analyzed in this study. All patients had been treated with anti-inflammatory drugs before enrollment. The time to symptom resolution was significantly shorter (p = 0.001) and the total respiratory symptom score (p = 0.0457) was significantly lower in the TP group than in the placebo group. In young children with mild-to-moderate asthma who had been treated with anti-inflammatory drugs, using the TP soon after the appearance of URTI symptoms led to quicker resolution of respiratory symptoms and lower respiratory symptom scores.

  10. Creation and implementation of SAMPRO™: A school-based asthma management program

    PubMed Central

    Lemanske, Robert F.; Kakumanu, Sujani; Shanovich, Kathleen; Antos, Nicholas; Cloutier, Michelle M.; Mazyck, Donna; Phipatanakul, Wanda; Schantz, Shirley; Szefler, Stanley; Vandlik, Renee; Williams, Paul

    2016-01-01

    Clinicians who care for children with asthma have an obligation to coordinate asthma care with the schools. Aside from routine clinical care of asthmatic children, providers must educate the family and child about the need for an asthma treatment plan in school and support the school nurse meeting the needs of the student requiring school-based asthma care. The following article was developed by multiple stakeholders to address this need. It describes the 4 components of the School-based Asthma Management Program (SAMPRO™). SAMPRO™ details elements necessary for the education of children, families, clinicians, and school-based personnel based on a “circle of support” that would enhance multidirectional communication and promote better care for children with asthma within the school setting. PMID:27596707

  11. Creation and implementation of SAMPRO™: A school-based asthma management program.

    PubMed

    Lemanske, Robert F; Kakumanu, Sujani; Shanovich, Kathleen; Antos, Nicholas; Cloutier, Michelle M; Mazyck, Donna; Phipatanakul, Wanda; Schantz, Shirley; Szefler, Stanley; Vandlik, Renee; Williams, Paul

    2016-09-01

    Clinicians who care for children with asthma have an obligation to coordinate asthma care with the schools. Aside from routine clinical care of asthmatic children, providers must educate the family and child about the need for an asthma treatment plan in school and support the school nurse meeting the needs of the student requiring school-based asthma care. The following article was developed by multiple stakeholders to address this need. It describes the 4 components of the School-based Asthma Management Program (SAMPRO™). SAMPRO™ details elements necessary for the education of children, families, clinicians, and school-based personnel based on a "circle of support" that would enhance multidirectional communication and promote better care for children with asthma within the school setting. PMID:27596707

  12. Adolescent Asthma Self-Management: Patient and Parent-Caregiver Perspectives on Using Social Media to Improve Care

    ERIC Educational Resources Information Center

    Panzera, Anthony D.; Schneider, Tali K.; Martinasek, Mary P.; Lindenberger, James H.; Couluris, Marisa; Bryant, Carol A.; McDermott, Robert J.

    2013-01-01

    Background: Self-management of asthma can now leverage new media technologies. To optimize implementation they must employ a consumer-oriented developmental approach. This study explored benefits of and barriers to improved asthma self-management and identified key elements for the development of a digital media tool to enhance asthma control.…

  13. Asthma Management among Low-Income Latino and African American Families of Infants and Young Children

    ERIC Educational Resources Information Center

    Koenig, Karel; Chesla, Catherine A.

    2004-01-01

    To discover the underlying understandings that organize how low-income Latino and African American parents of infants and toddlers with severe persistent asthma manage symptoms in their children, 11 families with children 12-48 months old and recently hospitalized with asthma were interviewed over 3-6 months. Interpretive phenomenology was used to…

  14. Difficult‐to‐control asthma management through the use of a specific protocol

    PubMed Central

    Giavina‐Bianchi, Pedro; Aun, Marcelo Vivolo; Bisaccioni, Carla; Agondi, Rosana; Kalil, Jorge

    2010-01-01

    The present study is a critical review of difficult‐to‐control asthma, highlighting the characteristics and severity of the disease. It also presents a protocol for the management of patients with this asthma phenotype. The protocol, which was based on relevant studies in the literature, is described and analyzed. PMID:21049219

  15. Process and Outcomes of School Nurse Case Management for Students with Asthma

    ERIC Educational Resources Information Center

    Engelke, Martha Keehner; Swanson, Melvin; Guttu, Martha

    2014-01-01

    There have been many studies that have examined the impact of school-based asthma programs on students with asthma. However, most studies do not provide adequate elaboration on the components of the program. Therefore, replication of these programs is difficult. This study examines the process of school nurse case management, which includes the…

  16. Improvement of Rural Children's Asthma Self-Management by Lay Health Educators

    ERIC Educational Resources Information Center

    Horner, Sharon D.; Fouladi, Rachel T.

    2008-01-01

    Background: The purpose of the present analysis is to examine changes in rural children's asthma self-management after they received lay health educator (LHE)-delivered classes. Methods: Elementary schools were randomly assigned to the treatment or attention-control condition and their participating students received either asthma education or…

  17. Do self-management plans reduce morbidity in patients with asthma?

    PubMed Central

    Hoskins, G; Neville, R G; Smith, B; Clark, R A

    1996-01-01

    BACKGROUND: Self-management plans may help patients with asthma intervene when symptoms deteriorate, thus preventing asthma attacks. AIM: A study set out to test whether a self-management plan tailored to the circumstances of the individual reduces morbidity from asthma. METHOD: General practitioners who had participated in a national audit of asthma attacks were randomized into intervention and control groups. Six months after the intervention group had issued self-management plans to patients with asthma, both groups of practitioners completed morbidity questionnaires on patients. Morbidity outcomes were compared for the 6-month periods before and after the issue of the plans. RESULTS: In the 6 months before the study, the 376 patients enrolled by the intervention group experienced higher levels of morbidity than the 530 patients for whom details were recorded by the control group. In the 6 months after the issue of the plans, control group patients showed little change in levels of morbidity, but intervention group patients showed significant reductions in hospital admissions, consultations for asthma symptoms, asthma review consultations, courses of oral steroids and use of emergency nebulized bronchodilators. CONCLUSION: General practitioners appeared to operate enthusiast bias' and issued more self-management plans to patients with uncontrolled asthma. The reduction in morbidity in this group is probably a result of the use of the plans, but the verdict on whether plans reduce morbidity must be deemed 'not proven'. PMID:8731624

  18. Implementation of a 12-week disease management program improved clinical outcomes and quality of life in adults with asthma in a rural district hospital: pre- and post-intervention study.

    PubMed

    Chamnan, Parinya; Boonlert, Kittipa; Pasi, Wanit; Yodsiri, Songkran; Pong-on, Sirinya; Khansa, Bhoonsab; Yongkulwanitchanan, Pichapat

    2010-03-01

    Despite the availability of effective medical treatment and disease management guidelines, asthma remains a poorly controlled disease in developing countries. There is little evidence of the effectiveness of disease management guidelines in rural clinical practice. The effect of disease management guidelines on clinical outcomes and quality of life in asthmatic patients in a rural community hospital was examined. Fifty-seven patients aged > or = 16 years with physician-diagnosed asthma from a hospital outpatient clinic in Ubon-ratchathani, Thailand, were recruited. Asthma diagnosis was confirmed by reviewing clinical records. We implemented a 12-week disease management program, including the use of written asthma treatment plan and asthma action plan tailored to individual patients. Using one-group pre- and post-intervention design, we compared the average number of emergency visits and hospitalizations from acute asthmatic attacks before and after the implementation of interventions using the Wilcoxon matched-pairs signed-rank test. We also compared patient's asthma quality of life (AQL) scores, measured using the 7-point scaled Mini Asthma Quality of Life Questionnaire. It was found that among the 57 patients, 38 (67%) were women, and the mean age (SD) of the patients was 47.6 (17.0) years. Sixteen patients (28%) had a family history of asthma. Emergency visits decreased from 0.48 (SD = 0.83) per patient before implementation of interventions to 0.11 (0.37) per patient after implementation of interventions (p = 0.003). Hospitalizations with acute asthma attacks reduced from 0.14 (0.35) per patient to 0.04 (0.27) per patient (p = 0.034). Overall AQL scores increased significantly from 3.7 to 5.4 (p < 0.001), with most improvement observed in symptoms and emotions. It was concluded that implementation of a 12-week asthma disease management program could reduce emergency visits and hospitalizations, and improve patients' quality of life in a rural practice setting.

  19. Role of leukotriene receptor antagonists in the management of pediatric asthma: an update.

    PubMed

    Dumitru, Catalina; Chan, Susan M H; Turcanu, Victor

    2012-10-01

    At present, the main indications for leukotriene receptor antagonists (LTRA) in pediatric asthma are as add-on therapy to inhaled corticosteroids (ICS) and as initial controller therapy in children with mild asthma, especially those who cannot or will not use ICS. LTRA are also useful for patients who have concomitant rhinitis, and patients with viral-induced wheeze and exercise-induced asthma. It should be noted that the benefits of LTRA therapy have been demonstrated in children as young as 6 months of age and recent clinical trials have further proven the benefits of LTRA in acute asthma exacerbations. However, considering the important pro-inflammatory effects that leukotrienes (LT) have in experimental models of asthma, it may seem surprising that LTRA treatment outcomes are not better and that in some clinical trials only a minority of patients could be classified as full responders. This could be explained by potential additional LT receptors that are not affected by LTRA. Such receptors could represent new therapeutic targets in asthma. Furthermore, progress in differentiating between asthma phenotypes that result from different pathogenic mechanisms, some of which may involve LT to a lesser degree, should lead to an improved, personalized use of LTRA for treating asthma. PMID:22897162

  20. Asthma-related emergency department use: current perspectives.

    PubMed

    Johnson, Laurie H; Chambers, Patricia; Dexheimer, Judith W

    2016-01-01

    Asthma is one of the most common chronic pediatric diseases. Patients with asthma often present to the emergency department for treatment for acute exacerbations. These patients may not have a primary care physician or primary care home, and thus are seeking care in the emergency department. Asthma care in the emergency department is multifaceted to treat asthma patients appropriately and provide quality care. National and international guidelines exist to help drive clinical care. Electronic and paper-based tools exist for both physicians and patients to help improve emergency, home, and preventive care. Treatment of patients with asthma should include the acute exacerbation, long-term management of controller medications, and controlling triggers in the home environment. We will address the current state of asthma research in emergency medicine in the US, and discuss some of the resources being used to help provide a medical home and improve care for patients who suffer from acute asthma exacerbations. PMID:27471415

  1. Asthma-related emergency department use: current perspectives

    PubMed Central

    Johnson, Laurie H; Chambers, Patricia; Dexheimer, Judith W

    2016-01-01

    Asthma is one of the most common chronic pediatric diseases. Patients with asthma often present to the emergency department for treatment for acute exacerbations. These patients may not have a primary care physician or primary care home, and thus are seeking care in the emergency department. Asthma care in the emergency department is multifaceted to treat asthma patients appropriately and provide quality care. National and international guidelines exist to help drive clinical care. Electronic and paper-based tools exist for both physicians and patients to help improve emergency, home, and preventive care. Treatment of patients with asthma should include the acute exacerbation, long-term management of controller medications, and controlling triggers in the home environment. We will address the current state of asthma research in emergency medicine in the US, and discuss some of the resources being used to help provide a medical home and improve care for patients who suffer from acute asthma exacerbations. PMID:27471415

  2. Occupational asthma: a challenge in patient management and community care

    SciTech Connect

    Reed, C.E.

    1981-08-01

    Occupational exposure to irritants accounts for 2% to 15% of all cases of asthma. Most of the offending agents evoke an IgE allergic reaction, but some seem to act through pharmacologic rather than immunologic pathways. Usually, symptoms are worse during working hours and improve in the evening and over the weekend, but in some cases onset is delayed. Symptoms may persist for weeks after exposure ceases. Skin tests or serologic tests for IgE antibody are helpful in diagnosis. Bronchial challenge with the suspected agent is valuable research procedure that occasionally is clinically useful in diagnosis. Management requires the cooperation of the medical and industrial communities. It consists of identifying asthmatic workers, removing them from exposure to the affecting environment, and treating their symptoms; preventing exposure of susceptible people through preemployment screening; and setting and adhering to reasonable occupational safety standards.

  3. Asthma Management in Educational Settings: Implementing Guideline-Based Care in Washington State Schools.

    PubMed

    Evans-Agnew, Robin A; Klein, Nicole; Lecce, Sally

    2015-11-01

    Managing asthma in the schools is complex and requires careful planning. This article highlights key steps in implementing guideline-based care for children with asthma in Washington State schools: assessing students, establishing acuity, communicating with parents, and training staff. Advance planning can improve outcomes for students, parents, and school staff in managing this complex and prevalent disease. NASN recently developed asthma management guidelines. Developing state-specific guidelines provides an opportunity to speak specifically to state laws and nurse practice acts while also reinforcing the importance of specialized practice to school nurses, school administrators and teachers, parents, and students. PMID:26515566

  4. Managing acute enigmatic chest pain.

    PubMed

    Wielgosz, A T

    1996-09-01

    The author comments on the report by Dr. Akbar Panju and associates (see pages 541 to 547 of this issue) on patient outcomes associated with a discharge diagnosis of "chest pain not yet diagnosed." Acute chest pain without evidence of cardiac involvement presents a diagnostic challenge for the clinician, particularly in the present climate of cost containment. Esophageal disorders and psychiatric conditions appear to be the most prevalent causes of noncardiac chest pain. Although screening by means of electrocardiography and cardiac enzyme testing may rule out acute ischemia, and other tests may clearly point to a gastrointestinal cause, it is possible for cardiac and gastrointestinal problems to present simultaneously. Understanding and managing persistent chest pain even after a diagnosis has been made continues to challenge clinicians and researchers, and further progress in this area will depend on multidisciplinary collaboration.

  5. Managing acute enigmatic chest pain.

    PubMed Central

    Wielgosz, A T

    1996-01-01

    The author comments on the report by Dr. Akbar Panju and associates (see pages 541 to 547 of this issue) on patient outcomes associated with a discharge diagnosis of "chest pain not yet diagnosed." Acute chest pain without evidence of cardiac involvement presents a diagnostic challenge for the clinician, particularly in the present climate of cost containment. Esophageal disorders and psychiatric conditions appear to be the most prevalent causes of noncardiac chest pain. Although screening by means of electrocardiography and cardiac enzyme testing may rule out acute ischemia, and other tests may clearly point to a gastrointestinal cause, it is possible for cardiac and gastrointestinal problems to present simultaneously. Understanding and managing persistent chest pain even after a diagnosis has been made continues to challenge clinicians and researchers, and further progress in this area will depend on multidisciplinary collaboration. PMID:8804262

  6. Acute Management of Propionic Acidemia

    PubMed Central

    Chapman, Kimberly A; Gropman, Andrea; MacLeod, Erin; Stagni, Kathy; Summar, Marshall L.; Ueda, Keiko; Mew, Nicholas Ah; Franks, Jill; Island, Eddie; Matern, Dietrich; Pena, Loren; Smith, Brittany; Sutton, V. Reid; Urv, Tiina; Venditti, Charles; Chakrapani, Anupam

    2014-01-01

    Propionic Acidemia or aciduria is an intoxication-type disorder of organic metabolism. Patients deteriorate in times of increased metabolic demand and subsequent catabolism. Metabolic decompensation can manifest with lethargy, vomiting, coma and death if not appropriately treated. On January 28-30, 2011 in Washington, D.C., Children's National Medical Center hosted a group of clinicians, scientists and parental group representatives to design recommendations for acute management of individuals with Propionic Acidemia. Although many of the recommendations are geared towards the previously undiagnosed neonate, the recommendations for a severely metabolically decompensated individual are applicable to any known patient as well. Initial management is critical for prevention of morbidity and mortality. The following manuscript provides recommendations for initial treatment and evaluation, a discussion of issues concerning transport to a metabolic center (if patient presents to a non-metabolic center), acceleration of management and preparation for discharge. PMID:22000903

  7. [Effect of inhaled terbutaline sulphate (dry powder, Turbuhaler and nebulizer solution) in children with acute asthma].

    PubMed

    Solé, D; Rizzo, M C; Pimentel, A F; Sano, F; Barreto, B A; Wandalsen, N F; Naspitz, C K

    1995-01-01

    Forty seven children (6-14 years), with an acute mild or moderate attack of asthma (clinical score 3 or FEV1 > 50% of the predicted), were treated with terbutaline sulphate, by inhalation route with a dry powder inhaler (Turbuhaler - 0,5 mg - group T; N=27, or by a nebulizer 1% solution-in saline-compressed air (6 l/min.) group S; N=20. The children were evaluated at 5, 15, 25 and 30 minutes after the initial treatment. In both groups a significant fall of the clinical score (starting at 15 minutes) (p < 0.05) and a significant improvement of the FEV(1), VC and FEF25-75% (starting at 5 minutes), were observed (p < 0.05). There were no significant changes in heart rates, respiratory rates and blood pressure (p > 0.05). At the end of the first treatment, the number of patients with a FEV(1) < 80% was similar in both groups (T = 13/27 and S = 10/20). The same treatment was repeated, and all the children showed a marked improvement, except for one boy of the group T was hospitalized. In conclusion, children with mild or moderate acute attacks of asthma can be treated up to a week with an inhalation of dry powder, resulting in adequate bronchodilatation without important side effects. PMID:14689023

  8. INTERCONNECTION BETWEEN NITRIC OXIDE FORMATION AND HYPERSENSITIVITY PARAMETERS UNDER GUINEA PIG MODEL OF ACUTE ASTHMA WITH MULTIPLE CHALLENGES.

    PubMed

    Parilova, O O; Shandrenko, S G

    2015-01-01

    An immunoregulatory role of nitric oxide (NO) in the development of adaptive immune responses associated with allergic diseases is very important. The present study extended these observations by the examination of the reciprocal changes in characteristic immunologic parameters of the disease and NO level of bronchoalveolar lavage (BAL) cells under guinea pig model of acute asthma with multiple challenges. Development of guinea pig Th2 mediated asthma was accompanied by increasing the level of allergic markers: ovalbumin (OVA) specific IgG and IL-4. We demonstrated that the infiltrate of airway cells contributes to NO synthesis in the respiratory tract during allergic inflammation. The level of intracellular NO formation significantly correlated with plasma allergen specific IgG value in OVA-induced asthma. The presented data evidence that the elevated intracellular NO level in BAL fluid may reflect a nitrosative stress in respiratory tract in general, when allergic asthma exacerbation is present.

  9. Use of a management plan for treating asthma in an emergency department.

    PubMed

    Town, I; Kwong, T; Holst, P; Beasley, R

    1990-09-01

    A standardised management protocol has been developed for the assessment and treatment of adults with acute asthma attending an emergency department. The management protocol consists of an assessment sheet for recording essential features of the history and examination findings and a flow diagram with guidelines for initial management that were based on spirometric recordings. The protocol was introduced at Wellington Hospital in 1986. The effect of this intervention was assessed by analysing emergency department records during the three months before and one year after the introduction of the protocol. The use of the assessment sheet improved history taking and led to the increased use of serial measures of airflow obstruction and improved documentation of follow up arrangements. The provision of management guidelines influenced the emphasis of management, including an increased use of corticosteroids intravenously and more frequent use of an additional dose of nebulised bronchodilator. In the light of the initial experience the protocol has been modified and its use either in an emergency department or in general practice is recommended.

  10. Management of acute neurorehabilitation programs.

    PubMed

    Vogl, Susan M

    2011-06-01

    Outcome management, performance improvement, evidence-based practice, and policy payment mechanisms are critical operational drivers at every level of health care delivery. It is essential that all health care providers involved in patient care have a working knowledge of health care operations, including the policies and reimbursement mechanisms that drive their particular clinical practice. Providing excellent patient care includes understanding health care policies, regulations, and outcomes that have a historical and current impact on health care delivery. Some of these factors include patient access, patient safety, and information measurement and management. Inpatient acute neurorehabilitation programs have standard outcome measures and a unique set of fiscal rules and regulations. This article discusses the most common variables and terms found in program evaluation systems for acute neurorehabilitation programs as well as some of the clinical and regulatory requirements and reimbursement and level-of-care considerations that are critical for neurorehabilitation health care practitioners. The current health care environment requires providers to understand and continually evaluate quality outcomes, patient access, and patient safety, all within the confines of an efficacy-based care delivery system. PMID:22810871

  11. Immunological characteristics and management considerations in obese patients with asthma

    PubMed Central

    Ather, Jennifer L; Poynter, Matthew E; Dixon, Anne E

    2015-01-01

    Obesity is associated with severe, poorly controlled asthma that does not respond as well to therapy as asthma in leaner asthmatics. Important insights gained from animal models of obesity and asthma suggests that different forms of obesity may lead to different manifestations of airway disease: obesity is associated with both innate increased airway reactivity and altered responses to aeroallergen and pollutant challenges. In humans, at least two broad groups of obese asthmatics have been recognized: one that is likely unique to obesity and another that is likely lean allergic asthma much complicated by obesity. This article will discuss what we have learned about the immunological and pathophysiological basis of asthma in obesity from animal and human studies, and how this might guide therapy. PMID:25914932

  12. Recognizing asthma mimics and asthma complications.

    PubMed

    Amundson, Dennis; Seda, Gilbert; Daheshia, Massoud

    2011-10-01

    Asthma is a chronic inflammatory disorder of the airways characterized by airflow obstruction, bronchial hyperreactivity, and underlying inflammation. Two common reasons asthmatics fail standard therapy are incorrect diagnosis and failure to recognize underlying contributing factors. A correct diagnosis of asthma is of great importance to military practitioners since misdiagnosis or uncontrolled asthma affects an individual's operational readiness or determines whether one can receive a medical waiver to enlist in military service. This article presents four cases of patients with dyspnea that have conditions which mimic asthma or complicate asthma management: vocal cord dysfunction misdiagnosed as asthma, respiratory bronchiolitis interstitial lung disease mistaken as asthma, difficult-to-control asthma because of bronchiectasis and allergic bronchopulmonary aspergillosis, and difficult and fatal asthma. Asthma is contrasted to other respiratory disorders, and an outlined approach to asthma diagnosis and management is presented using the Global Initiative for Asthma guidelines.

  13. Adolescence and asthma management: the perspective of adolescents receiving primary health care☆

    PubMed Central

    Araújo, Alisson; Rocha, Regina Lunardi; Alvim, Cristina Gonçalves

    2014-01-01

    Objective: To study the influence of adolescence characteristics on asthma management. Methods: This was a qualitative study conducted in the city of Divinópolis, Minas Gerais, Southeast Brazil. Data were collected through semistructured interviews guided by a questionnaire with seven asthmatic adolescents followed-up in the primary public health care service of the city. Results: Using content analysis, three thematic categories were observed in the adolescents' responses: 1) family relationships in the treatment of asthma in adolescence; 2) the asthmatic adolescents and their peers; and 3) the role of the school for the asthmatic adolescents. Conclusions: The results demonstrated that peers, family, and school should be more valued by health professionals and by health care services when treating asthmatic adolescents, as these social relationships are closely associated with the adolescent and have an important role in asthma management. Attempts to meet the demands of adolescents contribute to improve asthma management. PMID:25479845

  14. Comparative efficacy of terbutaline administered by Nebuhaler and by nebulizer in young children with acute asthma.

    PubMed

    Pendergast, J; Hopkins, J; Timms, B; Van Asperen, P P

    1989-10-01

    We compared the use of terbutaline sulphate that was delivered by a nebulizer with its delivery by a Nebuhaler at two dose levels in 27 children (nine children per group) of between three and six years of age with acute asthma. No significant difference was found in the mean baseline clinical score among the three groups, and a significant decline occurred in the mean clinical scores in all groups by 15 minutes which was maintained to 60 minutes after the dose was administered. The decline that was achieved with delivery of the drug by way of a Nebuhaler (at either dose level) was not significantly different from that with a nebulizer, although cooperation with Nebuhaler usage was not universal in the age-group. PMID:2677624

  15. Effectiveness of asthma education with and without a self-management plan in hospitalized children.

    PubMed

    Espinoza-Palma, Tatiana; Zamorano, Alejandra; Arancibia, Francisca; Bustos, María-Francisca; Silva, Maria José; Cardenas, Consuelo; De La Barra, Pedro; Puente, Victoria; Cerda, Jaime; Castro-Rodriguez, José A; Prado, Francisco

    2009-11-01

    Background. Formal education in primary care can reduce asthma exacerbations. However, there are few studies in hospitalized children, with none originating in Latin America. Methods. A prospective randomized study was designed to evaluate whether a full education with self-management plan (ESM) was more effective than an education without self-management plan (E) in reducing asthma hospitalization. Children (5 to 15 years of age) who were hospitalized for an asthma attack were divided in two groups. Children in the E group received general instructions based on a booklet. Those in the ESM group received the same booklet plus a self-management guide and a puzzle game that reinforces the lessons learned in the booklet. Patients were interviewed every 3 months, by telephone, for one year. Interviewers recording the number of hospitalizations, exacerbations, and emergency visits for asthma and oral steroid burst uses. Results. From 88 children who met the inclusion criteria, 77 (86%) completed one year of follow-up (41 from E and 36 from ESM group). Overall, after one year, the hospitalization decreased by 66% and the inhaled corticosteroids therapy increased from 36% to 79%. At the end of the study, there was no difference in exacerbations, emergency visits, oral steroid burst uses, or hospitalizations between the two groups. Conclusions. Asthma education with or without a self-management plan during asthma hospitalization were effective in reducing exacerbations, emergency visits, oral steroid burst uses, and future rehospitalizations. This evidence supports the importance of providing a complete asthma education plan in any patient who is admitted for asthma exacerbation. PMID:19905916

  16. Effectiveness of asthma education with and without a self-management plan in hospitalized children.

    PubMed

    Espinoza-Palma, Tatiana; Zamorano, Alejandra; Arancibia, Francisca; Bustos, María-Francisca; Silva, Maria José; Cardenas, Consuelo; De La Barra, Pedro; Puente, Victoria; Cerda, Jaime; Castro-Rodriguez, José A; Prado, Francisco

    2009-11-01

    Background. Formal education in primary care can reduce asthma exacerbations. However, there are few studies in hospitalized children, with none originating in Latin America. Methods. A prospective randomized study was designed to evaluate whether a full education with self-management plan (ESM) was more effective than an education without self-management plan (E) in reducing asthma hospitalization. Children (5 to 15 years of age) who were hospitalized for an asthma attack were divided in two groups. Children in the E group received general instructions based on a booklet. Those in the ESM group received the same booklet plus a self-management guide and a puzzle game that reinforces the lessons learned in the booklet. Patients were interviewed every 3 months, by telephone, for one year. Interviewers recording the number of hospitalizations, exacerbations, and emergency visits for asthma and oral steroid burst uses. Results. From 88 children who met the inclusion criteria, 77 (86%) completed one year of follow-up (41 from E and 36 from ESM group). Overall, after one year, the hospitalization decreased by 66% and the inhaled corticosteroids therapy increased from 36% to 79%. At the end of the study, there was no difference in exacerbations, emergency visits, oral steroid burst uses, or hospitalizations between the two groups. Conclusions. Asthma education with or without a self-management plan during asthma hospitalization were effective in reducing exacerbations, emergency visits, oral steroid burst uses, and future rehospitalizations. This evidence supports the importance of providing a complete asthma education plan in any patient who is admitted for asthma exacerbation.

  17. Development of a Tool to Evaluate Asthma Preparedness and Management in Child-Care Centers

    PubMed Central

    Young, Chelsea A.; Chan, Curtis; Stookey, Jodi; Patel, Anisha I.; Evans, Jane; Cohn, Karen; Agana, Luz; Yen, Irene H.; Fernandez, Alicia

    2015-01-01

    Introduction: Asthma is a common condition affecting many children in child-care centers. The National Asthma Education and Prevention Program offers recommendations about creating an asthma-friendly child-care setting. However, no studies have investigated the extent to which child-care centers adhere to these recommendations. This study describes the development of a novel instrument to determine the ability of child-care centers to meet national recommendations for asthma. Methods: The Preparing for Asthma in Child Care (PACC) Instrument was developed using information from existing recommendations and standards, the peer-reviewed literature, site visits, and expert interviews. The survey questions were pilot-tested at 36 child-care centers throughout San Francisco. Results: The instrument is composed of 43 items across seven domains: smoking exposure, presence of a medical consultant and policies, management of ventilation and triggers, access to medication, presence of asthma action plans, staff training, and encouragement of physical activity. Discussion: The PACC Instrument is an evidence-based and comprehensive tool designed to identify areas to target to improve asthma care for children in child-care centers. PMID:26155370

  18. A workshop on asthma management programs and centers in Brazil: reviewing and explaining concepts*

    PubMed Central

    Stelmach, Rafael; Neto, Alcindo Cerci; Fonseca, Ana Cristina de Carvalho Fernandez; Ponte, Eduardo Vieira; Alves, Gerardo; Araujo-Costa, Ildely Niedia; Lasmar, Laura Maria de Lima Belizário Facury; de Castro, Luci Keiko Kuromoto; Lenz, Maria Lucia Medeiros; Silva, Paulo; Cukier, Alberto; Alves, Alexssandra Maia; Lima-Matos, Aline Silva; Cardoso, Amanda da Rocha Oliveira; Fernandes, Ana Luisa Godoy; de São-José, Bruno Piassi; Riedi, Carlos Antônio; Schor, Deborah; Peixoto, Décio Medeiros; Brandenburg, Diego Djones; Camillo, Elineide Gomes dos Santos; Serpa, Faradiba Sarquis; Brandão, Heli Vieira; Lima, João Antonio Bonfadini; Pio, Jorge Eduardo; Fiterman, Jussara; Anderson, Maria de Fátima; Cardoso, Maria do Socorro de Lucena; Rodrigues, Marcelo Tadday; Pereira, Marilyn Nilda Esther Urrutia; Antila, Marti; Martins, Sonia Maria; Guimarães, Vanessa Gonzaga Tavares; Mello, Yara Arruda Marques; de Andrade, Wenderson Clay Correia; Salibe-Filho, William; Caldeira, Zelina Maria da Rocha; da Cruz-Filho, Álvaro Augusto Souza; Camargos, Paulo

    2015-01-01

    Objective: To report the results of a workshop regarding asthma management programs and centers (AMPCs) in Brazil, so that they can be used as a tool for the improvement and advancement of current and future AMPCs. Methods: The workshop consisted of five presentations and the corresponding group discussions. The working groups discussed the following themes: implementation of asthma management strategies; human resources needed for AMPCs; financial resources needed for AMPCs; and operational maintenance of AMPCs. Results: The workshop involved 39 participants, from all regions of the country, representing associations of asthma patients (n = 3), universities (n = 7), and AMPCs (n = 29). We found a direct relationship between a lack of planning and the failure of AMPCs. Based on the experiences reported during the workshop, the common assumptions about AMPCs in Brazil were the importance of raising awareness of managers; greater community participation; interdependence between primary care and specialized care; awareness of regionalization; and use of medications available in the public health system. Conclusions: Brazil already has a core of experience in the area of asthma management programs. The implementation of strategies for the management of chronic respiratory disease and their incorporation into health care system protocols would seem to be a natural progression. However, there is minimal experience in this area. Joint efforts by individuals with expertise in AMPCs could promote the implementation of asthma management strategies, thus speeding the creation of treatment networks, which might have a multiplier effect, precluding the need for isolated centers to start from zero. PMID:25750669

  19. The management of acute pericarditis.

    PubMed

    Wells, T A; Curzen, N P

    2005-01-01

    Acute pericarditis is usually a benign self-limiting condition, often of unexplained or viral aetiology, involving inflammation of the pericardial layers. It is often part of the differential diagnosis in patients admitted with acute chest pain and can be confused with acute myocardial infarction, acute pulmonary embolism and pleurisy. Occasionally it can result in cardiac tamponade and, if associated with myocarditis, in heart failure. This article sets out how to diagnose acute pericarditis, the common underlying causes, the possible treatment options and outcomes. PMID:21655516

  20. Value of Inhaled Corticosteroid Therapy In Long-Term Asthma Management

    PubMed Central

    Beam, Donald S.

    2010-01-01

    Asthma, which affects more than 22 million people in the U.S. every year, poses a significant clinical and economic burden to our health care system. Patients, health care practitioners, and payers require a variety of resources to ensure optimal disease management and positive clinical outcomes while also managing costs. In addition, decision makers in health care must determine the most appropriate and cost-efficient therapy or class of agents to achieve asthma control. As such, payers rely on evidence-based medicine, including guidelines to determine the right therapy for the right patient. Inhaled corticosteroid (ICS) therapy plays a critical role in the management of mild-to-moderate persistent asthma. Despite national treatment guidelines that cite ICS therapy as the most effective and safest long-term treatment option for persistent asthma, ICS monotherapy continues to be underused. One retrospective claims study found that 55.2% of children with mild-to-moderate asthma received prescriptions for combination therapy (ICS and long-acting beta-agonists) as initial controller treatment. This practice is contrary to national treatment guidelines, which recommend a step-therapy approach. These prescribing patterns result in higher pharmacy costs, do not always ensure control of symptoms, and sometimes expose patients to potential safety risks. This article addresses the importance of ICS therapy in the treatment of mild-to-moderate asthma, as advocated by the National Asthma Education and Prevention Program (NAEPP) Expert Panel Report 3 guidelines; the role of small airway disease in asthma pathophysiology; and the clinical and economic benefits of ICS therapy. PMID:20689625

  1. Evidence based guidelines for the prevention, identification, and management of occupational asthma

    PubMed Central

    Nicholson, P; Cullinan, P; Newman, T; Burge, P; Boyle, C

    2005-01-01

    Background: Occupational asthma is the most frequently reported work related respiratory disease in many countries. This work was commissioned by the British Occupational Health Research Foundation to assist the Health and Safety Executive in achieving its target of reducing the incidence of occupational asthma in Great Britain by 30% by 2010. Aim: The guidelines aim to improve the prevention, identification, and management of occupational asthma by providing evidence based recommendations on which future practice can be based. Methods: The literature was searched systematically using Medline and Embase for articles published in all languages up to the end of June 2004. Evidence based statements and recommendations were graded according to the Royal College of General Practitioner's star system and the revised Scottish Intercollegiate Guidelines Network grading system. Results: A total of 474 original studies were selected for appraisal from over 2500 abstracts. The systematic review produced 52 graded evidence statements and 22 recommendations based on 223 studies. Discussion: Evidence based guidelines have become benchmarks for practice in healthcare and the process used to prepare them is well established. This evidence review and its recommendations focus on interventions and outcomes to provide a robust approach to the prevention, identification, and management of occupational asthma, based on and using the best available medical evidence. The most important action to prevent cases of occupational asthma is to reduce exposure at source. Thereafter surveillance should be performed for the early identification of symptoms, including occupational rhinitis, with additional functional and immunological tests where appropriate. Effective management of workers suspected to have occupational asthma involves the identification and investigation of symptoms suggestive of asthma immediately they occur. Those workers who are confirmed to have occupational asthma should be

  2. Pulmonary function abnormalities and asthma are prevalent in children with sickle cell disease and are associated with acute chest syndrome.

    PubMed

    Intzes, Stefanos; Kalpatthi, Ram V; Short, Robert; Imran, Hamayun

    2013-11-01

    Pulmonary diseases form major sources of morbidity and mortality in children with sickle cell disease (SCD). The objective of the study was to determine the prevalence of lung function abnormalities and asthma and their association with acute chest syndrome (ACS) in children with SCD. This was a cross-sectional retrospective study of 127 children with SCD; we collected information regarding ACS and asthma and pulmonary function test (PFT) data. Based on PFT results, the patients were assigned to one pattern of lung function [normal, obstructive lung disease (OLD), restrictive lung disease (RLD)]. Statistical analyses included Pearson correlation, prevalence odds ratio (POR), cross-tabulation, and multiple binary logistic regression. OLD was noted in 35% and RLD in 23% of the patients, with the remainder exhibiting a normal PFT pattern. Forty-six percent of patients had asthma, 64% of whom had a history of ACS. OLD (r = .244, P = .008, POR = 2.8) and asthma (r = .395, P < .001, POR = 5.4) were significantly associated with a history of ACS. There was a negative correlation between having normal PFT data and a history of ACS (r = -.289, P = .002, POR = .3). Asthma and pulmonary function abnormalities are prevalent in children with SCD, with OLD being more common than RLD. There is an association between asthma, OLD, and ACS, however causality cannot be proven due to the study design. We stress the importance of actively investigating for a clinical diagnosis of asthma in all patients with SCD and suggest that PFT data may help detect patients at lower risk for ACS.

  3. Recommendations for the use of bronchial thermoplasty in the management of severe asthma.

    PubMed

    Dheda, Keertan; Koegelenberg, Coenraad F N; Esmail, Aliasgar; Irusen, Elvis; Wechsler, Michael E; Niven, Rob M; Bateman, Eric D; Chung, Kian Fan

    2015-09-01

    There are approximately 3 million asthma suffers in South Africa, and the national death rate is ranked as one of the highest in the world. Approximately 5% have severe asthma (uncontrolled despite being adherent on maximal and optimised therapy). Such uncontrolled asthma is associated with high healthcare expenditure and may require treatment with anti-IgE and/or systemic corticosteroids, in addition to inhaler therapy and oral agents. These treatments may be costly, and those such as oral corticosteroids may have potential serious adverse events. There is therefore a need for more effective, affordable and safe therapies for asthma. A new modality of treatment, bronchial thermoplasty (BT), has recently been developed and approved for the treatment of severe asthma. BT involves delivering radio frequency-generated thermal energy to the airways, with the goal of reducing airway-specific smooth-muscle mass. Several clinical studies have confirmed that BT is effective and safe, that it improves control and quality of life in patients whose asthma remains severe despite optimal medical therapy, and that the beneficial effects are sustained for at least 5 years. We provide recommendations for the management of severe asthma, with an emphasis on the role of BT, and endorse the use of BT in patients with severe persistent asthma who remain uncontrolled despite optimal medical therapy as outlined in steps 4 and 5 of the British Thoracic Society (BTS)/Scottish Intercollegiate Guidelines Network (SIGN), UK National Institute of Clinical Excellence (NICE) and Global Initiative for Asthma (GINA) guidelines. We outline the context in which BT should be used, how it works and associated potential adverse events and contraindications, and also review unanswered questions and controversies. PMID:26428967

  4. Improving acute medical management: Junior Doctor Emergency Prescription Cards

    PubMed Central

    Hutton, Joe; Gingell, Megan; Hutchinson, Lisa

    2016-01-01

    Doctors commencing Foundation Year (FY) training face many stresses and challenges. FY doctors are often the first point of contact for acutely unwell and deteriorating patients. Trust guidelines are used to aid acute medical management. Accessing guidelines is often fraught with barriers. Evidence suggests aide-memoire cards can provide easier access to guidelines and management pathways. We aimed to improve prescribing accuracy and efficiency of FY doctors for acute medical conditions within Gloucestershire trust by improving access to and usability of trust guidelines. Questionnaires were distributed to FY doctors to identify acute medical conditions to include on the emergency prescription cards (EPCs). Two small double-sided cards were created containing bullet pointed trust guidelines for: hyper/hypokalaemia, status epilepticus, diabetic emergencies, arrhythmias, myocardial infarction, acute asthma, pulmonary oedema, anaphylaxis and a ward-round checklist. Feedback was used to improve EPCs prior to distribution. Pre (N=53) and post-intervention (N=46) written questionnaires were completed by FY doctors. These assessed acute clinical management including use of guidance, confidence in management, speed of prescribing and EPC “usability”. To assess prescribing accuracy, prescriptions for acute medical conditions were reviewed pre (N=8) and post-intervention (N=12). The EPCs were well received (80% quite/very useful) and found “easy to use” (83%). The introduction of EPCs increased guidance use (pre-intervention 58.8%, post-intervention 71.7%), increased confidence (pre-intervention 79%, post-intervention 89%) and significantly improved prescribing speed (p=0.05). There was a significant correlation with confidence and prescribing speed (p = 0.023). The accuracy of prescribed doses improved (pre-intervention 62.5%, post-intervention 87.5% accurate) as did details regarding route / additional required information (pre-intervention 75%, post

  5. Improving acute medical management: Junior Doctor Emergency Prescription Cards.

    PubMed

    Hutton, Joe; Gingell, Megan; Hutchinson, Lisa

    2016-01-01

    Doctors commencing Foundation Year (FY) training face many stresses and challenges. FY doctors are often the first point of contact for acutely unwell and deteriorating patients. Trust guidelines are used to aid acute medical management. Accessing guidelines is often fraught with barriers. Evidence suggests aide-memoire cards can provide easier access to guidelines and management pathways. We aimed to improve prescribing accuracy and efficiency of FY doctors for acute medical conditions within Gloucestershire trust by improving access to and usability of trust guidelines. Questionnaires were distributed to FY doctors to identify acute medical conditions to include on the emergency prescription cards (EPCs). Two small double-sided cards were created containing bullet pointed trust guidelines for: hyper/hypokalaemia, status epilepticus, diabetic emergencies, arrhythmias, myocardial infarction, acute asthma, pulmonary oedema, anaphylaxis and a ward-round checklist. Feedback was used to improve EPCs prior to distribution. Pre (N=53) and post-intervention (N=46) written questionnaires were completed by FY doctors. These assessed acute clinical management including use of guidance, confidence in management, speed of prescribing and EPC "usability". To assess prescribing accuracy, prescriptions for acute medical conditions were reviewed pre (N=8) and post-intervention (N=12). The EPCs were well received (80% quite/very useful) and found "easy to use" (83%). The introduction of EPCs increased guidance use (pre-intervention 58.8%, post-intervention 71.7%), increased confidence (pre-intervention 79%, post-intervention 89%) and significantly improved prescribing speed (p=0.05). There was a significant correlation with confidence and prescribing speed (p = 0.023). The accuracy of prescribed doses improved (pre-intervention 62.5%, post-intervention 87.5% accurate) as did details regarding route / additional required information (pre-intervention 75%, post-intervention 97

  6. Developing education for children with asthma through study of self-management behavior.

    PubMed

    Clark, N M; Feldman, C H; Freudenberg, N; Millman, E J; Wasilewski, Y; Valle, I

    1980-01-01

    Bronchial asthma is the major cause of disability in childhood. Among its effects are impaired levels of physical activity and self-esteem, reduced school attendance and performance, and increased utilization of emergency health services. This paper describes the development of a health education program designed to test the hypothesis that better family self-management of asthma can reduce the negative impact of the disease. Three hundred low income Black and Hispanic families were enrolled in the study. Children and primary caretakers were interviewed separately to obtain baseline data on current levels of self-management and to assess needs for educational intervention. Data have been accumulated on a variety of topics concerning asthma self-management, including health practices and beliefs, coping skills, asthma knowledge, and locus of control. An Asthma Self-Management Index was developed to measure positive management behaviors by the family. The needs assessment indicated that six core themes were priorities for these families in terms of relevant skills and behaviors. These topics were incorporated as lesson plans in the intervention.

  7. Developing education for children with asthma through study of self-management behavior.

    PubMed

    Clark, N M; Feldman, C H; Freudenberg, N; Millman, E J; Wasilewski, Y; Valle, I

    1980-01-01

    Bronchial asthma is the major cause of disability in childhood. Among its effects are impaired levels of physical activity and self-esteem, reduced school attendance and performance, and increased utilization of emergency health services. This paper describes the development of a health education program designed to test the hypothesis that better family self-management of asthma can reduce the negative impact of the disease. Three hundred low income Black and Hispanic families were enrolled in the study. Children and primary caretakers were interviewed separately to obtain baseline data on current levels of self-management and to assess needs for educational intervention. Data have been accumulated on a variety of topics concerning asthma self-management, including health practices and beliefs, coping skills, asthma knowledge, and locus of control. An Asthma Self-Management Index was developed to measure positive management behaviors by the family. The needs assessment indicated that six core themes were priorities for these families in terms of relevant skills and behaviors. These topics were incorporated as lesson plans in the intervention. PMID:7275647

  8. Advances in Management of Acute Pancreatitis.

    PubMed

    Janisch, Nigeen H; Gardner, Timothy B

    2016-03-01

    This article reviews advances in the management of acute pancreatitis. Medical treatment has been primarily supportive for this diagnosis, and despite extensive research efforts, there are no pharmacologic therapies that improve prognosis. The current mainstay of management, notwithstanding the ongoing debate regarding the volume, fluid type, and rate of administration, is aggressive intravenous fluid resuscitation. Although antibiotics were used consistently for prophylaxis in severe acute pancreatitis to prevent infection, they are no longer used unless infection is documented. Enteral nutrition, especially in patients with severe acute pancreatitis, is considered a cornerstone in management of this disease.

  9. Prediction of relapse within eight weeks after an acute asthma exacerbation in adults.

    PubMed

    McCarren, M; McDermott, M F; Zalenski, R J; Jovanovic, B; Marder, D; Murphy, D G; Kampe, L M; Misiewicz, V M; Rydman, R J

    1998-02-01

    Associations between historical, presenting, and treatment-related characteristics and relapse within 8 weeks after a moderate to severe asthma exacerbation were studied in a cohort of 284 adult asthmatics. Data were collected prospectively, and a multivariate model was developed and internally validated. Within 10 days, only 8% had relapsed, increasing to 45% by 8 weeks. Three variables that could be identified at the time of discharge were independently associated with relapse. These included: having made three or more visits to an emergency department in the prior 6 months (hazard ratio (HR) = 2.3, 95% CI = 1.6-3.4); difficulty performing work or activities as a result of physical health in the 4 weeks prior (HR = 2.7, 95% CI = 1.6-4.3); discontinuing hospital-based treatment for the exacerbation within 24 hours without having achieved a peak expiratory flow rate of at least 50% of predicted (HR = 2.6, 95% CI = 1.6-4.1). These risk factors may help to identify patients with poorly controlled asthma in need of more intensive and comprehensive management. PMID:9474071

  10. Controlled studies of childhood asthma self-management in Italy using the "open airways" and "living with asthma" programs: a preliminary report.

    PubMed

    Indinnimeo, L; Midulla, F; Hindi-Alexander, M; Bonci, E; Tancredi, G C; Cutrera, R; Zicari, A M; Evans, D; Ronchetti, R

    1987-01-01

    The concept of self-management for childhood asthma was introduced to Italy through a scientific exchange agreement with the United States. Two self-management programs, Living with Asthma (LWA) and Open Airways (OA), are being evaluated in three studies, two of which (Pilot and Atri-Viterbo) were conducted by the Respiratory Service of the Pediatric Department of the University "La Sapienza" in Rome and one by 14 Italian university pediatric respiratory centers (Project Italia). In October 1985, 20 children and their 40 parents were enrolled in the Pilot Study. One hundred percent of the mothers and children and 70% of the fathers attended all of the sessions. Theoretical knowledge about asthma and knowledge of asthma self-management behavior were assessed three times by a questionnaire: at the beginning of the program, at the end of the program and one year later. Significant improvements in knowledge of asthma and in knowledge of asthma self-management behavior were demonstrated by both parents and children at the end of the program and one year later. Analysis of clinical symptoms and drug consumption indicated a statistically nonsignificant trend towards a reduction of asthma severity in the year after the program. In the Atri-Viterbo study 8229 children were initially screened by a questionnaire. One hundred eighty-two children with asthma (2.4%) were identified and invited to participate in a self-management program. Open Airways was used in a shortened version. Only 29 families in Atri (22% of the eligible families) and 24 families in Viterbo (50%) ultimately agreed to participate in the program. A comparison of these families with those who did not participate showed that higher social status (p less than 0.001) and more severe asthma (p less than 0.05) were significantly associated with participation. Attendance by mothers and children was 78% in Atri and 61% in Viterbo. Only 5% of the fathers regularly attended the program. Parents who received the

  11. Asthma in inner cities.

    PubMed Central

    LeNoir, M. A.

    1999-01-01

    While the management of asthma has improved over the past two decades, the incidence of asthma in the inner city has not. The inner city, comprising a disproportionate number of people who live close to or below the poverty line, shows increased rates of morbidity and mortality from asthma. African Americans and Hispanic Americans are two to six times more likely to die from asthma than their white counterparts. When federally funded programs have targeted reducing morbidity and mortality in children from these populations, they have succeeded, but in a national study only 18 states had initiatives targeting asthma in low-income populations. This is tantamount to a public health crisis. Patients are not always properly diagnosed and are often without a regular source of health care, and symptoms are seen only in an acute context. Living conditions for the inner-city child have significant allergen triggers associated with house dust, cockroaches, cigarette smoke, chemical pollutants, and particulate matter. Viral infections, such as those caused by respiratory syncytial virus, are worse in crowded living conditions. The desirability of an increased public awareness of the seriousness of the disease and the need for chronic health care are issues that should be raised, through culturally relevant public means and in the knowledge that visual information is most effective. Physicians must understand the proper use of rescue and controller drugs, and asthma education must expand beyond doctors and nurses in their offices. The National Medical Association is committed to doing this aggressively, and community organizations, alliances, and coalitions must also aggressively follow. Public agencies must be lobbied to set high standards for proper asthma care and resources. With organizations acting in concert, the mortality and morbidity from asthma can be substantially prevented in the inner city. PMID:12653387

  12. Findings from a pilot Randomised trial of an Asthma Internet Self-management Intervention (RAISIN)

    PubMed Central

    Morrison, D; Wyke, S; Saunderson, K; McConnachie, A; Agur, K; Chaudhuri, R; Thomas, M; Thomson, N C; Yardley, L; Mair, F S

    2016-01-01

    Objective To evaluate the feasibility of a phase 3 randomised controlled trial (RCT) of a website (Living Well with Asthma) to support self-management. Design and setting Phase 2, parallel group, RCT, participants recruited from 20 general practices across Glasgow, UK. Randomisation through automated voice response, after baseline data collection, to website access for minimum 12 weeks or usual care. Participants Adults (age≥16 years) with physician diagnosed, symptomatic asthma (Asthma Control Questionnaire (ACQ) score ≥1). People with unstable asthma or other lung disease were excluded. Intervention ‘Living Well with Asthma’ is a desktop/laptop compatible interactive website designed with input from asthma/ behaviour change specialists, and adults with asthma. It aims to support optimal medication management, promote use of action plans, encourage attendance at asthma reviews and increase physical activity. Outcome measures Primary outcomes were recruitment/retention, website use, ACQ and mini-Asthma Quality of Life Questionnaire (AQLQ). Secondary outcomes included patient activation, prescribing, adherence, spirometry, lung inflammation and health service contacts after 12 weeks. Blinding postrandomisation was not possible. Results Recruitment target met. 51 participants randomised (25 intervention group). Age range 16–78 years; 75% female; 28% from most deprived quintile. 45/51 (88%; 20 intervention group) followed up. 19 (76% of the intervention group) used the website, for a mean of 18 min (range 0–49). 17 went beyond the 2 ‘core’ modules. Median number of logins was 1 (IQR 1–2, range 0–7). No significant difference in the prespecified primary efficacy measures of ACQ scores (−0.36; 95% CI −0.96 to 0.23; p=0.225), and mini-AQLQ scores (0.38; −0.13 to 0.89; p=0.136). No adverse events. Conclusions Recruitment and retention confirmed feasibility; trends to improved outcomes suggest use of Living Well with Asthma may improve

  13. MicroRNAs Profiling in Murine Models of Acute and Chronic Asthma: A Relationship with mRNAs Targets

    PubMed Central

    Huynh-Thu, Vân Anh; Geurts, Pierre; Irrthum, Alexandre; Crahay, Céline; Arnould, Thierry; Deroanne, Christophe; Piette, Jacques; Cataldo, Didier; Colige, Alain

    2011-01-01

    Background miRNAs are now recognized as key regulator elements in gene expression. Although they have been associated with a number of human diseases, their implication in acute and chronic asthma and their association with lung remodelling have never been thoroughly investigated. Methodology/Principal Findings In order to establish a miRNAs expression profile in lung tissue, mice were sensitized and challenged with ovalbumin mimicking acute, intermediate and chronic human asthma. Levels of lung miRNAs were profiled by microarray and in silico analyses were performed to identify potential mRNA targets and to point out signalling pathways and biological processes regulated by miRNA-dependent mechanisms. Fifty-eight, 66 and 75 miRNAs were found to be significantly modulated at short-, intermediate- and long-term challenge, respectively. Inverse correlation with the expression of potential mRNA targets identified mmu-miR-146b, -223, -29b, -29c, -483, -574-5p, -672 and -690 as the best candidates for an active implication in asthma pathogenesis. A functional validation assay was performed by cotransfecting in human lung fibroblasts (WI26) synthetic miRNAs and engineered expression constructs containing the coding sequence of luciferase upstream of the 3′UTR of various potential mRNA targets. The bioinformatics analysis identified miRNA-linked regulation of several signalling pathways, as matrix metalloproteinases, inflammatory response and TGF-β signalling, and biological processes, including apoptosis and inflammation. Conclusions/Significance This study highlights that specific miRNAs are likely to be involved in asthma disease and could represent a valuable resource both for biological makers identification and for unveiling mechanisms underlying the pathogenesis of asthma. PMID:21305051

  14. Protective effect of curcumin on acute airway inflammation of allergic asthma in mice through Notch1-GATA3 signaling pathway.

    PubMed

    Chong, Lei; Zhang, Weixi; Nie, Ying; Yu, Gang; Liu, Liu; Lin, Li; Wen, Shunhang; Zhu, Lili; Li, Changchong

    2014-10-01

    Curcumin, a natural product derived from the plant Curcuma longa, has been found to have anti-inflammatory, antineoplastic and antifibrosis effects. It has been reported that curcumin attenuates allergic airway inflammation in mice through inhibiting NF-κB and its downstream transcription factor GATA3. It also has been proved the antineoplastic effect of curcumin through down-regulating Notch1 receptor and its downstream nuclear transcription factor NF-κB levels. In this study, we aimed to investigate the anti-inflammatory effect of curcumin on acute allergic asthma and its underlying mechanisms. 36 male BALB/c mice were randomly divided into four groups (normal, asthma, asthma+budesonide and asthma+curcumin groups). BALF (bronchoalveolar lavage fluid) and lung tissues were analyzed for airway inflammation and the expression of Notch1, Notch2, Notch3, Notch4 and the downstream transcription factor GATA3. Our findings showed that the levels of Notch1 and Notch2 receptors were up-regulated in asthma group, accompanied by the increased expression of GATA3. But the expression of Notch2 receptor was lower than Notch1 receptor. Curcumin pretreatment improved the airway inflammatory cells infiltration and reversed the increasing levels of Notch1/2 receptors and GATA3. Notch3 receptor was not expressed in all of the four groups. Notch4 receptor protein and mRNA expression level in the four groups had no significant differences. The results of the present study suggested that Notch1 and Notch2 receptor, major Notch1 receptor, played an important role in the development of allergic airway inflammation and the inhibition of Notch1-GATA3 signaling pathway by curcumin can prevent the development and deterioration of the allergic airway inflammation. This may be a possible therapeutic option of allergic asthma.

  15. Behavioral and cognitive processes in the self-management of asthma.

    PubMed

    Creer, Thomas L

    2008-03-01

    The commonly used research approach to asthma self-management is based on black box theory where emphasis is placed on input (manipulation of independent variables) and output (the assessment of dependent variables). In this paradigm, little attention is paid to the behavioral and cognitive processes that occur between input and output. This paper discusses six processes--goal setting, information collection, information interpretation, decision-making, action, and self-efficacy--that mediate the transition from acquiring self-management skills to their performance over time. Operant learning and social cognitive theory provide the foundation for a process model of self-management. Each process, as well as the interactions of processes, is described by presenting information obtained from direct observation and patient reports gathered over a 40-year period with both children and adults. It illustrates that patients are far more consistent, imaginative, and confident in utilizing self-management skills to manage their asthma than might be expected. The conclusion is that in the majority of cases the combination of factors--unknown physiological changes, potent asthma medications, and the sustained performance of self-management skills--results in remission of asthma symptoms.

  16. Lung ultrasound-guided management of acute breathlessness during pregnancy.

    PubMed

    Zieleskiewicz, L; Lagier, D; Contargyris, C; Bourgoin, A; Gavage, L; Martin, C; Leone, M

    2013-01-01

    Lung ultrasonography is a standard tool in the intensive care unit and in emergency medicine, but has not been described in the particular setting of the labour ward. During pregnancy, acute respiratory failure and pulmonary oedema are not uncommon life-threatening events. We present two case reports outlining the potential of lung ultrasonography in parturients. In case 1, lung ultrasonography allowed early diagnosis and treatment of acute dyspnoea in a parturient admitted for suspected asthma exacerbation. Lung ultrasonography revealed a 'B-pattern' of vertical lines radiating into the lung tissue, indicating severe pulmonary oedema complicating previously undiagnosed pre-eclampsia. In case 2, a pre-eclamptic patient was managed with combined transthoracic echocardiography and lung ultrasonography. The accuracy of lung ultrasonography in detecting interstitial oedema at a pre-clinical stage allowed adequate fluid resuscitation in this patient who had a high risk of alveolar pulmonary oedema. We believe that these cases strongly support the prospective validation of lung ultrasound for management of lung disorders in pregnant women. PMID:23088788

  17. Occupational asthma.

    PubMed Central

    Chan-Yeung, M

    1995-01-01

    Many toxic compounds found in air emissions may induce bronchoconstriction. In the workplace, workers are exposed to these compounds, often in much higher concentrations. Some of these compounds act as sensitizers. Of these, some compounds induce asthma by producing specific IgE antibodies to the compound or its protein conjugate, while others induce asthma through yet unidentified immunologic mechanisms. Some compounds, when inhaled in high concentrations, act as irritants and produce bronchoconstriction probably by inducing acute airway inflammation. The latter condition is called Reactive Airways Dysfunction Syndrome (RADS) or irritant-induced asthma. Occupational asthma is an excellent model to study the pathogenesis and the natural history of adult onset asthma because the responsible agent can be identified, complete avoidance is possible, and exposure can be measured or estimated. PMID:8549481

  18. Steroid-induced acute psychosis in a child with asthma: report of one case.

    PubMed

    Lee, K M; Lin, Y Z; Huang, F Y

    2001-01-01

    A 5-year-old girl was admitted due to severe asthmatic attack. She was treated with methylprednisolone (40 mg i.v. q6h), aminophylline (loading with 5 mg/kg and maintained with 0.6 mg/kg/hr i.v. drip), nebulized terbutaline sulphate (5 mg q6h), oral procaterol 12.5 micrograms bid, along with oxygen therapy. Acute psychotic reaction with visual hallucination, delusion, panic reaction and myoclonic movement of hands developed on day 3 of admission. The patient had no previous history of psychiatric problems. The theophylline level was 9.89 micrograms/ml at the moment of psychotic reaction. After the dose of methylprednisolone was reduced from 40 mg to 20 mg i.v. q6h and shifted to other anti-asthma treatment by procaterol metered dose inhaler via spacer, the psychotic reaction disappeared a few hours later. The psychotic reaction was thought to be due to steroid therapy since no other causes could explain the psychotic reaction. PMID:11431864

  19. Importance of patient/parents education in childhood asthma.

    PubMed

    Gupta, A; Gupta, R

    2001-09-01

    Asthma is fairly common in pediatric age group and the suffering due to asthma continues to increase despite excellent treatments available. One of the four major components of asthma management is patient education and is critical to the success of asthma management. Reasons for continued suffering include that our management strategies are not easily understood by the patient/parents without a simple and careful approach towards this step. Eliciting common concerns and fears is the single and foremost strategy to develop a relationship of trust with the patients/parents. Making them understand about the chronic nature of asthma, need for a long-term care approach, what happens during acute attacks and where medications act are some of the important areas you should be educating about in the beginning. Then comes the skill transfer, i.e. giving them skills to monitor asthma including use of peakflowmeter and use of inhalation devices effectively. Joint development of written plans for medications is essential. Development of plans to control of asthma; jointly with them; including learning about warning signs and a plan to manage acute attack at home is also very important and patient/parents should be having an active participation. Finally, educating them how to identify asthma triggers helps as a long-term strategy to keep control over asthma with or without medications. Reminding patient/parents when to come for follow-up and what would be discussed next time are some important tricks of the trade. PMID:11980470

  20. Nedocromil sodium versus albuterol in the management of allergic asthma.

    PubMed

    de Jong, J W; Teengs, J P; Postma, D S; van der Mark, T W; Koëter, G H; de Monchy, J G

    1994-01-01

    In a double-blind, double-placebo, randomized crossover study, we compared the effects of 6 wk of treatment with the anti-inflammatory drug nedocromil sodium (16 mg/day) with 6 wk of treatment with the bronchodilator drug albuterol (800 micrograms/day) in 29 adults with allergic asthma. After 3 and 6 wk of treatment with nedocromil sodium, patients were significantly less hyperresponsive to propranolol (p = 0.002 and p = 0.02) and almost significantly less hyperresponsive to histamine (p = 0.071 and p = 0.065). FEV1 and FVC percent predicted tended to be higher, morning PEF values increased significantly (p = 0.038 and p = 0.03), and diurnal and day-to-day PEF variation decreased (p = 0.03 and p = 0.093, p = 0.005 and p = 0.096, respectively) with nedocromil sodium treatment compared with albuterol treatment. Almost all symptoms (daytime and nighttime asthma, wheezing, shortness of breath) and the additional bronchodilator use were significantly reduced with nedocromil sodium treatment compared with albuterol treatment. Treatment with the anti-inflammatory drug nedocromil sodium was shown to be superior to treatment with the bronchodilator drug albuterol. The patient's clinical situation may deteriorate when beta 2-agonists are used continuously. Nedocromil sodium has good clinical effect, and it may serve as a first-line choice for antiinflammatory therapy in asthma.

  1. Hospital Admissions for Acute Myocardial Infarction, Angina, Stroke, and Asthma After Implementation of Arizona's Comprehensive Statewide Smoking Ban

    PubMed Central

    Walsh, Michele E.

    2011-01-01

    Objectives. We examined the impact of Arizona's May 2007 comprehensive statewide smoking ban on hospital admissions for diagnoses for which there is evidence of a causal relationship with secondhand smoke (SHS) exposure (acute myocardial infarction [AMI], angina, stroke, and asthma). Methods. We compared monthly hospital admissions from January 2004 through May 2008 for these primary diagnoses and 4 diagnoses not associated with SHS (appendicitis, kidney stones, acute cholecystitis, and ulcers) for Arizona counties with preexisting county or municipal smoking bans and counties with no previous bans. We attributed reductions in admissions to the statewide ban if they occurred only in diagnoses associated with SHS and if they were larger in counties with no previous bans. We analyzed the data with Poisson regressions, controlling for seasonality and admissions trends. We also estimated cost savings. Results. Statistically significant reductions in hospital admissions were seen for AMI, angina, stroke, and asthma in counties with no previous bans over what was seen in counties with previous bans. No ban variable coefficients were statistically significant for diagnoses not associated with SHS. Conclusions. Arizona's statewide smoking ban decreased hospital admissions for AMI, stroke, asthma, and angina. PMID:20466955

  2. Relevance of serology for Mycoplasma pneumoniae diagnosis compared with PCR and culture in acute exacerbation of bronchial asthma.

    PubMed

    El Sayed Zaki, Maysaa; Raafat, Doaa; El Metaal, Amal Abd

    2009-01-01

    We studied Mycoplasma pneumoniae as the etiologic pathogen in acute exacerbations of asthma and the value of polymerase chain reaction (PCR), culture, and serologic tests for its accurate diagnosis. For the study, 59 nonsmoking patients with asthma (37 females, 22 males; age, 15-50 years) underwent clinical, radiologic, and laboratory examinations. Bacteria isolated from sputum were Streptococcus pneumoniae (32 [54%]), Staphylococcus aureus (23 [39%]), and M pneumoniae (5 [15%]). All M pneumoniae were associated with S pneumoniae (8/32 [25%]) and S aureus (1/23 [4%]). No M pneumoniae were isolated as single pathogens. Serologic testing for M pneumoniae revealed that all samples were positive for specific IgG; 40 (68%) had a high titer, and 19 (32%) had a moderate titer. Of 59 samples, 29 (49%) were positive by Serodia Myco II gelatin particle testing (Fujirebio, Tokyo, Japan). PCR was positive in 25 samples, all of which had a high IgG titer; all culture-positive cases were PCR+. M pneumoniae is a common bacterial pathogen associated with acute exacerbations of asthma in people 15 years or older. Prompt laboratory diagnosis of M pneumoniae requires direct detection by PCR and culture. A high serologic titer can be a clue for the presence of M pneumoniae.

  3. Helping African American Children Self-Manage Asthma: The Importance of Self-Efficacy

    ERIC Educational Resources Information Center

    Kaul, Teri

    2011-01-01

    Background: Asthma is the leading cause of chronic illness among children in the United States, with a disproportionately higher incidence among minority children. In an attempt to increase understanding of the factors that may influence self-management of chronic disease, the study examined the relationship between self-efficacy belief and asthma…

  4. Managing acute invasive fungal sinusitis.

    PubMed

    Dwyhalo, Kristina M; Donald, Carrlene; Mendez, Anthony; Hoxworth, Joseph

    2016-01-01

    Acute invasive fungal sinusitis is the most aggressive form of fungal sinusitis and can be fatal, especially in patients who are immunosuppressed. Early diagnosis and intervention are crucial and potentially lifesaving, so primary care providers must maintain a high index of suspicion for this disease. Patients may need to be admitted to the hospital for IV antifungal therapy and surgical debridement.

  5. The role of inhaled long-acting beta-2 agonists in the management of asthma.

    PubMed Central

    Kelly, H. William; Harkins, Michelle S.; Boushey, Homer

    2006-01-01

    The role of inhaled beta-2 agonists in the management of asthma has changed significantly over the last several years. This review outlines the most recent understanding of the pathophysiology of asthma and the studies that define the roles that both short- and long-acting beta-2 agonists play in therapy for this disease. A concentration on the clinical pharmacology and genetic implications for clinical use of this class of drugs in accordance with the national and international guidelines are described. PMID:16532973

  6. A systematic review of complementary and alternative medicine for asthma self-management.

    PubMed

    George, Maureen; Topaz, Maxim

    2013-03-01

    This article is a systematic review of complementary and alternative medicine use for pediatric and adult asthma self-management. The aim of the review was to summarize the existing body of research regarding the types and patterns of, adverse events and risky behaviors associated with, and patient-provider communication about complementary therapies in asthma. This evidence serves as the basis for a series of recommendations in support of patient-centered care, which addresses both patient preferences for integrated treatment and patient safety.

  7. Near fatal asthma: treatment and prevention.

    PubMed

    D'Amato, G; Vitale, C; Lanza, M; Sanduzzi, A; Molino, A; Mormile, M; Vatrella, A; Bilò, M B; Antonicelli, L; Bresciani, M; Micheletto, C; Vaghi, A; D'Amato, M

    2016-07-01

    Near-fatal asthma (NFA) is described as acute asthma associated with a respiratory arrest or arterial carbon dioxide tension greater than 50 mmHg, with or without altered consciousness, requiring mechanical ventilation. Risk factors for near fatal asthma have not been fully elucidated. In 80-85% of all fatal events, a phenotype, characterized by eosinophilic inflammation associated with gradual deterioration occurring in patients with severe and poorly controlled asthma, has been identified. Regarding to the management, acute severe asthma remains a significant clinical problem, which needs to be identified to facilitate early and appropriate therapeutic interventions. The assessment relies on clinical signs, but additional information might be obtained from chest radiography or blood gas analysis. No investigation should delay the initiation of appropriate therapy. The goals of therapy are the maintenance of oxygenation, relief of airflow obstruction, reduction of airways edema and mucus plugging (with Increased use of medications such as beta-agonists via metered dose inhalers and nebulizers, oral and/or intravenous (other than by inhalation) corticosteroids and oral or intravenous theophylline) whereas supporting ventilation as clinically indicated. Of course, the emergency physician needs to consider the wide range of potential complications, as attention to these problems when managing severe acute asthma might significantly improve outcome. An understanding of the available agents and potential pitfalls in the management of NFA is mandatory for the emergency physician. PMID:27425166

  8. Watch, Discover, Think, and Act: Evaluation of Computer-Assisted Instruction To Improve Asthma Self-Management in Inner-City Children.

    ERIC Educational Resources Information Center

    Bartholomew, L. K.; Gold, R. S.; Parcel, G. S.; Czyzewski, D. I.; Sockrider, M. M.; Fernandez, M.; Shegog, R.; Swank, P.

    2000-01-01

    An interactive multimedia computer game to enhance self-management skills and thereby improve asthma outcomes in inner city children with asthma was evaluated. Results find that the intervention was associated with fewer hospitalizations, better symptom scores, increased functional status, greater knowledge of asthma management, and better child…

  9. The Effects of Self-Management Education for School-Age Children on Asthma Morbidity: A Systematic Review

    ERIC Educational Resources Information Center

    Ahmad, Emily; Grimes, Deanna E.

    2011-01-01

    The effects of asthma self-management education for school-age children on number of school days missed, emergency department visits and hospital admissions were evaluated through a systematic review of the published research. A total of 9 studies on asthma education programs that were conducted in schools by school nurses and health educators and…

  10. Anaesthetic management of acute airway obstruction

    PubMed Central

    Wong, Patrick; Wong, Jolin; Mok, May Un Sam

    2016-01-01

    The acutely obstructed airway is a medical emergency that can potentially result in serious morbidity and mortality. Apart from the latest advancements in anaesthetic techniques, equipment and drugs, publications relevant to our topic, including the United Kingdom’s 4th National Audit Project on major airway complications in 2011 and the updated American Society of Anesthesiologists’ difficult airway algorithm of 2013, have recently been published. The former contained many reports of adverse events associated with the management of acute airway obstruction. By analysing the data and concepts from these two publications, this review article provides an update on management techniques for the acutely obstructed airway. We discuss the principles and factors relevant to the decision-making process in formulating a logical management plan. PMID:26996162

  11. Randomised comparison of guided self management and traditional treatment of asthma over one year.

    PubMed Central

    Lahdensuo, A.; Haahtela, T.; Herrala, J.; Kava, T.; Kiviranta, K.; Kuusisto, P.; Perämäki, E.; Poussa, T.; Saarelainen, S.; Svahn, T.

    1996-01-01

    OBJECTIVE: To compare the efficacy of self management of asthma with traditional treatment. DESIGN: 12 month prospective randomised trial. SETTING: Outpatient clinics in Finland. SUBJECTS: 115 patients with mild to moderately severe asthma. INTERVENTIONS: Patient education and adjustment of anti-inflammatory therapy guided by peak flow measurements. MAIN OUTCOME MEASURES: Unscheduled admissions to hospital and outpatient visits, days off work, courses of antibiotics and prednisolone, lung function, and quality of life. RESULTS: The mean number of unscheduled visits to ambulatory care facilities (0.5 v 1.0), days off work (2.8 v 4.8), and courses of antibiotics (0.4 v 0.9) and prednisolone (0.4 v 1.0) per patient were lower and the quality of life score (16.6 v 8.4 at 12 months) higher in the self management group than in the traditionally treated group. In both groups admissions for asthma were rare. CONCLUSIONS: Self management reduces incidents caused by asthma and improves quality of life. PMID:8605463

  12. Mechanical ventilation for severe asthma.

    PubMed

    Leatherman, James

    2015-06-01

    Acute exacerbations of asthma can lead to respiratory failure requiring ventilatory assistance. Noninvasive ventilation may prevent the need for endotracheal intubation in selected patients. For patients who are intubated and undergo mechanical ventilation, a strategy that prioritizes avoidance of ventilator-related complications over correction of hypercapnia was first proposed 30 years ago and has become the preferred approach. Excessive pulmonary hyperinflation is a major cause of hypotension and barotrauma. An appreciation of the key determinants of hyperinflation is essential to rational ventilator management. Standard therapy for patients with asthma undergoing mechanical ventilation consists of inhaled bronchodilators, corticosteroids, and drugs used to facilitate controlled hypoventilation. Nonconventional interventions such as heliox, general anesthesia, bronchoscopy, and extracorporeal life support have also been advocated for patients with fulminant asthma but are rarely necessary. Immediate mortality for patients who are mechanically ventilated for acute severe asthma is very low and is often associated with out-of-hospital cardiorespiratory arrest before intubation. However, patients who have been intubated for severe asthma are at increased risk for death from subsequent exacerbations and must be managed accordingly in the outpatient setting. PMID:26033128

  13. Factors associated with health care professionals' choice of written asthma management plans.

    PubMed

    Bibb, Sandra C; Norwood, Ricky; Meyer, John F

    2007-10-01

    The objective of this descriptive-comparative study was to determine what factors were associated with health care professionals' choice of written asthma management plans (WAMP) for health care practice. A convenience sample of medical and nursing students and practicing health care professionals was asked to choose the preferred WAMP and give a brief explanation for the choice on the questionnaire. Comparative groups were formed based on the WAMP choice. Independent sample chi2 and content analysis were used to analyze data. Ninety-five percent (n = 192) of all survey respondents (N = 202) preferred the highly readable Global Initiative for Asthma Sample Patient Asthma Management Plan, as compared to the Veterans Administration/Department of Defense (DoD) WAMP. Major themes as to why respondents preferred the Global Initiative for Asthma WAMP include "pictures," "readability," "user-friendliness," and "simplicity." Use of the current DoD/Veterans Health Administration WAMP within the DoD Military Health System may need to be re-evaluated.

  14. Using scenarios to test the appropriateness of pharmacist prescribing in asthma management

    PubMed Central

    Hanna, Tamer; Bajorek, Beata; LeMay, Kate; Armour, Carol L.

    Objective To explore the potential for community pharmacist prescribing in terms of usefulness, pharmacists’ confidence, and appropriateness, in the context of asthma management. Methods Twenty community pharmacists were recruited using convenience sampling from a group of trained practitioners who had already delivered asthma services. These pharmacists were asked to complete a scenario-based questionnaire (9 scenarios) modelled on information from real patients. Pharmacist interventions were independently reviewed and rated on their appropriateness according to the Respiratory Therapeutic Guidelines (TG) by three expert researchers. Results In seven of nine scenarios (78%), the most common prescribing intervention made by pharmacists agreed with TG recommendations. Although the prescribing intervention was appropriate in the majority of cases, the execution of such interventions was not in line with guidelines (i.e. dosage or frequency) in the majority of scenarios. Due to this, only 47% (76/162) of the interventions overall were considered appropriate. However, pharmacists were deemed to be often following common clinical practice for asthma prescribing. Therefore 81% (132/162) of prescribing interventions were consistent with clinical practice, which is often not guideline driven, indicating a need for specific training in prescribing according to guidelines. Pharmacists reported that they were confident in making prescribing interventions and that this would be very useful in their management of the patients in the scenarios. Conclusions Community pharmacists may be able to prescribe asthma medications appropriately to help achieve good outcomes for their patients. However, further training in the guidelines for prescribing are required if pharmacists are to support asthma management in this way. PMID:24644524

  15. Aspirin-induced asthma: clinical aspects, pathogenesis and management.

    PubMed

    Hamad, Ahmed M; Sutcliffe, Amy M; Knox, Alan J

    2004-01-01

    Aspirin (acetylsalicylic acid)-induced asthma (AIA) consists of the clinical triad of asthma, chronic rhinosinusitis with nasal polyps, and precipitation of asthma and rhinitis attacks in response to aspirin and other NSAIDs. The prevalence of the syndrome in the adult asthmatic populations is approximately 4-10%. Respiratory disease in these patients may be aggressive and refractory to treatment. The aetiology of AIA is complex and not fully understood, but most evidence points towards an abnormality of arachidonic acid (AA) metabolism. Cyclo-oxygenase (COX), the rate-limiting enzyme in AA metabolism, exists as two main isoforms. COX-1 is the constitutive enzyme responsible for synthesis of protective prostanoids, whereas COX-2 is induced under inflammatory conditions. A number of theories regarding its pathogenesis have been proposed. The shunting hypothesis proposes that inhibition of COX-1 shunts AA metabolism away from production of protective prostanoids and towards cysteinyl leukotriene (cys-LT) biosynthesis, resulting in bronchoconstriction and increased mucus production. The COX-2 hypothesis proposes that aspirin causes a structural change in COX-2 that results in the generation of products of the lipoxygenase pathway. It is speculated that this may result in the formation of mediators that cause respiratory reactions in AIA. Related studies provide evidence for abnormal regulation of the lipoxygenase pathway, demonstrating elevated levels of cys-LTs in urine, sputum and peripheral blood, before and following aspirin challenge in AIA patients. These studies suggest that cys-LTs are continually and aggressively synthesised before exposure to aspirin and, during aspirin-induced reactions, acceleration of synthesis occurs. A genetic polymorphism of the LTC4S gene has been identified consisting of an A to C transversion 444 nucleotides upstream of the first codon, conferring a relative risk of AIA of 3.89. Furthermore, carriers of the C444 allele demonstrate a

  16. Development and pilot testing of a mobile health solution for asthma self-management: Asthma action plan smartphone application pilot study

    PubMed Central

    Licskai, Christopher J; Sands, Todd W; Ferrone, Madonna

    2013-01-01

    BACKGROUND: Collaborative self-management is a core recommendation of national asthma guidelines; the written action plan is the knowledge tool that supports this objective. Mobile health technologies have the potential to enhance the effectiveness of the action plan as a knowledge translation tool. OBJECTIVE: To design, develop and pilot a mobile health system to support asthma self-management. METHODS: The present study was a prospective, single-centre, nonrandomized, pilot preintervention-postintervention analysis. System design and development were guided by an expert steering committee. The network included an agnostic web browser-based asthma action plan smart-phone application (SPA). Subjects securely transmitted symptoms and peak flow data daily, and received automated control assessment, treatment advice and environmental alerts. RESULTS: Twenty-two adult subjects (mean age 47 years, 82% women) completed the study. Biophysical data were received on 84% of subject days (subject day = 1 subject × 1 day). Subjects viewed their action plan current zone of control on 54% and current air quality on 61% of subject days, 86% followed self-management advice and 50% acted to reduce exposure risks. A large majority affirmed ease of use, clarity and timeliness, and 95% desired SPA use after the study. At baseline, 91% had at least one symptom criterion for uncontrolled asthma and 64% had ≥2, compared with 45% (P=0.006) and 27% (P=0.022) at study close. Mean Asthma Quality of Life Questionnaire score improved from 4.3 to 4.8 (P=0.047). CONCLUSIONS: A dynamic, real-time, interactive, mobile health system with an integrated asthma action plan SPA can support knowledge translation at the patient and provider levels. PMID:23936890

  17. Clinical Effectiveness Research in Managed-care Systems: Lessons from the Pediatric Asthma Care PORT

    PubMed Central

    Finkelstein, Jonathan A; Lozano, Paula; Streiff, Kachen A; Arduino, Kelly E; Sisk, Cynthia A; Wagner, Edward H; Weiss, Kevin B; Inui, Thomas S

    2002-01-01

    Objective To highlight the unique challenges of evaluative research on practice behavior change in the “real world” settings of contemporary managed-care organizations, using the experience of the Pediatric Asthma Care PORT (Patient Outcomes Research Team). Study Setting The Pediatric Asthma Care PORT is a five-year initiative funded by the Agency for Healthcare Research and Quality to study strategies for asthma care improvement in three managed-care plans in Chicago, Seattle, and Boston. At its core is a randomized trial of two care improvement strategies compared with usual care: (1) a targeted physician education program using practice based Peer Leaders (PL) as change agents, (2) adding to the PL intervention a “Planned Asthma Care Intervention” incorporating joint “asthma check-ups” by nurse-physician teams. During the trial, each of the participating organizations viewed asthma care improvement as an immediate priority and had their own corporate improvement programs underway. Data Collection Investigators at each health plan described the organizational and implementation challenges in conducting the PAC PORT randomized trial. These experiences were reviewed for common themes and “lessons” that might be useful to investigators planning interventional research in similar care-delivery settings. Conclusions Randomized trials in “real world” settings represent the most robust design available to test care improvement strategies. In complex, rapidly changing managed-care organizations, blinding is not feasible, corporate initiatives may complicate implementation, and the assumption that a “usual care” arm will be static is highly likely to be mistaken. Investigators must be prepared to use innovative strategies to maintain the integrity of the study design, including: continuous improvement within the intervention arms, comanagement by researchers and health plan managers of condition-related quality improvement initiatives, procedures

  18. Nutritional management of acute and chronic pancreatitis.

    PubMed

    Latifi, R; McIntosh, J K; Dudrick, S J

    1991-06-01

    Acute pancreatitis often results in a catabolic state characterized by profound hemodynamic, metabolic, cardiovascular, pulmonary, hematologic, and renal aberrations. Parenteral nutrition and metabolic support are essential if morbidity and mortality are to be minimized. In chronic pancreatitis, nutritional management ranges from fundamental dietary manipulation with or without administration of appropriate digestive enzymes to enteral supplementation with modular chemically defined diets to total parenteral nutrition, depending on the stage, severity, and manifestations of the disease. In prescribing nutrient substrates in both acute and chronic pancreatitis, consideration must be given to their effects on pancreatic enzyme secretion if optimal results are to be achieved.

  19. The management of asthma in the phenotype and biomarker era: The proposal of a new diagnostic-therapeutic model.

    PubMed

    Blasi, Francesco; Bettoncelli, Germano; Canonica, Giorgio Walter; Centanni, Stefano; Crimi, Nunzio; DiMaria, Giuseppe; Gasparini, Stefano; Gentili, Gilberto; Girbino, Giuseppe; Mereu, Carlo; Minghetti, Paola; Nardini, Stefano; Paggiaro, Pierluigi; Papi, Alberto; Pistolesi, Massimo; Rossi, Andrea

    2016-09-01

    Treatment goals in asthma patients are the achievement of a good control of symptoms and the reduction of the risk of exacerbation. However, a "one-size-fits-all" therapeutic strategy is no longer appropriate to effectively pursue these goals, due to the heterogeneity of asthma. To make the treatment scenario even more complex, asthma patients often present comorbidities that may alter response to therapy. In addition, adherence to asthma treatment is poor. Given this complex and heterogeneous picture, the management of asthma is highly challenging. A clear diagnostic-therapeutic model of patients' care and the definition of the specific responsibilities of different healthcare providers appear necessary to improve clinical outcomes and better allocate healthcare resources. We present here a proposal for this model.

  20. Acute Migraine Management in Children.

    PubMed

    Chen, Lei; Alfonzo, Michael

    2015-10-01

    Migraines are common, incapacitating, and often stress inducing for pediatric patients and parents alike. According to the Agency for Healthcare Research and Quality, more than 1 million Americans seek emergency care every year due to migraines, with increasing frequency among adolescents. The disease can vary in severity and character, often mimicking life-threatening conditions, requiring prompt nuanced recognition by emergency personnel and implementation of an effective treatment strategy. Development of emergency department guidelines for the management of pediatric migraines should be based on up-to-date evidence supporting safe, appropriate therapies for children.

  1. Pharmacogenetics of beta2 adrenergic receptor agonists in asthma management.

    PubMed

    Ortega, V E

    2014-07-01

    Beta2 (β2) adrenergic receptor agonists (beta agonists) are a commonly prescribed treatment for asthma despite the small increase in risk for life-threatening adverse responses associated with long-acting beta agonist (LABA). The concern for life-threatening adverse effects associated with LABA and the inter-individual variability of therapeutic responsiveness to LABA-containing combination therapies provide the rationale for pharmacogenetic studies of beta agonists. These studies primarily evaluated genes within the β2-adrenergic receptor and related pathways; however, recent genome-wide studies have identified novel loci for beta agonist response. Recent studies have identified a role for rare genetic variants in determining beta agonist response and, potentially, the risk for rare, adverse responses to LABA. Before genomics research can be applied to the development of genetic profiles for personalized medicine, it will be necessary to continue adapting to the analysis of an increasing volume of genetic data in larger cohorts with a combination of analytical methods and in vitro studies.

  2. Asthma in childhood.

    PubMed

    Ellis, E F

    1983-11-01

    Asthma is defined as an obstructive disease of the pulmonary airways resulting from spasm of airway muscle, increased mucus secretion, and inflammation. The airways of asthmatic individuals are hyperresponsive to a variety of stimuli including cold air, atmospheric irritants, pharmacologically active chemicals, various drugs, and hyperventilation. The fundamental abnormality underlying the hyperresponsiveness appears to be genetically determined; two theories explaining the abnormality have received the most attention. One theory suggests that asthma is due to abnormal beta-adrenergic receptor-adenylate cyclase function with decreased adrenergic responsiveness. An alternate theory proposes that increased cholinergic activity in the airway is the fundamental defect in the disease. The true prevalence of asthma has been difficult to determine owing to uncertainties regarding the definition of the disease. Prevalence in various populations of children ranged from 1.37% to 11.4% or higher. Most studies report a preponderance of asthma in boys over girls, with ratios varying from 1.3:1 to 3.3:1. Risk factors for the disease include a history of atopy, acute lower respiratory tract disease, parental cigarette smoking, and bronchiolitis or croup. The spectrum of asthma is that of an illness beginning early in life and persisting, in some cases, through adulthood. Signs of the disease may be apparent in the first 2 yr of life and are often associated with viral respiratory infections. Disproportionate narrowing of peripheral airways and decreased static elastic recoil properties of the lung predispose infants and young children to asthma. During midchildhood there is a tendency toward improvement, with continued improvement during adolescence. The goal of management of the child with asthma is to reduce symptoms sufficiently so that the child can regularly attend school, engage in play activities, and sleep through the night uninterrupted, while avoiding unacceptable

  3. Management of acute childhood fevers.

    PubMed

    Teuten, Polly; Paul, Siba Prosad; Heaton, Paul Anthony

    2015-01-01

    Feverish illnesses commonly affect children and are the second most frequent reason for a child to be admitted to hospital. Most cases are viral in origin, usually with a good prognosis. Fever can be caused by severe and rapidly progressive illness which needs urgent referral to hospital for potentially life-saving treatment, and community practitioners must be able to identify such cases showing 'red flag'features. The fear of serious disease among parents and carers may result in 'fever phobia' leading to minor illnesses being managed inappropriately. Community practitioners are well placed to reassure and support families, and to provide education regarding the facts about fever, the appropriate use of antipyretic medication, how to avoid dehydration, and the beneficial role of immunisation in preventing infection.

  4. Management of acute childhood fevers.

    PubMed

    Teuten, Polly; Paul, Siba Prosad; Heaton, Paul Anthony

    2015-01-01

    Feverish illnesses commonly affect children and are the second most frequent reason for a child to be admitted to hospital. Most cases are viral in origin, usually with a good prognosis. Fever can be caused by severe and rapidly progressive illness which needs urgent referral to hospital for potentially life-saving treatment, and community practitioners must be able to identify such cases showing 'red flag'features. The fear of serious disease among parents and carers may result in 'fever phobia' leading to minor illnesses being managed inappropriately. Community practitioners are well placed to reassure and support families, and to provide education regarding the facts about fever, the appropriate use of antipyretic medication, how to avoid dehydration, and the beneficial role of immunisation in preventing infection. PMID:26387247

  5. Benefit-risk assessment of antileukotrienes in the management of asthma.

    PubMed

    García-Marcos, Luis; Schuster, Antje; Pérez-Yarza, Eduardo G

    2003-01-01

    Antileukotrienes are a relatively new class of anti-asthma drugs that either block leukotriene synthesis (5-lipoxygenase inhibitors) like zileuton, or antagonise the most relevant of their receptors (the cysteinyl leukotriene 1 receptor [CysLT1]) like montelukast, zafirlukast or pranlukast. Hence, their major effect is an anti-inflammatory one. With the exception of pranlukast, the other antileukotrienes have been studied and marketed in the US and Europe for long enough to establish that they are useful drugs in the management of asthma. Their effects, significantly better than placebo, seem more pronounced in subjective measurements (i.e. symptoms scores or quality-of-life tests) than in objective parameters (i.e. forced expiratory volume in 1 second or peak expiratory flow rate). Also, there is some evidence that these drugs work better in some subsets of patients with certain genetic polymorphisms - probably related to their leukotriene metabolism - or patients with certain asthma characteristics. There are a small number of comparative studies only, and with regard to long-term asthma control differences between the agents have not been evaluated. Nevertheless, their overall effect appears comparable with sodium cromoglycate (cromolyn sodium) or theophylline, but significantly less than low-dose inhaled corticosteroids. Antileukotrienes have been shown to have a degree of corticosteroid-sparing effect, but salmeterol appears to perform better as an add-on drug. Montelukast is probably the most useful antileukotriene for continuous treatment of exercise-induced asthma, performing as well as salmeterol without inducing any tolerance. All antileukotrienes are taken orally; their frequency of administration is quite different ranging from four times daily (zileuton) to once daily (montelukast). Antileukotrienes are well tolerated drugs, even though zileuton intake has been related to transitional liver enzyme elevations in some cases. Also Churg-Strauss syndrome

  6. Clinical practice guideline: management of acute pancreatitis

    PubMed Central

    Greenberg, Joshua A.; Hsu, Jonathan; Bawazeer, Mohammad; Marshall, John; Friedrich, Jan O.; Nathens, Avery; Coburn, Natalie; May, Gary R.; Pearsall, Emily; McLeod, Robin S.

    2016-01-01

    There has been an increase in the incidence of acute pancreatitis reported worldwide. Despite improvements in access to care, imaging and interventional techniques, acute pancreatitis continues to be associated with significant morbidity and mortality. Despite the availability of clinical practice guidelines for the management of acute pancreatitis, recent studies auditing the clinical management of the condition have shown important areas of noncompliance with evidence-based recommendations. This underscores the importance of creating understandable and implementable recommendations for the diagnosis and management of acute pancreatitis. The purpose of the present guideline is to provide evidence-based recommendations for the management of both mild and severe acute pancreatitis as well as the management of complications of acute pancreatitis and of gall stone–induced pancreatitis. Une hausse de l’incidence de pancréatite aiguë a été constatée à l’échelle mondiale. Malgré l’amélioration de l’accès aux soins et aux techniques d’imagerie et d’intervention, la pancréatite aiguë est toujours associée à une morbidité et une mortalité importantes. Bien qu’il existe des guides de pratique clinique pour la prise en charge de la pancréatite aiguë, des études récentes sur la vérification de la prise en charge clinique de cette affection révèlent des lacunes importantes dans la conformité aux recommandations fondées sur des données probantes. Ces résultats mettent en relief l’importance de formuler des recommandations compréhensibles et applicables pour le diagnostic et la prise en charge de la pancréatite aiguë. La présente ligne directrice vise à fournir des recommandations fondées sur des données probantes pour la prise en charge de la pancréatite aiguë, qu’elle soit bénigne ou grave, ainsi que de ses complications et de celles de la pancréatite causée par un calcul biliaire. PMID:27007094

  7. Occupational asthma: a case of Baker's asthma.

    PubMed

    Murphy, Thomas R; Sheffer, Albert L

    2004-01-01

    Asthma is one of the most prominent respiratory diseases worldwide. It is defined by airflow limitation and/or airway hyperresponsiveness and can be exacerbated by a number of environmental allergens. When allergic asthma exacerbations are attributed to stimuli in a particular work environment, then occupational asthma must be considered. Incidence estimates vary, but in 1999 the Surveillance of Work-Related and Occupational Respiratory Disease in the United Kingdom estimated 4293 incident cases of occupational respiratory disease, an increase of 1427 cases over the previous year. Occupational asthma represented 26% of these cases. Baker's asthma is one of the most frequently reported types of occupational asthma in several countries. Diagniostic steps include thorough history, careful exam, and demonstration of functional reversible airflow obstruction. Treatment modalities used for occupational asthma are similar to those used in the management of other forms of asthma, with particular attention to reducing the level of exposure to the inciting allergen.

  8. The immune profile associated with acute allergic asthma accelerates clearance of influenza virus

    PubMed Central

    Samarasinghe, Amali E; Woolard, Stacie N; Boyd, Kelli L; Hoselton, Scott A; Schuh, Jane M; McCullers, Jonathan A

    2014-01-01

    Asthma was the most common comorbidity in hospitalized patients during the 2009 influenza pandemic. For unknown reasons, hospitalized asthmatics had less severe outcomes and were less likely to die from pandemic influenza. Our data with primary human bronchial cells indicate that changes intrinsic to epithelial cells in asthma may protect against cytopathology induced by influenza virus. To further study influenza virus pathogenesis in allergic hosts, we aimed to develop and characterize murine models of asthma and influenza comorbidity to determine structural, physiological and immunological changes induced by influenza in the context of asthma. Aspergillus fumigatus-sensitized and -challenged C57BL/6 mice were infected with pandemic H1N1 influenza virus, either during peak allergic inflammation or during airway remodeling to gain insight into disease pathogenesis. Mice infected with the influenza virus during peak allergic inflammation did not lose body weight and cleared the virus rapidly. These mice exhibited high eosinophilia, preserved airway epithelial cell integrity, increased mucus, reduced interferon response and increased insulin-like growth factor-1. In contrast, weight loss and viral replication kinetics in the mice that were infected during the late airway remodeling phase were equivalent to flu-only controls. These mice had neutrophils in the airways, damaged airway epithelial cells, less mucus production, increased interferons and decreased insulin-like growth factor-1. The state of the allergic airways at the time of influenza virus infection alters host responses against the virus. These murine models of asthma and influenza comorbidity may improve our understanding of the epidemiology and pathogenesis of viral infections in humans with asthma. PMID:24469764

  9. Self-Management Behaviors among Older Adults with Asthma: Associations with Health Literacy

    PubMed Central

    Federman, Alex D.; Wolf, Michael S.; Sofianou, Anastasia; Martynenko, Melissa; O’Connor, Rachel; Halm, Ethan A.; Leventhal, Howard; Wisnivesky, Juan P.

    2014-01-01

    Background/Objectives: Older adults asthmatics experience high rates of morbidity and mortality yet little is known about their self-management behaviors. We examined self-management behaviors, including medication adherence and inhaler technique, among older adults and their association with health literacy. Design: Observational cohort study. Setting: Primary care and pulmonary specialty practices in two tertiary academic medical centers and three Federally Qualified Health Centers in New York City, NY and Chicago, IL. Participants: Adults with moderate or severe persistent asthma, ages 60 years and older (n=433). Measurements: Outcomes were adherence to asthma controller medications, metered dose inhaler (MDI) and dry powder inhaler (DPI) techniques, having a usual asthma physician, and avoidance of four common triggers. Health literacy was assessed with the Short Test of Functional Health Literacy in Adults. Results: The mean age was 67 years and 36% had marginal or low health literacy. Adherence was low (38%) overall and worse among individuals with low health literacy (22% vs. 47%, p<0.0001) and after adjusting for demographic factors and health status (odds ratio [OR] 0.48, 95% confidence [CI] 0.31-0.73). Similarly, inhaler technique was poor: only 38% and 54% had good MDI and DPI technique, respectively. Technique was worse among those with low health literacy (MDI technique: OR 0.57, 95% CI 0.38-0.85; DPI technique: OR 0.42, 95% CI 0.25 to 0.71). Asthma self-monitoring and avoidance of triggers occurred infrequently but were less consistently associated with low health literacy. Conclusion: Adherence to medications and inhaler technique are poor among older asthmatics, and worse among those with low health literacy. Clinicians should routinely assess controller medication adherence and inhaler technique, and use low-literacy communication strategies to support self-management in older asthmatics. PMID:24779482

  10. Rhinoviral infection and asthma: the detection and management of rhinoviruses by airway epithelial cells.

    PubMed

    Parker, L C; Stokes, C A; Sabroe, I

    2014-01-01

    Human rhinoviruses (HRV) have been linked to the development of childhood asthma and recurrent acute asthma exacerbations throughout life, and contribute considerably to the healthcare and economic burden of this disease. However, the ability of HRV infections to trigger exacerbations, and the link between allergic status and HRV responsiveness, remains incompletely understood. Whilst the receptors on human airway cells that detect and are utilized by most HRV group A and B, but not C serotypes are known, how endosomal pattern recognition receptors (PRRs) detect HRV replication products that are generated within the cytoplasm remains somewhat of an enigma. In this article, we explore a role for autophagy, a cellular homeostatic process that allows the cell to encapsulate its own cytosolic constituents, as the crucial mechanism controlling this process and regulating the innate immune response of airway epithelial cells to viral infection. We will also briefly describe some of the recent insights into the immune responses of the airway to HRV, focusing on neutrophilic inflammation that is a potentially unwanted feature of the acute response to viral infection, and the roles of IL-1 and Pellinos in the regulation of responses to HRV.

  11. ASSESSMENT OF ACUTE LUNG INJURY INDUCED BY PM 2.5 SAMPLES FROM TWO CITIES IN GERMANY WITH DIFFERING INCIDENCE OF ALLERGIES AND ASTHMA

    EPA Science Inventory

    ASSESSMENT OF ACUTE LUNG INJURY INDUCED BY PM 2.5 SAMPLES FROM TWO CITIES IN GERMANY WITH DIFFERING INCIDENCE OF ALLERGIES AND ASTHMA.

    LR Bishop, J Heinrich*, MK Selgrade & MI Gilmour.
    Experimental Toxicology Division, ORD/ NHEERL, U.S. EPA, RTP, NC. *GSF, Neuherberg,...

  12. Pain Management: Part 1: Managing Acute and Postoperative Dental Pain

    PubMed Central

    Becker, Daniel E.

    2010-01-01

    Abstract Safe and effective management of acute dental pain can be accomplished with nonopioid and opioid analgesics. To formulate regimens properly, it is essential to appreciate basic pharmacological principles and appropriate dosage strategies for each of the available analgesic classes. This article will review the basic pharmacology of analgesic drug classes, including their relative efficacy for dental pain, and will suggest appropriate regimens based on pain intensity. Management of chronic pain will be addressed in the second part of this series. PMID:20553137

  13. AB019. Longitudinal asthma management profiles: visualisation of patient histories using multiple data sources

    PubMed Central

    Van Ganse, Eric; Herbage, Sandrine; Dima, Alexandra L.; de Bruin, Marijn; Texier, Nathalie; Jacoud, Flore; Nolin, Maëva; Langlois, Carole; Laforest, Laurent

    2016-01-01

    Background Electronic medical records (EMR) offer valuable information for research and clinical case management, but are currently underused. Barriers to EMR use include the limited information on medication use and health outcomes provided by single data sources, the challenge of linking multiple sources, and the lack of methods to integrate all information to reconstitute patients’ complete medical trajectories. The ASTRO-LAB cohort study, assessing the safety of long-acting β-agonists (LABA) in asthma, collected data from direct patient follow-up and healthcare databases, and thus allowed a more comprehensive exploration of medication use patterns, asthma control and exacerbations over time. To develop longitudinal asthma management patient profiles for the ASTROLAB cohort by integrating data on prescription and dispensation events, and patient-reported medication exposure and occurrence of severe asthma exacerbations (SAEx). Methods Children and adults with persistent asthma (aged 6–40) were included in France and the United Kingdom (UK) if on a stable therapy pattern of either LABA without inhaled corticosteroids (ICs), ICs without LABAs, LABAs and ICs in separate canisters, or fixed-dose combination (FDC) for ≥6 of 12 baseline months. The main study outcome was occurrence of asthma-related courses of oral corticosteroids, unscheduled medical contacts or death (SAEx). Patients were followed for ≤24 months via 4-monthly computer-assisted telephone interviews (CATIs) inquiring on recent asthma control, medication use, and SAEx, and via monthly text messages. Linkage was performed with prescription data (UK primary care records, physician reports in France) and dispensing data (French health insurance records). Prescription and exposure patterns were described and data visualization plots of longitudinal medication management profiles during follow-up developed for each patient. Results At inclusion, of 1,051 patients [(48.3% women, mean (SD) age =21

  14. Pharmacotherapy in the management of asthma in the elderly: a review of clinical studies

    PubMed Central

    Kim, Mi-Yeong; Song, Woo-Jung

    2016-01-01

    Asthma in the elderly is a disease with emerging concern. Despite some recent advances in our understanding of epidemiology and pathophysiology, there is a considerable lack of clinical evidence specific to elderly patients. Currently available high quality clinical evidence has been mostly obtained from younger adults, but rarely from elderly patients. Under-representation of elderly patients in previous randomized trials may have been due to being, old age, or having comorbidities. Thus, a question may be raised whether current clinical evidence could be well generalized into elderly patients. Further clinical trials should address clinical issues raised in elderly population. In this review, we aimed to overview the efficacy and safety of pharmacological management, and also to summarize the literature relevant to elderly asthma. PMID:26844215

  15. The national review of asthma deaths: what did we learn and what needs to change?

    PubMed Central

    2015-01-01

    Key points The 2014 UK National Review of Asthma Deaths identified potentially preventable factors in two-thirds of the medical records of cases scrutinised 45% of people who died from asthma did not call for or receive medical assistance in their final fatal attack Overall asthma management, acute and chronic, in primary and secondary care was judged to be good in less than one-fifth of those who died There was a failure by doctors and nurses to identify and act on risk factors for asthma attacks and asthma death The rationale for diagnosing asthma was not evident in a considerable number of cases, and there were inaccuracies related to the completion of medical certificates of the cause of death in over half of the cases considered for the UK National Review of Asthma Deaths Educational aims To increase awareness of some of the findings of the recent UK National Review of Asthma Deaths and previous similar studies To emphasise the need for accurate diagnosis of asthma, and of the requirements for completion of medical certificates of the cause of death To consider areas for improving asthma care and prevention of attacks and avoidable deaths Summary Despite the development and publication of evidence-based asthma guidelines nearly three decades ago, potentially preventable factors are repeatedly identified in studies of the care provided for patients who die from asthma. The UK National Review of Asthma Deaths (NRAD), a confidential enquiry, was no exception: major preventable factors were identified in two-thirds of asthma deaths. Most of these factors, such as inappropriate prescription and failure to provide patients with personal asthma action plans (PAAPs), could possibly have been prevented had asthma guidelines been implemented. NRAD involved in-depth scrutiny by clinicians of the asthma care for 276 people who were classified with asthma as the underlying cause of death in real-life. A striking finding was that a third of these patients did not actually

  16. [Acute interstitial pneumonia: diagnostic approach and management].

    PubMed

    Feuillet, S; Tazi, A

    2011-06-01

    Acute interstitial pneumonia (AIP) encompasses a spectrum of pulmonary disorders characterized by involvement of the lung interstitium and distal airways (bronchioles and alveoli). The onset of respiratory symptoms is acute, most often within two weeks. Most AIP take place de novo, but sometimes represent an acute exacerbation of chronic lung disease. The clinical presentation of AIP comprises rapidly progressive dyspnoea, associated sometimes with cough, fever, myalgia and asthenia. Chest radiography shows diffuse pulmonary opacities. The associated hypoxemia may be severe enough to cause acute respiratory failure. Underlying aetiologies are numerous and variable, particularly in relation to the underlying immune status of the host. Various histopathological entities may be responsible for AIP although diffuse alveolar damage is the predominant pattern. The diagnostic approach to a patient presenting with AIP is to try to determine the most likely underlying histopathological pattern and to search for a precise aetiology. It relies mainly on a meticulous clinical evaluation and accurate biological investigation, essentially guided by the results of bronchoalveolar lavage performed in an area identified by abnormalities on high resolution computed tomography of the lungs. Initial therapeutic management includes symptomatic measures, broad-spectrum antibiotic treatment adapted to the clinical context, frequently combined with systemic corticosteroid therapy.

  17. Geospatial relationships of air pollution and acute asthma events across the Detroit-Windsor international border: study design and preliminary results.

    PubMed

    Lemke, Lawrence D; Lamerato, Lois E; Xu, Xiaohong; Booza, Jason C; Reiners, John J; Raymond Iii, Delbert M; Villeneuve, Paul J; Lavigne, Eric; Larkin, Dana; Krouse, Helene J

    2014-07-01

    The Geospatial Determinants of Health Outcomes Consortium (GeoDHOC) study investigated ambient air quality across the international border between Detroit, Michigan, USA and Windsor, Ontario, Canada and its association with acute asthma events in 5- to 89-year-old residents of these cities. NO2, SO2, and volatile organic compounds (VOCs) were measured at 100 sites, and particulate matter (PM) and polycyclic aromatic hydrocarbons (PAHs) at 50 sites during two 2-week sampling periods in 2008 and 2009. Acute asthma event rates across neighborhoods in each city were calculated using emergency room visits and hospitalizations and standardized to the overall age and gender distribution of the population in the two cities combined. Results demonstrate that intra-urban air quality variations are related to adverse respiratory events in both cities. Annual 2008 asthma rates exhibited statistically significant positive correlations with total VOCs and total benzene, toluene, ethylbenzene and xylene (BTEX) at 5-digit zip code scale spatial resolution in Detroit. In Windsor, NO2, VOCs, and PM10 concentrations correlated positively with 2008 asthma rates at a similar 3-digit postal forward sortation area scale. The study is limited by its coarse temporal resolution (comparing relatively short term air quality measurements to annual asthma health data) and interpretation of findings is complicated by contrasts in population demographics and health-care delivery systems in Detroit and Windsor.

  18. Geospatial relationships of air pollution and acute asthma events across the Detroit–Windsor international border: Study design and preliminary results

    PubMed Central

    Lemke, Lawrence D; Lamerato, Lois E; Xu, Xiaohong; Booza, Jason C; Reiners, John J; Raymond III, Delbert M; Villeneuve, Paul J; Lavigne, Eric; Larkin, Dana; Krouse, Helene J

    2014-01-01

    The Geospatial Determinants of Health Outcomes Consortium (GeoDHOC) study investigated ambient air quality across the international border between Detroit, Michigan, USA and Windsor, Ontario, Canada and its association with acute asthma events in 5- to 89-year-old residents of these cities. NO2, SO2, and volatile organic compounds (VOCs) were measured at 100 sites, and particulate matter (PM) and polycyclic aromatic hydrocarbons (PAHs) at 50 sites during two 2-week sampling periods in 2008 and 2009. Acute asthma event rates across neighborhoods in each city were calculated using emergency room visits and hospitalizations and standardized to the overall age and gender distribution of the population in the two cities combined. Results demonstrate that intra-urban air quality variations are related to adverse respiratory events in both cities. Annual 2008 asthma rates exhibited statistically significant positive correlations with total VOCs and total benzene, toluene, ethylbenzene and xylene (BTEX) at 5-digit zip code scale spatial resolution in Detroit. In Windsor, NO2, VOCs, and PM10 concentrations correlated positively with 2008 asthma rates at a similar 3-digit postal forward sortation area scale. The study is limited by its coarse temporal resolution (comparing relatively short term air quality measurements to annual asthma health data) and interpretation of findings is complicated by contrasts in population demographics and health-care delivery systems in Detroit and Windsor. PMID:24220215

  19. Acute Effects of Asian Dust Events on Respiratory Symptoms and Peak Expiratory Flow in Children with Mild Asthma

    PubMed Central

    Yoo, Young; Choung, Ji Tae; Yu, Jinho; Kim, Do Kyun

    2008-01-01

    The aim of this study was to investigate the possible adverse effects of Asian dust events on respiratory health in asthmatic children. Fifty-two children with mild asthma were studied for eight consecutive weeks in the spring of 2004 (March 8 to May 2). During the study period, five Asian dust days were identified; we included a lag period of two days following each of the events. Subjects recorded their respiratory symptom diaries and peak expiratory flow (PEF) twice daily during the study period; and they underwent methacholine bronchial challenge tests. The subjects reported a significantly higher frequency of respiratory symptoms during the Asian dust days than during the control days. They showed significantly more reduced morning and evening PEF values, and more increased PEF variability (10.1%±3.5% vs. 5.5%±2.2%) during the Asian dust days than during the control days. Methacholine PC20 was not significantly different between before and after the study period (geometric mean: 2.82 mg/mL vs. 3.16 mg/mL). These results suggest that the short-term Asian dust events might be associated with increased acute respiratory symptoms and changes in PEF outcomes. However, there might be little long-term influence on airway hyperresponsiveness in children with mild asthma. PMID:18303201

  20. Acute effects of urban ambient air pollution on respiratory symptoms, asthma medication use, and doctor visits for asthma in a cohort of Australian children.

    PubMed

    Jalaludin, Bin B; O'Toole, Brian I; Leeder, Stephen R

    2004-05-01

    We enrolled a cohort of primary school children with a history of wheeze (n=148) in an 11-month longitudinal study to examine the relationship between ambient air pollution and respiratory morbidity. We obtained daily air pollution (ozone, particulate matter less than 10 microm, and nitrogen dioxide), meteorological, and pollen data. One hundred twenty-five children remained in the final analysis. We used logistic regression models to determine associations between air pollution and respiratory symptoms, asthma medication use, and doctor visits for asthma. There were no associations between ambient ozone concentrations and respiratory symptoms, asthma medication use, and doctor visits for asthma. There was, however, an association between PM(10) concentrations and doctor visits for asthma (RR=1.11, 95% CI=1.04-1.19) and between NO(2) concentration and wet cough (RR=1.05, 95% CI=1.003-1.10) in single-pollutant models. The associations remained significant in multipollutant models. There was no consistent evidence that children with wheeze, positive histamine challenge, and doctor diagnosis of asthma reacted differently to air pollution from children with wheeze and doctor diagnosis of asthma and children with wheeze only. There were significant associations between PM(10) levels and doctor visits for asthma and an association between NO(2) levels and the prevalence of wet cough. We were, however, unable to demonstrate that current levels of ambient air pollution in western Sydney have a coherent range of adverse health effects on children with a history of wheezing.

  1. Management of acute decompensated heart failure.

    PubMed

    Varughese, Sheeba

    2007-01-01

    Heart failure, a debilitating complex clinical syndrome, affects nearly 5 million people in the United States and presents a heavy socioeconomic burden. Neurohormonal abnormalities contribute to the pathophysiology of heart failure. Acute decompensated heart failure (ADHF) has emerged as a major health problem associated with poor prognosis, increased costs related to care, reduced quality of life, and frequent readmissions. Symptoms of ADHF are primarily related to congestion and/or low perfusion states. The use of biomakers such as B-natriuretic peptides is useful in distinguishing between cardiac and noncardiac causes of symptoms. Treatment for ADHF begins with identification and treatment of precipitating factors for acute decompensation. Initial goal of therapy is focused on symptom management followed by interventions that delay disease progression, reduce readmission, and prolong survival. PMID:17356351

  2. Childhood asthma: a guide for pediatric emergency medicine providers.

    PubMed

    Kline-Krammes, Sarah; Patel, Nirali H; Robinson, Shawn

    2013-08-01

    Pediatric asthma is a disease that is managed across outpatient physicians, hospitalists, critical care physicians, and emergency department (ED) physicians. Scoring systems may facilitate a rapid assessment of the child with asthma in the ED. Short-acting beta agonists are still the mainstay of therapy for acute exacerbations along with corticosteroids and ipratropium bromide. ED providers must also know the indications for noninvasive ventilation and intubation. Most patients can be treated and discharged from the ED after acute exacerbation, and should be given a plan for going home that provides educational material and emergency scenarios to help prevent future acute incidents.

  3. Comparison of effects of a self management booklet and audiocassette for patients with asthma.

    PubMed Central

    Jenkinson, D.; Davison, J.; Jones, S.; Hawtin, P.

    1988-01-01

    The effects on self management of asthma of a specially prepared book and audiocassette tape with similar contents were observed in a controlled study of 177 patients with asthma in general practice. After a run in period of six months patients were randomly given the book, the tape, both the book and tape, or neither. Patients' knowledge of the use of drugs, perceptions of their disability, skill in using an inhaler, consumption of drugs, consultations with their general practitioners, morbidity (from patients' entries on diary cards), and use of the educational material were measured. Knowledge about the use of drugs was significantly increased in the groups who received the material after three months and persisted after 12 months. Patients who had been given the tape or the book and tape increased their scores of knowledge of drugs more than patients given the book alone. Patients in all groups given the material considered that their disability was reduced. There were no other significant changes. Patients given both the book and the tape preferred the book. Patients with asthma can obtain useful information from such material. The paradoxical result whereby patients learnt more from the tape but preferred the book suggests that a distinction can be made between information that patients need, which may be acquired better from an audiocassette, and information that they want, which may be acquired better from a book. PMID:3416147

  4. Identifying asthma triggers.

    PubMed

    McCarty, Justin C; Ferguson, Berrylin J

    2014-02-01

    Asthma has many triggers including rhinosinusitis; allergy; irritants; medications (aspirin in aspirin-exacerbated respiratory disease); and obesity. Paradoxic vocal fold dysfunction mimics asthma and may be present along with asthma. This article reviews each of these triggers, outlining methods of recognizing the trigger and then its management. In many patients more than one trigger may be present. Full appreciation of the complexity of these relationships and targeted therapy to the trigger is needed to best care for the patient with asthma.

  5. Risk of severe life threatening asthma and beta agonist type: an example of confounding by severity.

    PubMed Central

    Garrett, J E; Lanes, S F; Kolbe, J; Rea, H H

    1996-01-01

    BACKGROUND: A study was undertaken to test the hypothesis that a particular inhaled beta agonist, fenoterol, increases the incidence of severe life threatening asthma. METHODS: A retrospective cohort was assembled comprising 655 patients with asthma aged 15-55 years who attended a single Auckland hospital for acute asthma between 1 January 1986 and 31 December 1987 (the "index event"). Patients were followed for the occurrence of death from asthma or admission to the intensive care unit for asthma, until death or 31 May 1989. Data on asthma medications and asthma severity were obtained from forms used specifically for managing patients with acute asthma in the emergency department and maintained as part of the hospital record and/or from the hospital record (when patients were admitted). RESULTS: Following the index event 90 admissions to the intensive care unit (ICU) and 15 asthma deaths were identified. Before adjusting for asthma severity, patients using inhaled fenoterol had a greater incidence of severe life threatening asthma than patients using inhaled salbutamol (RR = 2.1, 95% CI 1.4 to 3.1). After controlling for two markers of severe asthma used in previous studies-a hospital admission in the previous year and prescribed oral corticosteroids-the relative risk estimate declined to 1.5 (95% CI 1.0 to 2.3). After controlling further for the number of hospital admissions during the study period, continuous oral corticosteroid use rather than short courses of treatment, severity of the previous attack requiring a hospital visit, and race, fenoterol was not associated with severe life threatening asthma at the time of attendance for a previous hospital visit (RR = 1.0, 95% CI 0.6 to 1.7). CONCLUSION: Fenoterol is used more often by patients with severe asthma and, after adjusting for differences in baseline risk, it does not increase the risk of severe life threatening asthma. PMID:8958891

  6. Treatment of acute severe asthma with inhaled albuterol delivered via jet nebulizer, metered dose inhaler with spacer, or dry powder.

    PubMed

    Raimondi, A C; Schottlender, J; Lombardi, D; Molfino, N A

    1997-07-01

    Despite the increasing use of dry powder formulations in the ambulatory setting, there is a paucity of information on the efficacy of this therapeutic modality to treat acute severe asthma. In addition, studies that compared wet nebulization vs metered dose inhalers formulated with chlorofluorocarbon (CFCMDI) attached to holding chambers have yielded discrepant results. Thus, it is unclear which of the three delivery systems would elicit a superior bronchodilator response, particularly in patients with life-threatening asthma. In a prospective, randomized open design, we studied the response to inhaled albuterol (salbutamol) in 27 adult asthmatics presenting to the emergency department (ED) with an FEV1 <30% predicted. Subjects were treated with one of the following regimens (nine subjects in each group): group A, mean (SD) baseline FEV1 of 0.7 (0.2) L, received albuterol solution, 5 mg, via a nebulizer (Puritan-Bennett Raindrop; Lawrenceville, Ga) impelled with oxygen (O2) at 8 L/min; group B, baseline FEV1 of 0.6 (0.15) L, received albuterol, 400 microg, via a CFCMDI attached to a 145-mL valved aerosol holding chamber (Aerochamber; Trudell Medical; London, ON); and group C, baseline FEV1 of 0.6 (0.17) L, received albuterol powder, 400 microg, by another means (Rotahaler; Glaxo; Research Triangle Park, NC). All groups received the respective treatments on arrival in the ED, every 30 min during the first 2 h, and then hourly until the sixth hour. Clinical parameters and FEV1 were recorded on ED admission and 15 min after each dose of albuterol. At the time of ED admission, all patients also received continuous O2 and one dose of I.V. steroids (dexamethasone, 8 mg). The total dose of inhaled albuterol administered during the 6-h treatment was 45 mg of nebulized solution in group A and 3,600 microg of albuterol aerosol and dry powder in groups B and C, respectively. No significant differences were found in the population demographics, baseline FEV1, and arterial

  7. [Evaluation and management of acute radiation dermatitis].

    PubMed

    Modesto, A; Faivre, J-C; Granel-Brocard, F; Tao, Y-G; Pointreau, Y

    2012-09-01

    Acute radiation dermatitis remains one of the most commonly observed side effect during radiation therapy leading to complication such as superinfection or treatment disruption. Its management is characterized by a great heterogeneity. Few strategies have demonstrated a benefit in preventing radiation dermatitis, which relies mostly on decreasing dose delivered to the skin and skin care practices. Simple emollients and use of topical steroids can be useful in early stages. The singularity of the skin toxicity seen with cetuximab and radiotherapy warrants a specific grading system and distinctive clinical treatment with use of antibiotics.

  8. [Occupational asthma].

    PubMed

    Rico-Rosillo, Guadalupe; Cambray-Gutiérrez, Julio César; Vega-Robledo, Gloria Bertha

    2015-01-01

    The occupational asthma is the most common form of lung disease caused by factors that are attributed to a specific working environment in industrialized countries. It causes variable limitation of airflow and/or hyper-responsiveness of the airway due to contact with specific agents present in an atmosphere of work and not to stimuli found out of this place. It is recognized more and more frequently, and many agents are capable of causing occupational asthma by different pathophysiological mechanisms. More than 400 agents causing occupational asthma are known and every year new triggers are detected. Numerous factors contribute to the pathogenesis of occupational asthma induced chemically, including immunological, non-immunological mechanisms of epithelial damage, airway remodeling, oxidative stress, neurogenic inflammation as well as genetic factors. The most important risk factors for occupational asthma include: atopy, smoking and genetic factors. The diagnosis is based on the clinical history, skin tests, immunological tests and functional studies. The fundamental treatment is removing the worker from exposure as soon as possible. The advance in the knowledge of the pathogenesis of occupational asthma will importantly influence in the prevention and the management of this disease.

  9. Effect of Sameera Pannaga Rasa (arsenomercurial formulation) in the management of Tamaka Shwasa (bronchial asthma) - Randomized double blind clinical study

    PubMed Central

    Mashru, Mayur; Galib, R.; Shukla, Vinay J.; Ravishankar, B.; Prajapati, Pradeep Kumar

    2013-01-01

    Asthma represents a profound world-wide public health problem. The most effective anti-asthmatic drugs currently available include β2-agonists and glucocorticoids which can controls asthma in about 90-95% of patients. In Ayurveda, this miserable condition is comparable with Tamaka Shwasa type of Shwasa Roga. In the present study, 52 patients were treated with Sameera Pannaga Rasa at a dose of 30 mg twice a day for 4 weeks along with Nagavallidala (leaf of Piper betel Linn.) The results were assessed in terms of clinical recovery, symptomatic relief, pulmonary function improvement and on subjective and objective parameters. A significant improvement in subjective parameters, control on asthma, recurrence of asthma, increase in peak expiratory flow rate, considerable decrease in total and absolute, acute eosinophil count and erythrocyte sedimentation rate were observed. Overall marked improvement was found in 33.33%, moderate improvement in 44.44% and mild improvement in 20.00% was observed. The study reveals that Sameera Pannaga Rasa can be used as an effective drug in bronchial asthma. PMID:24696570

  10. Time Management in Acute Vertebrobasilar Occlusion

    SciTech Connect

    Kamper, Lars; Mansour, Michael; Winkler, Sven B.; Kempkes, Udo; Haage, Patrick

    2009-03-15

    Acute vertebrobasilar occlusion (VBO) is associated with a high risk of stroke and death. Although local thrombolysis may achieve recanalization and improve outcome, mortality is still between 35% and 75%. However, without recanalization the chance of a good outcome is extremely poor, with mortality rates of 80-90%. Early treatment is a fundamental factor, but detailed studies of the exact time management of the diagnostic and interventional workflow are still lacking. Data on 18 patients were retrospectively evaluated. Time periods between symptom onset, admission to hospital, time of diagnosis, and beginning of intervention were correlated with postinterventional neurological status. The Glasgow Coma Scale and National Institute of Health Stroke Scale (NIHSS) were used to examine patients before and after local thrombolysis. Additionally, multivariate statistics were applied to reveal similarities between patients with neurological improvement. Primary recanalization was achieved in 77% of patients. The overall mortality was 55%. Major complications were intracranial hemorrhage and peripheral embolism. The time period from symptom onset to intervention showed a strong correlation with the postinterventional NIHSS as well as the patient's age, with the best results in a 4-h interval. Multivariate statistics revealed similarities among the patients. Evaluation of time management in acute VBO by multivariate statistics is a helpful tool for definition of similarities in this patient group. Similarly to the door-to-balloon time for acute coronary interventions, the chances for a good outcome depend on a short time interval between symptom onset and intervention. While the only manipulable time period starts with hospital admission, our results emphasize the necessity of efficient intrahospital workflow.

  11. Feasibility of Adapting Multisystemic Therapy to Improve Illness Management Behaviors and Reduce Asthma Morbidity in High Risk African American Youth: A Case Series

    ERIC Educational Resources Information Center

    Naar-King, Sylvie; Ellis, Deborah; Kolmodin, Karen; Cunningham, Phillippe; Secord, Elizabeth

    2009-01-01

    African-American adolescents have the highest rates of asthma morbidity and mortality, yet there are few successful behavioral interventions to improve illness management for this group. Mental health providers have an opportunity to expand their services and impact by targeting adolescents with poor asthma management. We describe the adaptation…

  12. Asthma in Sickle Cell Disease: Implications for Treatment

    PubMed Central

    Blake, Kathryn; Lima, John

    2011-01-01

    Objective. To review issues related to asthma in sickle cell disease and management strategies. Data Source. A systematic review of pertinent original research publications, reviews, and editorials was undertaken using MEDLlNE, the Cochrane Library databases, and CINAHL from 1947 to November 2010. Search terms were [asthma] and [sickle cell disease]. Additional publications considered relevant to the sickle cell disease population of patients were identified; search terms included [sickle cell disease] combined with [acetaminophen], [pain medications], [vitamin D], [beta agonists], [exhaled nitric oxide], and [corticosteroids]. Results. The reported prevalence of asthma in children with sickle cell disease varies from 2% to approximately 50%. Having asthma increases the risk for developing acute chest syndrome , death, or painful episodes compared to having sickle cell disease without asthma. Asthma and sickle cell may be linked by impaired nitric oxide regulation, excessive production of leukotrienes, insufficient levels of Vitamin D, and exposure to acetaminophen in early life. Treatment of sickle cell patients includes using commonly prescribed asthma medications; specific considerations are suggested to ensure safety in the sickle cell population. Conclusion. Prospective controlled trials of drug treatment for asthma in patients who have both sickle cell disease and asthma are urgently needed. PMID:21490765

  13. Cough reflex sensitivity in various phenotypes of childhood asthma.

    PubMed

    Jesenak, M; Babusikova, E; Petrikova, M; Turcan, T; Rennerova, Z; Michnova, Z; Havlicekova, Z; Villa, M P; Banovcin, P

    2009-11-01

    Cough is a major symptom in some children with asthma, but the relationship between cough and the severity of asthma is defined insufficiently. As cough represents common problem of pediatrics, several objective methods for its assessment were developed. Cough reflex sensitivity (CRS) test with capsaicin is one of the most important tools for studying cough. In the present study, we aimed to study the CRS in various phenotypes of childhood asthma. We found that, in general, CRS was increased in asthmatic children compared with controls. The most evident increase of CRS was observed during acute asthma exacerbation, in children suffering from asthma with concomitant allergic rhinitis, and in atopic asthmatics. Interestingly, we noted a significant decline in lung function after capsaicin CRS. Various laboratory and clinical characteristics of asthmatic children influence cough sensitivity to a different extent. Cough reflex sensitivity measurement can add valuable information beside the commonly used spirometric and inflammometric methods in the management of asthmatic children.

  14. Spirometry for Asthma - When You Need It and Why

    MedlinePlus

    ... Search Patient Resources Spirometry for Asthma Spirometry for Asthma When you need the test—and why DOWNLOAD ... ADVICE FROM CONSUMER REPORTS How should you manage asthma? The following steps can help to control asthma: ...

  15. Valuing the Economic Costs of Allergic Rhinitis, Acute Bronchitis, and Asthma from Exposure to Indoor Dampness and Mold in the US

    PubMed Central

    2016-01-01

    Two foundational methods for estimating the total economic burden of disease are cost of illness (COI) and willingness to pay (WTP). WTP measures the full cost to society, but WTP estimates are difficult to compute and rarely available. COI methods are more often used but less likely to reflect full costs. This paper attempts to estimate the full economic cost (2014$) of illnesses resulting from exposure to dampness and mold using COI methods and WTP where the data is available. A limited sensitivity analysis of alternative methods and assumptions demonstrates a wide potential range of estimates. In the final estimates, the total annual cost to society attributable to dampness and mold is estimated to be $3.7 (2.3–4.7) billion for allergic rhinitis, $1.9 (1.1–2.3) billion for acute bronchitis, $15.1 (9.4–20.6) billion for asthma morbidity, and $1.7 (0.4–4.5) billion for asthma mortality. The corresponding costs from all causes, not limited to dampness and mold, using the same approach would be $24.8 billion for allergic rhinitis, $13.5 billion for acute bronchitis, $94.5 billion for asthma morbidity, and $10.8 billion for asthma mortality. PMID:27313630

  16. Anesthesia in children with asthma and rhinitis.

    PubMed

    Franceschini, F; De Benedictis, F M; Peroni, D G; Marseglia, G L; Caffarelli, C; Crisafulli, G; Indinnimeo, L

    2011-01-01

    The incidence of asthma is increasing worldwide, but morbidity and mortality are decreasing, because of improvements in medical care. Although the incidence of severe perioperative bronchospasm is relatively low in asthmatics undergoing anaesthesia, when it does occur it may be life-threatening. Preoperative assessment of asthma should include a specialized medical hystory and physical examination as well as pulmonary function testing. Potential trigger agents should be identified and avoided. In many asthmatic patients treatment with systemic corticosteroids and bronchodilators is indicated to prevent the inflammation and bronchocostriction associated with endotracheal intubation. Nonetheless, acute bronchospasm can still occur, especially at induction and emergence, and should be promptly and methodically managed. PMID:22014930

  17. Evaluation of a practice-based intervention to improve the management of pediatric asthma.

    PubMed

    Ragazzi, Helen; Keller, Adrienne; Ehrensberger, Ryan; Irani, Anne-Marie

    2011-02-01

    Pediatric asthma remains a significant burden upon patients, families, and the healthcare system. Despite the availability of evidence-based best practice asthma management guidelines for over a decade, published studies suggest that many primary care physicians do not follow them. This article describes the Provider Quality Improvement (PQI) intervention with six diverse community-based practices. A pediatrician and a nurse practitioner conducted the year-long intervention, which was part of a larger CDC-funded project, using problem-based learning within an academic detailing model. Process and outcome assessments included (1) pre- and post-intervention chart reviews to assess eight indicators of quality care, (2) post-intervention staff questionnaires to assess contact with the intervention team and awareness of practice changes, and (3) individual semi-structured interviews with physician and nurse champions in five of the six practices. The chart review indicated that all six practices met predefined performance improvement criteria for at least four of eight indicators of quality care, with two practices meeting improvement criteria for all eight indicators. The response rate for the staff questionnaires was high (72%) and generally consistent across practices, demonstrating high staff awareness of the intervention team, the practice "asthma champions," and changes in practice patterns. In the semi-structured interviews, several respondents attributed the intervention's acceptability and success to the expertise of the PQI team and expressed the belief that sustaining changes would be critically dependent on continued contact with the team. Despite significant limitations, this study demonstrated that interventions that are responsive to individual practice cultures can successfully change practice patterns. PMID:21337050

  18. Evaluation of a practice-based intervention to improve the management of pediatric asthma.

    PubMed

    Ragazzi, Helen; Keller, Adrienne; Ehrensberger, Ryan; Irani, Anne-Marie

    2011-02-01

    Pediatric asthma remains a significant burden upon patients, families, and the healthcare system. Despite the availability of evidence-based best practice asthma management guidelines for over a decade, published studies suggest that many primary care physicians do not follow them. This article describes the Provider Quality Improvement (PQI) intervention with six diverse community-based practices. A pediatrician and a nurse practitioner conducted the year-long intervention, which was part of a larger CDC-funded project, using problem-based learning within an academic detailing model. Process and outcome assessments included (1) pre- and post-intervention chart reviews to assess eight indicators of quality care, (2) post-intervention staff questionnaires to assess contact with the intervention team and awareness of practice changes, and (3) individual semi-structured interviews with physician and nurse champions in five of the six practices. The chart review indicated that all six practices met predefined performance improvement criteria for at least four of eight indicators of quality care, with two practices meeting improvement criteria for all eight indicators. The response rate for the staff questionnaires was high (72%) and generally consistent across practices, demonstrating high staff awareness of the intervention team, the practice "asthma champions," and changes in practice patterns. In the semi-structured interviews, several respondents attributed the intervention's acceptability and success to the expertise of the PQI team and expressed the belief that sustaining changes would be critically dependent on continued contact with the team. Despite significant limitations, this study demonstrated that interventions that are responsive to individual practice cultures can successfully change practice patterns.

  19. Assessment, investigation, and management of acute monoarthritis.

    PubMed Central

    Till, S H; Snaith, M L

    1999-01-01

    Trauma is the commonest cause of acute monoarticular joint pain and swelling in patients attending an accident and emergency (A&E) department. However, in a significant minority of patients there will be no history of trauma and consequently a different approach to assessment and investigation is required. Our aim is to offer an outline of how to assess, investigate, and manage a patient with monoarthritis. Despite advances in antibiotic treatment diagnostic delay partly explains why septic arthritis is still associated with considerable morbidity and mortality. It is therefore imperative that joint infection is considered above all other diagnoses. Arthrocentesis is a relatively safe procedure and doctors in A&E medicine are encouraged to develop the skills required to aspirate large joints. In the same way that the A&E department is often portrayed as the shop window of a hospital, the joint can reflect a wide variety of internal diseases. Connective tissue disease, inflammatory bowel disease, sarcoidosis, and vasculitis can all present with a monoarthritis. A non-specific reactive monoarthritis may be a feature of a wide variety of common and uncommon infections including, brucellosis, Lyme disease, and leptospirosis. Drugs are also associated with acute arthritis either through their metabolic consequences or as idiosyncratic drug reactions. The ability for the joint to reflect multisystem disease necessitates close liaison with specialists from other fields. A multidisciplinary approach to the management of these patients is strongly encouraged as some will have unusual diseases that require specialist advice. It is not difficult to appreciate how the patient with monoarthritis can present the clinician with a fascinating diagnostic and therapeutic challenge, which we hope this article will help to unravel. Images PMID:10505918

  20. [Management of acute exacerbations of COPD].

    PubMed

    Rabbat, A; Guetta, A; Lorut, C; Lefebvre, A; Roche, N; Huchon, G

    2010-10-01

    Exacerbations of COPD are common and cause a considerable burden to the patient and the healthcare system. To optimize the hospital care of patients with exacerbations of COPD, clinicians should be aware of some key points: management of exacerbations is broadly based on clinical features and severity. Initial clinical evaluation is crucial to define those patients requiring hospital admission and those who could be managed as outpatients. In hospitalized patients, the appropriate level of care should be determined by the initial severity and response to initial medical treatment. Medical treatment should follow recent recommendations, including rest, titrated oxygen therapy, inhaled or nebulized short-acting bronchodilators (Beta2-agonists and anticholinergic agents), DVT prevention with LMWH, steroids in most severely ill patients, unless there are contraindications and antibiotics in the case of a clear bacterial infectious aetiology. Severe exacerbations may lead to acute hypercapnic respiratory failure. Unless contraindicated, non-invasive ventilation (NIV) should be the first line ventilatory support for these patients. NIV should be commenced early, before severe acidosis ensues, to avoid the need for endotracheal intubation and to reduce mortality and treatment failures. Several randomised controlled clinical trials support the use of NIV in the management of acute exacerbations of COPD, demonstrating a decreased need for mechanical ventilation and an improved survival. In most severe cases, NIV should be provided in ICU. Although it has been shown that for less severe patients (with pH values>7.30), NIV can be administered safely and effectively on general medical wards, a lead respiratory consultant and trained nurses are mandatory. Mechanical ventilation through an endotracheal tube should be considered when patients have contraindications to the use of NIV or fail to improve on NIV. The duration of mechanical ventilation should be shortened as much as

  1. A comparison of budesonide/formoterol maintenance and reliever therapy vs. conventional best practice in asthma management

    PubMed Central

    Louis, R; Joos, G; Michils, A; Vandenhoven, G

    2009-01-01

    Objective: To study the effectiveness and safety of budesonide/formoterol (Symbicort®) Maintenance And Reliever Therapy (Symbicort SMART®, AstraZeneca, Södertalje, Sweden), a simplified management approach with one inhaler compared with conventional best practice (CBP) with multiple inhalers in patients with persistent asthma. Design: Open-label randomised controlled parallel group trial, 6-month treatment. Participants: A total of 908 patients ≥ 12 years of age, with persistent asthma receiving treatment with inhaled corticosteroids (ICS), either alone or in conjunction with long-acting β2-agonist. Main outcome measures: Time to first severe asthma exacerbation and number of severe asthma exacerbations. Results: No difference between groups was seen in time to first severe exacerbation (p = 0.75). Exacerbation rates were low in both groups. A total of 12 patients in the Symbicort SMART® group experienced a total of 14 severe asthma exacerbations, and 19 patients in the CBP group experienced a total of 25 severe asthma exacerbations (annual rate 0.07 vs. 0.13 p = 0.09). The mean daily dose of ICS expressed in BDP equivalent was significantly lower in the Symbicort SMART® group (including as-needed use) vs. in the CBP group (749 μg vs. 1059 μg; p < 0.0001). Mean scores in Asthma Control Questionnaire, 5 question version improved significantly in the SMART group compared with the CBP group (p = 0.0026). Symbicort SMART and CBP were equally well tolerated. The mean drug cost/patient/month was significantly lower for the patients in the Symbicort SMART group compared with patients receiving CBP (51.3 € vs. 66.5 €; p < 0.0001). Conclusions: In Belgian patients, a simplified regimen using budesonide/formoterol maintenance and reliever therapy was at least as effective at improving clinical control compared with CBP with a significantly lower ICS dose and significantly lower drug costs. PMID:19769705

  2. School-based Management of Chronic Asthma Among Inner-city African-American Schoolchildren in Dallas, Texas.

    ERIC Educational Resources Information Center

    McEwen, Melanie; Johnson, Pauline; Neatherlin, Jacque; Millard, Mark W.; Lawrence, Gretchen

    1998-01-01

    Examined the efficacy of a school-based asthma management program to prevent exacerbation of symptoms in inner-city, African-American students. Students visited the school clinic twice daily for treatment with inhaled anti-inflammatory medication and measurement of respiratory peak flow rates. Regular use of inhaled anti-inflammatory medication…

  3. Occupational asthma prevention and management in industry--an example of a global programme.

    PubMed

    Gannon, Paul F G; Berg, A S; Gayosso, R; Henderson, B; Sax, S E; Willems, H M J

    2005-12-01

    Isocyanates are widely used in the manufacture of polyurethane foams, plastics, coatings and adhesives, and are known to cause occupational asthma in a proportion of exposed workers. Substitution as a prevention strategy is not currently a feasible option. For this reason, health and safety professionals working together in an automotive coatings business created a proactive global programme to address the known potential effects of isocyanates on its workers. The goals of the programme are prevention, early detection and mitigation of effect of key endpoints, especially asthma and to a lesser degree dermatitis, in people who are occupationally exposed, or potentially exposed, to isocyanates and products containing isocyanates. The surveillance programme for isocyanates has several important components, which include assessment of exposure, pre-placement questionnaire and spirometry, training and education of employees, regularly administered periodic questionnaires, medical assessment for abnormal questionnaire responses, process for early reporting and investigation of symptomatic employees and incidents, group data review and management reporting. Although regional differences exist regarding availability of specialized services, we have successfully implemented this programme in parts of North America, Europe and Latin America, and are currently implementing elsewhere. These simple control measures are relatively inexpensive and can be applied in even small business settings. It is recommended that all employers who manufacture, handle or use isocyanate-containing products consider such a strategy.

  4. Acute Coronary Syndrome: Posthospital Outpatient Management.

    PubMed

    Veauthier, Brian; Sievers, Karlynn; Hornecker, Jaime

    2015-10-01

    When providing care for patients who are discharged from the hospital after experiencing acute coronary syndrome (ACS), several issues should be addressed. Drug regimens should be reviewed to ensure that patients are taking appropriate drugs, including antiplatelet agents, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, aldosterone antagonists, beta blockers/calcium channel blockers, cholesterol-lowering drugs, and nitroglycerin. The review also should confirm that patients understand when and how to take their drugs, and that there are no obstacles (eg, cost) that might result in nonadherence to drug regimens. Lifestyle modifications, including improvements in diet and exercise regimens, along with participation in a cardiac rehabilitation program, should be encouraged. Risk factor reduction measures include smoking cessation for smokers, weight management for patients who are overweight, and optimal control of blood pressure and blood glucose levels. Appropriate vaccinations should be administered; influenza and pneumococcal vaccines are indicated for all patients with ACS in the absence of contraindications. Patients requiring pain control should avoid use of nonsteroidal anti-inflammatory drugs because they increase the risk of cardiovascular events; acetaminophen or other drugs should be used. Finally, depression is common among patients with ACS. Screening for and management of depression are significant components of care. PMID:26439396

  5. Acute rhinosinusitis in adults: an update on current management

    PubMed Central

    Masood, Ajmal; Moumoulidis, Ioannis; Panesar, Jaan

    2007-01-01

    Acute rhinosinusitis is a common disease with worldwide prevalence. It is a significant burden on the health services. It is most commonly caused by viruses and is self‐limiting in nature. The diagnosis of acute rhinosinusitis is clinical and sinus radiography is not indicated routinely. Most cases of acute rhinosinusitis are treated symptomatically. However, symptoms may persist beyond 10 days when secondary bacterial infection prevails. Antibiotics are reserved for moderate or severe cases or when there is development of complications of acute rhinosinusitis. This paper provides an update on the current management of acute rhinosinusitis. PMID:17551072

  6. Chlamydia pneumoniae and asthma

    PubMed Central

    Cook, P; Davies, P; Tunnicliffe, W; Ayres, J; Honeybourne, D; Wise, R

    1998-01-01

    BACKGROUND—This study was designed to test the association of Chlamydia pneumoniae infection with asthma in a multiracial population, after adjustments for several potential confounding variables.
METHODS—Antibodies to C pneumoniae were measured by microimmunofluorescence in 123 patients with acute asthma, 1518 control subjects admitted to the same hospital with various non-cardiovascular, non-pulmonary disorders, and 46 patients with severe chronic asthma, including some with "brittle" asthma. Acute infection or reinfection was defined by titres of IgG of ⩾512 or IgM ⩾8 or a fourfold rise in IgG, and previous infection by IgG 64-256 or IgA ⩾8. Logistic regression was used to control for likely confounders, including ethnic origin, age, sex, smoking habit, steroid medication, diabetes mellitus and social deprivation, on antibody levels.
RESULTS—Antibody titres consistent with acute C pneumoniae infection were found in 5.7% of patients with acute asthma and 5.7% of control patients, while 14.6% of patients with acute asthma and 12.7% of control patients had titres suggesting previous infection. These two groups did not differ significantly. However, titres suggesting previous infection were found in 34.8% of patients with severe chronic asthma: the difference between this group and the control group was statistically significant with an adjusted odds ratio of 3.99 (95% confidence interval 1.60 to 9.97).
CONCLUSIONS—These data raise important questions about the previously demonstrated association of C pneumoniae infection with asthma, and suggest that future studies of this association should give particular attention to the presence or absence of a history of severe chronic asthma.

 PMID:9741366

  7. Management of pemphigus vulgaris during acute phase.

    PubMed

    Kar, P K; Murthy, P S; Rajagopal, R

    2003-01-01

    We present our experience with 21 patients of pemphigus vulgaris seen over a period of 10 years managed in service hospitals during acute phase of the disease. Age groups of patients ranged from 25-45 years. Eighteen (85.7%) were young adults, 30-40 years of age. Fifteen (71.4%) were men and 6 (28.6%) were women. All the cases were hospitalized in ICU, till the acute phase of the disease subsided. Complete hematological profile, urinalysis, serum biochemistry and repeated bacterial cultures from the skin were carried out in all patients at the time of admission and thereafter weekly. The treatment comprised of potassium permanganate lotion bath (1:10,000) and 1 framycetin gauze dressing of the denuded areas, maintenance of fluid and electrolyte balance. All suspected infections and septicemia were treated with appropriate antibiotics. The corticosteroids were usually administered as a single dose of prednisolone 1 mg/kg/day. Cyclophosphamide was given at an initial dose of 50 mg/day and the dose was escalated to 100 mg/day. Once the bulk of the lesions were healed, the dose of corticosteroids was gradually lowered by approximately 50% every two weeks and cyclophosphamide was continued till patients were symptom-free. Out of 21 patients receiving corticosteroids, cyclophosphamide and other supportive therapy, 20 (95%) had undergone clinical resolution of the disease. During follow up study 15 (71.4%) patients remained symptom-free and undergone clinical remission. Five patients (23.8%) had relapse, out of which 4 (19%) remained symptom free, after subsequent treatment. There was one death (4.7%) in our study.

  8. Lung penetration and patient adherence considerations in the management of asthma: role of extra-fine formulations

    PubMed Central

    Scichilone, Nicola; Spatafora, Mario; Battaglia, Salvatore; Arrigo, Rita; Benfante, Alida; Bellia, Vincenzo

    2013-01-01

    The mainstay of management in asthma is inhalation therapy at the target site, with direct delivery of the aerosolized drug into the airways to treat inflammation and relieve obstruction. Abundant evidence is available to support the concept that inflammatory and functional changes at the level of the most peripheral airways strongly contribute to the complexity and heterogeneous manifestations of asthma. It is now largely accepted that there is a wide range of clinical phenotypes of the disease, characterized primarily by small airways involvement. Thus, an appropriate diagnostic algorithm cannot exclude biological and functional assessment of the peripheral airways. Similarly, achievement of optimal control of the disease and appropriate management of specific phenotypes of asthma should be based on drugs (and delivery options) able to distribute uniformly along the bronchial tree and to reach the most peripheral airways. Products developed with the Modulite® technology platform have been demonstrated to meet these aims. Recent real-life studies have shown clearly that extra-fine fixed-combination inhaled therapy provides better asthma control than non-extra-fine formulations, thus translating the activity of the drugs into greater effectiveness in clinical practice. We suggest that in patients with incomplete asthma control despite good lung function, involvement of the peripheral airways should always be suspected. When this is the case, treatments targeting both the large and small airways should be used to improve asthma control. Above all, it is emphasized that patient adherence with prescribed medications can contribute to clinical success, and clinicians should always be aware of the role played by patients themselves in determining the success or failure of treatment. PMID:23378776

  9. Delivering asthma education to special high risk groups.

    PubMed

    FitzGerald, J M; Turner, M O

    1997-12-01

    Patients at high risk from their asthma and therefore worthy of more focused asthma education are those at risk of fatal and near fatal asthma(NFA). In recent years the characteristics of these patients have been better defined. The most important risk factor appears to be a prior history of NFA. Other important features include prior emergency room visits or hospitalization for asthma. Excess use of beta-agonists, especially in the absence of inhaled corticosteroids, also confers increased risk. High risk groups also share similar psychosocial barriers as well as economic deprivation. The benefits of asthma education in these groups have been assessed in a number of studies. In general, asthma education has been shown to have an impact on these patients. Greater effects have been achieved where there has been consistent follow-up by the same physician. Patients require frequent reinforcement of their asthma management, especially regarding their response to acute exacerbations. A sub-group of patients with more severe asthma appear to have a problem perceiving dyspnoea and may therefore benefit from peak flow monitoring but the problem of compliance with this intervention is significant. Behaviour modification plays an important role as does ensuring the patient has adequate resources to purchase medications especially the more expensive anti-inflammatory therapy. Future studies should focus on optimizing the potential benefits of educating high risk patients as they are not only those at greatest risk of death but also consume a disproportionate amount of health care resources.

  10. Pilot Testing "Okay with Asthma"[TM]: An Online Asthma Intervention for School-Age Children

    ERIC Educational Resources Information Center

    Wyatt, Tami H.; Hauenstein, Emily J.

    2008-01-01

    Asthma is the leading cause of missed school days despite advancements in asthma treatment. This may be, in part, due to a lack of understanding about asthma. "Okay With Asthma"[TM], an online story with psychosocial management strategies for school-age children, was pilot tested to measure its effect on asthma knowledge and attitude. The online…

  11. Assessing the risk of attack in the management of asthma: a review and proposal for revision of the current control-centred paradigm.

    PubMed

    Blakey, John D; Woolnough, Kerry; Fellows, Jodie; Walker, Samantha; Thomas, Mike; Pavord, Ian D

    2013-09-01

    Asthma guidelines focus on day-to-day control of symptoms. However, asthma attacks remain common. They continue to cause mortality and considerable morbidity, and are a major financial burden to the UK National Health Service (NHS) and the wider community. Asthma attacks have chronic consequences, being associated with loss of lung function and significant psychological morbidity. In this article we argue that addressing daily symptom control is only one aspect of asthma treatment, and that there should be a more explicit focus on reducing the risk of asthma attacks. Management of future risk by general practitioners is already central to other conditions such as ischaemic heart disease and chronic renal impairment. We therefore propose a revised approach that separately considers the related domains of daily control and future risk of asthma attack. We believe this approach will have advantages over the current 'stepwise' approach to asthma management. It should encourage individualised treatment, including non-pharmacological measures, and thus may lead to more efficacious and less harmful management strategies. We speculate that this type of approach has the potential to reduce morbidity and healthcare costs related to asthma attacks.

  12. Update: Acute Heart Failure (VII): Nonpharmacological Management of Acute Heart Failure.

    PubMed

    Plácido, Rui; Mebazaa, Alexandre

    2015-09-01

    Acute heart failure is a major and growing public health problem worldwide with high morbidity, mortality, and cost. Despite recent advances in pharmacological management, the prognosis of patients with acute decompensated heart failure remains poor. Consequently, nonpharmacological approaches are being developed and increasingly used. Such techniques may include several modalities of ventilation, ultrafiltration, mechanical circulatory support, myocardial revascularization, and surgical treatment, among others. This document reviews the nonpharmacological approach in acute heart failure, indications, and prognostic implications.

  13. Endovascular Management of Acute Bleeding Arterioenteric Fistulas

    SciTech Connect

    Leonhardt, Henrik Mellander, Stefan; Snygg, Johan; Loenn, Lars

    2008-05-15

    The objective of this study was to review the outcome of endovascular transcatheter repair of emergent arterioenteric fistulas. Cases of abdominal arterioenteric fistulas (defined as a fistula between a major artery and the small intestine or colon, thus not the esophagus or stomach), diagnosed over the 3-year period between December 2002 and December 2005 at our institution, were retrospectively reviewed. Five patients with severe enteric bleeding underwent angiography and endovascular repair. Four presented primary arterioenteric fistulas, and one presented a secondary aortoenteric fistula. All had massive persistent bleeding with hypotension despite volume substitution and transfusion by the time of endovascular management. Outcome after treatment of these patients was investigated for major procedure-related complications, recurrence, reintervention, morbidity, and mortality. Mean follow-up time was 3 months (range, 1-6 months). All massive bleeding was controlled by occlusive balloon catheters. Four fistulas were successfully sealed with stent-grafts, resulting in a technical success rate of 80%. One patient was circulatory stabilized by endovascular management but needed immediate further open surgery. There were no procedure-related major complications. Mean hospital stay after the initial endovascular intervention was 19 days. Rebleeding occurred in four patients (80%) after a free interval of 2 weeks or longer. During the follow-up period three patients needed reintervention. The in-hospital mortality was 20% and the 30-day mortality was 40%. The midterm outcome was poor, due to comorbidities or rebleeding, with a mortality of 80% within 6 months. In conclusion, endovascular repair is an efficient and safe method to stabilize patients with life-threatening bleeding arterioenteric fistulas in the emergent episode. However, in this group of patients with severe comorbidities, the risk of rebleeding is high and further intervention must be considered

  14. Asthma in Latin America

    PubMed Central

    Forno, Erick; Gogna, Mudita; Cepeda, Alfonso; Yañez, Anahi; Solé, Dirceu; Cooper, Philip; Avila, Lydiana; Soto-Quiros, Manuel; Castro-Rodriguez, Jose A.; Celedón, Juan C.

    2015-01-01

    Consistent with the diversity of Latin America, there is profound variability in asthma burden among and within countries in this region. Regional variation in asthma prevalence is likely multifactorial and due to genetics, perinatal exposures, diet, obesity, tobacco use, indoor and outdoor pollutants, psychosocial stress, and microbial or parasitic infections. Similarly, nonuniform progress in asthma management leads to regional variability in disease morbidity. Future studies of distinct asthma phenotypes should follow up well-characterized Latin American subgroups and examine risk factors that are unique or common in Latin America (e.g. stress and violence, parasitic infections and use of biomass fuels for cooking). Because most Latin American countries share the same barriers to asthma management, concerted and multifaceted public health and research efforts are needed, including approaches to curtail tobacco use, campaigns to improve asthma treatment, broadening access to care and clinical trials of non-pharmacologic interventions (e.g. replacing biomass fuels with gas or electric stoves). PMID:26103996

  15. Asthma in Latin America.

    PubMed

    Forno, Erick; Gogna, Mudita; Cepeda, Alfonso; Yañez, Anahi; Solé, Dirceu; Cooper, Philip; Avila, Lydiana; Soto-Quiros, Manuel; Castro-Rodriguez, Jose A; Celedón, Juan C

    2015-09-01

    Consistent with the diversity of Latin America, there is profound variability in asthma burden among and within countries in this region. Regional variation in asthma prevalence is likely multifactorial and due to genetics, perinatal exposures, diet, obesity, tobacco use, indoor and outdoor pollutants, psychosocial stress and microbial or parasitic infections. Similarly, non-uniform progress in asthma management leads to regional variability in disease morbidity. Future studies of distinct asthma phenotypes should follow-up well-characterised Latin American subgroups and examine risk factors that are unique or common in Latin America (eg, stress and violence, parasitic infections and use of biomass fuels for cooking). Because most Latin American countries share the same barriers to asthma management, concerted and multifaceted public health and research efforts are needed, including approaches to curtail tobacco use, campaigns to improve asthma treatment, broadening access to care and clinical trials of non-pharmacological interventions (eg, replacing biomass fuels with gas or electric stoves).

  16. Adoption of a Portal for the Primary Care Management of Pediatric Asthma: A Mixed-Methods Implementation Study

    PubMed Central

    DuRivage, Nathalie; Mayne, Stephanie L; Finch, Stacia; Ross, Michelle E; Giacomini, Kelli; Suh, Andrew; McCarn, Banita; Brandt, Elias; Karavite, Dean; Staton, Elizabeth W; Shone, Laura P; McGoldrick, Valerie; Noonan, Kathleen; Miller, Dorothy; Lehmann, Christoph U; Pace, Wilson D; Grundmeier, Robert W

    2016-01-01

    Background Patient portals may improve communication between families of children with asthma and their primary care providers and improve outcomes. However, the feasibility of using portals to collect patient-reported outcomes from families and the barriers and facilitators of portal implementation across diverse pediatric primary care settings have not been established. Objective We evaluated the feasibility of using a patient portal for pediatric asthma in primary care, its impact on management, and barriers and facilitators of implementation success. Methods We conducted a mixed-methods implementation study in 20 practices (11 states). Using the portal, parents of children with asthma aged 6-12 years completed monthly surveys to communicate treatment concerns, treatment goals, symptom control, medication use, and side effects. We used logistic regression to evaluate the association of portal use with child characteristics and changes to asthma management. Ten clinician focus groups and 22 semistructured parent interviews explored barriers and facilitators of use in the context of an evidence-based implementation framework. Results We invited 9133 families to enroll and 237 (2.59%) used the portal (range by practice, 0.6%-13.6%). Children of parents or guardians who used the portal were significantly more likely than nonusers to be aged 6-9 years (vs 10-12, P=.02), have mild or moderate/severe persistent asthma (P=.009 and P=.04), have a prescription of a controller medication (P<.001), and have private insurance (P=.002). Portal users with uncontrolled asthma had significantly more medication changes and primary care asthma visits after using the portal relative to the year earlier (increases of 14% and 16%, respectively). Qualitative results revealed the importance of practice organization (coordinated workflows) as well as family (asthma severity) and innovation (facilitated communication and ease of use) characteristics for implementation success

  17. Combination of lung ultrasound (a comet-tail sign) and N-terminal pro-brain natriuretic peptide in differentiating acute heart failure from chronic obstructive pulmonary disease and asthma as cause of acute dyspnea in prehospital emergency setting

    PubMed Central

    2011-01-01

    Introduction We studied the diagnostic accuracy of bedside lung ultrasound (the presence of a comet-tail sign), N-terminal pro-brain natriuretic peptide (NT-proBNP) and clinical assessment (according to the modified Boston criteria) in differentiating heart failure (HF)-related acute dyspnea from pulmonary (chronic obstructive pulmonary disease (COPD)/asthma)-related acute dyspnea in the prehospital setting. Methods Our prospective study was performed at the Center for Emergency Medicine, Maribor, Slovenia, between July 2007 and April 2010. Two groups of patients were compared: a HF-related acute dyspnea group (n = 129) and a pulmonary (asthma/COPD)-related acute dyspnea group (n = 89). All patients underwent lung ultrasound examinations, along with basic laboratory testing, rapid NT-proBNP testing and chest X-rays. Results The ultrasound comet-tail sign has 100% sensitivity, 95% specificity, 100% negative predictive value (NPV) and 96% positive predictive value (PPV) for the diagnosis of HF. NT-proBNP (cutoff point 1,000 pg/mL) has 92% sensitivity, 89% specificity, 86% NPV and 90% PPV. The Boston modified criteria have 85% sensitivity, 86% specificity, 80% NPV and 90% PPV. In comparing the three methods, we found significant differences between ultrasound sign and (1) NT-proBNP (P < 0.05) and (2) Boston modified criteria (P < 0.05). The combination of ultrasound sign and NT-proBNP has 100% sensitivity, 100% specificity, 100% NPV and 100% PPV. With the use of ultrasound, we can exclude HF in patients with pulmonary-related dyspnea who have positive NT-proBNP (> 1,000 pg/mL) and a history of HF. Conclusions An ultrasound comet-tail sign alone or in combination with NT-proBNP has high diagnostic accuracy in differentiating acute HF-related from COPD/asthma-related causes of acute dyspnea in the prehospital emergency setting. Trial registration ClinicalTrials.gov NCT01235182. PMID:21492424

  18. Don’t Ask, Don’t Tell: Parental Nondisclosure of Complementary and Alternative Medicine and Over-the-Counter Medication Use in Children’s Asthma Management

    PubMed Central

    Sidora-Arcoleo, Kimberly; Yoos, H. Lorrie; Kitzman, Harriet; McMullen, Ann; Anson, Elizabeth

    2008-01-01

    Background Parent-healthcare provider (HCP) communication is an important component of pediatric asthma management. Given the high prevalence of complementary and alternative medicine (CAM) and over-the-counter (OTC) medication use among this population, it is important to examine parental nondisclosure of these asthma management strategies. Method One-time interview and one-year retrospective medical record review with 228 parents of 5–12 year old children with asthma enrolled from 6 pediatric primary care practices examining parental nondisclosure of CAM and OTC medication use, reasons for nondisclosure, medical record documentation of CAM usage, and association between parent-HCP relationship and nondisclosure. Results Seventy-one percent of parents reported using CAM and/or OTC medication for children’s asthma management and 54% of those parents did not disclose usage. Seventy-five percent “did not think” to discuss it. Better parent-HCP relationship led to decreased nondisclosure. Discussion HCPs can play an important role in creating an environment where parents feel comfortable sharing information about their children’s asthma management strategies in order to arrive at a shared asthma management plan for the child leading to improved asthma health outcomes. PMID:18590866

  19. Management of Acute Hypertensive Response in Patients With Ischemic Stroke

    PubMed Central

    Qureshi, Adnan I.

    2016-01-01

    High blood pressure (BP) >140/90 mm Hg is seen in 75% of patients with acute ischemic stroke and in 80% of patients with acute intracerebral hemorrhages and is independently associated with poor functional outcome. While BP reduction in patients with chronic hypertension remains one of the most important factors in primary and secondary stroke prevention, the proper management strategy for acute hypertensive response within the first 72 hours of acute ischemic stroke has been a matter of debate. Recent guidelines recommend clinical trials to ascertain whether antihypertensive therapy in the acute phase of stroke is beneficial. This review summarizes the current data on acute hypertensive response or elevated BP management during the first 72 hours after an acute ischemic stroke. Based on the potential deleterious effect of lowering BP observed in some clinical trials in patients with acute ischemic stroke and because of the lack of convincing evidence to support acute BP lowering in those situations, aggressive BP reduction in patients presenting with acute ischemic stroke is currently not recommended. While the early use of angiotensin receptor antagonists may help reduce cardiovascular events, this benefit is not necessarily related to BP reduction. PMID:27366297

  20. Asthma Prevention and Management for Aboriginal People: Lessons From Mi’kmaq Communities, Unama’ki, Canada, 2012

    PubMed Central

    Watson, Robert; Bennett, Ella; Masuda, Jeffrey; King, Malcolm; Stewart, Miriam

    2016-01-01

    Background Asthma affects at least 10% of Aboriginal children (aged 11 or younger) in Canada, making it the second most common chronic disease suffered by this demographic group; yet asthma support strategies specific to Aboriginal peoples have only begun to be identified. Community Context This research builds on earlier phases of a recent study focused on identifying the support needs and intervention preferences of Aboriginal children with asthma and their parents or caregivers. Here, we seek to identify the implications of our initial findings for asthma programs, policies, and practices in an Aboriginal context and to determine strategies for implementing prevention programs in Aboriginal communities. Methods Five focus groups were conducted with 22 recruited community health care professionals and school personnel in 5 Mi’kmaq communities in Unama’ki (Cape Breton), Nova Scotia, Canada, through a community-based participatory research design. Each focus group was first introduced to findings from a local “social support for asthma” intervention, and then the groups explored issues associated with implementing social support from their respective professional positions. Outcome Thematic analysis revealed 3 key areas of opportunity and challenges for implementing asthma prevention and management initiatives in Mi’kmaq communities in terms of 1) professional awareness, 2) local school issues, and 3) community health centers. Interpretation Culturally relevant support initiatives are feasible and effective community-driven ways of improving asthma support in Mi’kmaq communities; however, ongoing assistance from the local leadership (ie, chief and council), community health directors, and school administrators, in addition to partnerships with respiratory health service organizations, is needed. PMID:26766847

  1. Health Service Utilization and Poor Health Reporting in Asthma Patients

    PubMed Central

    Behr, Joshua G.; Diaz, Rafael; Akpinar-Elci, Muge

    2016-01-01

    The management and treatment of adult asthma has been associated with utilization of health services. Objectives: First, to investigate the likelihood of health service utilization, including primary care, emergency department, and hospital stays, among persons diagnosed with an asthma condition relative to those that do not have an asthma condition. Second, to examine the likelihood of poor physical health among asthma respondents relative to those that do not have an asthma condition. Third, to demonstrate that these relationships vary with frequency of utilization. Fourth, to discuss the magnitude of differences in frequent utilization between asthma and non-asthma respondents. Data Source: Data is derived from a random, stratified sampling of Hampton Roads adults, 18 years and older (n = 1678). Study Design: Study participants are interviewed to identify asthma diagnosis, access to primary care, frequency of emergency department utilization, hospital admissions, and days of poor physical health. Odds-ratios establish relationships with the covariates on the outcome variable. Findings: Those with asthma are found more likely (OR 1.50, 95% CI 1.05–2.15) to report poor physical health relative to non-asthma study participants. Further, asthma respondents are found more likely (OR 4.23, 95% CI 1.56–11.69) to frequently utilize primary care that may be associated with the management of the condition and are also more likely to utilize treatment services, such as the emergency department (OR 1.87, 95% CI 1.32–2.65) and hospitalization (OR 2.21, 95% CI 1.39–3.50), associated with acute and episodic care. Further, it is a novel finding that these likelihoods increase with frequency of utilization for emergency department visits and hospital stays. Conclusion: Continuity in care and better management of the diseases may result in less demand for emergency department services and hospitalization. Health care systems need to recognize that asthma patients are

  2. A controlled trial of a school-based intervention to improve asthma management.

    PubMed

    McCann, D C; McWhirter, J; Coleman, H; Calvert, M; Warner, J O

    2006-05-01

    The present study investigated schools as an appropriate context for an intervention designed to produce clinical and psychological benefits for children with asthma. A total of 193 out of 219 (88.1%) children with asthma (aged 7-9 yrs) from 23 out of 24 (95.8%) schools completed the study. Intervention schools received a staff asthma-training session, advice on asthma policy, an emergency beta2-agonist inhaler with spacer and whole-class asthma workshops. Nonintervention schools received no asthma-related input. Intervention children required less general practitioner-prescribed preventer medication despite no differences in symptom control compared with the nonintervention asthmatic group. Increased peer knowledge of asthma may have mediated improved active quality of life in the intervention group, together with increased self-esteem in young females. Those females not receiving the intervention, but identified as being asthmatic within the classroom, and thus possibly stigmatised, reported decreased self-esteem. Lower self-esteem in young males was associated with pet ownership. No change was found in staff knowledge, the establishment of asthma policies or school absences which were low even before intervention. In conclusion, a whole-school intervention can improve the health of children with asthma when followed with support for all children but effects are likely to be modified by sex and the home environment. PMID:16455821

  3. Impact of Age and Sex on Outcomes and Hospital Cost of Acute Asthma in the United States, 2011-2012

    PubMed Central

    Teague, W. Gerald; Koroukian, Siran M.; Schlitz, Nicholas K.; Bleecker, Eugene R.; Busse, William B.; Calhoun, William J.; Castro, Mario; Comhair, Suzy A.; Fitzpatrick, Anne M.; Israel, Elliot; Wenzel, Sally E.; Holguin, Fernando; Gaston, Benjamin M.

    2016-01-01

    Background Worldwide, asthma is a leading cause of morbidity, mortality and economic burden, with significant gender and racial disparities. However, little attention has been given to the independent role of age on lifetime asthma severity and hospitalization. We aimed to assess the effect of age, gender, race and ethnicity on indicators of asthma severity including asthma related hospitalization, mortality, hospital cost, and the rate of respiratory failure. Methods We analyzed the 2011 and 2012 Healthcare Cost and Utilization Project- National Inpatient Sample (NIS). We validated and extended those results using the National Heart, Lung, and Blood Institute-Severe Asthma Research Program (SARP; 2002–2011) database. Severe asthma was prospectively defined using the stringent American Thoracic Society (ATS) definition. Results Hospitalization for asthma was reported in 372,685 encounters in 2012 and 368,528 in 2011. The yearly aggregate cost exceeded $2 billion. There were distinct bimodal distributions for hospitalization age, with an initial peak at 5 years and a second at 50 years. Likewise, this bimodal age distribution of patients with severe asthma was identified using SARP. Males comprised the majority of individuals in the first peak, but women in the second. Aggregate hospital cost mirrored the bimodal peak distribution. The probability of respiratory failure increased with age until the age of 60, after which it continued to increase in men, but not in women. Conclusions Severe asthma is primarily a disease of young boys and middle age women. Greater understanding of the biology of lung aging and influence of sex hormones will allow us to plan for targeted interventions during these times in order to reduce the personal and societal burdens of asthma. PMID:27294365

  4. Identifying and managing patients with delirium in acute care settings.

    PubMed

    Bond, Penny; Goudie, Karen

    2015-11-01

    Delirium is an acute medical emergency affecting about one in eight acute hospital inpatients. It is associated with poor outcomes, is more prevalent in older people and it is estimated that half of all patients receiving intensive care or surgery for a hip fracture will be affected. Despite its prevalence and impact, delirium is not reliably identified or well managed. Improving the identification and management of patients with delirium has been a focus for the national improving older people's acute care work programme in NHS Scotland. A delirium toolkit has been developed, which includes the 4AT rapid assessment test, information for patients and carers and a care bundle for managing delirium based on existing guidance. This toolkit has been tested and implemented by teams from a range of acute care settings to support improvements in the identification and immediate management of delirium.

  5. Asthma is Different in Women

    PubMed Central

    Erzurum, Serpil C.

    2015-01-01

    Gender differences in asthma incidence, prevalence and severity have been reported worldwide. After puberty, asthma becomes more prevalent and severe in women, and is highest in women with early menarche or with multiple gestations, suggesting a role for sex hormones in asthma genesis. However, the impact of sex hormones on the pathophysiology of asthma is confounded by and difficult to differentiate from age, obesity, atopy, and other gender associated environmental exposures. There are also gender discrepancies in the perception of asthma symptoms. Understanding gender differences in asthma is important to provide effective education and personalized management plans for asthmatics across the lifecourse. PMID:26141573

  6. Ability to control persistent asthma in obese versus non-obese children enrolled in an asthma-specific disease management program (breathmobile).

    PubMed

    Kwong, K Y; Rhandhawa, I; Saxena, J; Morphew, T; Jones, C A

    2006-11-01

    To determine if asthma control was more difficult to achieve in obese versus non-obese asthmatic children, retrospective analysis was performed on obese and non-obese Los Angeles inner-city children (2 to 18 years of age) with persistent asthma. No difference in time required to achieve control of asthma, ability to maintain control of asthma, baseline pulmonary functions, and number of controllers prescribed was found between the two groups. We conclude that in a Los Angeles inner-city pediatric population, obesity is not a factor in the ability to control asthma.

  7. Medical management of the acute radiation syndrome

    PubMed Central

    López, Mario; Martín, Margarita

    2011-01-01

    The acute radiation syndrome (ARS) occurs after whole-body or significant partial-body irradiation (typically at a dose of >1 Gy). ARS can involve the hematopoietic, cutaneous, gastrointestinal and the neurovascular organ systems either individually or in combination. There is a correlation between the severity of clinical signs and symptoms of ARS and radiation dose. Radiation induced multi-organ failure (MOF) describes the progressive dysfunction of two or more organ systems over time. Radiation combined injury (RCI) is defined as radiation injury combined with blunt or penetrating trauma, burns, blast, or infection. The classic syndromes are: hematopoietic (doses >2–3 Gy), gastrointestinal (doses 5–12 Gy) and cerebrovascular syndrome (doses 10–20 Gy). There is no possibility to survive after doses >10–12 Gy. The Phases of ARS are—prodromal: 0–2 days from exposure, latent: 2–20 days, and manifest illness: 21–60 days from exposure. Granulocyte-colony stimulating factor (G-CSF) at a dose of 5 μg/kg body weight per day subcutaneously has been recommended as treatment of neutropenia, and antibiotics, antiviral and antifungal agents for prevention or treatment of infections. If taken within the first hours of contamination, stable iodine in the form of nonradioactive potassium iodide (KI) saturates iodine binding sites within the thyroid and inhibits incorporation of radioiodines into the gland. Finally, if severe aplasia persists under cytokines for more than 14 days, the possibility of a hematopoietic stem cell (HSC) transplantation should be evaluated. This review will focus on the clinical aspects of the ARS, using the European triage system (METREPOL) to evaluate the severity of radiation injury, and scoring groups of patients for the general and specific management of the syndrome. PMID:24376971

  8. [Acute pancreatitis: an overview of the management].

    PubMed

    Rebours, V

    2014-10-01

    Over the past decades, the incidence and the number of hospital admissions for acute pancreatitis have increased in the Western countries. The two most common etiological factors of acute pancreatitis are gallstones (including small gallstones or microlithiasis) and alcohol abuse. Acute pancreatitis is associated with a significant mortality (4-10%) and 25% in case of pancreatic necrosis, especially. Edematous pancreatitis is benign and oral feeding can be restarted once abdominal pain is decreasing and inflammatory markers are improving. Enteral tube feeding should be the primary therapy in patients with predicted severe acute pancreatitis who require nutritional support. Enteral nutrition in acute pancreatitis can be administered via either the nasojejunal or nasogastric route. In case of necrosis, preventive antibiotics are not recommended. The single indication is infected necrosis confirmed by fine needle aspiration. The incidence trends of acute pancreatitis possibly reflect a change in the prevalence of main etiological factors (e.g. gallstones and alcohol consumption) and cofactors such as tobacco, obesity and genetic susceptibility. Priority is to search for associated causes, especially in cases with atypical symptoms. In case of first acute pancreatitis in patients older than 50 years, the presence of a tumor (benign or malignant) has to be specifically ruled out, using CT-scan, MRI and endoscopic ultrasound.

  9. Management of Vertebral Stenosis Complicated by Presence of Acute Thrombus

    SciTech Connect

    Canyigit, Murat; Arat, Anil Cil, Barbaros E.; Sahin, Gurdal; Turkbey, Baris; Elibol, Bulent

    2007-04-15

    A 44-year-old male presented with multiple punctate acute infarcts of the vertebrobasilar circulation and a computed tomographic angiogram showing stenosis of the right vertebral origin. A digital subtraction angiogram demonstrated a new intraluminal filling defect at the origin of the stenotic vertebral artery where antegrade flow was maintained. This filling defect was accepted to be an acute thrombus of the vertebral origin, most likely due to rupture of a vulnerable plaque. The patient was treated with intravenous heparin. A control angiogram revealed dissolution of the acute thrombus under anticoagulation and the patient was treated with stenting with distal protection. Diffusion-weighted magnetic resonance imaging demonstrated no additional acute ischemic lesions. We were unable to find a similar report in the English literature documenting successful management of an acute vertebral ostial thrombus with anticoagulation. Anticoagulation might be considered prior to endovascular treatment of symptomatic vertebral stenoses complicated by the presence of acute thrombus.

  10. Biomarkers in Severe Asthma.

    PubMed

    Wan, Xiao Chloe; Woodruff, Prescott G

    2016-08-01

    Biomarkers have been critical for studies of disease pathogenesis and the development of new therapies in severe asthma. In particular, biomarkers of type 2 inflammation have proven valuable for endotyping and targeting new biological agents. Because of these successes in understanding and marking type 2 inflammation, lack of knowledge regarding non-type 2 inflammatory mechanisms in asthma will soon be the major obstacle to the development of new treatments and management strategies in severe asthma. Biomarkers can play a role in these investigations as well by providing insight into the underlying biology in human studies of patients with severe asthma. PMID:27401625

  11. The Evidence for Intravenous Theophylline Levels between 10-20mg/L in Children Suffering an Acute Exacerbation of Asthma: A Systematic Review

    PubMed Central

    2016-01-01

    Background Intravenous theophyllines are a second line treatment for children suffering an acute exacerbation of asthma. Various guidelines and formularies recommend aiming for serum theophylline levels between 10-20mg/l. This review aims to assess the evidence underpinning this recommendation. Methods A systematic review comparing outcomes of children who achieved serum theophylline concentrations between 10-20mg/l with those who did not. Primary outcomes were time until resolution of symptoms, mortality and need for mechanical ventilation. Secondary outcomes were date until discharge criteria are met, actual discharge, adverse effects and FEV1. Data sources MEDLINE, CINAHL, CENTRAL and Web of Science. Search performed in October 2015. Eligibility criteria Interventional or observational studies utilizing intravenous theophyllines for an acute exacerbation of asthma in children where serum theophylline levels and clinical outcomes were measured. Findings 10 RCTs and 2 observational studies were included. Children with serum levels between 10-20mg/l did not have a reduction in duration of symptoms, length of hospital stay or need for mechanical ventilation or better spirometric results compared with levels <10mg/l. Levels above 20mg/l are not associated with higher rates of adverse effects. This study is limited due to heterogeneity in the way theophylline levels were reported and poor surveillance of adverse effects across studies. Conclusion Dosing strategies aiming for levels between 10-20mg/l are not associated with better outcomes. Clinicians should rely on clinical outcomes and not serum levels when using intravenous theophyllines in children suffering an acute exacerbation of asthma. PMID:27096742

  12. Promoting Self-Management in Adults with Asthma: An Overview of the UAB Program.

    ERIC Educational Resources Information Center

    Bailey, William C.; And Others

    1987-01-01

    A study at the University of Alabama/Birmingham (UAB) compared adult asthma patients receiving a self-care workbook with those receiving only asthma pamphlets. Outcomes were assessed in five areas: (1) health care utilization, (2) functional status, (3) knowledge, (4) adherence, and (5) psychological reactions. (Author/CH)

  13. Cybersupport: empowering asthma caregivers.

    PubMed

    Sullivan, Claire E

    2008-01-01

    In the United States, an estimated 6.5 million children have asthma (Akinbami, 2005). Due to the chronic and unpredictable nature of asthma, the condition places excessive demands on the primary caregiver. The complexity of asthma management has required parents to take increased responsibility for the assessment and treatment of their child's asthma (Dickinson & Dignam, 2002). Many families are turning to the Internet for information and support. The purpose of this study was to gain insight into the "lived" experiences of an online asthma caregivers support group. Archived messages posted to an online discussion list were analyzed using phenomenological thematic analysis. Five themes emerged providing insight into the meaning of caregiving and the provision of social support. Online support narratives provide a unique way to gain insight and understanding of the experiences of mother's enacting the caregiver role. Understanding the everyday lives of asthma caregivers can help nurses and other health care providers better meet caregiver needs.

  14. InSpire to Promote Lung Assessment in Youth: Evolving the Self-Management Paradigms of Young People With Asthma

    PubMed Central

    Elias, Pierre; Rajan, Nithin O; Dacso, Clifford C

    2013-01-01

    Background Asthma is the most common chronic disease in childhood, disproportionately affecting urban, minority, and disadvantaged children. Individualized care plans supported by daily lung-function monitoring can reduce morbidity and mortality. However, despite 20 years of interventions to increase adherence, only 50% of US youth accurately follow their care plans, which leads to millions of preventable hospitalizations, emergency room visits, and sick days every year. We present a feasibility study of a novel, user-centered approach to increasing young people’s lung-function monitoring and asthma self-care. Promoting Lung Assessment in Youth (PLAY) helps young people become active managers of their asthma through the Web 2.0 principles of participation, cocreation, and information sharing. Specifically, PLAY combines an inexpensive, portable spirometer with the motivational power and convenience of mobile phones and virtual-community gaming. Objective The objective of this study was to develop and pilot test InSpire, a fully functional interface between a handheld spirometer and an interactive game and individualized asthma-care instant-messaging system housed on a mobile phone. Methods InSpire is an application for mobile smartphones that creates a compelling world in which youth collaborate with their physicians on managing their asthma. Drawing from design-theory on global timer mechanics and role playing, we incentivized completing spirometry maneuvers by making them an engaging part of a game young people would want to play. The data can be sent wirelessly to health specialists and return care recommendations to patients in real-time. By making it portable and similar to applications normally desired by the target demographic, InSpire is able to seamlessly incorporate asthma management into their lifestyle. Results We describe the development process of building and testing the InSpire prototype. To our knowledge, the prototype is a first-of-its kind

  15. Self-management support and other alternatives to reduce the burden of asthma and chronic obstructive pulmonary disease.

    PubMed

    Reddel, H K; Jenkins, C R; Partridge, M R

    2014-12-01

    While pharmacotherapy is important in the management of asthma and chronic obstructive pulmonary disease, it is also important to consider additional interventions that can further reduce the burden of ill health for patients, their families and the health care system. In this review, the evidence in favour of self-management support that leads to successful self-care by the patient is reviewed, and the key components of successful strategies are outlined; areas where more research is needed are identified. In addition to self-management support, other methods of delivering care, such as telemonitoring, admission avoidance, assisted discharge schemes and use of lay educators, are reviewed.

  16. Advances in asthma and COPD management: delivering CFC-free inhaled therapy using Modulite technology.

    PubMed

    Acerbi, D; Brambilla, G; Kottakis, I

    2007-01-01

    Inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA) are currently used in the management of asthma and chronic obstructive pulmonary disease (COPD). Localized targeted delivery of these drugs into the lungs is achieved by means of two types of inhalation devices; pressurized metered-dose inhalers (pMDIs) and dry powder-inhalers (DPIs). For environmental reasons, the chlorofluorocarbon (CFC) propellants used in pMDIs are now being replaced by ozone friendly hydrofluoroalkanes (HFAs). These new generation HFA-based pMDIs, developed to provide effective lung deposition of the active moiety, have a favorable safety and tolerability profile. However, HFA-based re-formulation of LABAs and ICS for pMDIs presents particular technical difficulties, especially in terms of ensuring dose content uniformity. This review focuses on the technology and clinical efficacy of the HFA solution pMDIs using Modulite platform technology (Chiesi Farmaceutici S.p.A). Modulite technology allows the development of HFA solution formulations that can mimic the established CFC-based drug formulations on a microgram to microgram basis and provides formulations with novel particle size distributions that improve on existing delivery systems; by manipulation of aerosol clouds and particle size, the delivery of HFA-formulated drugs can be optimized to either achieve fine particle fractions and deposition patterns similar to established CFC-based drug formulations, thus facilitating the transition to new environment-friendly pMDIs in the clinical setting, or achieve finer drug particles able to penetrate deeper into the bronchi for targeted drug delivery as medical need may dictate. Long-term, multiple-dose clinical studies of Modulite formulations of beclomethasone dipropionate (BDP), budesonide and formoterol have been demonstrated to be therapeutically equivalent to their respective previously established CFC or DPI formulations. As a result, a number of Modulite pMDIs have either

  17. Asthma in childhood.

    PubMed

    de Benedictis, Fernando Maria; Attanasi, Marina

    2016-03-01

    Several topics on childhood asthma were addressed in the Paediatric Clinical Year in Review session at the 2015 European Respiratory Society International Congress. With regard to the relationship between lower respiratory tract infections and asthma, it emerges that is the number of respiratory episodes in the first years of life, but not the particular viral trigger, to be associated with later asthma development. Understanding which characteristics of individual patients are associated with an increased risk for asthma exacerbation is a critical step to implement strategies preventing these seasonal events. Recent data suggest the possibility that exhaled volatile organic compounds may qualify as biomarkers in detecting early signs of asthma. Adding information of exhaled volatile organic compounds and expression of inflammation genes to a clinical tool significantly improves asthma prediction in preschool wheezy children. Personal communication with children and adolescents is likely more important than the tools actually used for monitoring asthma. Systemic corticosteroids do not affect the long-term prognosis in children with first viral-induced wheezing episode and should be used cautiously during acute episodes. Finally, stress and a polymorphism upstream of a specific gene are both associated with reduced bronchodilator response in children with asthma.

  18. Asthma - control drugs

    MedlinePlus

    Asthma - inhaled corticosteroids; Asthma - long-acting beta-agonists; Asthma - leukotriene modifiers; Asthma - cromolyn; Bronchial asthma-control drugs; Wheezing - control drugs; Reactive airway disease - control drugs

  19. Emergency room assessment and adrenaline treatment of patients with acute asthma of different severity.

    PubMed

    Limthongkul, S

    1989-06-01

    The adequacy of emergency room assessment and treatment of patients with acute severe asthmatic attacks was evaluated by analyzing the course of 451 visits of 348 patients to Chulalongkorn hospital's Emergency Room. Eighty-five per cent of the patients had an initial index score of greater than or equal to 4 and an average peak expiratory flow rate of 92.16 +/- 46.3 L/min. The discharge index score was 85 per cent with a score of less than or equal to 3 and an average peak expiratory flow rate of 192 +/- 40.3 L/min. Our study indicated that the predictive index proposed by Fischl et al correlated with the severity of airway obstruction; however, the initial index did not help with emergency room decision-making in predicting which patients might be hospitalized, have a relapse or be discharged. In fact, in our emergency room department, the index score to determine airway obstruction and the pattern of response to treatment were better predictors of the outcome, which was classified into three categories: non-responsive or minimally responsive, responsive, and partially responsive. By using conventional clinical criteria (i.e. recumbent position with elimination of laboured breathing, disappearance of dyspnea and reduction of wheezing), there was a 93 per cent accurate determination in the episodes of patients who responded sufficiently to the emergency room treatment to allow their discharge. The remaining 7 per cent of those seeking emergency treatment were hospitalized, which is a lower incidence than that of others series.(ABSTRACT TRUNCATED AT 250 WORDS)

  20. Acute Bacterial Prostatitis: Diagnosis and Management.

    PubMed

    Coker, Timothy J; Dierfeldt, Daniel M

    2016-01-15

    Acute bacterial prostatitis is an acute infection of the prostate gland that causes pelvic pain and urinary tract symptoms, such as dysuria, urinary frequency, and urinary retention, and may lead to systemic symptoms, such as fevers, chills, nausea, emesis, and malaise. Although the true incidence is unknown, acute bacterial prostatitis is estimated to comprise approximately 10% of all cases of prostatitis. Most acute bacterial prostatitis infections are community acquired, but some occur after transurethral manipulation procedures, such as urethral catheterization and cystoscopy, or after transrectal prostate biopsy. The physical examination should include abdominal, genital, and digital rectal examination to assess for a tender, enlarged, or boggy prostate. Diagnosis is predominantly made based on history and physical examination, but may be aided by urinalysis. Urine cultures should be obtained in all patients who are suspected of having acute bacterial prostatitis to determine the responsible bacteria and its antibiotic sensitivity pattern. Additional laboratory studies can be obtained based on risk factors and severity of illness. Radiography is typically unnecessary. Most patients can be treated as outpatients with oral antibiotics and supportive measures. Hospitalization and broad-spectrum intravenous antibiotics should be considered in patients who are systemically ill, unable to voluntarily urinate, unable to tolerate oral intake, or have risk factors for antibiotic resistance. Typical antibiotic regimens include ceftriaxone and doxycycline, ciprofloxacin, and piperacillin/tazobactam. The risk of nosocomial bacterial prostatitis can be reduced by using antibiotics, such as ciprofloxacin, before transrectal prostate biopsy. PMID:26926407

  1. Management of the patient with eosinophilic asthma: a new era begins

    PubMed Central

    ten Brinke, Anneke; Bel, Elisabeth H.D.

    2015-01-01

    Now that it is generally accepted that asthma is a heterogeneous condition, phenotyping of asthma patients has become a mandatory part of the diagnostic workup of all patients who do not respond satisfactorily to standard therapy with inhaled corticosteroids. Late-onset eosinophilic asthma is currently one of the most well-defined asthma phenotypes and seems to have a different underlying pathobiology to classical childhood-onset, allergic asthma. Patients with this phenotype can be identified in the clinic by typical symptoms (few allergies and dyspnoea on exertion), typical lung function abnormalities (“fixed” airflow obstruction, reduced forced vital capacity and increased residual volume), typical comorbidities (nasal polyposis) and a good response to systemic corticosteroids. The definitive diagnosis is based on evidence of eosinophilia in bronchial biopsies or induced sputum, which can be estimated with reasonable accuracy by eosinophilia in peripheral blood. Until recently, patients with eosinophilic asthma had a very poor quality of life and many suffered from frequent severe exacerbations or were dependent on oral corticosteroids. Now, for the first time, novel biologicals targeting the eosinophil have become available that have been shown to be able to provide full control of this type of refractory asthma, and to become a safe and efficacious substitute for oral corticosteroids. PMID:27730141

  2. [Management of acute low back pain].

    PubMed

    Marty, Marc

    2008-02-15

    Acute low back pain is evolving for less than 4 or 6 weeks. The diagnostic stake in front of an acute low back pain is not to ignore a condition requiring a specific treatment (vertebral fracture, tumours, infections, inflammatory diseases...). Signs of alerts from patient history are to be looked for to enable it. Once the diagnosis of non specific low back pain has been confirmed and in absence of neurological complications, the therapeutic stake is to avoid chronicity by a treatment adapted to every patient. Numerous scientific quality data questioned the interest of the bed rest for non specific acute low back pain and the beneficial role of the preservation of the activities to avoid chronicity. The interest to inform and to reassure the patient on his future is also an important condition of the care. PMID:18536202

  3. The dissemination of the British Guideline on the Management of Asthma 2003.

    PubMed

    Dennis, S M; Edwards, S; Partridge, M R; Pinnock, H J; Qureshi, S J

    2004-09-01

    The BTS/SIGN British Guideline on the Management of Asthma was published in February 2003 (4). If health outcomes are to be influenced successfully, dissemination of the guideline and implementation of recommendations is essential. We report the dissemination activities undertaken during the 18 weeks following the guideline launch. To facilitate implementation a range of educational materials were produced reflecting the key messages from the guideline. In addition to postal mailing of the guideline to appropriate healthcare professionals, both educational materials and the guidelines were made freely available from the BTS and SIGN websites. In total, 135,710 copies of the guideline and 90,198 copies of the Quick Reference Guide were downloaded in the first 18 weeks, representing a considerable increase over the number of copies of the 1997 guidelines disseminated by mailing alone. Large quantities of educational materials were downloaded with many used for teaching purposes. An on-line survey suggested that most respondents rated the materials as useful or very useful. Using websites to disseminate guidelines is a cost-effective method of informing health professionals of their content and is a more active process than the passive receipt of mailed copies. The availability of interactive educational materials for use in teaching appears to have been popular.

  4. Development of oral dispersible tablets containing prednisolone nanoparticles for the management of pediatric asthma.

    PubMed

    Chen, Yi-Dan; Liang, Zhong-Yuan; Cen, Yan-Yan; Zhang, He; Han, Mei-Gui; Tian, Yun-Qiao; Zhang, Jie; Li, Shu-Jun; Yang, Da-Sheng

    2015-01-01

    The purpose of the present study was to develop oral dispersible tablets containing prednisolone (PDS)-loaded chitosan nanoparticles using microcrystalline cellulose (MCC 101), lactose, and croscarmellose sodium (CCS). The PDS-loaded chitosan nanoparticles were formulated by ionotropic external gelation technique in order to enhance the solubility of PDS in salivary pH. Prepared nanoparticles were used for the development of oral fast disintegrating tablets by direct compression method. The prepared tablets were evaluated for disintegration time (DT), in vitro drug release (DR), thickness, weight variation, drug content uniformity, friability, and hardness. The effect of concentrations of the dependent variables (MCC, lactose, CCS) on DT and in vitro DR was studied. Fast disintegrating tablets of PDS can be prepared by using MCC, CCS, and lactose with enhanced solubility of PDS. The minimum DT was found to be 15 seconds, and the maximum DR within 30 minutes was 98.50%. All independent variables selected for the study were statistically significant. Oral fast disintegrating tablets containing PDS nanoparticles could be the better choice for the pediatric patients that would result in better patient compliance. From this study, it can be concluded that fast disintegrating tablets could be a potential drug delivery technology for the management of asthma in pediatrics.

  5. Development of oral dispersible tablets containing prednisolone nanoparticles for the management of pediatric asthma.

    PubMed

    Chen, Yi-Dan; Liang, Zhong-Yuan; Cen, Yan-Yan; Zhang, He; Han, Mei-Gui; Tian, Yun-Qiao; Zhang, Jie; Li, Shu-Jun; Yang, Da-Sheng

    2015-01-01

    The purpose of the present study was to develop oral dispersible tablets containing prednisolone (PDS)-loaded chitosan nanoparticles using microcrystalline cellulose (MCC 101), lactose, and croscarmellose sodium (CCS). The PDS-loaded chitosan nanoparticles were formulated by ionotropic external gelation technique in order to enhance the solubility of PDS in salivary pH. Prepared nanoparticles were used for the development of oral fast disintegrating tablets by direct compression method. The prepared tablets were evaluated for disintegration time (DT), in vitro drug release (DR), thickness, weight variation, drug content uniformity, friability, and hardness. The effect of concentrations of the dependent variables (MCC, lactose, CCS) on DT and in vitro DR was studied. Fast disintegrating tablets of PDS can be prepared by using MCC, CCS, and lactose with enhanced solubility of PDS. The minimum DT was found to be 15 seconds, and the maximum DR within 30 minutes was 98.50%. All independent variables selected for the study were statistically significant. Oral fast disintegrating tablets containing PDS nanoparticles could be the better choice for the pediatric patients that would result in better patient compliance. From this study, it can be concluded that fast disintegrating tablets could be a potential drug delivery technology for the management of asthma in pediatrics. PMID:26640367

  6. Diagnosing and managing acute heart failure in the emergency department

    PubMed Central

    Kuo, Dick C.; Peacock, W. Frank

    2015-01-01

    Heart failure is a clinical syndrome that results from the impairment of ventricular filling or ejection of blood and affects millions of people worldwide. Diagnosis may not be straightforward and at times may be difficult in an undifferentiated patient. However, rapid evaluation and diagnosis is important for the optimal management of acute heart failure. We review the many aspects of diagnosing and treating acute heart failure in the emergency department. PMID:27752588

  7. An evidence-based approach to managing acute otitis media.

    PubMed

    Nesbit, Chadd E; Powers, Margaret C

    2013-04-01

    Acute otitis media is one of the most common pediatric illnesses; however, there is considerable controversy in its management. While most cases are treated with antibiotics, there is a growing concern regarding antibiotic overuse and subsequent drug resistance. Researchers in the Netherlands have developed a "watchful waiting" (ie, an observation approach) that has been successful in treating acute otitis media, although it has not gained widespread popularity in the United States. This review will summarize the latest research on diagnosing acute otitis media as well as different treatment regimens, including the efficacy of the watchful-waiting approach.

  8. Caerulomycin A inhibits Th2 cell activity: a possible role in the management of asthma

    PubMed Central

    Kujur, Weshely; Gurram, Rama Krishna; Haleem, Nazia; Maurya, Sudeep K.; Agrewala, Javed N.

    2015-01-01

    We have recently demonstrated that Caerulomycin A induces regulatory T cells differentiation by suppressing Th1 cells activity. The role of regulatory T cells is well established in suppressing the function of Th2 cells. Th2 cells are known to inflict the induction of the activation of asthma. Consequently, in the present study, we monitored the influence of Caerulomycin A in inhibiting the activity of Th2 cells and its impact in recuperating asthma symptoms. Interestingly, we observed that Caerulomycin A significantly suppressed the differentiation of Th2 cells, as evidenced by downregulation in the GATA-3 expression. Further, decline in the levels of IL-4, IL-5 and IL-13 cytokines and IgE was noted in the animals suffering from asthma. Furthermore, we noticed substantial suppression in the inflammatory response and number of eosinophils in the lungs. In essence, this study signifies an important therapeutic role of Caerulomycin A in asthma. PMID:26481184

  9. Fentanyl-induced hyperalgesia in acute pain management.

    PubMed

    Lyons, Pamela J; Rivosecchi, Ryan M; Nery, Jose P; Kane-Gill, Sandra L

    2015-06-01

    There are safety concerns with the use of fentanyl, including respiratory depression, nausea, constipation, and possibly opioid-induced hyperalgesia (OIH). The purpose of this review is to evaluate the occurrence and significance of opioid-induced hyperalgesia (OIH) after acute fentanyl exposure. A literature search was conducted from October 1995 through January 2015 using MEDLINE, Embase, and Scopus with the terms hyperalgesia, fentanyl, pronociceptive, acute tolerance, and acute. Published articles evaluating the adverse effects of fentanyl during acute pain management (≤96 hours) in humans were included. Opioid-induced hyperalgesia is a phenomenon defined by increasing pain after opioid exposure with the worsening of pain occurring when opioid doses are increased. Hyperalgesia has been described following remifentanil and morphine use, but the question remains about the associated risk with acute fentanyl exposure. Six randomized, controlled trials evaluating the effect of fentanyl on pain in the acute setting have been conducted. Two trials oppose whereas four trials support the occurrence of fentanyl-induced hyperalgesia. The data on OIH after acute fentanyl exposure are limited and conflicting. Hyperalgesia should be considered in patients with uncontrolled pain despite escalating fentanyl doses, since the possibility of fentanyl-induced OIH exists in the acute setting. Well-designed trials are needed to determine the clinical significance of this phenomenon.

  10. Mobile phone-based asthma self-management aid for adolescents (mASMAA): a feasibility study

    PubMed Central

    Rhee, Hyekyun; Allen, James; Mammen, Jennifer; Swift, Mary

    2014-01-01

    Purpose Adolescents report high asthma-related morbidity that can be prevented by adequate self-management of the disease. Therefore, there is a need for a developmentally appropriate strategy to promote effective asthma self-management. Mobile phone-based technology is portable, commonly accessible, and well received by adolescents. The purpose of this study was to develop and evaluate the feasibility and acceptability of a comprehensive mobile phone-based asthma self-management aid for adolescents (mASMAA) that was designed to facilitate symptom monitoring, treatment adherence, and adolescent–parent partnership. The system used state-of-the-art natural language-understanding technology that allowed teens to use unconstrained English in their texts, and to self-initiate interactions with the system. Materials and methods mASMAA was developed based on an existing natural dialogue system that supports broad coverage of everyday natural conversation in English. Fifteen adolescent–parent dyads participated in a 2-week trial that involved adolescents’ daily scheduled and unscheduled interactions with mASMAA and parents responding to daily reports on adolescents’ asthma condition automatically generated by mASMAA. Subsequently, four focus groups were conducted to systematically obtain user feedback on the system. Frequency data on the daily usage of mASMAA over the 2-week period were tabulated, and content analysis was conducted for focus group interview data. Results Response rates for daily text messages were 81%–97% in adolescents. The average number of self-initiated messages to mASMAA was 19 per adolescent. Symptoms were the most common topic of teen-initiated messages. Participants concurred that use of mASMAA improved awareness of symptoms and triggers, promoted treatment adherence and sense of control, and facilitated adolescent–parent partnerships. Conclusion This study demonstrates the utility and user acceptability of mASMAA as a potential asthma

  11. Cultural perspectives of interventions for managing diabetes and asthma in children and adolescents from ethnic minority groups.

    PubMed

    Mc Manus, V; Savage, E

    2010-09-01

    Both diabetes and asthma are increasingly being recognized as health problems for ethnic groups. Because of cultural differences, ethnicity is reported to be a risk factor for poorer quality in health care, disease management and disease control. Ethnic groups are at risk for poorer quality of life and increased disease complications when compared with non-ethnic counterparts living in the same country. There is little known about how culture is addressed in interventions developed for ethnic groups. The aim of this paper is to systematically review the cultural perspectives of interventions for managing diabetes and asthma in children, adolescents and/or their families from ethnic minority groups. A total of 92 records were identified that were potentially relevant to this review following which, 61 papers were excluded. The full texts of remaining papers (n= 31) were then read independently by both authors, and agreement was reached to exclude a further 27 papers that did not meet inclusion criteria. A total of four papers were eligible for inclusion in this review. Findings indicate that despite growing concerns about health disparities between ethnic and non-ethnic groups in relation to both asthma and diabetes in childhood, there has been little effort to develop cultural specific interventions for ethnic groups. By systematically reviewing asthma and diabetes interventions we have highlighted that few interventions have been developed from a cultural perspective. There are a limited number of interventions published that add knowledge on the specific elements of intervention that is needed to effectively and sensitively educate other cultures. More work is required into identifying which strategies or components of cultural interventions are most effective in achieving positive health outcomes for children, adolescents and/or their families from ethnic groups.

  12. Reslizumab in the management of poorly controlled asthma: the data so far

    PubMed Central

    Maselli, Diego Jose; Velez, Maria Ines; Rogers, Linda

    2016-01-01

    Interleukin-5, an important cytokine in the pathophysiology of asthma, participates in terminal maturation and increases chemotaxis, endothelial adhesion, and activation of eosinophils. Blockade of interleukin-5 activity with monoclonal antibodies have been successful in decreasing eosinophil counts. Reslizumab, a monoclonal antibody that targets interleukin-5, has been studied for the treatment of severe asthma. Several studies have shown that reslizumab can effectively treat severe asthma with an eosinophilic phenotype. Compared to placebo, patients treated with reslizumab had a reduction in the rates of asthma exacerbations and experienced improvement in FEV1 and asthma control questionnaires scores as early as 4 weeks after the therapy was initiated. Reslizumab was not effective in various asthma outcomes in patients without eosinophilia. The adverse events reported were similar in both treatment and placebo groups. Patients should be observed immediately after treatment because anaphylaxis may occur rarely (0.3%) after exposure to reslizumab. Future surveillance studies are still needed to establish the risks of malignancy and safety during pregnancy.

  13. Reslizumab in the management of poorly controlled asthma: the data so far

    PubMed Central

    Maselli, Diego Jose; Velez, Maria Ines; Rogers, Linda

    2016-01-01

    Interleukin-5, an important cytokine in the pathophysiology of asthma, participates in terminal maturation and increases chemotaxis, endothelial adhesion, and activation of eosinophils. Blockade of interleukin-5 activity with monoclonal antibodies have been successful in decreasing eosinophil counts. Reslizumab, a monoclonal antibody that targets interleukin-5, has been studied for the treatment of severe asthma. Several studies have shown that reslizumab can effectively treat severe asthma with an eosinophilic phenotype. Compared to placebo, patients treated with reslizumab had a reduction in the rates of asthma exacerbations and experienced improvement in FEV1 and asthma control questionnaires scores as early as 4 weeks after the therapy was initiated. Reslizumab was not effective in various asthma outcomes in patients without eosinophilia. The adverse events reported were similar in both treatment and placebo groups. Patients should be observed immediately after treatment because anaphylaxis may occur rarely (0.3%) after exposure to reslizumab. Future surveillance studies are still needed to establish the risks of malignancy and safety during pregnancy. PMID:27621657

  14. Reslizumab in the management of poorly controlled asthma: the data so far.

    PubMed

    Maselli, Diego Jose; Velez, Maria Ines; Rogers, Linda

    2016-01-01

    Interleukin-5, an important cytokine in the pathophysiology of asthma, participates in terminal maturation and increases chemotaxis, endothelial adhesion, and activation of eosinophils. Blockade of interleukin-5 activity with monoclonal antibodies have been successful in decreasing eosinophil counts. Reslizumab, a monoclonal antibody that targets interleukin-5, has been studied for the treatment of severe asthma. Several studies have shown that reslizumab can effectively treat severe asthma with an eosinophilic phenotype. Compared to placebo, patients treated with reslizumab had a reduction in the rates of asthma exacerbations and experienced improvement in FEV1 and asthma control questionnaires scores as early as 4 weeks after the therapy was initiated. Reslizumab was not effective in various asthma outcomes in patients without eosinophilia. The adverse events reported were similar in both treatment and placebo groups. Patients should be observed immediately after treatment because anaphylaxis may occur rarely (0.3%) after exposure to reslizumab. Future surveillance studies are still needed to establish the risks of malignancy and safety during pregnancy. PMID:27621657

  15. Management of Acute Aortic Syndrome and Chronic Aortic Dissection

    SciTech Connect

    Nordon, Ian M. Hinchliffe, Robert J.; Loftus, Ian M.; Morgan, Robert A.; Thompson, Matt M.

    2011-10-15

    Acute aortic syndrome (AAS) describes several life-threatening aortic pathologies. These include intramural hematoma, penetrating aortic ulcer, and acute aortic dissection (AAD). Advances in both imaging and endovascular treatment have led to an increase in diagnosis and improved management of these often catastrophic pathologies. Patients, who were previously consigned to medical management or high-risk open surgical repair, can now be offered minimally invasive solutions with reduced morbidity and mortality. Information from the International Registry of Acute Aortic Dissection (IRAD) database demonstrates how in selected patients with complicated AAD the 30-day mortality from open surgery is 17% and endovascular stenting is 6%. Despite these improvements in perioperative deaths, the risks of stroke and paraplegia remain with endovascular treatment (combined outcome risk 4%). The pathophysiology of each aspect of AAS is described. The best imaging techniques and the evolving role of endovascular techniques in the definitive management of AAS are discussed incorporating strategies to reduce perioperative morbidity.

  16. Nutritional management in acute and chronic pancreatitis.

    PubMed

    McClave, S A; Spain, D A; Snider, H L

    1998-06-01

    Patients with severe pancreatitis, characterized by multiple organ failure and pancreatic necrosis on CT scan (identified by an Acute Physiology and Chronic Health Evaluation II score of > or = 10 with > or = 3 Ranson criteria), most likely require aggressive nutritional support. Use of the enteral route of feeding may help contain the hypermetabolic stress response, reduce morphologic change and atrophy of the gut, and theoretically decrease late complications of nosocomial infection and organ failure. Evidence that decreasing degrees of stimulation of the pancreas occur as the site of feeding descends in the gastrointestinal tract and evidence from perspective, randomized trials suggest that jejunal feeding appears at least as safe and well tolerated as total parenteral nutrition in acute pancreatitis.

  17. Can Vitamin D Supplementation in Addition to Asthma Controllers Improve Clinical Outcomes in Patients With Asthma?

    PubMed Central

    Luo, Jian; Liu, Dan; Liu, Chun-Tao

    2015-01-01

    Abstract Effects of vitamin D on acute exacerbation, lung function, and fraction of exhaled nitric oxide (FeNO) in patients with asthma are controversial. We aim to further evaluate the roles of vitamin D supplementation in addition to asthma controllers in asthmatics. From 1946 to July 2015, we searched the PubMed, Embase, Medline, Cochrane Central Register of Controlled Trials, and ISI Web of Science using “Vitamin D,” “Vit D,” or “VitD” and “asthma,” and manually reviewed the references listed in the identified articles. Randomized controlled trials which reported rate of asthma exacerbations and adverse events, forced expiratory volume in 1 s (FEV1, % of predicted value), FeNO, asthma control test (ACT), and serum 25-hydroxyvitamin D levels were eligible. We conducted the heterogeneities test and sensitivity analysis of the enrolled studies, and random-effects or fixed-effects model was applied to calculate risk ratio (RR) and mean difference for dichotomous and continuous data, respectively. Cochrane systematic review software Review Manager (RevMan) was used to test the hypothesis by Mann–Whitney U test, which were displayed in Forest plots. Seven trials with a total of 903 patients with asthma were pooled in our final studies. Except for asthma exacerbations (I2 = 81%, χ2 = 10.28, P = 0.006), we did not find statistical heterogeneity in outcome measures. The pooled RR of asthma exacerbation was 0.66 (95% confidence interval: 0.32–1.37), but without significant difference (z = 1.12, P = 0.26), neither was in FEV1 (z = 0.30, P = 0.77), FeNO (z = 0.28, P = 0.78), or ACT (z = 0.92, P = 0.36), although serum 25-hydroxyvitamin D was significantly increased (z = 6.16, P < 0.001). Vitamin D supplementation in addition to asthma controllers cannot decrease asthma exacerbation and FeNO, nor improve lung function and asthma symptoms, although it can be safely applied to increase serum 25

  18. Evaluation of an Educational Program for Adolescents with Asthma

    ERIC Educational Resources Information Center

    Berg, Jill; Tichacek, Mary J.; Theodorakis, Renee

    2004-01-01

    In addition to challenges of adolescence itself, teens with asthma face demands of asthma management and risks of asthma sequelae, including fatalities. Few asthma educational programs specifically address their needs. In response to school nurse concern, this pilot study evaluated an adolescent asthma education program, the "Power Breathing[TM]…

  19. Precipitating factors of asthma.

    PubMed

    Lee, T H

    1992-01-01

    Asthma is characterised by bronchial hyperresponsiveness. This feature of the asthmatic diathesis predisposes patients to wheezing in response to a number of different factors. These precipitating factors include specific allergen acting via sensitised mediator cells through an IgE-dependent mechanism. There are irritants which may work through a non-specific manner, or stimuli such as exercise and hyperventilation, which probably also act through mediator release via a non-IgE-dependent manner. The mechanism whereby physical stimuli such as exercise induce bronchoconstriction is of interest, because it increases the context in which the mast cell may participate in acute asthmatic bronchoconstriction. Respiratory infections also commonly provoke asthma, especially in infants and may, indeed, precipitate the asthmatic state itself. Finally, drugs can often trigger asthma attacks and the mechanisms of asthma precipitated by non-steroidal anti-inflammatory drugs such as aspirin have been the subject of recent research.

  20. Risk Assessment and Community Participation Model for Environmental Asthma Management in an Elementary Public School: A Case Study in Puerto Rico

    PubMed Central

    Seguinot-Medina, Samarys; Rivera-Rentas, Alberto

    2006-01-01

    Asthma is a rapidly growing chronic disease in the general population of the world, mostly in children. Puerto Ricans have the highest prevalence of children with asthma among the Hispanic community in the US and its territories. Asthma and air quality are becoming a significant and potentially costly public health issue in Puerto Rico. The CDC has reported that in Puerto Rico, 320,350 adults have asthma and this number represents 11.5% of the island adult population. The north east municipality of Carolina, Puerto Rico, has the highest asthma prevalence in the 0 to 17 year old range (2001 data). In this study, we address the potential relationship between anthropogenic and naturally occurring environmental factors, and asthma prevalence in an urban elementary public school in Carolina in an effort to empower and engage communities to work on their environmental health issues. We integrated geographic information systems (GIS) data of anthropogenic activities near the school as well as the natural resources and geomorphology of the region. We found that as Carolina is close by to Caribbean National Forest (El Yunque), this together with the temperature and precipitation cycles in the zone creates the ideal environmental conditions for increased humidity and pollen, mold and fungi development through out the year. We also collected health and socio economic data to generate an asthma profile of the students, employees and parents from the school community, and through a survey we identified perceptions on environmental asthma triggers, and indoor air quality in the school and homes of the students and employees. Finally, we implemented a workshop on indoor air quality designed to engage the school community in managing asthma triggers and the school environment. Our results showed that nearly 30 % of its student’s population has asthma, and from this group 58% are males and 42% are female students. Of all asthmatic children, only 43% receive treatment for the

  1. Severe acute pancreatitis: Clinical course and management.

    PubMed

    Beger, Hans G; Rau, Bettina M

    2007-10-14

    Severe acute pancreatitis (SAP) develops in about 25% of patients with acute pancreatitis (AP). Severity of AP is linked to the presence of systemic organ dysfunctions and/or necrotizing pancreatitis pathomorphologically. Risk factors determining independently the outcome of SAP are early multi-organ failure, infection of necrosis and extended necrosis (>50%). Up to one third of patients with necrotizing pancreatitis develop in the late course infection of necroses. Morbidity of SAP is biphasic, in the first week strongly related to early and persistence of organ or multi-organ dysfunction. Clinical sepsis caused by infected necrosis leading to multi-organ failure syndrome (MOFS) occurs in the later course after the first week. To predict sepsis, MOFS or deaths in the first 48-72 h, the highest predictive accuracy has been objectified for procalcitonin and IL-8; the Sepsis-Related Organ Failure Assessment (SOFA)-score predicts the outcome in the first 48 h, and provides a daily assessment of treatment response with a high positive predictive value. Contrast-enhanced CT provides the highest diagnostic accuracy for necrotizing pancreatitis when performed after the first week of disease. Patients who suffer early organ dysfunctions or at risk of developing a severe disease require early intensive care treatment. Early vigorous intravenous fluid replacement is of foremost importance. The goal is to decrease the hematocrit or restore normal cardiocirculatory functions. Antibiotic prophylaxis has not been shown as an effective preventive treatment. Early enteral feeding is based on a high level of evidence, resulting in a reduction of local and systemic infection. Patients suffering infected necrosis causing clinical sepsis, pancreatic abscess or surgical acute abdomen are candidates for early intervention. Hospital mortality of SAP after interventional or surgical debridement has decreased in high volume centers to below 20%.

  2. Endoscopic management of acute peptic ulcer bleeding.

    PubMed

    Lu, Yidan; Chen, Yen-I; Barkun, Alan

    2014-12-01

    This review discusses the indications, technical aspects, and comparative effectiveness of the endoscopic treatment of upper gastrointestinal bleeding caused by peptic ulcer. Pre-endoscopic considerations, such as the use of prokinetics and timing of endoscopy, are reviewed. In addition, this article examines aspects of postendoscopic care such as the effectiveness, dosing, and duration of postendoscopic proton-pump inhibitors, Helicobacter pylori testing, and benefits of treatment in terms of preventing rebleeding; and the use of nonsteroidal anti-inflammatory drugs, antiplatelet agents, and oral anticoagulants, including direct thrombin and Xa inhibitors, following acute peptic ulcer bleeding.

  3. Community management of acute malnutrition in the developing world.

    PubMed

    Park, Se-Eun; Kim, Sungtae; Ouma, Cyprian; Loha, Mesfin; Wierzba, Thomas F; Beck, Nam Seon

    2012-12-01

    Globally, acute malnutrition triggers more than 50% of childhood mortality in children under 5 years old, which implies that about 3.5 million children die of malnutrition each year. Prior to the advent of ready-to-use therapeutic food (RUTF), the management of acute malnutrition was limited to hospitals, resulting in low coverage rates with high mortality, as malnourished cases were indentified at later stages often plagued with complications. However, current availability of RUTF has enabled malnourished children to be treated at communities. Further, because RUTF is dehydrated and sealed, it has the added advantage of a lower risk of bacterial contamination, thereby prolonging its storage life at room temperature. Recent data indicate that Community Management of Acute Malnutrition (CMAM) is as cost effective as other high-impact public health measures such as oral rehydration therapy for acute diarrheal diseases, vitamin A supplementation, and antibiotic treatment for acute respiratory infections. Despite the high efficacy of CMAM programs, CMAM still draws insufficient attention for global implementation, suggesting that CMAM programs should be integrated into local or regional routine health systems. Knowledge gaps requiring further research include: the definition of practical screening criteria for malnourished children at communities, the need for systematic antibiotic therapy during malnutrition treatment, and the dietary management of severe malnutrition in children below 6 months of age. PMID:24010090

  4. Managing Asthma in the School Environment: Indoor Air Quality Tools for Schools. EPA 402-K-10-004

    ERIC Educational Resources Information Center

    US Environmental Protection Agency, 2010

    2010-01-01

    Asthma has reached epidemic proportions in the United States, affecting millions of people of all ages and races. An average of one out of every 10 school-age children now has asthma, and the percentage of children with asthma is rising more rapidly in preschool-age children than in any other age group. Asthma is a leading cause of school…

  5. An update of clinical management of acute intermittent porphyria

    PubMed Central

    Pischik, Elena; Kauppinen, Raili

    2015-01-01

    Acute intermittent porphyria (AIP) is due to a deficiency of the third enzyme, the hydroxymethylbilane synthase, in heme biosynthesis. It manifests with occasional neuropsychiatric crises associated with overproduction of porphyrin precursors, aminolevulinic acid and porphobilinogen. The clinical criteria of an acute attack include the paroxysmal nature and various combinations of symptoms, such as abdominal pain, autonomic dysfunction, hyponatremia, muscle weakness, or mental symptoms, in the absence of other obvious causes. Intensive abdominal pain without peritoneal signs, acute peripheral neuropathy, and encephalopathy usually with seizures or psychosis are the key symptoms indicating possible acute porphyria. More than fivefold elevation of urinary porphobilinogen excretion together with typical symptoms of an acute attack is sufficient to start a treatment. Currently, the prognosis of the patients with AIP is good, but physicians should be aware of a potentially fatal outcome of the disease. Mutation screening and identification of type of acute porphyria can be done at the quiescent phase of the disease. The management of patients with AIP include following strategies: A, during an acute attack: 1) treatment with heme preparations, if an acute attack is severe or moderate; 2) symptomatic treatment of autonomic dysfunctions, polyneuropathy and encephalopathy; 3) exclusion of precipitating factors; and 4) adequate nutrition and fluid therapy. B, during remission: 1) exclusion of precipitating factors (education of patients and family doctors), 2) information about on-line drug lists, and 3) mutation screening for family members and education about precipitating factors in mutation-positive family members. C, management of patients with recurrent attacks: 1) evaluation of the lifestyle, 2) evaluation of hormonal therapy in women, 3) prophylactic heme therapy, and 4) liver transplantation in patients with severe recurrent attacks. D, follow-up of the AIP

  6. Recent advances in the management of acute bronchiolitis

    PubMed Central

    Ravaglia, Claudia

    2014-01-01

    Acute bronchiolitis is characterized by acute wheezing in infants or children and is associated with signs or symptoms of respiratory infection; it is rarely symptomatic in adults and the most common etiologic agent is respiratory syncytial virus (RSV). Usually it does not require investigation, treatment is merely supportive and a conservative approach seems adequate in the majority of children, especially for the youngest ones (<3 months); however, clinical scoring systems have been proposed and admission in hospital should be arranged in case of severe disease or a very young age or important comorbidities. Apnea is a very important aspect of the management of young infants with bronchiolitis. This review focuses on the clinical, radiographic, and pathologic characteristics, as well as the recent advances in management of acute bronchiolitis. PMID:25580257

  7. The acute pediatric scrotum: presentation, differential diagnosis and management.

    PubMed

    Vasdev, Nikhil; Chadwick, David; Thomas, David

    2012-09-01

    Both pediatric and adult urologists frequently evaluate pediatric patients with an acute scrotum. We present a detailed review on the acute pediatric scrotum highlighting the clinical presentation, differential diagnosis and management of this common clinical condition. It is important to highlight that a testicular torsion is the most important differential diagnosis and the main priority in each case is to diagnosis and treat a potential testicular torsion is of the essence. The aim of our extensive review is to update/review the appropriate evaluation and management of the acute scrotum and to guide the clinician in distinguishing testicular torsion from the other conditions that commonly mimic this surgical emergency. This review is useful for trainees in UK and Europe who plan to take the FRCS (Urol) examination. PMID:24917714

  8. Occupational asthma: a review.

    PubMed Central

    Lombardo, L J; Balmes, J R

    2000-01-01

    Occupational asthma is the most common form of occupational lung disease in the developed world at the present time. In this review, the epidemiology, pathogenesis/mechanisms, clinical presentations, management, and prevention of occupational asthma are discussed. The population attributable risk of asthma due to occupational exposures is considerable. Current understanding of the mechanisms by which many agents cause occupational asthma is limited, especially for low-molecular-weight sensitizers and irritants. The diagnosis of occupational asthma is generally established on the basis of a suggestive history of a temporal association between exposure and the onset of symptoms and objective evidence that these symptoms are related to airflow limitation. Early diagnosis, elimination of exposure to the responsible agent, and early use of inhaled steroids may play important roles in the prevention of long-term persistence of asthma. Persistent occupational asthma is often associated with substantial disability and consequent impacts on income and quality of life. Prevention of new cases is the best approach to reducing the burden of asthma attributable to occupational exposures. Future research needs are identified. PMID:10931788

  9. Management of patients after recovering from acute severe biliary pancreatitis

    PubMed Central

    Dedemadi, Georgia; Nikolopoulos, Manolis; Kalaitzopoulos, Ioannis; Sgourakis, George

    2016-01-01

    Cholelithiasis is the most common cause of acute pancreatitis, accounting 35%-60% of cases. Around 15%-20% of patients suffer a severe attack with high morbidity and mortality rates. As far as treatment is concerned, the optimum method of late management of patients with severe acute biliary pancreatitis is still contentious and the main question is over the correct timing of every intervention. Patients after recovering from an acute episode of severe biliary pancreatitis can be offered alternative options in their management, including cholecystectomy, endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy, or no definitive treatment. Delaying cholecystectomy until after resolution of the inflammatory process, usually not earlier than 6 wk after onset of acute pancreatitis, seems to be a safe policy. ERCP and sphincterotomy on index admission prevent recurrent episodes of pancreatitis until cholecystectomy is performed, but if used for definitive treatment, they can be a valuable tool for patients unfit for surgery. Some patients who survive severe biliary pancreatitis may develop pseudocysts or walled-off necrosis. Management of pseudocysts with minimally invasive techniques, if not therapeutic, can be used as a bridge to definitive operative treatment, which includes delayed cholecystectomy and concurrent pseudocyst drainage in some patients. A management algorithm has been developed for patients surviving severe biliary pancreatitis according to the currently published data in the literature. PMID:27678352

  10. Management of patients after recovering from acute severe biliary pancreatitis

    PubMed Central

    Dedemadi, Georgia; Nikolopoulos, Manolis; Kalaitzopoulos, Ioannis; Sgourakis, George

    2016-01-01

    Cholelithiasis is the most common cause of acute pancreatitis, accounting 35%-60% of cases. Around 15%-20% of patients suffer a severe attack with high morbidity and mortality rates. As far as treatment is concerned, the optimum method of late management of patients with severe acute biliary pancreatitis is still contentious and the main question is over the correct timing of every intervention. Patients after recovering from an acute episode of severe biliary pancreatitis can be offered alternative options in their management, including cholecystectomy, endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy, or no definitive treatment. Delaying cholecystectomy until after resolution of the inflammatory process, usually not earlier than 6 wk after onset of acute pancreatitis, seems to be a safe policy. ERCP and sphincterotomy on index admission prevent recurrent episodes of pancreatitis until cholecystectomy is performed, but if used for definitive treatment, they can be a valuable tool for patients unfit for surgery. Some patients who survive severe biliary pancreatitis may develop pseudocysts or walled-off necrosis. Management of pseudocysts with minimally invasive techniques, if not therapeutic, can be used as a bridge to definitive operative treatment, which includes delayed cholecystectomy and concurrent pseudocyst drainage in some patients. A management algorithm has been developed for patients surviving severe biliary pancreatitis according to the currently published data in the literature.

  11. Management of patients after recovering from acute severe biliary pancreatitis.

    PubMed

    Dedemadi, Georgia; Nikolopoulos, Manolis; Kalaitzopoulos, Ioannis; Sgourakis, George

    2016-09-14

    Cholelithiasis is the most common cause of acute pancreatitis, accounting 35%-60% of cases. Around 15%-20% of patients suffer a severe attack with high morbidity and mortality rates. As far as treatment is concerned, the optimum method of late management of patients with severe acute biliary pancreatitis is still contentious and the main question is over the correct timing of every intervention. Patients after recovering from an acute episode of severe biliary pancreatitis can be offered alternative options in their management, including cholecystectomy, endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy, or no definitive treatment. Delaying cholecystectomy until after resolution of the inflammatory process, usually not earlier than 6 wk after onset of acute pancreatitis, seems to be a safe policy. ERCP and sphincterotomy on index admission prevent recurrent episodes of pancreatitis until cholecystectomy is performed, but if used for definitive treatment, they can be a valuable tool for patients unfit for surgery. Some patients who survive severe biliary pancreatitis may develop pseudocysts or walled-off necrosis. Management of pseudocysts with minimally invasive techniques, if not therapeutic, can be used as a bridge to definitive operative treatment, which includes delayed cholecystectomy and concurrent pseudocyst drainage in some patients. A management algorithm has been developed for patients surviving severe biliary pancreatitis according to the currently published data in the literature. PMID:27678352

  12. Asthma Bronchiale and Exercise-Induced Bronchoconstriction.

    PubMed

    Jayasinghe, Harshani; Kopsaftis, Zoe; Carson, Kristin

    2015-01-01

    Exercising regularly has a wide range of beneficial health effects; in particular, it has been well documented to help in the management of chronic illnesses including asthma. However, in some individuals, exertion can also trigger an exacerbation of asthmatic episodes and subsequent acute attacks of breathlessness, coughing, tightness of the chest and wheezing. This physiological process is called exercise-induced bronchoconstriction (EIB) whereby post-exercise forced expiratory volume in 1 s is reduced by 10-15% from baseline. While EIB is highly prevalent in asthmatics and presents with similar respiratory symptoms, asthma and EIB are not mutually exclusive. The aim of this review is to present a broad overview of both conditions in order to enhance the understanding of the similarities and differences distinguishing them as two separate entities. The pathophysiology and mechanisms underlying asthma are well described with research now focussing on defining phenotypes for targeted management strategies. Conversely, the mechanistic understanding of EIB remains largely under-described. Diagnostic pathways for both are established and similar, as are pharmacologic and non-pharmacologic treatments and management approaches, which have enhanced success with early detection. Given the potential for exacerbation of asthma, exercise avoidance is common but counterproductive as current evidence indicates that it is well tolerated and improves quality of life. Literature supporting the benefit of exercise for EIB sufferers is at present favourable, yet extremely limited; therefore, future research should be directed in this area as well as towards further developing the understanding of the pathophysiology and mechanisms underpinning both EIB and asthma.

  13. Programmed management of acute cervical cord trauma.

    PubMed

    White, R J; Bryk, J P; Yashon, D; Albin, M S; Demian, Y K

    Results in ten patients admitted with the diagnosis of complete traumatic quadriplegia and with fracture-dislocation of the cervical spine are reviewed. Emphasis is placed on aggressive emergency surgical treatment of these lesions such as tracheostomy, laminectomy and cord cooling, incorporated into a detailed protocol of overall management.

  14. Asthma Education Programme in Russia: Educating Patients.

    ERIC Educational Resources Information Center

    Maslennikova, G. Ya.; Morosova, M. E.; Salman, N. V.; Kulikov, S. M.; Oganov, R. G.

    1998-01-01

    U.S. recommendations for asthma management were adapted for use in educating Moscow families with children with asthma (N=252). Use of anti-inflammatory drugs, doctor visits, peak flow rates, and daily peak flow were also measured. One-year follow up showed significant improvement in asthma self-management skills among the education group.…

  15. Acute Urinary Retention: Risks and Management

    PubMed Central

    Roehrborn, Claus G

    2005-01-01

    Acute urinary retention (AUR) secondary to benign prostatic hyperplasia has in the past represented an immediate indication for surgery, and today most patients failing to void after an attempt at catheter removal still undergo surgery. The concept that this disease is in fact progressive in nature is slowly being accepted. Descriptive and analytical epidemiological data have shown that the incidence rate per 1000 person-years is less variable in the community than previously assumed; however, the risk is cumulative and increases with advancing age. The risk for patients diagnosed with benign prostatic hyperplasia is naturally higher, and analytical epidemiology has identified several strong risk factors, the most important one being serum prostate-specific antigen (PSA). In addition, prostate volume, maximum flow rate, and symptom severity should be considered when counseling patients presenting with lower urinary tract symptoms and clinical benign prostatic hyperplasia who are considering a course of watchful waiting. Efforts toward primary prevention of AUR should be directed to patients at increased risk, ie, those who are older and have more severe symptoms, larger glands, and higher PSA values. Risk reduction with finasteride has been demonstrated, and α-blockers have been shown to aid patients in achieving spontaneous voiding after an episode of AUR. PMID:16986053

  16. Contemporary therapy: aromatherapy in the management of acute pain?

    PubMed

    Ching, M

    1999-12-01

    Recent surveys indicate that people are increasingly using complementary therapies as an adjunct or alternative to conventional treatment options as well as for general health and well being. Whilst complementary therapies such as aromatherapy have been utilised in clinical settings as diverse as long term care facilities and palliative care, its application to the acute care setting has not been explored in depth. The changes in contemporary health care practices such as post-operative pain management and length of hospital admissions have provided nurses with the challenge of examining the range of therapeutic interventions that can be applied to their practice. The purpose of this paper is to examine critically the potential uses of aromatherapy in the management of acute post-operative pain. The concept of aromatherapy will be explored in relation to its effects on the pain pathways, methods of administration and therapeutic effects. Specific reference will be made to Lavender (Lavandula angustifolia) and its use in aromatherapy. A review of the literature points to gaps in the knowledge related to the clinical application of aromatherapy in relation to issues of dosage, methods of administration and therapeutic effects. The relatively small number of studies that have looked at aromatherapy in the acute care setting supports the literature reviewed. Issues such as small sample sizes and the difficulty in replicating these studies make it difficult to generalize the findings. In order to achieve best practice, further research is necessary to explore the use of aromatherapy in the management of acute post-operative pain.

  17. The costs of asthma.

    PubMed

    Barnes, P J; Jonsson, B; Klim, J B

    1996-04-01

    At present, asthma represents a substantial burden on health care resources in all countries so far studied. The costs of asthma are largely due to uncontrolled disease, and are likely to rise as its prevalence and severity increase. Costs could be significantly reduced if disease control is improved. A large proportion of the total cost of illness is derived from treating the consequences of poor asthma control-direct costs, such as emergency room use and hospitalizations. Indirect costs, which include time off work or school and early retirement, are incurred when the disease is not fully controlled and becomes severe enough to have an effect on daily life. In addition, quality of life assessments show that asthma has a significant socioeconomic impact, not only on the patients themselves, but on the whole family. Underuse of prescribed therapy, which includes poor compliance, significantly contributes towards the poor control of asthma. The consequences of poor compliance in asthma include increased morbidity and sometimes mortality, and increased health care expenditure. To improve asthma management, international guidelines have been introduced which recommend an increase in the use of prophylactic therapy. The resulting improvements in the control of asthma will reduce the number of hospitalizations associated with asthma, and may ultimately produce a shift within direct costs, with subsequent reductions in indirect costs. In addition, costs may be reduced by improving therapeutic interventions and through effective patient education programmes. This paper reviews current literature on the costs of asthma to assess how effectively money is spent and, by estimating the proportion of the cost attributable to uncontrolled disease, will identify where financial savings might be made. PMID:8726924

  18. Acute myocardial infarction in young adults: causes and management

    PubMed Central

    Osula, S; Bell, G; Hornung, R

    2002-01-01

    The case report in this review illustrates an acute myocardial infarction in a young adult probably due to arterial thrombosis that can be attributed to a hypercoagulable state resulting from the nephrotic syndrome. Although rare, acute myocardial infarction should be considered in young adults presenting with chest pain. A detailed clinical history may help to identify the aetiology, and guide subsequent management, but diagnostic coronary angiography is essential. Careful risk factor modification and treatment of the underlying cause should reduce the incidence of recurrent cardiac events. PMID:11796868

  19. Acute pain management in the opioid-tolerant patient.

    PubMed

    Bourne, Nicola

    The main goals in treating acute pain in opioid-tolerant patients are effective pain relief and prevention of withdrawal symptoms. This article provides an overview of the issues that practitioners need to consider when caring for potential and actual opioid-tolerant patients experiencing acute pain, for example following surgery or injury. It highlights the importance of a multimodal analgesic approach to pain control and the prevention of withdrawal. It defines the terminology used in managing opioid-tolerant patients in order to allay healthcare professionals' misconceptions.

  20. Management of acute hydronephrosis in pregnancy by ureteral stenting.

    PubMed

    Zwergel, T; Lindenmeir, T; Wullich, B

    1996-01-01

    Acute hydronephrosis during pregnancy that fails to respond to conservative treatment can be managed by ureteral stenting or in special cases by application of a percutaneous nephrostomy tube. We report the outcome in 116 pregnant women with symptomatic hydronephrosis. In 30 cases ureteric stents were passed under local anesthesia. In 2 cases (pyeloureteral stenosis, impacted ureteric stone) percutaneous nephrostomy was necessary. Overall each course of pregnancy and disease was individually decided. In case of persisting symptoms due to acute hydronephrosis, ureteral stenting was preferred, since it is a simple, safe and effective method of internal upper urinary tract drainage.

  1. Best practices for pediatric asthma: improved clinical management for the inner-city patient.

    PubMed Central

    Jones, C. A.

    1999-01-01

    Asthma patients who live in urban areas face many challenges that contribute to and influence poor outcomes. Many inner-city asthma patients are burdened with significant barriers to care, which include difficulty in obtaining short- and long-term treatment and misperceptions about the chronic nature of the disease. Poor access to care, poor quality of care, or both have been shown to contribute to the high morbidity rate in this population. The objective of asthma therapy is to interrupt allergen/antigen exposures wherever possible and to control airway inflammation. The goal of an effective asthma program is to prevent exacerbations of the disease, achieve and maintain normal activity levels and normal or near-normal lung function, and achieve a personal best for each patient with an effective action plan. An effective action plan is often difficult to implement because it takes much effort from both physician and patient to incorporate complete treatment strategies. Nevertheless, over time these plans can be very effective. The 1997 NIH report provides specific guidelines to help accomplish these goals. PMID:12653389

  2. What is the current status of management of the patient with exercise-induced asthma?

    PubMed

    Kobayashi, R H; Mellion, M B; Kobayashi, A L

    1994-07-01

    Exercise-induced asthma (EIA) is a very common and troublesome disease frequently impairing optimal athletic performance. Although described as early as the second century A.D. and widely known since 1972, EIA often goes unrecognized by both patient and physician. The goals of treatment are to minimize symptoms thus allowing the athlete to participate fully in a broad array of activities and to utilize the most effective pharmacologic drugs available. The recognition and treatment of exercise-induced asthma (EIA) have made significant progress since 1972 when United States swimmer, Rick Demont had his Olympic gold medal award rescinded because of traces of ephedrine were detected in his urine. Lessons from this episode paid dividends subsequently; in preparation for the 1984 Olympic games in Los Angeles, the U.S. Olympic Committee developed a screening program which identified 67 U.S. team members with EIA. Astoundingly, several of these world-class athletes did not realize they had asthma. Affected individuals were counseled on the prevention of asthma and also on the effective use of medications; 41 won medals in various competitions including track and field, wrestling, basketball, cycling, swimming and rowing. Despite this resounding success, many athletes at all levels of competition still suffer from unrecognized or under-treated EIA despite knowledge of the problem since the second century A.D.(ABSTRACT TRUNCATED AT 250 WORDS)

  3. Acute management of military-related injury.

    PubMed

    Gilhooly, Jonathan; Siu, Alan; Beare, Marianne; Ecklund, James M

    2015-01-01

    Since the dawn of armed conflict head trauma has remained one of the most challenging afflictions for surgeons and medical personnel to treat. Interventions for head trauma from antiquity through the American Civil War were met with dismal outcomes. In the 20th century, despite greater lethality of weapons, progressive advances in management led to improved outcomes for head injured patients. A triage system consisting of appropriate levels of care from the front lines, through combat support hospitals to reconstructive and rehabilitative hospitals, has also contributed to the improved outcomes of head injured patients. This chapter examines the progressive improvement in management strategies during major conflicts, the mechanisms causing head trauma during conflict, and the current medical and surgical therapies recommended in the care of head-injured patients during armed conflict. PMID:25702229

  4. Augmentation of Conventional Medical Management of Moderately Severe or Severe Asthma with Acupuncture and Guided Imagery/Meditation

    PubMed Central

    Mehl-Madrona, Lewis

    2008-01-01

    Objective: I sought to determine if a combination of acupuncture and guided imagery could augment the conventional medical management of moderately severe or severe asthma. Design: This was an early-phase study with a convenience sample of self-selecting patients compared with self—year before, during treatment, and one year after treatment. Setting: Patients were recruited from an outpatient practice. Patients: All participants were adults with moderately severe or severe asthma (class 3 or 4). Interventions: The study employed acupuncture and guided imagery/meditation for a 24-week period. Main Outcome Measures: The main outcome measures were number of days of hospitalization, number of Emergency Department (ED) visits, number of physician visits, days per year taking steroids, puffs per week of inhaled β-agonists, FVC (forced vital capacity), FEV1 (forced expiratory volume in the first second), and FEF25-75 (forced expiratory flow between 25% and 75% of the FVC). Results: With the addition of acupuncture and guided imagery to conventional medical management, members of the study group experienced improvement. The number of hospitalized days and the number of ED visits not leading to hospitalizations decreased, as did number of medical visits and total days taking oral corticosteroids. Parameters of respiratory function improved despite reduced use of inhaled β-agonists. Conclusion: With acupuncture and guided imagery and meditation together, a self-selecting group of patients with moderately severe or severe asthma experienced improvement in respiratory function, taking less medication than before and having fewer emergencies and hospitalizations at a lower cost of care. PMID:21339915

  5. Adherence to asthma guidelines in general practices.

    PubMed

    Roghmann, M C; Sexton, M

    1999-06-01

    Adherence to asthma practice guidelines is low. Improved compliance could potentially improve care of patients with asthma. The purpose of this study was to determine if patients managed in a general practice with an associated asthma clinic are more likely to use asthma medications according to clinical practice guidelines than patients managed in the general surgery of the practice. A cross-sectional study of adult asthmatics, aged 18-55 years, was conducted in six British general practices. Prescription data on all asthma medication was collected for a 6-month period. Information on asthma clinic attendance, age, sex, employment status, other medical illness, and how patients used their inhaled beta2-agonist was collected through questionnaire. The prescription data for asthma medication and patient use of inhaled beta2-agonist were compared to the British Thoracic Society's (BTS) Guidelines for Management of Asthma in Adults to determine if the patient's asthma medication regimen was appropriate. There was no significant association found between appropriate asthma medication and asthma clinic attendance or other patient characteristics. Adherence to the BTS guidelines was low. Fifty-eight percent of the asthma patients used asthma medication regimens that were not consistent with the BTS guidelines published 1 year earlier. Adherence to the BTS guidelines was low regardless of patient characteristics, including asthma clinic attendance, age, sex, employment status, other medical illness, or individual practice. These findings underscore the need to document the utility of clinical practice guidelines which may improve physician compliance.

  6. House dust mite control measures in the management of asthma: meta-analysis

    PubMed Central

    Gøtzsche, Peter C; Hammarquist, Cecilia; Burr, Michael

    1998-01-01

    Objective To determine whether patients with asthma who are sensitive to mites benefit from measures designed to reduce their exposure to house dust mite antigen in the home. Design Meta-analysis of randomised trials that investigated the effects on asthma patients of chemical or physical measures to control mites, or both, in comparison with an untreated control group. All trials in any language were eligible for inclusion. Subjects Patients with bronchial asthma as diagnosed by a doctor and sensitisation to mites as determined by skin prick testing, bronchial provocation testing, or serum assays for specific IgE antibodies. Main outcome measures Number of patients whose allergic symptoms improved, improvement in asthma symptoms, improvement in peak expiratory flow rate. Outcomes measured on different scales were combined using the standardised effect size method (the difference in effect was divided by the standard deviation of the measurements). Results 23 studies were included in the meta-analysis; 6 studies used chemical methods to reduce exposure to mites, 13 used physical methods, and 4 used a combination. Altogether, 41/113 patients exposed to treatment interventions improved compared with 38/117 in the control groups (odds ratio 1.20, 95% confidence interval 0.66 to 2.18). The standardised mean difference for improvement in asthma symptoms was −0.06 (95% confidence interval −0.54 to 0.41). For peak flow rate measured in the morning the standardised mean difference was −0.03 (−0.25 to 0.19). As measured in the original units this difference between the treatment and the control group corresponds to −3 l/min (95% confidence interval −25 l/min to 19 l/min). The results were similar in the subgroups of trials that reported successful reduction in exposure to mites or had long follow up times. Conclusion Current chemical and physical methods aimed at reducing exposure to allergens from house dust mites seem to be ineffective and cannot be

  7. An international observational prospective study to determine the cost of asthma exacerbations (COAX).

    PubMed

    Lane, Stephen; Molina, Jesus; Plusa, Tadeusz

    2006-03-01

    Asthma is a common chronic condition that places substantial burden on patients and healthcare services. Despite the standards of asthma control that international guidelines recommend should be achieved, many patients continue to suffer sub-optimal control of symptoms and experience exacerbations (acute asthma attacks). In addition to being associated with reduced quality of life, asthma exacerbations are a key cost driver in asthma management. Routine clinical practice for the management of asthma exacerbations varies in different healthcare systems, so healthcare providers require local costs to be able to assess the value of therapies that reduce the frequency and severity of exacerbations. This prospective study, conducted in a total of 15 countries, assessed the local cost of asthma exacerbations managed in either primary or secondary care. Healthcare resources used were costed using actual values appropriate to each country in local currency and in Euros. Results are presented for exacerbations managed in primary care in Brazil, Bulgaria, Croatia, Czech Republic, Hungary, Poland, Russia, Slovakia, Slovenia, Spain and Ukraine, and in secondary care in Croatia, Denmark, Ireland, Latvia, Norway, Poland, Russia, Slovakia, Slovenia and Spain. Multiple regression analysis of the 2052 exacerbations included in the economic analysis showed that the cost of exacerbations was significantly affected by country (P<0.0001). Mean costs were significantly higher in secondary care (euro 1349) than primary care (euro 445, P=0.0003). Age was a significant variable (P=0.0002), though the effect showed an interaction with care type (P<0.0001). As severity of exacerbation increased, so did secondary care costs, though primary care costs remained essentially constant. In conclusion, the study showed that asthma exacerbations are costly to manage, suggesting that therapies able to increase asthma control and reduce the frequency or severity of exacerbations may bring economic

  8. Analysing the medicine-management interface in acute trusts.

    PubMed

    Ong, B N; Boaden, M; Cropper, S

    1997-01-01

    The impact of the NHS reforms, and the resulting purchaser-provider split, has refocused attention on the relationship between management and medicine in acute hospitals. It is timely to assess the explanatory power of various theoretical models regarding the management-medicine interface. Argues that this interface is currently rather fluid and that a dynamic and adaptive model is best suited to understanding the way in which doctors and managers develop their relationship within the changing policy context. Two examples illustrate these shifting boundaries.

  9. Personal Exposures to Traffic-Related Air Pollution and Acute Respiratory Health among Bronx Schoolchildren with Asthma

    PubMed Central

    Spira-Cohen, Ariel; Chen, Lung Chi; Kendall, Michaela; Lall, Ramona; Thurston, George D.

    2011-01-01

    Background Previous studies have reported relationships between adverse respiratory health outcomes and residential proximity to traffic pollution, but have not shown this at a personal exposure level. Objective We compared, among inner-city children with asthma, the associations of adverse asthma outcome incidences with increased personal exposure to particulate matter mass ≤ 2.5 μm in aerodynamic diameter (PM2.5) air pollution versus the diesel-related carbonaceous fraction of PM2.5. Methods Daily 24-hr personal samples of PM2.5, including the elemental carbon (EC) fraction, were collected for 40 fifth-grade children with asthma at four South Bronx schools (10 children per school) during approximately 1 month each. Spirometry and symptom scores were recorded several times daily during weekdays. Results We found elevated same-day relative risks of wheeze [1.45; 95% confidence interval (CI), 1.03–2.04)], shortness of breath (1.41; 95% CI, 1.01–1.99), and total symptoms (1.30; 95% CI, 1.04–1.62) with an increase in personal EC, but not with personal PM2.5 mass. We found increased risk of cough, wheeze, and total symptoms with increased 1-day lag and 2-day average personal and school-site EC. We found no significant associations with school-site PM2.5 mass or sulfur. The EC effect estimate was robust to addition of gaseous pollutants. Conclusion Adverse health associations were strongest with personal measures of EC exposure, suggesting that the diesel “soot” fraction of PM2.5 is most responsible for pollution-related asthma exacerbations among children living near roadways. Studies that rely on exposure to PM mass may underestimate PM health impacts. PMID:21216722

  10. [Exercise-induced asthma].

    PubMed

    Dinh Xuan, A T; Marsac, J; Lockhart, A

    1988-12-10

    Exercise-induced asthma only differs from common asthma in its causative factor. It is a typical asthmatic attack which follows a strenuous and continuous physical exercise lasting 5 to 10 minutes, most often in cold and dry weather. The prevalence of exercise-induced asthma has not yet been firmly established; its pathophysiological mechanisms are still debated, and the respective roles of heat and water losses by the airways are not clearly defined. However, the influence of the type of exercise as a precipitating factor of exercise-induced asthma is now well-known. All things being equal, swimming generates less asthma than running and cycling. This enables the subjects to be directed towards the most suitable sports and encouraged to improve their physical fitness. Drug treatment of exercise-induced asthma must preferentially be preventive; it relies on cromoglycate and beta-2 adrenergic agonists, the latter being also capable of treating acute exercise-induced bronchial obstruction. Education of the patients and their family is also important.

  11. Relvar Ellipta for asthma.

    PubMed

    2014-08-01

    ▼Relvar Ellipta (GSK) is a dry powder inhaler that contains a corticosteroid (fluticasone furoate) and a long-acting beta2 agonist (vilanterol trifenatate). It is licensed for once-daily use as maintenance therapy for chronic obstructive pulmonary disease (COPD) and asthma. In a previous article we considered its use in the management of COPD.1 Here we review the evidence for Relvar Ellipta in the treatment of patients with asthma.

  12. Management of Acute-on-Chronic Liver Failure.

    PubMed

    Durand, Francois; Nadim, Mitra K

    2016-05-01

    Acute-on-chronic liver failure (ACLF) is defined by the occurrence of organ failure(s) other than the liver in patients with cirrhosis. Even though mortality rates are high, there should no longer be reluctance to admit patients with ACLF in the intensive care unit. The prevalence of multidrug-resistant bacteria is high and broad spectrum antibiotics should be initiated as soon as infection is suspected. In patients with circulatory failure, the assessment of circulatory status is challenging due to the hyperkinetic state and an imbalance between the splanchnic and systemic blood volume. Acute kidney injury is common in patients with ACLF. Acute tubular necrosis should be differentiated from hepatorenal syndrome, which justifies vasoconstrictive agents. Renal replacement therapy and mechanical ventilation should be decided on clinical grounds. Recent trials on extracorporeal liver support failed to demonstrate a survival benefit. Aggressive management may serve as a bridge to transplantation provided patients are likely to survive after transplantation. PMID:27172356

  13. Inpatient management of acute alcohol withdrawal syndrome.

    PubMed

    Perry, Elizabeth C

    2014-05-01

    Alcohol withdrawal is a common condition encountered in the hospital setting after abrupt discontinuation of alcohol in an alcohol-dependent individual. Patients may present with mild symptoms of tremulousness and agitation or more severe symptoms including withdrawal seizures and delirium tremens. Management revolves around early identification of at-risk individuals and symptom assessment using a validated tool such as the revised Clinical Institute Withdrawal Assessment for Alcohol score. Benzodiazepines remain the mainstay of treatment and can be administered using a front-loading, fixed-dose, or symptom-triggered approach. Long-acting benzodiazepines such as chlordiazepoxide or diazepam are commonly used and may provide a smoother withdrawal than shorter-acting benzodiazepines, but there are no data to support superiority of one benzodiazepine over another. Elderly patients or those with significant liver disease may have increased accumulation and decreased clearance of the long-acting benzodiazepines, and lorazepam or oxazepam may be preferred in these patients. Patients with symptoms refractory to high doses of benzodiazepines may require addition of a rescue medication such as phenobarbital, propofol or dexmedetomidine. Anticonvulsants (carbamazepine, valproate, gabapentin) may have a role in the management of mild to moderate withdrawal. Other medications such as β-antagonists or neuroleptics may offer additional benefit in select patients but should not be used a monotherapy.

  14. Acute graft-vs-host disease: pathobiology and management.

    PubMed

    Goker, H; Haznedaroglu, I C; Chao, N J

    2001-03-01

    Acute graft-vs-host disease (GVHD) is a major obstacle to safe allogeneic hematopoietic stem cell transplantation (HSCT), leading to a significant morbidity and mortality. GVHD occurs when transplanted donor T lymphocytes react to foreign host cells. It causes a wide variety of host tissue injuries. This review focuses on the pathobiological basis, clinical aspects, and current management strategies of acute GVHD. Afferent phase of acute GVHD starts with myeloablative conditioning, i.e., before the infusion of the graft. Total-body irradiation (TBI) or high-dose chemotherapy regimens cause extensive damage and activation in host tissues, which release inflammatory cytokines and enhance recipient major histocompatibility complex (MHC) antigens. Recognition of the foreign host antigens by donor T cells and activation, stimulation, and proliferation of T cells is crucial in the afferent phase. Effector phase of acute GVHD results in direct and indirect damage to host cells. The skin, gastrointestinal tract, and liver are major target organs of acute GVHD. Combination drug prophylaxis in GVHD is essential in all patients undergoing allogeneic HSCT. Steroids have remained the standard for the treatment of acute GVHD. Several clinical trials have evaluated monoclonal antibodies or receptor antagonist therapy for steroid-resistant acute GVHD, with different successes in a variety of settings. There are some newer promising agents like mycophenolate mofetil, glutamic acid-lysine-alanine-tyrosine (GLAT), rapamycin, and trimetrexate currently entering in the clinical studies, and other agents are in development. Future experimental and clinical studies on GVHD will shed further light on the better understanding of the disease pathobiology and generate the tools to treat malignant disorders with allogeneic HSCT with specific graft-vs-tumor effects devoid of GVHD. PMID:11274753

  15. Internet-based self-management support for adults with asthma: a qualitative study among patients, general practitioners and practice nurses on barriers to implementation

    PubMed Central

    van Gaalen, Johanna L; van Bodegom-Vos, Leti; Bakker, Moira J; Snoeck-Stroband, Jiska B; Sont, Jacob K

    2016-01-01

    Objectives The aim of this study was to explore barriers among patients, general practitioners (GPs) and practice nurses to implement internet-based self-management support as provided by PatientCoach for asthma in primary care. Setting Primary care within South Holland, the Netherlands. Participants Twenty-two patients (12 women, mean age 38 years), 21 GPs (6 women, mean age 52 years) and 13 practice nurses (all women, mean age 41 years). Design A qualitative study using focus groups and interviews. Outcomes Barriers as perceived by patients, GPs and practice nurses to implementation of PatientCoach. Methods 10 focus groups and 12 interviews were held to collect data: 4 patient focus groups, 4 GP focus groups, 2 practice nurse focus group, 2 patient interviews, 5 GP interviews and 5 practice nurse interviews. A prototype of PatientCoach that included modules for coaching, personalised information, asthma self-monitoring, medication treatment plan, feedback, e-consultations and a forum was demonstrated. A semistructured topic guide was used. Directed content analysis was used to analyse data. Reported barriers were classified according to a framework by Grol and Wensing. Results A variety of barriers emerged among all participant groups. Barriers identified among patients include a lack of a patient–professional partnership in using PatientCoach and a lack of perceived benefit in improving asthma symptoms. Barriers identified among GPs include a low sense of urgency towards asthma care and current work routines. Practice nurses identified a low level of structured asthma care and a lack of support by colleagues as barriers. Among all participant groups, insufficient ease of use of PatientCoach, lack of financial arrangements and patient characteristics such as a lack of asthma symptoms were reported as barriers. Conclusions We identified a variety of barriers to implementation of PatientCoach. An effective implementation strategy for internet-based self-management

  16. The acute management of acid assault burns: A pragmatic approach

    PubMed Central

    Burd, A.; Ahmed, K.

    2010-01-01

    This case series comprises 31 patients who were victims of acid assault burns. They were admitted for acute or reconstructive care to a regional burns unit. Ten patients were admitted late with suboptimal acute care and needed a total of 50 reconstructive procedures. Of 13 patients admitted acutely, 7 had surgery performed after 48 hours of constant lavage while seven had urgent surgical debridement within 48 hours, followed by lavage. Although the number of reconstructive procedures performed in these two groups was similar, i.e., 20 and 19, respectively, the magnitude of the deformity in the urgent surgery group was significantly less than in the conventional surgery group. As in many cases of acute burns care, determining the evidence for best practice using a prospective, randomised, controlled comparison of conventional versus urgent surgery is difficult in view of the small number of cases involved. However, basing surgical practice on ethical principles, and in particular 'primum non nocere,' we propose that the urgent reduction of the chemical load on the skin by surgical debridement is appropriate in selected cases and should be considered in the acute management of these devastating injuries. PMID:20924446

  17. Management of acute organophosphorus pesticide poisoning

    PubMed Central

    Eddleston, Michael; Buckley, Nick A; Eyer, Peter; Dawson, Andrew H

    2008-01-01

    Summary Organophosphorus pesticide self-poisoning is an important clinical problem in rural regions of the developing world, and kills an estimated 200 000 people every year. Unintentional poisoning kills far fewer people but is a problem in places where highly toxic organophosphorus pesticides are available. Medical management is difficult, with case fatality generally more than 15%. We describe the limited evidence that can guide therapy and the factors that should be considered when designing further clinical studies. 50 years after first use, we still do not know how the core treatments—atropine, oximes, and diazepam—should best be given. Important constraints in the collection of useful data have included the late recognition of great variability in activity and action of the individual pesticides, and the care needed cholinesterase assays for results to be comparable between studies. However, consensus suggests that early resuscitation with atropine, oxygen, respiratory support, and fluids is needed to improve oxygen delivery to tissues. The role of oximes is not completely clear; they might benefit only patients poisoned by specific pesticides or patients with moderate poisoning. Small studies suggest benefit from new treatments such as magnesium sulphate, but much larger trials are needed. Gastric lavage could have a role but should only be undertaken once the patient is stable. Randomised controlled trials are underway in rural Asia to assess the effectiveness of these therapies. However, some organophosphorus pesticides might prove very difficult to treat with current therapies, such that bans on particular pesticides could be the only method to substantially reduce the case fatality after poisoning. Improved medical management of organophosphorus poisoning should result in a reduction in worldwide deaths from suicide. PMID:17706760

  18. Occupational Asthma

    PubMed Central

    Sheppard, Dean

    1982-01-01

    Bronchospasm is a common cause of morbidity in the workplace. More than 100 agents are now recognized as occupational causes of asthma and numerous agents can cause exacerbations of preexisting asthma. Because of the large number of potential causative agents and the complexity of modern industrial processes, knowledge of the characteristic clinical features of occupational asthma is the key to recognizing this disease. Early diagnosis of occupational asthma is important in preventing long-term morbidity. Present evidence that prolonged exposure to some work-encountered agents can cause asthma that persists for years after the end of exposure suggests that avoidance is the only acceptable countermeasure against this disease. PMID:7164429

  19. Pain management in the acute care setting: Update and debates.

    PubMed

    Palmer, Greta M

    2016-02-01

    Pain management in the paediatric acute care setting is underutilised and can be improved. An awareness of the analgesic options available and their limitations is an important starting point. This article describes the evolving understanding of relevant pharmacogenomics and safety data of the various analgesic agents with a focus on agents available in Australia and New Zealand. It highlights the concerns with the use of codeine in children and discusses alternative oral opioids. Key features of oral, parenteral, inhaled and intranasal analgesic agents are discussed, as well as evidence supported use of sweet tasting solutions and non-pharmacological interventions. One of the biggest changes in acute care pain management has been the advent of intranasal fentanyl providing reliable potent analgesia without the need for intravenous access. The article will also address the issue of multimodal analgesia where a single agent is insufficient.

  20. Novelties in the early management of acute heart failure syndromes.

    PubMed

    Salem, Reda; Sibellas, Franck; Socrates, Thenral; Arenja, Nisha; Yilmaz, Mehmet Birhan; Mueller, Christian; Mebazaa, Alexandre

    2010-07-22

    The recent European Society of Cardiology (ESC) guidelines delineate the diagnosis and management of distinct categories of acute heart failure syndromes. However, physicians dealing with these patients may need guidance in choosing therapeutic alternatives as soon as the dyspneic patient arrives at the emergency department, until distinct categories of the ESC guidelines are identified. Hence, this manuscript summarizes practical recommendations for the very early management of patients with acute heart failure syndromes. The recommendations are based on a clinical classification system considering the initial systolic blood pressure and other symptoms. Early initiation of diagnostic and goal-directed treatment strategies are key factors in improving patient outcomes. Early and frequent reassessment is also imperative so that adjustments to the initial therapeutic approach can be made, as clinically indicated.

  1. Patient-controlled modalities for acute postoperative pain management.

    PubMed

    Miaskowski, Christine

    2005-08-01

    Although numerous clinical practice guidelines for pain management have been published throughout the last 12 years, inadequate pain relief remains a significant health care issue. Several patient-controlled analgesia (PCA) modalities are currently available for the treatment of acute postoperative pain, including intravenous (IV) PCA, epidural (PCEA), and oral PCA. Although PCEA and IV PCA are both commonly used modalities, IV PCA is considered the standard of care for postoperative pain management. Limitations of this modality do exist, however. Consequently, noninvasive PCA systems are under development to circumvent many of these limitations, including the fentanyl hydrochloride patient-controlled transdermal system (PCTS); (IONSYS Ortho-McNeil Pharmaceutical, Raritan, NJ) and a number of patient-controlled intranasal analgesia (PCINA) delivery systems. The objective of this article is to review the PCA modalities currently in use and to discuss those in development for the treatment of acute postoperative pain.

  2. Current concepts: management of diarrhea in acute care.

    PubMed

    Fruto, L V

    1994-09-01

    Diarrhea is common in the acute care setting, particularly among critically ill patients. Factors that cause diarrhea are usually multifactorial; some of the most common include medications, hyperosmolar or rapidly delivered tube feedings, atrophy of intestinal epithelium or ischemic bowel, short bowel syndrome, pseudomembranous colitis, infection (Salmonella and Shigella species), opportunistic infections in patients with acquired immunodeficiency syndrome and severe hypoproteinemia. This article reviews different types and mechanisms of diarrhea commonly encountered in acute care. It includes current concepts of managing diarrhea, such as calculation of stool osmotic gap, identification of medications that cause diarrhea, modification of enteral therapy, and the use of antisecretory agents. Nursing responsibilities and contributions in the collaborative assessment and clinical management of diarrhea are also explored. PMID:7704125

  3. Asthma and Allergic Diseases in Pregnancy: A Review

    PubMed Central

    2009-01-01

    Asthma and allergic disorders can affect the course and outcome of pregnancy. Pregnancy itself may also affect the course of asthma and related diseases. Optimal management of these disorders during pregnancy is vital to ensure the welfare of the mother and the baby. Specific pharmacological agents for treatment of asthma or allergic diseases must be cautiously selected and are discussed here with respect to safety considerations in pregnancy. Although most drugs do not harm the fetus, this knowledge is incomplete. Any drug may carry a small risk that must be balanced against the benefits of keeping the mother and baby healthy. The goals and principles of management for acute and chronic asthma, rhinitis, and dermatologic disorders are the same during pregnancy as those for asthma in the general population. Diagnosis of allergy during pregnancy should mainly consist of the patient's history and in vitro testing. The assured and well-evaluated risk factors revealed for sensitization in mother and child are very limited, to date, and include alcohol consumption, exposure to tobacco smoke, maternal diet and diet of the newborn, drug usage, and insufficient exposure to environmental bacteria. Consequently, the recommendations for primary and secondary preventive measures are also very limited in number and verification. PMID:21151812

  4. Resuscitation algorithm for management of acute emergencies.

    PubMed

    Shoemaker, W C; Hopkins, J A; Greenfield, S; Chang, P C; Umof, P; Shabot, M M; Spenler, C W; State, D

    1978-10-01

    Assuming that unrecognized or inadequately corrected hypovolemia results in higher mortality and morbidity rates, we developed a systematic approach to resuscitation that would: 1) identify criteria to aid in the recognition of hypovolemia and ensure the expeditious correction of this defect without interfering with diagnostic workup and management; 2) define criteria to prevent fluid overload which may jeopardize the patient's course, and 3) express these criteria in an explicit, systematic, patient care algorithm, ie, protocol, useful to both the resident and the practicing physician. We are now conducting prospective clinical trials with one service using the algorithm and the others acting as the control group. Preliminary results comparing patient outcomes suggest that the algorithm improves patient care by shortening resuscitation time and results in fewer hospital days, intensive care unit days, febrile days, and days on mechanical ventilation as well as reduced mortality. The algorithm provides a systematic plan to organize patient care so that the most urgently needed procedures are not delayed or overlooked.

  5. Thrombolytic Therapy in the Acute Management of Frostbite Injuries

    PubMed Central

    Wagner, Christopher; Pannucci, Christopher J.

    2015-01-01

    Frostbite injuries frequently result in devastating ischemic damage to the distal extremities. This ischemia and resultant necrosis have historically been managed expectantly, with amputation of devitalized tissue commonly being the end result after severe injury. Advances in nuclear medicine, interventional radiology, and thrombolytic therapy have contributed to the development of a therapy proving successful in reversing these acute ischemic effects and ameliorating the morbidity of these rare limb-threatening injuries. PMID:21211711

  6. Assessment and management of asthma in an accident and emergency department.

    PubMed Central

    Reed, S; Diggle, S; Cushley, M J; Sleet, R A; Tattersfield, A E

    1985-01-01

    Patients with asthma presenting to the accident and emergency department at Southampton General Hospital during 12 months were reviewed retrospectively to determine how many patients attended, when and how patients were assessed and treated, and what factors appeared to influence whether a patient was admitted to a medical ward or not. Thirty five visits were made by patients requesting a repeat prescription for a metered dose inhaler. A further 193 visits were made by 152 patients (93 male, 59 female); only data on the first visit of any individual were analysed in this study. Patients were more likely to visit in the autumn, at the weekend, and in the evenings. Observations and measurements used to assess the severity of asthma were recorded with variable frequency--heart rate in 84% of examinations, pulsus paradoxus in 13%, and peak flow rate in 11%. Blood pressure was five times more likely to be recorded than peak flow rate. The drugs used to treat asthma were, in order of frequency, a beta agonist (120 patients), intravenous aminophylline (39), and intravenous corticosteroids (30). Sixty (39%) of the patients were admitted to a medical ward. Admission was more likely to occur when patients arrived during the week than at the weekend, when they had cyanosis or pulsus paradoxus, and after receiving parenteral treatment. There was no difference in mean heart rate between patients admitted to the ward and those discharged home. Although there was no specific evidence of inappropriate admission to or discharge from hospital in this retrospective study, the failure to record more objective measurements of the severity of asthma and, in particular, the extent of the airflow obstruction, is cause for concern. PMID:2869594

  7. Managing acute and chronic renal stone disease.

    PubMed

    Moran, Conor P; Courtney, Aisling E

    2016-02-01

    Nephrolithiasis, or renal stone disease, is common and the incidence is increasing globally. In the UK the lifetime risk is estimated to be 8-10%. On a population level, the increase in stone incidence, erosion of gender disparity, and younger age of onset is likely to reflect increasing prevalence of obesity and a Western diet with a high intake of animal protein and salt. Stones can be detected by a variety of imaging techniques. The gold standard is a non-contrast CT of kidneys, ureters and bladder (CT KUB) which can identify > 99% of stones. CT KUB should be the primary mode of imaging for all patients with colic unless contraindicated. In such instances, or if a CT KUB is not available, an ultrasound KUB is an alternative. This has advantages in terms of radiation exposure and cost, but is limited in sensitivity, particularly for ureteric stones. Once diagnosed, a plain film KUB can be used for follow-up of radiopaque stones. For most patients diclofenac is a reasonable first choice of analgesia, e.g. 50-100 mg rectally, or 75 mg IM. Opioid medication can worsen nausea and be less effective, but should be used if there is a contraindication to NSAIDs. A combination of diclofenac, paracetamol, and/or codeine regularly can provide adequate pain control in many cases. Failure of this analgesic combination should prompt consideration of secondary care support. If a ureteric stone < 5 mm in diameter is identified, the expectation is that this will pass without intervention. Initially medical management is still useful for stones between 5 and 10mm in diameter, but urology input is more likely to be necessary as up to 50% of these may require intervention. Stones that are >10 mm in diameter should be discussed with the urology service as they are unlikely to pass spontaneously.

  8. Getting control of uncontrolled asthma.

    PubMed

    Wechsler, Michael E

    2014-11-01

    Despite various treatment modalities, a large proportion of patients have asthma that remains uncontrolled. These patients remain at an increased risk of developing severe exacerbations, have a poor quality of life, and pose a high economic healthcare burden, with an estimated mean annual cost more than double that of patients with good symptom control. It is therefore important to accurately diagnose asthma and continually assess asthma control. Several validated tools are available to do this, including questionnaires, biomarker analysis, and bronchoscopy. Current guidelines advise physicians to establish a self-management program for the patient to assess and monitor asthma control. A further recommendation is the establishment of an educational action plan to increase treatment adherence and to improve asthma control. National and international guidelines provide long-term management strategies for these patients and recommend a stepwise approach for achieving and maintaining asthma control. Despite availability of a wide range of controller and reliever therapies, uncontrolled asthma remains a challenge and reflects the need for new therapeutic options. This review discusses current global guidelines for the assessment and management of asthma control and summarizes the broad spectrum of novel therapeutic agents currently under development for the treatment of asthma, including anticholinergics, chemoattractant receptor-homologous molecules expressed on T-helper 2 lymphocyte antagonists, and anti-interleukin (IL)-5, anti-IL-13, and anti-IL-4 agents. PMID:24844737

  9. Efficacy of the I Can Control Asthma and Nutrition Now (ICAN) pilot program on health outcomes in high school students with asthma.

    PubMed

    Kouba, Joanne; Velsor-Friedrich, Barbarba; Militello, Lisa; Harrison, Patrick R; Becklenberg, Amy; White, Barb; Surya, Shruti; Ahmed, Avais

    2013-06-01

    Asthma is the most prevalent chronic illness in childhood affecting 7 million youth. Many youth with asthma face another risk factor in obesity. Obesity, in turn, increases disorders such as asthma. Studies have recommended that asthma programs also address weight management in youth. Taking this into consideration, the I Can Control Asthma and Nutrition Now (ICAN) program is an innovative school-based program composed of (1) nutrition and weight management education, (2) asthma education, and (3) monthly reenforcement visits. This pilot study tested the initial effectiveness of the ICAN pilot program on a variety of asthma and nutrition outcomes in 25 urban minority students with asthma. Over the course of the pilot program, significant increases in asthma knowledge, asthma self-efficacy, asthma quality of life, asthma self-care, nutrition knowledge, nutrition self-efficacy, and asthma control were observed. The ICAN program has demonstrated promising preliminary results in improving nutrition and asthma health outcomes with urban minority high school students.

  10. [The therapy of bronchial asthma].

    PubMed

    Fabbri, L M; Papi, A; Corbetta, L; Ciaccia, A

    1999-05-01

    Asthma (Greek word that means "breathlessness" or "open-mouth breath") is a chronic inflammatory disorder of the airways, with extensive infiltration of the airway lumen and wall with eosinophils, mast cells, activated T-lymphocytes. Airway inflammation is associated with airway hyperresponsiveness, recurrent episodes of reversible airflow limitation and respiratory symptoms such as wheezing, chest tightness, breathlessness and cough with mucus production. Curiously, asthma worsens particularly at night and in the early hours of the morning. The current consensus on asthma therapy suggests that pharmacological control of asthma can be achieved with antiinflammatory "controller" medications such as inhaled glucocorticoids and cromones. Short-acting bronchodilators act as "reliever" medications and rapidly reverse acute manifestations of asthma. Asthmatic exacerbations require the repetitive administration of inhaled short-acting beta-2-agonist and the early introduction of oral glucocorticoids. Rarely the severity of exacerbation requires the administration of oxygen (that, if available, is not contraindicated), intravenous bronchodilators, glucocorticoids and epinephryne and mechanical ventilation.

  11. Improvement in symptoms and pulmonary function of asthmatic patients due to their treatment according to the Global Strategy for Asthma Management (GINA)

    PubMed Central

    Boskabady, Mohammad H; Rezaeitalab, Fariba; Rahimi, Najmah; Dehnavi, Damon

    2008-01-01

    Background Global Initiative Strategy for Asthma Management (GINA) is poorly applied in undeveloped and developing countries. The current study examined the effects of applying GINA guidelines on treatment efficacy in asthmatic patients in Iran. Methods Twenty four asthmatic patients (usual care group) were treated as usual and 26 patients (intervention group) according to the GINA for 2 months. Asthma symptom score, asthma severity, frequency of symptoms/week and wheezing were recorded at the beginning (first visit), one month after treatment (second visit), and at the end of the study (third visit). Pulmonary function tests (PFTs) were performed by spirometry, and the patients' use of asthma drugs and their symptoms were evaluated, at each visit. Results Asthma symptoms, frequency of symptoms/week, chest wheezing, and PFT values were significantly improved in the intervention group at the second and third visits compared to first visit (p < 0.001 for all measures). In addition, exercise induced cough and wheeze were significant improved in the third visit compared to the second visit in this group (p < 0.01 for both measures). In the second and third visits all symptoms were significantly lower, and PFT values higher, in the intervention group compared to the usual care group (p < 0.005 to p < 0.001). In the usual care group, there were only small improvements in some parameters in just the second visit (p < 0.01 for all measures). The use of asthma drugs was unchanged in the usual care group and significantly reduced in the intervention group (p < 0.01) by the end of the study. Conclusion Adoption of GINA guidelines improves asthma symptoms and pulmonary function in asthmatic patients in Iran. PMID:19102753

  12. Randomized Trial of Problem-Based versus Didactic Seminars for Disseminating Evidence-Based Guidelines on Asthma Management to Primary Care Physicians

    ERIC Educational Resources Information Center

    White, Marc; Michaud, Gaetane; Pachev, George; Lirenman, David; Kolenc, Anna; FitzGerald, J. Mark

    2004-01-01

    Introduction: This randomized controlled trial (RCT) investigated the effectiveness of and satisfaction with small-group problem-based learning (PBL) versus a didactic lecture approach to guideline dissemination in asthma management controlling for confounders common in comparative educational interventions. Methods: Sites were selected as either…

  13. The diagnosis and management of acute and chronic urticaria: 2014 update.

    PubMed

    Bernstein, Jonathan A; Lang, David M; Khan, David A; Craig, Timothy; Dreyfus, David; Hsieh, Fred; Sheikh, Javed; Weldon, David; Zuraw, Bruce; Bernstein, David I; Blessing-Moore, Joann; Cox, Linda; Nicklas, Richard A; Oppenheimer, John; Portnoy, Jay M; Randolph, Christopher R; Schuller, Diane E; Spector, Sheldon L; Tilles, Stephen A; Wallace, Dana

    2014-05-01

    These parameters were developed by the Joint Task Force on Practice Parameters (JTFPP), representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology. The AAAAI and ACAAI have jointly accepted responsibility for establishing "The diagnosis and management of acute and chronic urticaria: 2014 update." This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the JTFPP, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma & Immunology. The JTFPP understands that the cost of diagnostic tests and therapeutic agents is an important concern that might appropriately influence the work-up and treatment chosen for a given patient. The JTFPP recognizes that the emphasis of our primary recommendations regarding a medication might vary, for example, depending on third-party payer issues and product patent expiration dates. However, because a given test or agent's cost is so widely variable and there is a paucity of pharmacoeconomic data, the JTFPP generally does not consider cost when formulating practice parameter recommendations. In extraordinary circumstances, when the cost/benefit ratio of an intervention is prohibitive, as supported by pharmacoeconomic data, commentary might be provided. These parameters are not designed for use by pharmaceutical companies in drug promotion. The JTFPP is committed to ensuring that the practice parameters are based

  14. Asthma in pregnancy: a review

    PubMed Central

    Giles, Warwick; Murphy, Vanessa

    2013-01-01

    Asthma is one of the most common medical conditions in women of childbearing age. There are now data to show that asthma is not a benign condition with respect to maternal and fetal health. Despite this there are several problems encountered in the management of such women. There is a tendency to cease or reduce optimal asthma treatments because pregnant women and/or their clinicians may believe they pose a risk to the fetus. There is also a lack of clinician awareness of the complications of asthma in pregnancy. PMID:27757158

  15. Wastewater-based epidemiological evaluation of the effect of air pollution on short-acting beta-agonist consumption for acute asthma treatment.

    PubMed

    Fattore, Elena; Davoli, Enrico; Castiglioni, Sara; Bosetti, Cristina; Re Depaolini, Andrea; Marzona, Irene; Zuccato, Ettore; Fanelli, Roberto

    2016-10-01

    Asthma, one of the most common chronic diseases in the world and a leading cause of hospitalization among children, has been associated with outdoor air pollution. We applied the wastewater-based epidemiology (WBE) approach to study the association between the use of salbutamol, a short-acting beta-agonist used to treat acute bronchospasm, and air pollution in the population of Milan, Italy. Composite 24-h samples of untreated wastewater were collected daily and analyzed for human metabolic residues of salbutamol by liquid chromatography tandem mass spectrometry. Corresponding daily outdoor concentrations of particular matter up to 10µm (PM10) and 2.5µm (PM2.5) in aerodynamic diameter, nitrogen dioxide, ozone, sulfur dioxide, and benzene were collected from the public air monitoring network. Associations at different lag times (0-10 days) were assessed by a log-linear Poisson regression model. We found significant direct associations between defined daily doses (DDD) of salbutamol and mean daily concentrations of PM10 and PM2.5 up to nine days of lag time. The highest rate ratio, and 95% confidence interval (CI), of DDD of salbutamol was 1.06 (95% CI: 1.02-1.10) and 1.07 (95% CI: 1.02-1.12) at seven days of lag time and for an increase of 10 μg/m(3) of PM10 and PM2.5, respectively. Reducing the mean daily PM10 concentration in Milan from 50 to 30μg/m(3) means that 852 (95% CI: 483-1504) daily doses of salbutamol per day would not be used. These results confirm the association between asthma and outdoor PM10 and PM2.5 and prove the potential of the WBE approach to quantitatively estimate the relation between environmental exposures and diseases. PMID:27281687

  16. Asthma Medications and Pregnancy

    MedlinePlus

    ... Asthma: Associated Conditions Asthma and Pregnancy Asthma Medications Asthma Medications Make an Appointment Refer a Patient Ask ... make sure you are using it correctly. Other Asthma Related Medication Treatment Annual influenza vaccine (flu shot) ...

  17. Children with Asthma: Strategies for Educators.

    ERIC Educational Resources Information Center

    Neuharth-Pritchett, Stacey; Getch, Yvette Q.

    1999-01-01

    Guidelines for managing the child with asthma in educational settings address effects of asthma on academic performance, psychosocial effects, the need for collaboration with parents and medical personnel, common triggers of asthmatic episodes, symptoms, communication with parents, and resources. A sample asthma care plan is attached. (DB)

  18. Asthma: Not Just a Childhood Condition.

    ERIC Educational Resources Information Center

    Strauss, Kandra

    2002-01-01

    Asthma has grown to epidemic proportions among school-age children, and nearly 10 million U.S. adults suffer from it. This paper describes asthma and its triggers and explains how to take measures to manage asthma symptoms within the school (e.g., dusting regularly and keeping medications available). A sidebar presents tips on controlling asthma…

  19. Management of asthma and chronic obstructive pulmonary disease with combination inhaled corticosteroids and long-acting β-agonists: a review of comparative effectiveness research.

    PubMed

    Mapel, Douglas W; Roberts, Melissa H

    2014-05-01

    The value of combination therapy with inhaled corticosteroids and long-acting β-agonists (ICS/LABA) is well recognized in the management of asthma and chronic obstructive pulmonary disease (COPD). Despite differences in the pharmacological properties between two well-established ICS/LABA products (budesonide/formoterol and fluticasone/salmeterol), data from randomized clinical trials (RCTs) and meta-analyses suggest that these two products perform similarly under RCT conditions. In contrast, a few recently reported real-world comparative effectiveness studies have suggested that there are substantial differences between ICS/LABA combination treatments in terms of clinical and healthcare outcomes in patients with asthma or COPD. The purpose of this article is to provide a brief review of the benefits, as well as the limitations, of comparative effectiveness research (CER) in the therapeutic area of asthma and COPD. We conducted a structured literature review of the current CER studies on ICS/LABA combinations in asthma and COPD. These articles were then used to illustrate the unique challenges of CER studies, providing a summary of study results and limitations. We focus particularly on difficult biases and confounding factors that may be introduced before, during, and after the initiation of therapy. Beyond being a review of these two ICS/LABA combination treatments, this article is intended to help those who wish to assess the quality of CER published projects in asthma and COPD, or guide investigators who wish to design new CER studies for chronic respiratory disease treatments.

  20. Surgical and interventional management of complications caused by acute pancreatitis

    PubMed Central

    Karakayali, Feza Y

    2014-01-01

    Acute pancreatitis is one of the most common gastrointestinal disorders worldwide. It requires acute hospitalization, with a reported annual incidence of 13 to 45 cases per 100000 persons. In severe cases there is persistent organ failure and a mortality rate of 15% to 30%, whereas mortality of mild pancreatitis is only 0% to 1%. Treatment principles of necrotizing pancreatitis and the role of surgery are still controversial. Despite surgery being effective for infected pancreatic necrosis, it carries the risk of long-term endocrine and exocrine deficiency and a morbidity and mortality rate of between 10% to 40%. Considering high morbidity and mortality rates of operative necrosectomy, minimally invasive strategies are being explored by gastrointestinal surgeons, radiologists, and gastroenterologists. Since 1999, several other minimally invasive surgical, endoscopic, and radiologic approaches to drain and debride pancreatic necrosis have been described. In patients who do not improve after technically adequate drainage, necrosectomy should be performed. When minimal invasive management is unsuccessful or necrosis has spread to locations not accessible by endoscopy, open abdominal surgery is recommended. Additionally, surgery is recognized as a major determinant of outcomes for acute pancreatitis, and there is general agreement that patients should undergo surgery in the late phase of the disease. It is important to consider multidisciplinary management, considering the clinical situation and the comorbidity of the patient, as well as the surgeons experience. PMID:25309073

  1. Lung Ultrasound in the Management of Acute Decompensated Heart Failure

    PubMed Central

    Ang, Shiang-Hu; Andrus, Phillip

    2012-01-01

    Once thought impracticable, lung ultrasound is now used in patients with a variety of pulmonary processes. This review seeks to describe the utility of lung ultrasound in the management of patients with acute decompensated heart failure (ADHF). A literature search was carried out on PubMed/Medline using search terms related to the topic. Over three thousand results were narrowed down via title and/or abstract review. Related articles were downloaded for full review. Case reports, letters, reviews and editorials were excluded. Lung ultrasonographic multiple B-lines are a good indicator of alveolar interstitial syndrome but are not specific for ADHF. The absence of multiple B-lines can be used to rule out ADHF as a causative etiology. In clinical scenarios where the assessment of acute dyspnea boils down to single or dichotomous pathologies, lung ultrasound can help rule in ADHF. For patients being treated for ADHF, lung ultrasound can also be used to monitor response to therapy. Lung ultrasound is an important adjunct in the management of patients with acute dyspnea or ADHF. PMID:22708913

  2. Gouty Arthritis: A Review of Acute Management and Prevention.

    PubMed

    Wilson, Liza; Saseen, Joseph J

    2016-08-01

    Gouty arthritis is one of the most common rheumatic diseases. The clinical burden of gouty arthritis has historically been well recognized; however, gout is often misdiagnosed and mismanaged. The prevalence of gout is rising and is likely attributed to several factors including increased incidence of comorbidities, lifestyle factors, and increased use of causative medications. With the increasing prevalence, there have been several innovations and evidence-based updates related to the diagnosis and management of gout. Acute gouty arthritis should be treated with nonsteroidal antiinflammatory drugs (NSAIDs), colchicine, or corticosteroids, or a combination of two agents. Xanthine oxidase inhibitor therapy remains the consensus first-line treatment option for the prevention of recurrent gout. Add-on therapies that reduce serum urate concentration include traditional uricosuric agents and a novel uric acid reabsorption inhibitor. Prophylaxis of acute gout with NSAIDs, colchicine, or corticosteroids is universally recommended when initiating any urate-lowering therapy in order to prevent acute gouty arthritis for a period of at least 6 months. In this review, we discuss the epidemiology and risk factors for gouty arthritis and evaluate diagnostic strategies and therapeutic regimens for the management of gout, including a new drug approval. PMID:27318031

  3. Reframing tobacco dependency management in acute care: A case study.

    PubMed

    Schultz, Annette S H; Guzman, Randolph; Sawatzky, Jo-Ann V; Thurmeier, Rick; Fedorowicz, Anna; Fulmore, Kaitlin

    2016-08-01

    Effective tobacco dependence treatment within acute care tends to be inadequate. The purpose of the Utilizing best practices to Manage Acute care patients Tobacco Dependency (UMAT) was to implement and evaluate an evidence-based intervention to support healthcare staff to effectively manage nicotine withdrawal symptoms of acute surgical patients. Data collection for this one-year longitudinal case study included: relevant patient experiences and staff reported practice, medication usage, and chart review. Over the year each data source suggested changes in tobacco dependence treatment. Key changes in patient survey responses (N=55) included a decrease in daily smoking and cigarette cravings. Of patients who used nicotine replacement therapy, they reported an increase in symptom relief. Staff (N=45) were surveyed at baseline, mid-point and end of study. Reported rates of assessing smoking status did not change over the year, but assessment of withdrawal symptoms emerged as daily practice and questions about cessation diminished. Also delivery of nicotine replacement therapy products increased over the year. Chart reviews showed a shift in content from documenting smoking behavior to withdrawal symptoms and administration of nicotine replacements; also frequency of comments increased. In summary, the evidence-based intervention influenced unit norms and reframed the culture related to tobacco dependence treatment. PMID:27392584

  4. Management of acute pancreatitis (AP) – Polish Pancreatic Club recommendations

    PubMed Central

    Rosołowski, Mariusz; Lipiński, Michał; Dobosz, Marek; Durlik, Marek; Głuszek, Stanisław; Kuśnierz, Katarzyna; Lampe, Paweł; Małecka-Panas, Ewa; Nowakowska-Duława, Ewa; Nowak-Niezgoda, Magdalena; Radomańska, Barbara; Talar-Wojnarowska, Renata; Wereszczyńska-Siemiątkowska, Urszula

    2016-01-01

    The presented recommendations concern the current management of acute pancreatitis. The recommendations relate to the diagnostics and treatment of early and late phases of acute pancreatitis and complications of the disease taking into consideration surgical and endoscopic methods. All the recommendations were subjected to voting by the members of the Working Group of the Polish Pancreatic Club, who evaluated them every single time on a five-point scale, where A means full acceptance, B means acceptance with a certain reservation, C means acceptance with a serious reservation, D means rejection with a certain reservation and E means full rejection. The results of the vote, together with commentary, are provided for each recommendation. PMID:27350832

  5. Current prevention and management of acute mountain sickness.

    PubMed Central

    Bia, F. J.

    1992-01-01

    Acute mountain sickness was known to the Chinese in ancient times, as they traversed mountain passes between the Great Headache and Little Headache mountains into present-day Afghanistan. The Jesuit priest, Father Joseph Acosta, lived in Peru during the sixteenth century; he described both this syndrome and deaths which occurred in the high Andes. The incidence of high-altitude illness will rise as previously remote sites become more accessible to trekkers and skiers. Prevention and treatment are important concerns for those physicians who wish to advise their more adventuresome patients properly. This article incorporates a selected review of pertinent investigations, in the English-language literature over the past five years, into material previously presented at travel symposia for clinicians managing the prophylaxis and treatment of acute mountain sickness. PMID:1290275

  6. Availability of Asthma Quick Relief Medication in Five Alabama School Systems

    PubMed Central

    Stroupe, Nancy; McClure, Leslie A.; Wheeler, Lani; Gerald, Lynn B.

    2012-01-01

    Objectives This paper documents individual asthma action plan presence and quick relief medication (albuterol) availability for elementary students enrolled in five Alabama school systems. Patients and Methods Data were obtained during baseline data collection (fall 2005) of a school-based supervised asthma medication trial. All students attended 1 of 36 participating elementary schools across five school systems in Jefferson County, Alabama. In addition, they had to have physician-diagnosed asthma requiring daily controller medication. Each school system had its own superintendent and elected school board. Asthma action plan presence and albuterol availability was confirmed by study personnel. Asthma action plans had to contain daily and acute asthma management instructions. Predictors of asthma action plan presence and albuterol availability were also investigated. Associations between albuterol availability and self-reported characteristics including health care utilization prior to study enrollment and outcomes during the study baseline period were also investigated. Results Enrolled students had a mean (SD) age of 11.0 (2.1) years, 91% were African American, and 79% had moderate persistent asthma. No student had a complete asthma action plan on file and only 14% had albuterol physically available at school. Albuterol availability was not predicted by gender, race, insurance status, second-hand smoke exposure, need for pre-exercise albuterol, asthma severity, or self-reported health care utilization prior to study enrollment. Albuterol availability did not predict school absences, red/yellow peak flow recordings, or medication adherence during the study's baseline period. Conclusion Despite policies permitting students to possess albuterol, few elementary students across five independent school systems in Alabama actually had it readily available at school. PMID:22454787

  7. Availability of Asthma Quick Relief Medication in Five Alabama School Systems.

    PubMed

    Gerald, Joe K; Stroupe, Nancy; McClure, Leslie A; Wheeler, Lani; Gerald, Lynn B

    2012-03-01

    OBJECTIVES: This paper documents individual asthma action plan presence and quick relief medication (albuterol) availability for elementary students enrolled in five Alabama school systems. PATIENTS AND METHODS: Data were obtained during baseline data collection (fall 2005) of a school-based supervised asthma medication trial. All students attended 1 of 36 participating elementary schools across five school systems in Jefferson County, Alabama. In addition, they had to have physician-diagnosed asthma requiring daily controller medication. Each school system had its own superintendent and elected school board. Asthma action plan presence and albuterol availability was confirmed by study personnel. Asthma action plans had to contain daily and acute asthma management instructions. Predictors of asthma action plan presence and albuterol availability were also investigated. Associations between albuterol availability and self-reported characteristics including health care utilization prior to study enrollment and outcomes during the study baseline period were also investigated. RESULTS: Enrolled students had a mean (SD) age of 11.0 (2.1) years, 91% were African American, and 79% had moderate persistent asthma. No student had a complete asthma action plan on file and only 14% had albuterol physically available at school. Albuterol availability was not predicted by gender, race, insurance status, second-hand smoke exposure, need for pre-exercise albuterol, asthma severity, or self-reported health care utilization prior to study enrollment. Albuterol availability did not predict school absences, red/yellow peak flow recordings, or medication adherence during the study's baseline period. CONCLUSION: Despite policies permitting students to possess albuterol, few elementary students across five independent school systems in Alabama actually had it readily available at school.

  8. Efficacy of the I Can Control Asthma and Nutrition Now (ICAN) Pilot Program on Health Outcomes in High School Students with Asthma

    ERIC Educational Resources Information Center

    Kouba, Joanne; Velsor-Friedrich, Barbarba; Militello, Lisa; Harrison, Patrick R.; Becklenberg, Amy; White, Barb; Surya, Shruti; Ahmed, Avais

    2013-01-01

    Asthma is the most prevalent chronic illness in childhood affecting 7 million youth. Many youth with asthma face another risk factor in obesity. Obesity, in turn, increases disorders such as asthma. Studies have recommended that asthma programs also address weight management in youth. Taking this into consideration, the I Can Control Asthma and…

  9. Effects of a self-management asthma educational program in Taiwan based on PRECEDE-PROCEED model for parents with asthmatic children.

    PubMed

    Chiang, Li-Chi; Huang, Jing-Long; Yeh, Kuo-Wei; Lu, Chang-Ming

    2004-04-01

    This study was conducted to evaluate the comparative effectiveness of two different asthma educational programs. One was self-management asthma education based on the PRECEDE-PROCEED model to change the influential factors based on a previous need assessment study in Taiwan. The other consisted of regular outpatient asthma education. The purposes were: 1) to compare differences in the asthma knowledge, self-efficacy, perceived effectiveness, children's cooperation, doctor-patient communication, and self-management behaviors in the experimental and control groups before education, and 2 weeks, 3 months, and 6 months after education; and 2) to compare differences in drug use, medication utilization, asthma severity, signs/symptoms of asthma, school absenteeism, and exercise ability before education, and 2 weeks, 3 months, and 6 months after education. Parents of asthmatic children were recruited from among outpatients of Chang Gung Children's Hospital, Taoyuan, Taiwan. They were grouped by registration number: those with even numbers were assigned to the experimental group, and those with odd numbers were assigned to the control group. Measurements were collected four times from all parents by means of a questionnaire and chart review. The General Linear Model: Repeat Measurement was used to compare variance differences. The following results were found. 1) Asthma knowledge, self-efficacy, perceived effectiveness, children's cooperation, and self-management behaviors significantly improved after the self-management asthma educational program based on PRECEDE-PROCEED. Except for perceived effectiveness, all variables still had good effectiveness after 6 months of follow-up. The experimental group was better than the control group in knowledge, children's cooperation, and self-management behaviors at the 3-month follow up, as well as in knowledge and children's cooperation at the 6-month follow-up. 2) In both the experimental and control groups, the educational program

  10. Patient perspectives in the management of asthma: improving patient outcomes through critical selection of treatment options

    PubMed Central

    Scichilone, Nicola; Contino, Adele; Figlioli, Giovanni Battista; Paglino, Giuseppe; Bellia, Vincenzo

    2010-01-01

    Asthma is a chronic inflammatory disorder of the airways that requires long-term treatment, the goal of which is to control clinical symptoms for extended periods with the least possible amount of drugs. International guidelines recommend the addition of an inhaled long-acting beta2-agonist (LABA) to a low- to medium-dose inhaled corticosteroid (ICS) when low doses of ICS fail to control asthma symptoms. The fixed combined administration of ICS/LABA improves patient compliance, reducing the risk of therapy discontinuation. The relative deposition pattern of the inhaled drug to the target site is the result of a complex interaction between the device used, the aerosol formulation and the patient’s adherence to therapy. Different inhalation devices have been introduced in clinical practice over time. The new hydrofluoroalkane (HFA) solution aerosols allow for the particle size to be modified, thus leading to deeper penetration of the medication into the lung. The Modulite® technology allows for the manipulation of inhaled HFA-based solution formulations, such as the fixed beclomethasone/formoterol combination, resulting in a uniform treatment of inflammation and bronchoconstriction. The success of any anti-asthmatic treatment depends on the choice of the correct device and the adherence to therapy. PMID:20165595

  11. Gunshot wounds to the face--acute management.

    PubMed

    McLean, J Nicolas; Moore, Charles E; Yellin, Seth A

    2005-08-01

    The complex facial trauma victim poses a genuine therapeutic challenge as a whole, and may be particularly challenging to the medical team. The literature on acute management of gunshot wounds to the face is scarce. We performed an extensive review of the English-language literature in an effort to better delineate the diagnosis and acute management of these injuries. Most of these injuries do not present with initial threat to life and can safely be managed non-operatively. Definitive treatment is often deferred in patients with multiple, or more severe, injuries. Airway compromise is the most frequent and most life-threatening early problem reported in most series. CT scan remains the most useful method in the evaluation of these types of injuries and associated cervical spine lesions. Facial bleeding is best controlled by angiography and subsequent embolization. Anatomic repair of soft tissue and bony injuries is recommended to obtain an optimal functional and aesthetic outcome. Despite the creation of some algorithms, no clear correlation has been found between the site of entrance wound and the injuries and outcome of gunshot wounds to the face. PMID:16307399

  12. The Acute Management of Sport Concussion in Pediatric Athletes.

    PubMed

    Resch, Jacob E; Kutcher, Jeffrey S

    2015-10-01

    During the past two decades the focus on sport concussion has increased significantly. Young athletes represent the most vulnerable population to sustain a sport concussion yet receive the least amount of attention. Specifically, young athletes who sustain a sport concussion can go unrecognized and continue to participate in sport putting them at an increased risk for a more significant injury. The purpose of this review is to provide a clinical framework for the evaluation and management of sport concussion. In addition, this review provides considerations for health care professionals in regard to clinical measures and follow-up strategies during the acute phase following concussion in young concussed athletes following injury.

  13. [Pre-hospital management of acute coronary syndrome].

    PubMed

    Lefort, Hugues; Fradin, Jordan; Blgnand, Michel; Tourtier, Jean-Pierre

    2015-03-01

    The medical management of acute coronary syndrome (ACS) follows the recommendations of international medical societies. The call to the emergency services by the patient triggers a race against the clock in pre-hospital care. It is essential to reduce the duration of the inadequate perfusion of the heart in order to limit its consequences. An effective reperfusion strategy must be planned in advance taking into account the logistical constraints. It is crucial that the general public is educated to recognise the signs of ACS and to call the emergency services immediately (such as 15, 112 or 991). PMID:26040140

  14. Contemporary concepts in management of acute otitis media in children.

    PubMed

    Rettig, Eleni; Tunkel, David E

    2014-10-01

    Acute otitis media (AOM) is a common disease of childhood. AOM is most appropriately diagnosed by careful otoscopy with an understanding of clinical signs and symptoms. The distinction between AOM and chronic otitis media with effusion should be emphasized. Treatment should include pain management, and initial antibiotic treatment should be given to those most likely to benefit, including young children, children with severe symptoms, and those with otorrhea and/or bilateral AOM. Tympanostomy tube placement may be helpful for those who experience frequent episodes of AOM or fail medical therapy. Recent practice guidelines may assist the clinician with such decisions. PMID:25213276

  15. Contemporary concepts in management of acute otitis media in children.

    PubMed

    Rettig, Eleni; Tunkel, David E

    2014-10-01

    Acute otitis media (AOM) is a common disease of childhood. AOM is most appropriately diagnosed by careful otoscopy with an understanding of clinical signs and symptoms. The distinction between AOM and chronic otitis media with effusion should be emphasized. Treatment should include pain management, and initial antibiotic treatment should be given to those most likely to benefit, including young children, children with severe symptoms, and those with otorrhea and/or bilateral AOM. Tympanostomy tube placement may be helpful for those who experience frequent episodes of AOM or fail medical therapy. Recent practice guidelines may assist the clinician with such decisions.

  16. Severe Raynaud's phenomenon-A streamlined approach to acute management.

    PubMed

    Lee, Regent; Lomas, Oliver; Handa, Ashok

    2011-01-01

    Raynaud's phenomenon is an exaggerated vasospastic response to cold or emotional stress which not only may cause the patient severe pain but also critical ischaemia and necrosis of the digits. We report the case of a 69-year-old woman who presented with rest pain, impending ulceration and necrosis of finger tips due to an episode of left-sided Raynaud's phenomenon. Intravenous prostacyclin was administered successfully as a bridge to endoscopic thoracic sympathectomy. Vascular surgery units are ideally positioned for the acute management of severe Raynaud's phenomenon to provide continuity of care to patients with profound digital ischaemia and impending tissue loss.

  17. A cluster randomised intervention trial of asthma clubs to improve quality of life in primary school children: the School Care and Asthma Management Project (SCAMP)

    PubMed Central

    Patterson, E; Brennan, M; Linskey, K; Webb, D; Shields, M; Patterson, C

    2005-01-01

    Aim: To evaluate the effectiveness of a programme of asthma clubs in improving quality of life in primary school children with asthma. Methods: A cluster randomised intervention trial was undertaken in 22 primary schools within the urban area of south and east Belfast, Northern Ireland. Schools were randomised in pairs to immediate or delayed groups. The study subjects comprised 173 children aged 7–11 years whose parents had notified the school of their asthma diagnosis. Children attended school based weekly clubs over an 8 week period. The main outcome measures were the interview administered Paediatric Quality of Life Questionnaire scores, ranging from 1 (worst) to 7 (best), spirometry, and inhaler technique. Results: Over 15 weeks, small but non-significant improvements in the overall quality of life score (mean 0.20; 95% confidence interval (CI) –0.20 to 0.61) and in each of its three components, activity limitation (0.20; –0.43 to 0.84), symptoms (0.23; –0.23 to 0.70), and emotional function (0.17; –0.18 to 0.52), were observed in the immediate compared with the delayed group. Inhaler technique at week 16 was markedly better in the immediate group, with 56% having correct technique compared with 15% in the delayed group. No significant effect of the intervention on spirometry results could be demonstrated. Conclusion: This primary school based asthma education programme resulted in sustained improvements in inhaler technique, but changes in quality of life scores were not significant. PMID:16040874

  18. Airway smooth muscle in the pathophysiology and treatment of asthma

    PubMed Central

    Solway, Julian

    2013-01-01

    Airway smooth muscle (ASM) plays an integral part in the pathophysiology of asthma. It is responsible for acute bronchoconstriction, which is potentiated by constrictor hyperresponsiveness, impaired relaxation and length adaptation. ASM also contributes to airway remodeling and inflammation in asthma. In light of this, ASM is an important target in the treatment of asthma. PMID:23305987

  19. Management of Patients Admitted with Acute Decompensated Heart Failure

    PubMed Central

    Krim, Selim R.; Campbell, Patrick T.; Desai, Sapna; Mandras, Stacy; Patel, Hamang; Eiswirth, Clement; Ventura, Hector O.

    2015-01-01

    Background Hospital admission for the treatment of acute decompensated heart failure is an unfortunate certainty in the vast majority of patients with heart failure. Regardless of the etiology, inpatient treatment for acute decompensated heart failure portends a worsening prognosis. Methods This review identifies patients with heart failure who need inpatient therapy and provides an overview of recommended therapies and management of these patients in the hospital setting. Results Inpatient therapy for patients with acute decompensated heart failure should be directed at decongestion and symptom improvement. Clinicians should also treat possible precipitating events, identify comorbid conditions that may exacerbate heart failure, evaluate and update current guideline-directed medical therapy, and perform risk stratification for all patients. Finally, efforts should be made to educate patients about the importance of restricting salt and fluid, monitoring daily weights, and adhering to a graded exercise program. Conclusion Early discharge follow-up and continued optimization of guideline-directed medical therapy are key to preventing future heart failure readmissions. PMID:26413005

  20. Management based on exhaled nitric oxide levels adjusted for atopy reduces asthma exacerbations in children: A dual centre randomized controlled trial.

    PubMed

    Petsky, Helen L; Li, Albert M; Au, Chun T; Kynaston, Jennifer A; Turner, Catherine; Chang, Anne B

    2015-06-01

    While several randomized control trials (RCTs) have evaluated the use of fractional exhaled nitric oxide (FeNO) to improve asthma outcomes, none used FeNO cut-offs adjusted for atopy, a determinant of FeNO levels. In a dual center RCT, we assessed whether a treatment strategy based on FeNO levels, adjusted for atopy, reduces asthma exacerbations compared with the symptoms-based management (controls). Children with asthma from hospital clinics of two hospitals were randomly allocated to receive an a-priori determined treatment hierarchy based on symptoms or FeNO levels. There was a 2-week run-in period and they were then reviewed 10 times over 12-months. The primary outcome was the number of children with exacerbations over 12-months. Sixty-three children were randomized (FeNO = 31, controls = 32); 55 (86%) completed the study. Although we did achieve our planned sample size, significantly fewer children in the FeNO group (6 of 27) had an asthma exacerbation compared to controls (15 of 28), P = 0.021; number to treat for benefit = 4 (95% CI 3-24). There was no difference between groups for any secondary outcomes (quality of life, symptoms, FEV1 ). The final daily inhaled corticosteroids (ICS) dose was significantly (P = 0.037) higher in the FeNO group (median 400 µg, IQR 250-600) compared to the controls (200, IQR100-400). Taking atopy into account when using FeNO to tailor asthma medications is likely beneficial in reducing the number of children with severe exacerbations at the expense of increased ICS use. However, the strategy is unlikely beneficial for improving asthma control. A larger study is required to confirm or refute our findings.

  1. A review of asthma and scuba diving.

    PubMed

    Tetzlaff, Kay; Muth, Claus M; Waldhauser, Lisa K

    2002-10-01

    An increasing number of asthmatics participate in recreational scuba diving. This activity presents unique physical and physiological challenges to the respiratory system. This review addresses the susceptibility of divers with asthma to diving accidents, acute asthmatic attacks, and long-term exacerbation of their disease. Recommendations on fitness to dive with asthma and airway hyperresponsiveness are provided.

  2. Asthma epigenetics.

    PubMed

    Salam, Muhammad T

    2014-01-01

    Asthma is the most common chronic disease of childhood, and a growing body of evidence indicates that epigenetic variations may mediate the effects of environmental exposures on the development and natural history of asthma. Epigenetics is the study of mitotically or meiotically heritable changes in gene expression that occur without directly altering the DNA sequence. DNA methylation, histone modifications and microRNAs are major epigenetic variations in humans that are currently being investigated for asthma etiology and natural history. DNA methylation results from addition of a methyl group to the 5 position of a cytosine ring and occurs almost exclusively on a cytosine in a CpG dinucleotide. Histone modifications involve posttranslational modifications such as acetylation, methylation, phosphorylation and ubiquitination on the tails of core histones. MicroRNAs are short ~22 nucleotide long, non-coding, single-stranded RNAs that binds to complementary sequences in the target mRNAs, usually resulting in gene silencing. While many studies have documented relationships of environmental exposures that have been implicated in asthma etiology with epigenetic alterations, to date, few studies have directly linked epigenetic variations with asthma development. There are several methodological challenges in studying the epigenetics of asthma. In this chapter, the influence of epigenetic variations on asthma pathophysiology, methodological concerns in conducting epigenetic research and future direction of asthma epigenetics research are discussed.

  3. [Childhood asthma].

    PubMed

    Liñán Cortés, Santos; Cobos Barroso, Nicolás

    2004-11-01

    Very frequently we have to deal with children who follow specific treatment to combat their repetitive episodes of breathing difficulty and wheezing. In many cases, they suffer from asthma. Hippocrates defined asthma as "the condition which causes an excessive narrowing of the bronchi after a reaction with a provocative stimulus which usually does not produce any effect". PMID:15648894

  4. Feasibility of a smartphone application based action plan and monitoring in asthma

    PubMed Central

    Kim, Mi-Yeong; Lee, Suh-Young; Jo, Eun-Jung; Lee, Seung-Eun; Kang, Min-Gyu; Song, Woo-Jung; Kim, Sae-Hoon; Cho, Sang-Heon; Min, Kyung-Up; Ahn, Ki-Hwan

    2016-01-01

    Background Asthma patients may experience acute episodic exacerbation. The guidelines recommend that written action plan should be given to asthma patients. However, no one can predict when and where acute exacerbation will happen. As people carry smart phone almost anytime and anywhere, smartphone application could be a useful tool in asthma care. We evaluated the feasibility of the ubiquitous healthcare system of asthma care using a smartphone application (snuCare) based on the self-management guideline or action plan. Methods Forty-four patients including fragile asthmatics were enrolled from Seoul National University Bundang Hospital between December 2011 and February 2012. They were randomly assigned into application user (n = 22) or application nonuser group (n = 22). We evaluated user-satisfaction, and clinical parameters such as asthma control, Quality of Life Questionnaire for Adult Korean Asthmatics, and the adherence of patients. Results The characteristics were similar at baseline between the 2 groups except those who treated with short-term systemic steroid or increased dose of systemic steroid during previous 8 weeks (user vs. nonuser: 31.8% vs. 4.5%, p = 0.020). Total of 2,226 signals was generated during 8 weeks including 5 risky states. After eight weeks, the users answered that it was very easy to use the application, which was shown in highest scores in terms of satisfaction (mean ± standard deviation, 4.3 ± 0.56). Seventy-three percent of patients answered that the application was very useful for asthma care. User group showed improved the adherence scores (p = 0.017). One patient in application user group could avoid Emergency Department visit owing to the application while a patient in nonuser group visited Emergency Department. Conclusion The ubiquitous healthcare system using a smartphone application (snuCare) based on the self-management guideline or action plan could be helpful in the monitoring and the management of asthma. PMID

  5. Principles for Management of Intraoperative Acute Type A Aortic Dissection.

    PubMed

    Gukop, Philemon; Chandrasekaran, Vankatachalam

    2015-12-01

    Intraoperative Type A aortic dissection is a rare pathology with incidence of 0.06-0.32%. It is associated with a high mortality between 30-50%. Some associated risk factors, including hypertension, enlarged aorta, peripheral vascular disease, advanced age, atheroma, and high arterial pressure on cardiopulmonary bypass, have been identified. Modification of these risk factors could reduce the incidence of this event. Prompt diagnosis and management, with the aid of intraoperative trans-esophageal echocardiography and/or epi-aortic ultrasound has been shown to reduce the mortality to 17%. We illustrate the principles of management of this pathology with the case of a 62-year-old female who developed acute Type A aortic dissection while undergoing minimally invasive mitral valve repair.

  6. Survey of management in acute upper gastrointestinal haemorrhage1

    PubMed Central

    Thomas, G E; Cotton, P B; Clark, C G; Boulos, P B

    1980-01-01

    The answers to a questionnaire concerning attitudes of members of the British Society of Gastroenterology to the management of acute upper gastrointestinal bleeding are analysed. In the majority of cases patients were admitted to general wards under the care of physicians. Use of intensive therapy units and venous pressure monitoring varied widely. Emergency endoscopy appeared readily available and was usually the first diagnostic procedure. Double contrast radiology and emergency angiography were available in relatively few centres. Specific nonoperative treatments (angiographic and endoscopic) were scarcely employed. Most respondents agreed that elderly patients fared badly, but there was little agreement concerning other factors which influence re-bleeding or outcome. There was a wide divergence of opinion concerning the need for surgical intervention in certain hypothetical clinical situations. Despite the difficulties involved, we believe that controlled trials are necessary to improve the management of bleeding patients. PMID:6971943

  7. Early phase of acute pancreatitis: Assessment and management

    PubMed Central

    Phillip, Veit; Steiner, Jörg M; Algül, Hana

    2014-01-01

    Acute pancreatitis (AP) is a potentially life-threatening disease with a wide spectrum of severity. The overall mortality of AP is approximately 5%. According to the revised Atlanta classification system, AP can be classified as mild, moderate, or severe. Severe AP often takes a clinical course with two phases, an early and a late phase, which should both be considered separately. In this review article, we first discuss general aspects of AP, including incidence, pathophysiology, etiology, and grading of severity, then focus on the assessment of patients with suspected AP, including diagnosis and risk stratification, followed by the management of AP during the early phase, with special emphasis on fluid therapy, pain management, nutrition, and antibiotic prophylaxis. PMID:25133018

  8. Diagnosis, prognosis and therapeutic management of acute pulmonary embolism.

    PubMed

    Tapson, Victor F

    2016-08-01

    Pulmonary embolism (PE) is a leading cause of mortality worldwide. Recognizing PE and administering anticoagulants can significantly improve patient outcomes by reducing mortality rates and preventing recurrent events. For more than 50 years, standard therapy has involved parenteral anticoagulation followed by long-term therapy with the vitamin K antagonist warfarin. However, management of warfarin therapy is challenging due to its narrow therapeutic range and interactions with genetic and environmental factors. Direct oral anticoagulants (DOACs) have been developed to simplify anticoagulation and avoid the concerns associated with warfarin. DOACs are administered at a fixed dosage without routine monitoring and have few drug interactions. In recent years, DOACs have received FDA approval for the treatment of acute deep venous thrombosis (DVT) and PE based on the results of well-conducted clinical trials. This review discusses approaches to the diagnosis and treatment of PE and the use of DOACs as an alternative to warfarin treatment for the management of the disease. While many of the indications for DOACs and concepts discussed apply to both DVT and PE, our focus will be acute PE. PMID:27450108

  9. Acute postoperative pain management: focus on iontophoretic transdermal fentanyl

    PubMed Central

    Mattia, Consalvo; Coluzzi, Flaminia

    2007-01-01

    Despite progress in the management of chronic pain, acute pain remains an issue for many postoperative patients. Although patient-controlled analgesia (PCA) has demonstrated efficacy and patient satisfaction, current techniques using intravenous (IV) administration present limitations, including the risk of programming errors and the potential to limit patient mobility due to pumps, lines, and tubing. The patient-controlled fentanyl hydrochloride (HCl) iontophoretic transdermal system (fentanyl ITS) was designed to address these concerns. Fentanyl ITS is an innovative, needle-free, self-contained drug-delivery system that uses iontophoretic technology to deliver fentanyl through the skin by application of a low-intensity electrical field. The results of several clinical studies are presented in this review. In three phase 3 placebo-controlled trials, fentanyl ITS was shown to be superior to placebo for the treatment of postoperative pain following major abdominal, orthopedic, and thoracic surgery. The results of one active-comparator phase 3 trial demonstrated comparable safety and efficacy with a standard morphine IV PCA dosing regimen, without significant difference in the side effect profile. Fentanyl ITS represents a safe, easy to use, non-invasive, and convenient alternative to current acute postoperative pain management modalities. PMID:18360612

  10. [Recommendations for management of acute pharyngitis in adults].

    PubMed

    Cots, Josep M; Alós, Juan-Ignacio; Bárcena, Mario; Boleda, Xavier; Cañada, José L; Gómez, Niceto; Mendoza, Ana; Vilaseca, Isabel; Llor, Carles

    2015-10-01

    Acute pharyngitis in adults is one of the most common infectious diseases seen in general practitioners' consultations. Viral aetiology is the most common. Among bacterial causes, the main agent is Streptococcus pyogenes or group A β-haemolytic streptococcus (GABHS), which causes 5%-30% of the episodes. In the diagnostic process, clinical assessment scales can help clinicians to better predict suspected bacterial aetiology by selecting patients who should undergo a rapid antigen detection test. If these techniques are not performed, an overdiagnosis of streptococcal pharyngitis often occurs, resulting in unnecessary prescriptions of antibiotics, most of which are broad spectrum. Consequently, management algorithms that include the use of predictive clinical rules and rapid tests have been set up. The aim of the treatment is speeding up symptom resolution, reducing the contagious time span and preventing local suppurative and non-suppurative complications. Penicillin and amoxicillin are the antibiotics of choice for the treatment of pharyngitis. The association of amoxicillin and clavulanate is not indicated as the initial treatment of acute infection. Neither are macrolides indicated as first-line therapy; they should be reserved for patients allergic to penicillin. The appropriate diagnosis of bacterial pharyngitis and proper use of antibiotics based on the scientific evidence available are crucial. Using management algorithms can be helpful in identifying and screening the cases that do not require antibiotic therapy.

  11. Recommendations for management of acute pharyngitis in adults.

    PubMed

    Cots, Josep M; Alós, Juan-Ignacio; Bárcena, Mario; Boleda, Xavier; Cañada, José L; Gómez, Niceto; Mendoza, Ana; Vilaseca, Isabel; Llor, Carles

    2015-01-01

    Acute pharyngitis in adults is one of the most common infectious diseases seen in general practitioners' consultations. Viral aetiology is the most common. Among bacterial causes, the main agent is Streptococcus pyogenes or group A β-haemolytic streptococcus (GABHS), which causes 5%-30% of the episodes. In the diagnostic process, clinical assessment scales can help clinicians to better predict suspected bacterial aetiology by selecting patients who should undergo a rapid antigen detection test. If these techniques are not performed, an overdiagnosis of streptococcal pharyngitis often occurs, resulting in unnecessary prescriptions of antibiotics, most of which are broad spectrum. Consequently, management algorithms that include the use of predictive clinical rules and rapid tests have been set up. The aim of the treatment is speeding up symptom resolution, reducing the contagious time span and preventing local suppurative and non-suppurative complications. Penicillin and amoxicillin are the antibiotics of choice for the treatment of pharyngitis. The association of amoxicillin and clavulanate is not indicated as the initial treatment of acute infection. Neither are macrolides indicated as first-line therapy; they should be reserved for patients allergic to penicillin. The appropriate diagnosis of bacterial pharyngitis and proper use of antibiotics based on the scientific evidence available are crucial. Using management algorithms can be helpful in identifying and screening the cases that do not require antibiotic therapy.

  12. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management.

    PubMed

    Bhangu, Aneel; Søreide, Kjetil; Di Saverio, Salomone; Assarsson, Jeanette Hansson; Drake, Frederick Thurston

    2015-09-26

    Acute appendicitis is one of the most common abdominal emergencies worldwide. The cause remains poorly understood, with few advances in the past few decades. To obtain a confident preoperative diagnosis is still a challenge, since the possibility of appendicitis must be entertained in any patient presenting with an acute abdomen. Although biomarkers and imaging are valuable adjuncts to history and examination, their limitations mean that clinical assessment is still the mainstay of diagnosis. A clinical classification is used to stratify management based on simple (non-perforated) and complex (gangrenous or perforated) inflammation, although many patients remain with an equivocal diagnosis, which is one of the most challenging dilemmas. An observed divide in disease course suggests that some cases of simple appendicitis might be self-limiting or respond to antibiotics alone, whereas another type often seems to perforate before the patient reaches hospital. Although the mortality rate is low, postoperative complications are common in complex disease. We discuss existing knowledge in pathogenesis, modern diagnosis, and evolving strategies in management that are leading to stratified care for patients.

  13. The Saudi Initiative for Asthma

    PubMed Central

    Al-Moamary, Mohamed S.; Al-Hajjaj, Mohamed S.; Idrees, Majdy M.; Zeitouni, Mohamed O.; Alanezi, Mohammed O.; Al-Jahdal, Hamdan H.; Al Dabbagh, Maha

    2009-01-01

    The Saudi Initiative for Asthma (SINA) provides up-to-date guidelines for healthcare workers managing patients with asthma. SINA was developed by a panel of Saudi experts with respectable academic backgrounds and long-standing experience in the field. SINA is founded on the latest available evidence, local literature, and knowledge of the current setting in Saudi Arabia. Emphasis is placed on understanding the epidemiology, pathophysiology, medications, and clinical presentation. SINA elaborates on the development of patient-doctor partnership, self-management, and control of precipitating factors. Approaches to asthma treatment in SINA are based on disease control by the utilization of Asthma Control Test for the initiation and adjustment of asthma treatment. This guideline is established for the treatment of asthma in both children and adults, with special attention to children 5 years and younger. It is expected that the implementation of these guidelines for treating asthma will lead to better asthma control and decrease patient utilization of the health care system. PMID:19881170

  14. Clinical review: Severe asthma

    PubMed Central

    Papiris, Spyros; Kotanidou, Anastasia; Malagari, Katerina; Roussos, Charis

    2002-01-01

    Severe asthma, although difficult to define, includes all cases of difficult/therapy-resistant disease of all age groups and bears the largest part of morbidity and mortality from asthma. Acute, severe asthma, status asthmaticus, is the more or less rapid but severe asthmatic exacerbation that may not respond to the usual medical treatment. The narrowing of airways causes ventilation perfusion imbalance, lung hyperinflation, and increased work of breathing that may lead to ventilatory muscle fatigue and life-threatening respiratory failure. Treatment for acute, severe asthma includes the administration of oxygen, β2-agonists (by continuous or repetitive nebulisation), and systemic corticosteroids. Subcutaneous administration of epinephrine or terbutaline should be considered in patients not responding adequately to continuous nebulisation, in those unable to cooperate, and in intubated patients not responding to inhaled therapy. The exact time to intubate a patient in status asthmaticus is based mainly on clinical judgment, but intubation should not be delayed once it is deemed necessary. Mechanical ventilation in status asthmaticus supports gas-exchange and unloads ventilatory muscles until aggressive medical treatment improves the functional status of the patient. Patients intubated and mechanically ventilated should be appropriately sedated, but paralytic agents should be avoided. Permissive hypercapnia, increase in expiratory time, and promotion of patient-ventilator synchronism are the mainstay in mechanical ventilation of status asthmaticus. Close monitoring of the patient's condition is necessary to obviate complications and to identify the appropriate time for weaning. Finally, after successful treatment and prior to discharge, a careful strategy for prevention of subsequent asthma attacks is imperative. PMID:11940264

  15. The World Anti-Doping Code: can you have asthma and still be an elite athlete?

    PubMed Central

    2016-01-01

    Key points The World Anti-Doping Code (the Code) does place some restrictions on prescribing inhaled β2-agonists, but these can be overcome without jeopardising the treatment of elite athletes with asthma. While the Code permits the use of inhaled glucocorticoids without restriction, oral and intravenous glucocorticoids are prohibited, although a mechanism exists that allows them to be administered for acute severe asthma. Although asthmatic athletes achieved outstanding sporting success during the 1950s and 1960s before any anti-doping rules existed, since introduction of the Code’s policies on some drugs to manage asthma results at the Olympic Games have revealed that athletes with confirmed asthma/airway hyperresponsiveness (AHR) have outperformed their non-asthmatic rivals. It appears that years of intensive endurance training can provoke airway injury, AHR and asthma in athletes without any past history of asthma. Although further research is needed, it appears that these consequences of airway injury may abate in some athletes after they have ceased intensive training. The World Anti-Doping Code (the Code) has not prevented asthmatic individuals from becoming elite athletes. This review examines those sections of the Code that are relevant to respiratory physicians who manage elite and sub-elite athletes with asthma. The restrictions that the Code places or may place on the prescription of drugs to prevent and treat asthma in athletes are discussed. In addition, the means by which respiratory physicians are able to treat their elite asthmatic athlete patients with drugs that are prohibited in sport are outlined, along with some of the pitfalls in such management and how best to prevent or minimise them. PMID:27408633

  16. Blockade of dopamine D1-like receptor signalling protects mice against OVA-induced acute asthma by inhibiting B-cell activating transcription factor signalling and Th17 function.

    PubMed

    Gong, Subo; Li, Jinxiu; Ma, Libing; Li, Keng; Zhang, Li; Wang, Guyi; Liu, Yi; Ji, Xiaoying; Liu, Xiaokun; Chen, Ping; Ouyang, Ruoyun; Zhang, Shu; Zhou, Zhiguang; Wang, Cong-Yi; Xiang, Xudong; Yang, Yu

    2013-12-01

    Previous studies have consistently demonstrated that dopamine D1-like receptor (D1-like-R) signalling is implicated in the pathogenesis of experimental autoimmune encephalomyelitis and type I diabetes. Given that allergic asthma shares certain disease aetiology similarities with autoimmune diseases, we conducted studies in OVA-induced mice aiming to address the impact of D1-like-R signalling on the pathogenesis of allergic asthma. It was noted that blockade of D1-like-R signalling provided protection for mice against OVA-induced acute asthma. Particularly, treatment of OVA-induced mice with SCH23390, a D1-like-R antagonist, significantly attenuated inflammatory infiltration in the airways along with repressed goblet cell hyperplasia and mucus production, as well as airway resistance. By contrast, administration of SKF83959, a D1-like-R agonist, displayed the opposite effect. Blockade of D1-like-R signalling impaired Th17 function, as manifested by a significant reduction of Th17 cells in the spleen and bronchoalveolar lavage fluid. Mechanistic studies revealed that D1-like-R signalling enhances B-cell activating transcription factor activity, which then transcribes the expression of RORγt, a Th17 transcription factor; accordingly, D1-like-R signalling regulates Th17 differentiation to promote the development of allergic asthma. Taken together, the data obtained in the present suggest that blockade of D1-like-R signalling could be an effective therapeutic strategy for the prevention and treatment of allergic asthma in clinical practice.

  17. Do we really need to keep redesigning β2-agonists for the management of asthma?

    PubMed

    Van Ly, David; Oliver, Brian G G

    2015-01-01

    There is an enormous drive to refine therapeutic designs and delivery systems, but in this review we ask if this is always the right direction? We choose to play devil's advocate, and argue that refining drug design is not always needed, and what is actually needed is a greater understanding of the biology of the disease. Here we focus on asthma and the β2-agonist group of bronchodilators as an example of how a class of therapeutic has been developed and continues to be developmentally refined. In this review, we define viral-induced exacerbations as the greatest cause of lung attacks and the most crucial time β2-agonist therapy is needed. We explore the reasons why β2-agonist therapy fails in patients with rhinovirus-induced exacerbations, and explain why further "engineered" β2-agonist therapies are likely to continue to fail in this subset of asthmatic population. We justify our perspective by returning to the biology that underlies the cause of disease and highlight the need for "more research" into alternative therapies for this population of asthmatic patients.

  18. What Is Asthma?

    MedlinePlus

    ... Current Issue Past Issues Special Section What Is Asthma? Past Issues / Fall 2007 Table of Contents For ... major trigger for asthma. Photo: iStock Who Gets Asthma? People get asthma because of an interaction between ...

  19. Exercise and Asthma

    MedlinePlus

    ... Issues Listen Español Text Size Email Print Share Exercise and Asthma Page Content Article Body Almost every ... children more likely to develop asthma. How does exercise cause asthma symptoms? The symptoms of asthma are ...

  20. Asthma and allergy - resources

    MedlinePlus

    Resources - asthma and allergy ... The following organizations are good resources for information on asthma and allergies : Allergy and Asthma Network Mothers of Asthmatics -- www.aanma.org American Academy of Allergy, Asthma ...

  1. Asthma and Hispanic Americans

    MedlinePlus

    ... and Data > Minority Population Profiles > Hispanic/Latino > Asthma Asthma and Hispanic Americans In 2014, 2.1 million Hispanics reported that they currently have asthma. Puerto Rican Americans have almost twice the asthma ...

  2. Evolving Guidance on Ureteric Calculi Management in the Acute Setting.

    PubMed

    Makanjuola, Jonathan K; Rintoul-Hoad, Sophie; Bultitude, Matthew

    2016-03-01

    Ureteric colic is a common presentation to acute emergency services. The gold standard test for the diagnosis of acute ureteric colic is a non-contrast computer tomography of the kidneys ureters and bladder (CT KUB). Non-steroidal anti-inflammatory drugs (NSAIDs) should be used as first-line analgesia, with studies showing that there is no role for steroid or phosphodiesterase-5 inhibitors. There is emerging evidence that a high body mass index (BMI) is a risk factor. The drugs used to facilitate stone passage are known as medical expulsive therapy (MET). The most evaluated being alpha-blockers. The Spontaneous Urinary Stone Passage Enabled by Drugs (SUSPEND) trial was designed to evaluate the use of MET (tamsulosin and nifedipine). This trial showed that there was no difference with MET and placebo for the spontaneous passage of ureteric stones. There is an emerging role for the use of primary ureteroscopy in the management of non-infective ureteric stones. PMID:26874536

  3. Acute management of poor condition subarachnoid hemorrhage patients

    PubMed Central

    Eleftherios, Archavlis; Carvi y Nievas, Mario Nazareno

    2007-01-01

    Poor condition subarachnoid hemorrhage (SAH) patients present a high mortality and morbidity. In this study, we reviewed the acute interventional (surgical and endovascular) management of 109 SAH-poor condition patients, who were treated as early as logistically possible after confirming stable circulation parameters. Patients over the age of 70 years, without clinical response to painful stimulation were excluded. We recognized at least 3 different postinterventional therapeutic approaches: (1) Norm- or hypovolemic, normotensive hemodilution in 30 patients with space-occupying intracranial hematomas as well as in 31 cases with acute cerebro-spinal-fluid obstruction. (2) Normovolemic, hypertensive hemodilution after unilateral decompressive craniotomy in 23 surgical- and 2 endovascular-treated patients with focalized space occupying lesions and reduced cerebral perfusion. (3) Hypovolemic, normo-, or hypertensive hemodilution after bilateral decompressive craniotomy in 23 cases with massive brain-swelling. We observed a reduced mortality (21%). The overall late outcome was favorable in 56% and unfavorable in 23%. Selective aggressive treatment adapted to increase the cerebral perfusion, seems to be an effective therapy to improve the survival and outcome of several poor condition SAH-patients. PMID:18200827

  4. TLC-Asthma: An Integrated Information System for Patient-centered Monitoring, Case Management, and Point-of-Care Decision Support

    PubMed Central

    Adams, William G.; Fuhlbrigge, Anne L.; Miller, Charles W.; Panek, Celeste G.; Gi, Yangsoon; Loane, Kathleen C.; Madden, Nancy E.; Plunkett, Anne M.; Friedman, Robert H.

    2003-01-01

    A great deal of successful work has been done in the area of EMR development, implementation, and evaluation. Less work has been done in the area of automated systems for patients. Efforts to link data at multiple levels – the patient, the case manager, and the clinician have been rudimentary to-date. In this paper we present a model information system that integrates patient health information across multiple domains to support the monitoring and care of children with persistent asthma. The system has been developed for use in a multi-specialty group practice and includes three primary components: 1) a patient-centered telephone-linked communication system; 2) a web-based alert reporting and nurse case-management system; and 3) EMR-based provider communication to support clinical decision making at the point-of-care. The system offers a model for a new level of connectivity for health information that supports customized monitoring, IT-enabled nurse case-managers, and the delivery of longitudinal data to clinicians to support the care of children with persistent asthma. Systems like the one described are well -suited, perhaps essential, technologies for the care of children and adults with chronic conditions such as asthma. PMID:14728122

  5. Acute liver failure in pregnancy: Challenges and management.

    PubMed

    Pandey, Chandra Kant; Karna, Sunaina Tejpal; Pandey, Vijay Kant; Tandon, Manish

    2015-03-01

    Acute liver failure (ALF) in pregnancy negatively affects both maternal and foetal outcome. The spectrum of liver disease in pregnancy may range from mild asymptomatic transaminitis to fatal and irreversible deterioration in liver functions leading to significant morbidity and even mortality. In this comprehensive review, we searched articles published as review articles, clinical trials, and case series in the Medline from 1970 to 2012. The overall outcome of ALF in pregnancy depends on the aetiology, timely diagnosis, prompt management, and early referral to a centre equipped in managing medical or obstetric complication. The foetal outcome is affected by the stage of pregnancy in which the mother has a deterioration of the liver function, with a worst prognosis associated with first or second-trimester liver failure. When ALF complicates pregnancy, liver transplantation is the one of the viable options. Management protocols need to be individualised for each case keeping in mind the risk versus benefit to both the mother and the foetus. PMID:25838585

  6. Current management of newly diagnosed acute promyelocytic leukemia.

    PubMed

    Cicconi, L; Lo-Coco, F

    2016-08-01

    The management of acute promyelocytic leukemia (APL) has considerably evolved during the past two decades. The advent of all-trans retinoic acid (ATRA) and its inclusion in combinatorial regimens with anthracycline chemotherapy has provided cure rates exceeding 80%; however, this widely adopted approach also conveys significant toxicity including severe myelosuppression and rare occurrence of secondary leukemias. More recently, the advent of arsenic trioxide (ATO) and its use in association with ATRA with or without chemotherapy has further improved patient outcome by allowing to minimize the intensity of chemotherapy, thus reducing serious toxicity while maintaining high anti-leukemic efficacy. The advantage of ATRA-ATO over ATRA chemotherapy has been recently demonstrated in two large randomized trials and this option has now become the new standard of care in low-risk (i.e. non-hyperleukocytic) patients. In light of its rarity, abrupt onset and high risk of early death and due to specific treatment requirements, APL remains a challenging condition that needs to be managed in highly experienced centers. We review here the results of large clinical studies conducted in newly diagnosed APL as well as the recommendations for appropriate diagnosis, prevention and management of the main complications associated with modern treatment of the disease. PMID:27084953

  7. Management of acute heart failure in elderly patients.

    PubMed

    Teixeira, Antonio; Arrigo, Mattia; Tolppanen, Heli; Gayat, Etienne; Laribi, Said; Metra, Marco; Seronde, Marie France; Cohen-Solal, Alain; Mebazaa, Alexandre

    2016-01-01

    Acute heart failure (AHF) is the most common cause of unplanned hospital admissions, and is associated with high mortality rates. Over the next few decades, the combination of improved cardiovascular disease survival and progressive ageing of the population will further increase the prevalence of AHF in developed countries. New recommendations on the management of AHF have been published recently, but as elderly patients are under-represented in clinical trials, and scientific evidence is often lacking, the diagnosis and management of AHF in this population is challenging. The clinical presentation of AHF, especially in patients aged>85years, differs substantially from that in younger patients, with unspecific symptoms, such as fatigue and confusion, often overriding dyspnoea. Older patients also have a different risk profile compared with younger patients: often heart failure with preserved ejection fraction, and infection as the most frequent precipitating factor of AHF. Moreover, co-morbidities, disability and frailty are common, and increase morbidity, recovery time, readmission rates and mortality; their presence should be detected during a geriatric assessment. Diagnostics and treatment for AHF should be tailored according to cardiopulmonary and geriatric status, giving special attention to the patient's preferences for care. Whereas many elderly AHF patients may be managed similarly to younger patients, different strategies should be applied in the presence of relevant co-morbidities, disability and frailty. The option of palliative care should be considered at an early stage, to avoid unnecessary and harmful diagnostics and treatments. PMID:27185193

  8. Critical management decisions in patients with acute liver failure.

    PubMed

    Stravitz, R Todd

    2008-11-01

    Few admissions to the ICU present a greater clinical challenge than the patient with acute liver failure (ALF), the syndrome of abrupt loss of liver function in a previously unaffected individual. Although advances in the intensive care management of patients with ALF have improved survival, the prognosis of ALF remains poor, with a 33% mortality rate and a 25% liver transplant rate in the United States. ALF adversely affects nearly every organ system, with most deaths occurring from sepsis and subsequent multiorgan system failure, and cerebral edema, resulting in intracranial hypertension (ICH) and brainstem herniation. Unfortunately, the optimal management of ALF remains poorly defined, and practices are often based on local experience and case reports rather than on randomized, controlled clinical trials. The paramount question in any patient presenting with ALF remains defining an etiology, since specific antidotes can save lives and spare the liver. This article will consider recent advances in the assignment of an etiology, the administration of etiology-specific treatment to abate the liver injury, and the management of complications (eg, infection, cerebral edema, and the bleeding diathesis) in patients with ALF. New data on the administration of N-acetylcysteine to patients with non-acetaminophen ALF, the treatment of ICH, and assessment of the need for liver transplantation will also be presented. PMID:18988787

  9. Respiratory Conditions Update: Asthma.

    PubMed

    Zeller, Timothy A

    2016-09-01

    Asthma is a chronic respiratory disease characterized by chronic airway inflammation and variable expiratory airflow limitation. Related clinical features include wheezing, dyspnea, chest tightness, and cough that worsens at night or in the early morning, and that varies over time and in intensity. A finding of variable expiratory airflow limitation on spirometry confirms the diagnosis. A forced expiratory volume in 1 second to forced vital capacity ratio less than the level predicted for the patient's age is suggestive of airflow limitation. Variability also must be confirmed. Updated guidelines recommend control-based management administered in a stepwise manner, with goals of achieving symptom control and minimizing the risks of exacerbations, future fixed airway limitation, and adverse effects of therapy. There is good evidence for the effectiveness of asthma education and self-management plans. Short-acting bronchodilators should be used as needed for symptom relief, with the addition of an inhaled corticosteroid early as maintenance therapy if symptoms are not well controlled. If asthma remains uncontrolled despite therapy, patients should be referred for more specialized treatment. Biomarkers, biologic drugs, and endoscopic treatments are being studied in the management of severe asthma, and ongoing research may determine which patients might benefit most from these emerging therapies. PMID:27576231

  10. Antiviral selection in the management of acute retinal necrosis

    PubMed Central

    Tam, Patrick MK; Hooper, Claire Y; Lightman, Susan

    2010-01-01

    There is no consensus on the optimal antiviral regimen in the management of acute retinal necrosis, a disease caused by herpetic viruses with devastating consequences for the eye. The current gold standard is based on retrospective case series. Because the incidence of disease is low, few well-designed, randomized trials have evaluated treatment dosage and duration. Newer oral antiviral agents are emerging as alternatives to high-dose intravenous acyclovir, avoiding the need for inpatient intravenous treatment. Drug resistance is uncommon but may also be difficult to identify. Antiviral drugs have few side effects, but special attention needs to be paid to patients who have underlying renal disease, are pregnant or are immunocompromised. PMID:20169044

  11. How to manage asparaginase hypersensitivity in acute lymphoblastic leukemia.

    PubMed

    Burke, Michael J

    2014-12-01

    Outcomes for children with acute lymphoblastic leukemia (ALL) have improved significantly in recent decades, primarily due to dose-intensified, multi-agent chemotherapy regimens, of which asparaginase has played a prominent role. Despite this success, hypersensitivity remains a significant problem, often requiring the termination of asparaginase. Failure to complete the entire asparaginase therapy course due to clinical hypersensitivity, subclinical hypersensitivity (i.e., silent inactivation), or other treatment-related toxicity is associated with poor ALL outcomes. Thus, it is critical to rapidly identify patients who develop clinical/subclinical hypersensitivity and switch these patients to an alternate asparaginase formulation. This article provides an overview of asparaginase hypersensitivity, identification and management of hypersensitivity and subclinical hypersensitivity, and issues related to switching patients to asparaginase Erwinia chrysanthemi following hypersensitivity reaction.

  12. Management of cardiogenic shock complicating acute myocardial infarction.

    PubMed

    Van Herck, Jozef L; Claeys, Marc J; De Paep, Rudi; Van Herck, Paul L; Vrints, Christiaan J; Jorens, Philippe G

    2015-06-01

    Cardiogenic shock complicates approximately 5-10% of cases with acute myocardial infarction and carries a poor prognosis. Early revascularization remains the cornerstone treatment of cardiogenic shock complicating myocardial infarction. Inotropic and/or vasopressor agents can be used for haemodynamic stabilization, although this comes at the expense of increased myocardial oxygen consumption and extended myocardial ischaemia. In recent years, the use of mechanical circulatory support has significantly increased. However, there is only limited data available from randomized trials evaluating the different percutaneous support systems. This review summarizes the available literature concerning the management of cardiogenic shock and gives an overview of the recommendations of the European and German-Austrian guidelines on cardiogenic shock.

  13. Diagnosing Asthma

    MedlinePlus

    ... Health Issues Conditions Abdominal ADHD Allergies & Asthma Autism Cancer Chest & Lungs Chronic Conditions Cleft & Craniofacial Developmental Disabilities Ear Nose & Throat Emotional Problems Eyes Fever From Insects or Animals Genitals and Urinary Tract Glands & Growth Head Neck & ...

  14. Asthma Inhalers

    MedlinePlus

    ... reduce the release of chlorofluorocarbons (CFCs) into the atmosphere when taking certain asthma medications. Until recently, most ... hydrofluoroalkane (HFA) inhalers, that do not rob the atmosphere of ozone. “The FDA [Food and Drug Administration] ...

  15. Asthma - children

    MedlinePlus

    ... children. It is a leading cause of missed school days and hospital visits for children. An allergic reaction ... how to let your child take medicine during school hours. (You may ... every day to prevent asthma symptoms. Your child should take ...

  16. Asthma Basics

    MedlinePlus

    ... KidsHealth in the Classroom What Other Parents Are Reading Upsetting News Reports? What to Say Vaccines: Which ... of asthma. The doctor may take a spirometer reading, give the child an inhaled medication that opens ...

  17. Implementation strategies of internet-based asthma self-management support in usual care. Study protocol for the IMPASSE cluster randomized trial

    PubMed Central

    2012-01-01

    Background Internet-based self-management (IBSM) support cost-effectively improves asthma control, asthma related quality of life, number of symptom-free days, and lung function in patients with mild to moderate persistent asthma. The current challenge is to implement IBSM in clinical practice. Methods/design This study is a three-arm cluster randomized trial with a cluster pre-randomisation design and 12 months follow-up per practice comparing the following three IBSM implementation strategies: minimum strategy (MS): dissemination of the IBSM program; intermediate strategy (IS): MS + start-up support for professionals (i.e., support in selection of the appropriate population and training of professionals); and extended strategy (ES): IS + additional training and ongoing support for professionals. Because the implementation strategies (interventions) are primarily targeted at general practices, randomisation will occur at practice level. In this study, we aim to evaluate 14 primary care practices per strategy in the Leiden-The Hague region, involving 140 patients per arm. Patients aged 18 to 50 years, with a physician diagnosis of asthma, prescription of inhaled corticosteroids, and/or montelukast for ≥3 months in the previous year are eligible to participate. Primary outcome measures are the proportion of referred patients that participate in IBSM, and the proportion of patients that have clinically relevant improvement in the asthma-related quality of life. The secondary effect measures are clinical outcomes (asthma control, lung function, usage of airway treatment, and presence of exacerbations); self-management related outcomes (health education impact, medication adherence, and illness perceptions); and patient utilities. Process measures are the proportion of practices that participate in IBSM and adherence of professionals to implementation strategies. Cost-effective measurements are medical costs and healthcare consumption. Follow-up is six months

  18. Evidence for the efficacy and safety of anti-interleukin-5 treatment in the management of refractory eosinophilic asthma.

    PubMed

    Hilvering, Bart; Xue, Luzheng; Pavord, Ian D

    2015-08-01

    Two recent phase III trials in patients with severe eosinophilic asthma have shown that anti-interleukin 5 (IL-5) therapy with mepolizumab reduces the frequency of asthma attacks, improves symptoms and allows patients to reduce oral glucocorticoid use without loss of control of asthma. An earlier large 616 patient Dose Ranging Efficacy And safety with Mepolizumab in severe asthma (DREAM) study had shown that the only variables associated with treatment efficacy were a prior history of asthma attacks and the peripheral blood eosinophil count. The link between blood eosinophil counts and treatment efficacy is biologically obvious given that IL-5 has a pivotal role in eosinophil production, proliferation and chemotaxis. It is also clinically relevant as the blood eosinophil count is routinely measured and thus readily available in patients with asthma. Recognition of the link between airway or blood eosinophilia and treatment response was also important in the clinical testing of the alternative IL-5 blocker, such as reslizumab, which is currently being evaluated in a phase III randomized controlled trial (RCT) after having shown to improve lung function, improve symptom score and reduce sputum eosinophilia in a smaller phase IIb study. In addition, benralizumab, an IL-5α receptor blocker, has shown good effects in a phase IIb RCT with patients with severe asthma that had sputum eosinophilia and more recently in a phase IIa trial with patients with eosinophilic chronic obstructive pulmonary disease. Therefore anti-IL-5 treatment seems generally effective in eosinophilic asthma, either assessed by blood or airway eosinophilia. This factor together with the impressive clinical efficacy and good safety profile make anti-IL-5 (mepolizumab, reslizumab) and benralizumab (anti-IL-5 receptor α) very promising drugs for the treatment of patients with severe eosinophilic asthma, a subgroup that is in desperate need of better treatments.

  19. Parents' perspectives of asthma crisis hospital management in infants and toddlers: an interpretive view through the lens of attachment theory.

    PubMed

    Koenig, Karel; Chesla, Catherine A; Kennedy, Christine M

    2003-08-01

    Interpretive phenomenology and attachment theory were used to discover the underlying concerns of parents and children during children's hospitalization for asthma. Home interviews were conducted with families of low income and with Latino and African-American infants and toddlers with severe persistent asthma. Narratives revealed that asthma crises were fearsome situations for parents and children. Hospital procedures escalated fear in children. Parents, agonized by their children's suffering, were embarrassed by feelings of helplessness. Results imply that effective, efficient care depends on addressing parents' fears, being aware of their sensitivity to the suffering of their children, and supporting their desire to alleviate it. PMID:12923734

  20. Nasal disease and asthma.

    PubMed

    Marseglia, G L; Merli, P; Caimmi, D; Licari, A; Labó, E; Marseglia, A; Ciprandi, G; La Rosa, M

    2011-10-01

    The nose plays a primary role within the airways, working as a filter and air-conditioner, together with other important functions. Thus, it is not surprising that nasal diseases are associated with several other comorbidities, including both upper and lower airways, such as bronchial hyperresponsiveness (BHR) and asthma. Several studies have investigated the relationship existing between the upper and the lower airways and new insights are rising. Nevertheless, some uncertainties still remain, mainly because nasal disorders are quite heterogeneous, overlapping (i.e. rhinitis-rhinosinusitis-sinusitis, acute or chronic, allergic or non-allergic) and difficult to diagnose, so that, frequently, many studies don’t differentiate between the various conditions. For this reason, the purpose of this review is to systematically analyze present epidemiological, pathophysiological and clinical data on the relationship between nasal diseases and asthma, splitting up three main conditions: allergic rhinitis, chronic rhinosinusitis and nasal polyposis. PMID:22032779

  1. The diagnosis and management of acute otitis media.

    PubMed

    Lieberthal, Allan S; Carroll, Aaron E; Chonmaitree, Tasnee; Ganiats, Theodore G; Hoberman, Alejandro; Jackson, Mary Anne; Joffe, Mark D; Miller, Donald T; Rosenfeld, Richard M; Sevilla, Xavier D; Schwartz, Richard H; Thomas, Pauline A; Tunkel, David E

    2013-03-01

    This evidence-based clinical practice guideline is a revision of the 2004 acute otitis media (AOM) guideline from the American Academy of Pediatrics (AAP) and American Academy of Family Physicians. It provides recommendations to primary care clinicians for the management of children from 6 months through 12 years of age with uncomplicated AOM. In 2009, the AAP convened a committee composed of primary care physicians and experts in the fields of pediatrics, family practice, otolaryngology, epidemiology, infectious disease, emergency medicine, and guideline methodology. The subcommittee partnered with the Agency for Healthcare Research and Quality and the Southern California Evidence-Based Practice Center to develop a comprehensive review of the new literature related to AOM since the initial evidence report of 2000. The resulting evidence report and other sources of data were used to formulate the practice guideline recommendations. The focus of this practice guideline is the appropriate diagnosis and initial treatment of a child presenting with AOM. The guideline provides a specific, stringent definition of AOM. It addresses pain management, initial observation versus antibiotic treatment, appropriate choices of antibiotic agents, and preventive measures. It also addresses recurrent AOM, which was not included in the 2004 guideline. Decisions were made on the basis of a systematic grading of the quality of evidence and benefit-harm relationships. The practice guideline underwent comprehensive peer review before formal approval by the AAP. This clinical practice guideline is not intended as a sole source of guidance in the management of children with AOM. Rather, it is intended to assist primary care clinicians by providing a framework for clinical decision-making. It is not intended to replace clinical judgment or establish a protocol for all children with this condition. These recommendations may not provide the only appropriate approach to the management of this

  2. Current trends in the management of acute ischemic stroke.

    PubMed

    Paramasivam, Srinivasan

    2015-01-01

    Stroke is the leading cause of disability and most of the cases are those of ischemic stroke. Management strategies especially for large vessel occlusive stroke have undergone a significant change in the recent years that include widespread use of thrombolytic medications followed by endovascular clot removal. For successful treatment by endovascular thrombectomy, the important factors are patient selection based on clinical criterion including age, time of onset, premorbid clinical condition, co-morbidities, National Institute of Health Stroke Scale, and imaging criterion including computed tomography (CT) head, CT angiogram and CT perfusion. Patients presenting within 4.5 hours of onset are considered for intravenous (IV) recombinant tissue plasminogen activator treatment. Mechanical clot retrieval devices have evolved over the past decade. The Mechanical Embolus Removal in Cerebral Ischemia device was approved first followed by the penumbra revascularization system. They have proven in various studies to improve recanalization with acceptable rates of symptomatic intra-cerebral hemorrhage. Introduction of stent retrievers has led to a new era in the interventional management of acute ischemic stroke (AIS). Recent trials namely MRCLEAN, ESCAPE, SWIFT PRIMEs, and EXTEND-IA have used the stent retriever predominantly and have shown unequivocal benefit in the outcome at 90 days for AIS patients with large vessel occlusion. More recently, a new catheter namely 5 MAX ACE was introduced along with improvement in the suction device. This has led to a direct aspiration first pass technique resulting in faster recanalization. Advancements in the endovascular management of AIS with large vessel occlusion have resulted in a paradigm shift in the way this disease is managed. Improvements in patient selection using clinical and imaging criterion along with technical and technological advancements in mechanical thrombectomy have made possible a significantly improved outcome

  3. The diagnosis and management of acute otitis media.

    PubMed

    Lieberthal, Allan S; Carroll, Aaron E; Chonmaitree, Tasnee; Ganiats, Theodore G; Hoberman, Alejandro; Jackson, Mary Anne; Joffe, Mark D; Miller, Donald T; Rosenfeld, Richard M; Sevilla, Xavier D; Schwartz, Richard H; Thomas, Pauline A; Tunkel, David E

    2013-03-01

    This evidence-based clinical practice guideline is a revision of the 2004 acute otitis media (AOM) guideline from the American Academy of Pediatrics (AAP) and American Academy of Family Physicians. It provides recommendations to primary care clinicians for the management of children from 6 months through 12 years of age with uncomplicated AOM. In 2009, the AAP convened a committee composed of primary care physicians and experts in the fields of pediatrics, family practice, otolaryngology, epidemiology, infectious disease, emergency medicine, and guideline methodology. The subcommittee partnered with the Agency for Healthcare Research and Quality and the Southern California Evidence-Based Practice Center to develop a comprehensive review of the new literature related to AOM since the initial evidence report of 2000. The resulting evidence report and other sources of data were used to formulate the practice guideline recommendations. The focus of this practice guideline is the appropriate diagnosis and initial treatment of a child presenting with AOM. The guideline provides a specific, stringent definition of AOM. It addresses pain management, initial observation versus antibiotic treatment, appropriate choices of antibiotic agents, and preventive measures. It also addresses recurrent AOM, which was not included in the 2004 guideline. Decisions were made on the basis of a systematic grading of the quality of evidence and benefit-harm relationships. The practice guideline underwent comprehensive peer review before formal approval by the AAP. This clinical practice guideline is not intended as a sole source of guidance in the management of children with AOM. Rather, it is intended to assist primary care clinicians by providing a framework for clinical decision-making. It is not intended to replace clinical judgment or establish a protocol for all children with this condition. These recommendations may not provide the only appropriate approach to the management of this

  4. Acute intracerebral haemorrhage: grounds for optimism in management.

    PubMed

    Delcourt, Candice; Anderson, Craig

    2012-12-01

    Spontaneous intracerebral haemorrhage (ICH) is one of the most devastating types of stroke, which has considerable disease burden in "non-white" ethnic groups where the population-attributable risks of elevated blood pressure are very high. Since the treatment of ICH remains largely supportive and expectant, nihilism and the early withdrawal of active therapy influence management decisions in clinical practice. However, approaches to management are now better defined on the basis of evidence that both survival and speed (and degree) of recovery are critically dependent on the location, size, and degree of expansion and extension into the intraventricular system of the haematoma of the ICH. Although no medical treatment has been shown to improve outcome in ICH, several promising avenues have emerged that include haemostatic therapy and intensive control of elevated blood pressure. Conversely, there is continued controversy over the role of evacuation of the haematoma of ICH via open craniotomy. Despite being an established practice for several decades, and having undergone evaluation in multiple randomised trials, there is uncertainty over which patients have the most to gain from an intervention with clear procedural risk. Minimally invasive surgery via local anaesthetic applied drill-puncture of the cranium and infusion of a thrombolytic agent is an attractive option for patients requiring critical management of the haematoma, not just in low resource settings but arguably also in specialist centres of western countries. With several ongoing clinical trials nearing completion, these treatments could enter routine practice within the next few years, further justifying the urgency of "time is brain" and that active management within well-organized, comprehensive acute stroke care units includes patients with ICH. PMID:23088860

  5. Current trends in the management of acute ischemic stroke.

    PubMed

    Paramasivam, Srinivasan

    2015-01-01

    Stroke is the leading cause of disability and most of the cases are those of ischemic stroke. Management strategies especially for large vessel occlusive stroke have undergone a significant change in the recent years that include widespread use of thrombolytic medications followed by endovascular clot removal. For successful treatment by endovascular thrombectomy, the important factors are patient selection based on clinical criterion including age, time of onset, premorbid clinical condition, co-morbidities, National Institute of Health Stroke Scale, and imaging criterion including computed tomography (CT) head, CT angiogram and CT perfusion. Patients presenting within 4.5 hours of onset are considered for intravenous (IV) recombinant tissue plasminogen activator treatment. Mechanical clot retrieval devices have evolved over the past decade. The Mechanical Embolus Removal in Cerebral Ischemia device was approved first followed by the penumbra revascularization system. They have proven in various studies to improve recanalization with acceptable rates of symptomatic intra-cerebral hemorrhage. Introduction of stent retrievers has led to a new era in the interventional management of acute ischemic stroke (AIS). Recent trials namely MRCLEAN, ESCAPE, SWIFT PRIMEs, and EXTEND-IA have used the stent retriever predominantly and have shown unequivocal benefit in the outcome at 90 days for AIS patients with large vessel occlusion. More recently, a new catheter namely 5 MAX ACE was introduced along with improvement in the suction device. This has led to a direct aspiration first pass technique resulting in faster recanalization. Advancements in the endovascular management of AIS with large vessel occlusion have resulted in a paradigm shift in the way this disease is managed. Improvements in patient selection using clinical and imaging criterion along with technical and technological advancements in mechanical thrombectomy have made possible a significantly improved outcome

  6. Improving asthma during pregnancy with dietary antioxidants: the current evidence.

    PubMed

    Grieger, Jessica A; Wood, Lisa G; Clifton, Vicki L

    2013-08-14

    The complication of asthma during pregnancy is associated with a number of poor outcomes for the mother and fetus. This may be partially driven by increased oxidative stress induced by the combination of asthma and pregnancy. Asthma is a chronic inflammatory disease of the airways associated with systemic inflammation and oxidative stress, which contributes to worsening asthma symptoms. Pregnancy alone also intensifies oxidative stress through the systemic generation of excess reactive oxidative species (ROS). Antioxidants combat the damaging effects of ROS; yet antioxidant defenses are reduced in asthma. Diet and nutrition have been postulated as potential factors to combat the damaging effects of asthma. In particular, dietary antioxidants may play a role in alleviating the heightened oxidative stress in asthma. Although there are some observational and interventional studies that have shown protective effects of antioxidants in asthma, assessment of antioxidants in pregnancy are limited and there are no antioxidant intervention studies in asthmatic pregnancies on asthma outcomes. The aims of this paper are to (i) review the relationships between oxidative stress and dietary antioxidants in adults with asthma and asthma during pregnancy, and (ii) provide the rationale for which dietary management strategies, specifically increased dietary antioxidants, might positively impact maternal asthma outcomes. Improving asthma control through a holistic antioxidant dietary approach might be valuable in reducing asthma exacerbations and improving asthma management during pregnancy, subsequently impacting perinatal health.

  7. Environmental factors associated with asthma.

    PubMed Central

    Walker, Bailus; Stokes, Lynette D.; Warren, Rueben

    2003-01-01

    Asthma, a disease of attacks and remission, continues to account for substantial morbidity and direct economic costs. Numerous studies--epidemiologic, toxicologic and clinical--present evidence for a broad spectrum of environmental risk factors associated with asthma. This review summarizes current thinking on a subset of these factors. Knowledge of potential environmental determinants of asthma is important to both the patient and healthcare professional in the application of multiple modalities of medical and environmental intervention for management of the development, and exacerbation of this chronic inflammatory disorder of the airways. PMID:12760611

  8. Effective management of acute deep vein thrombosis: direct oral anticoagulants.

    PubMed

    Roussin, A

    2015-02-01

    Deep vein thrombosis (DVT) is a manifestation of venous thromboembolism (VTE) and accounts for most venous thromboembolic events. Although DVT is not directly life-threatening, thrombi in the proximal veins of the leg can embolize to the lungs to form a pulmonary embolism, which may prove rapidly fatal. If untreated, DVT can also lead to significant morbidity, including development of post-thrombotic syndrome. Among many risk factors, surgery, hospitalization, older age and active cancer increase the risk of VTE, and a previous event increases the risk of recurrence. Early detection and effective clot resolution are vital in managing DVT. Conventional approaches to acute treatment of VTE involve initial fast-acting parenteral heparin overlapping with and followed by vitamin K antagonist therapy. However, vitamin K antagonists have a narrow therapeutic window, require regular monitoring, and have multiple food and drug interactions. Results from phase III clinical studies involving direct Factor Xa and IIa inhibitors suggest that these agents provide an alternative therapeutic option that overcomes some of the complications associated with conventional treatment with predictable pharmacological properties and convenient dosing schedules. Analysis of data from the rivaroxaban EINSTEIN studies also suggests that these agents have the potential to improve patient-reported treatment satisfaction and reduce the length of hospital stay compared with conventional therapy. This review considers these treatment options, suitable treatment durations to prevent recurrence, and the management of DVT treatment in challenging patient groups. PMID:24927023

  9. Pediatric Acute Respiratory Distress Syndrome: Fluid Management in the PICU

    PubMed Central

    Ingelse, Sarah A.; Wösten-van Asperen, Roelie M.; Lemson, Joris; Daams, Joost G.; Bem, Reinout A.; van Woensel, Job B.

    2016-01-01

    The administration of an appropriate volume of intravenous fluids, while avoiding fluid overload, is a major challenge in the pediatric intensive care unit. Despite our efforts, fluid overload is a very common clinical observation in critically ill children, in particular in those with pediatric acute respiratory distress syndrome (PARDS). Patients with ARDS have widespread damage of the alveolar–capillary barrier, potentially making them vulnerable to fluid overload with the development of pulmonary edema leading to prolonged course of disease. Indeed, studies in adults with ARDS have shown that an increased cumulative fluid balance is associated with adverse outcome. However, age-related differences in the development and consequences of fluid overload in ARDS may exist due to disparities in immunologic response and body water distribution. This systematic review summarizes the current literature on fluid imbalance and management in PARDS, with special emphasis on potential differences with adult patients. It discusses the adverse effects associated with fluid overload and the corresponding possible pathophysiological mechanisms of its development. Our intent is to provide an incentive to develop age-specific fluid management protocols to improve PARDS outcomes. PMID:27047904

  10. Advances in the management of acute liver failure

    PubMed Central

    Wang, Da-Wei; Yin, Yi-Mei; Yao, Yong-Ming

    2013-01-01

    Acute liver failure (ALF) is an uncommon but dramatic clinical syndrome characterized by hepatic encephalopathy and a bleeding tendency due to abrupt loss of liver function caused by massive or submassive liver necrosis in a patient with a previously healthy liver. The causes of ALF encompass a wide variety of toxic, viral, metabolic, vascular and autoimmune insults to the liver, and identifying the correct cause can be difficult or even impossible. Many patients with ALF develop a cascade of serious complications involving almost every organ system, and death is mostly due to multi-organ failure, hemorrhage, infection, and intracranial hypertension. Fortunately, the outcome of ALF has been improved in the last 3 decades through the specific treatment for the disease of certain etiology, and the advanced intensive care management. For most severely affected patients who fail to recover after treatment, rapid evaluation for transfer to a transplantation center and consideration for liver transplantation is mandatory so that transplantation can be applied before contraindications develop. This review focuses on the recent advances in the understanding of various contributing etiologies, the administration of etiology-specific treatment to alleviate the liver injury, and the management of complications (e.g., encephalopathy, coagulopathy, cardiovascular instability, respiratory failure, renal failure, sepsis and metabolic disturbance) in patients with ALF. Assessment of the need for liver transplantation is also presented. PMID:24222950

  11. [Peri-interventional management of acute endovascular stroke treatment].

    PubMed

    Schönenberger, S; Bösel, J

    2015-10-01

    Due to the ground breaking consistent evidence that supports the effect of endovascular stroke treatment (EST), many acute care hospitals and stroke centers will have to be prepared to provide this treatment in an optimal way within the coming years. In addition to the intervention itself, patient preparation, stabilization and monitoring during the treatment as well as the aftercare represent significant challenges and have mostly not yet been sufficiently investigated. Under these aspects, the questions of optimal sedation and airway management have received the highest attention. Based on retrospective study results it already seems to be justified, respecting certain criteria, to prefer EST with the patient under conscious sedation (CS) in comparison to general anesthesia (GA) and to only switch to GA in cases of emergency until this question has been clarified by prospective studies. This and other aspects of peri-interventional management, such as logistics, monitoring, blood pressure, ventilation settings, postprocedural steps of intensive or stroke unit care and imaging follow-up are summarized in this overview. The clinical and radiological selection of patients and thus the decision for intervention or technical aspects of the intervention itself will not be part of this article. PMID:26311331

  12. Asthma in Hispanics

    PubMed Central

    Hunninghake, Gary M.; Weiss, Scott T.; Celedón, Juan C.

    2006-01-01

    Hispanic individuals trace their ancestry to countries that were previously under Spanish rule, including Mexico, large parts of Central and South America, and some Caribbean islands. Most—but not all—Hispanics have variable proportions of European, Amerindian, and African ancestry. Hispanics are diverse with regard to many factors, including racial ancestry, country of origin, area of residence, socioeconomic status, education, and access to health care. Recent findings suggest that there is marked variation in the prevalence, morbidity, and mortality of asthma in Hispanics in the United States and in Hispanic America. The reasons for differences in asthma and asthma morbidity among and within Hispanic subgroups are poorly understood but are likely due to the interaction between yet-unidentified genetic variants and other factors, including environmental tobacco smoke exposure, obesity, allergen exposure, and availability of health care. Barriers to optimal management of asthma in Hispanics in the United States and in Hispanic America include inadequate access to health care, suboptimal use of antiinflammatory medications, and lack of reference values for spirometric measures of lung function in many subgroups (e.g., Puerto Ricans). Future studies of asthma in Hispanics should include large samples of subgroups that are well characterized with regard to self-reported ethnicity, country of origin, place of birth, area of residence, and indicators of socioeconomic status. Because Hispanics are disproportionately represented among the poor in the United States, implementation of adequate access to health care and social reforms (e.g., improving housing conditions) would likely have a major impact on reducing asthma morbidity in this population. PMID:16210666

  13. Acute Antibody-Mediated Rejection in Renal Transplantation: Current Clinical Management

    PubMed Central

    Schinstock, Carrie; Stegall, Mark D.

    2014-01-01

    Acute antibody mediated rejection (AMR) is recognized as a major cause of graft loss in renal transplant recipients. Early acute AMR in the first few days after transplantation occurs primarily in sensitized renal transplant recipients with donor-specific alloantibody at the time of transplant and is a relatively “pure” form of acute AMR. Late acute AMR occurs months to years after transplantation and is commonly a mixed cellular and humoral rejection. While there is no consensus regarding optimum treatment, we contend that rational therapeutic approaches are emerging and the acute episode can be managed in most instances. However, new therapies are needed to prevent ongoing chronic injury in these patients.

  14. Advances in asthma 2015: Across the lifespan.

    PubMed

    Liu, Andrew H; Anderson, William C; Dutmer, Cullen M; Searing, Daniel A; Szefler, Stanley J

    2016-08-01

    In 2015, progress in understanding asthma ranged from insights to asthma inception, exacerbations, and severity to advancements that will improve disease management throughout the lifespan. 2015's insights to asthma inception included how the intestinal microbiome affects asthma expression with the identification of specific gastrointestinal bacterial taxa in early infancy associated with less asthma risk, possibly by promoting regulatory immune development at a critical early age. The relevance of epigenetic mechanisms in regulating asthma-related gene expression was strengthened. Predicting and preventing exacerbations throughout life might help to reduce progressive lung function decrease and disease severity in adulthood. Although allergy has long been linked to asthma exacerbations, a mechanism through which IgE impairs rhinovirus immunity and underlies asthma exacerbations was demonstrated and improved by anti-IgE therapy (omalizumab). Other key molecular pathways underlying asthma exacerbations, such as cadherin-related family member 3 (CDHR3) and orosomucoid like 3 (ORMDL3), were elucidated. New anti-IL-5 therapeutics, mepolizumab and reslizumab, were US Food and Drug Administration approved for the treatment of patients with severe eosinophilic asthma. In a clinical trial the novel therapeutic inhaled GATA3 mRNA-specific DNAzyme attenuated early- and late-phase allergic responses to inhaled allergen. These current findings are significant steps toward addressing unmet needs in asthma prevention, severity modification, disparities, and lifespan outcomes. PMID:27497278

  15. Improving Sepsis Management in the Acute Admissions Unit.

    PubMed

    Adcroft, Laura

    2014-01-01

    Sepsis is a common condition with a major impact on healthcare resources and expenditure. We therefore wanted to investigate and improve how the acute admission unit (AAU) at the Great Western Hospital (GWH) is managing patients who present directly to the unit with sepsis. In order to obtain this information, an audit was undertaken against the College of Emergency Medicine standards used by the emergency department within GWH and across the UK. Data was retrospectively collected for 30 patients with a diagnosis of severe sepsis or septic shock. The notes were scrutinized with regard to the implementation of College of Emergency Medicine standards for the management of sepsis. This meant that performance in the AAU was compared against the emergency department at GWH and national figures. The data collected shows performance is below national standards with regard to documentation of high flow oxygen use (AAU: 24%, ED 100%; national median: 50%; CEM standard 95%), crystalloid fluid boluses (AAU: 52%; ED: 90%; national median: 83%; CEM standard 100%), lactate measurements (AAU: 66%, ED: 93%; national median: 80%; CEM standard 95%), and obtainment of blood cultures (AAU: 52%; ED 73%; national median: 77%; CEM standard: 95%). Only 3% of patients received all six parts of the sepsis bundle. Since auditing in 2012/2013 we have introduced a sepsis proforma based on a current proforma being used within Severn Deanery. This proforma uses the 'Sepsis Six' bundle appropriate to ward based care. We have raised awareness of sepsis implications and management through the creation of a 'sepsis working group' to educate both junior doctors and nurses. In turn, this has led to education through the use of posters, pocket reference cards, and teaching sessions. Re-audit shows significant improvement in administering all parts of the Sepsis Six bundle and an 8% improvement in patients receiving all six of the bundle.

  16. Anaesthetic management for a patient with Dejerine-Sottas disease and asthma.

    PubMed

    Huang, J; Soliman, I

    2001-03-01

    Dejerine-Sottas disease is a very uncommon degenerative disease of the peripheral nervous system. The details of perioperative anaesthetic management are discussed including the use of epidural anaesthesia, with supplemental intravenous anaesthesia and an LMA. PMID:11240883

  17. [Occupational asthma].

    PubMed

    Pauli, G; Bessot, J C; Gourdon, C

    1992-12-01

    The diagnosis of occupational asthma requires the integration of a multiplicity of data; the history, cutaneous skin tests, biological tests, respiratory function tests and non-specific tests of bronchial hyperreactivity and specific bronchial provocation test. The history search for the presence of an atopic state, the occurrence of similar disorders in members of the same firm and also the timing of symptoms in relation to the occupational activities. Cutaneous tests are particularly helpful in IgE-mediated asthma in relation to the inhalation of animal or vegetable materials of glycoprotein origin. For haptens, the need for their prior coupling to a protein carrier causes problems which have not been entirely resolved. Laboratory tests run into the same snags. Respiratory function and non-specific bronchial provocation tests, confirm the diagnosis of asthma and enable the medium and long term prognostic to be assessed. Specific bronchial provocation tests are the most appropriate tests to establish an aetiological diagnosis in occupational asthma. Different technical methods are possible: quantitative administration of allergen aerosols, realistic tests, and tests using exposure chambers to achieve true test doses. The products responsible for occupational asthma are multiple. The different substances are characterised in a simplified manner: first animal matter (mammalian and arthropod allergens), secondly substances of vegetable origin (roots, leaves, flowers, grain and flour, wood and its derivates) and finally chemical products. The chemical products are primarily from the pharmaceutical and metal industries and above all from the plastics industry. PMID:1296320

  18. Tiotropium – what role in asthma?

    PubMed

    2015-09-01

    Tiotropium solution for inhalation (Spiriva Respimat - Boehringer Ingelheim) is the first long-acting muscarinic antagonist to be marketed in the UK for the management of asthma. It is licensed as add-on maintenance bronchodilator treatment in adults with asthma who are using an inhaled corticosteroid (≥800μg budesonide/day or equivalent) and a long-acting beta2 agonist, and who have had one or more severe exacerbations in the previous year. This corresponds to use at step 4 of both the British asthma guideline and the Global Initiative for Asthma (GINA) strategy for the treatment of asthma in adults. Here we consider the evidence for tiotropium in the management of asthma and whether it offers any advantages over existing therapeutic options at step 4. PMID:26358316

  19. Tiotropium – what role in asthma?

    PubMed

    2015-09-01

    Tiotropium solution for inhalation (Spiriva Respimat - Boehringer Ingelheim) is the first long-acting muscarinic antagonist to be marketed in the UK for the management of asthma. It is licensed as add-on maintenance bronchodilator treatment in adults with asthma who are using an inhaled corticosteroid (≥800μg budesonide/day or equivalent) and a long-acting beta2 agonist, and who have had one or more severe exacerbations in the previous year. This corresponds to use at step 4 of both the British asthma guideline and the Global Initiative for Asthma (GINA) strategy for the treatment of asthma in adults. Here we consider the evidence for tiotropium in the management of asthma and whether it offers any advantages over existing therapeutic options at step 4.

  20. [Occupational asthma].

    PubMed

    Pérez, Padilla Alfredo

    2009-01-01

    The work-related asthma is a disease that is frequently reported in other countries, but little recognized in our own despite the large number of workers at risk. The lack of knowledge about its etiology at work involves a mishandling and poor outcome of the patient, because its treatment requires the removal of worker of exposure at work or at least this fall. The definitive diagnosis involves specialized medical procedures that are difficult to access and workplace studies that establish at first line the diagnosis of asthma and the work as cause of the disease or its aggravation. Health workers surveillance and compliance with work regulations are strategies that should be promoted prevention of asthma at work. PMID:20873063