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Asthma Free Forever Ebook

With Asthma Free Forever, asthma sufferers all over the world will discover the best way to cure asthma easily, naturally, and permanently. This guide was written by Jerry Ericson, an alternative medical specialist as well as former asthma sufferer. Inside this guidebook, users will discover the techniques that helped the author cure his asthma without useless and harmful medications. Inside this guide, users will discover the methods that helped the author cure his asthma without useless and harmful medications. The e-book contains a guided program that walks asthma sufferers through the process step by step, without the need for doctors. The program does not involve medication, drug therapies, or over the counter solutions. Asthma Free Forever is based on finding a natural solution to the problem, therefore it does not have any side effects. The natural treatments that are suggested are suitable for all asthma sufferers regardless of their gender or age. With the help of Asthma Free Forever, anyone can solve its asthma problem for good in just a few days right in the comfort of their own home. This treatment is based on proven medical research, so users can be sure that it's safe and guaranteed to work. Read more here...

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Genetic risk factors for the development of asthma

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

Asthma And Chronic Obstructive Pulmonary Disease

Studies have shown increased oxidative stress in patients with chronic airflow limitation (Ochs-Balcom et al 2005) and accumulating evidence suggests that dietary antioxidant vitamins are positively associated with lung function (Schunemann et al 2001), with serum beta-carotene levels being associated with improved FEV- (Grievink et al 2000). Thus it has been suggested that antioxidant protection is important for protecting the lungs against high oxygen levels and that oxidative stress may contribute to respiratory pathology such as asthma (Rahman et al 2006, Wood et al 2003). Studies on the correlation between serum beta-carotene levels and asthma, however, have produced mixed results. One small study of 1 5 asthmatic subjects and 16 healthy controls found that despite similar dietary intake, whole blood levels of total carotenoids, including beta-carotene, lycopene, lutein, beta-cryptoxanthin and alpha-carotene, were significantly lower in the asthmatics with no differences in...

Environmental risk factors for the development of asthma

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

Asthma and other respiratory diseases

The death rate and morbidity rate for asthma and other respiratory diseases is unacceptable and much of it can be prevented. 15 A recent report claims that at an estimated cost of 585 to 720 million per year the cost of asthma to the Australian community compares with the total cost of coronary artery disease ( 623 million). 15 The report also claimed that there is evidence that a significant proportion of diagnosed asthmatics are currently receiving treatment that does not provide the best possible control of the disease. Prevention means being better informed and treating such an 'irritable' disease as bronchial asthma aggressively. It means focusing on better assessment and monitoring (e.g. home use of the mini peak flow meter), better delivery of medication to the airways (e.g. use of spacers attached to inhalers and or use of pumps and nebulisers) and appropriate management of the cause (inflammation of the bronchial tree) by the use of inhaled corticosteroids or sodium...


Asthma, respiratory symptoms and ventilatory function have been associated with lowered circulatory selenium status and glutathione peroxidase activity (Devereux & Seaton 2005, Hasselmark et al 1990, Kadrabova et al 1996, Misso et al 1996, Omland et al 2002). When these observations are coupled with in vivo evidence of anti-inflammatory activity in the lung for selenium, it is not surprising that there is growing interest in using selenium supplementation to improve asthmatic symptoms and disease management. A small number of intervention studies have been conducted, producing mixed results (Gazdik et al 2002a, b, Hasselmark et al 1993). Hasselmark et al conducted a randomised double-blind study involving 24 patients with intrinsic asthma. A dose of 100 fjg sodium selenite was administered for 14 weeks, resulting in significant increases in serum selenium and platelet glutathione peroxidase activity, while no changes were observed with placebo. Clinical results varied, with...

Inner City Asthma

Inner city asthma, a pressing public health concern, illustrates the complexity of developing research evidence to reduce morbidity and mortality for a disease that is affected by a broad range of urban microenvironments. The prevalence and severity of childhood asthma have increased in the last 20 years, and the greatest increase has been seen among children and young adults living in U.S. inner cities (Crain, et al., 1994 Eggleston, et al., 1999). Despite deepening insight into the pathophysiology of asthma and a better understanding of chronic management of the disease, asthma remains the leading cause of chronic illness among children. According to the US National Health Interview Survey, nine million U.S. children under 18 years of age (12 ) have ever been diagnosed with asthma. More than 4 million children (6 ) had an asthma attack in the previous year (Dey, et al., 2004). Children in poor families (16 ) were more likely to have ever been diagnosed with asthma than children in...

Wheezing and Asthma

History of the Present Illness Onset, duration, and progression of wheezing severity of attack compared to previous episodes cough, fever, chills, purulent sputum current and baseline peak flow rate. Frequency of bronchodilator use, relief of symptoms by bronchodila-tors. Frequency of exacerbations and hospitalizations or emergency department visits duration of past exacerbations, steroid dependency, history of intubation, home oxygen or nebulizer use. Past Medical History Previous episodes of asthma, COPD, pneumonia. Baseline arterial blood gas results past pulmonary function testing. Family History Family history of asthma, allergies, hay-fever, atopic dermatitis.

B LT and Asthma

Asthma is a complex disease resulting in part from narrowing of the airways. Mediators having various roles in this syndrome are derived from mast cells in the bronchus. These mediators act either directly on airway tissues or by indirect mechanisms, which in clude recruitment of inflammatory cells. Some mediators are preformed within the mast cell, whereas others are generated from the plasma membrane. The latter category includes the LTs, which may play a substantial role in asthma. The two classes of mediators are summarized in Figure 16-22. One of the major secretions of the mast cell is histamine, which, experimentally, causes a rapid and transient increase in airway resistance resulting from the action of histamine on bronchial smooth muscle. Other secretions include ECF-A (eosinophil chemotactic factor of anaphylaxis), NCF (neutrophil chemotactic factor of anaphylaxis), and those listed in Figure 16-22. The precise roles of the enzymes secreted have not been clarified.

Atopy And Asthma

Vitamin C is the major antioxidant present in the extracellular fluid lining of the lung, where it protects against both endogenous free radicals (produced as a by-product of inflammation) and environmental free radicals (such as ozone in air pollution). According to many epidemiological studies, dietary intake of vitamin C-rich foods or serum ascorbate is associated with improved lung function in both asthmatic and normal subjects (Devereux & Seaton 2005). Despite a theoretical basis for its use in lung diseases such as asthma, its value in this disease is controversial. A 2001 Cochrane review of three studies concluded that current evidence is insufficient to recommend a specific role for vitamin C in the treatment of asthma and that a large-scale RCT is required to clarify its role (Kaur et al Alternatively, the evidence for its use in exercise-induced asthma appears stronger, as three human studies have produced positive results when vitamin C was used as pretreatment (Cohen et al...

Asthma bronchiale

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

Migration To The Cities The Process Of Immigration

Status of the patients or research participants. This information may be unavailable due to individuals' unwillingness to disclose their status or author unfamiliarity with issues specifically related to immigrants, as contrasted with specific ethnic, groups. Even when reports indicate immigration status, they often fail to specify individuals' duration of residence in the U.S., or the extent of their English language ability, which may be critical to an understanding of their ability to utilize the health care system or the occurrence of specific diseases. Many other reports speak about immigrants as a homogeneous group or immigrants of a particular ethnicity or nationality without specifying their area of residence, despite the potential relevance of their urban, suburban, or rural residence to the issue under examination such as, for example, exposure to violence or incidence of asthma.

Invasive Fungal Sinusitis

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

Prevention strategies whole populations highrisk groups or selected individuals

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

Mast Cells and Basophils

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

Epinephrine Adrenalin

Indications heart failure, hypotension, cardiac arrest, bronchospasm, anaphylaxis, severe bradycardia added to local anesthetics to decrease systemic absorption, increase duration of action, and decrease toxicity. Adult 0.1-1 mcg kg min IV (max 1.5 mcg kg min). Ped 0.1-1 mcg kg min IV (max 1.5 mcg kg min). Dose (bronchospasm)

Controlled studies of human exposure

Compared with those exposed to filtered air. The concentrations of inflammatory mediators IL-6, IL-8, prostaglandin E2, -antitrypsin and fibronectin were unchanged. This combination of markers indicates mild airway inflammation. In the quest to identify the chemical components in the ambient PM responsible for inflammatory responses to the exposures, a sulfate iron selenium factor was reportedly associated with an increase in the percentage of bronchoalveolar lavage neutrophils. These chemical components are usually associated with other pollution sources than traffic (Huang et al., 2003). In another study, the larger particles were filtered out and the remaining particles, mostly primary particles originating from motor vehicles, were concentrated. Healthy and asthmatic subjects were exposed to these fine CAPs during rest and exercise intervals (Gong et al., 2003). The average PM2.5 concentration during exposures was 174 pg m3 (range 99-224 pg m3). Relative to filtered air, CAPs...

Pulmonary Disease States Associated With Advanced

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

Development of the Concept Metal Immunotoxicology

The potential of metals, or more accurately metallic elements, their ions and their compounds (Duffus, 2003), to cause widely divergent effects on the body because of an interaction with the immune system is a recently discovered path in the history of metal tox-icity. Disease conditions like occupational asthma and dermatitis were associated with exposure to metals such as platinum, chromium, nickel, beryllium, and mercury during the first part of the 20th century or earlier. However, a clear recognition of these conditions as immune mediated had to await the rapidly expanding knowledge in immunology during the 1960s and 1970s. At the same time, animal studies linked metal exposure with immunosuppression, as well as nonspecific immune stimulation (Koller, 1973 Vos, 1977). Metals as a mean of inducing autoimmunity began to be explored in the late 1970s. The state of the art was summarized at the International Symposium on the Immunotoxic-ity of Metals and Immunotoxicology held in...

Building Codes and Other Regulation of Structures

These building and housing codes affect public health in several ways. Injuries are the leading cause of death in children ages 1 to 21. Smoke detectors, sprinklers, and safety requirements for electrical and gas systems can reduce fire injuries. Structural requirements can prevent building collapse. Design standards for stairs, railings and window barriers can prevent falls. Adequate ventilation may prevent build up of toxic or combustible compounds. Adequate sanitation may reduce cockroach infestations, a risk factor for asthma (Cummins and Jackson, 2001). On the other hand, codes that are too restrictive can have unintended and undesirable consequences. For example, it can be difficult to retrofit existing buildings to achieve compliance with building codes focused on new construction. This may discourage redevelopment of existing underused buildings which may, in turn, accelerate a decline of older urban neighborhoods and encourage suburban sprawl (McMahon, 2001b). Likewise...

Controlled exposure studies

Gong et al. (2003) reported on controlled exposures to concentrated fine particles, mostly from motor vehicles, in healthy and asthmatic subjects. In summary, exposures to CAPs elicited different biological end-points, with statistically significant differences between CAPs and filtered air. The observed changes in blood parameters and heart rate variability were consistent with systemic (rather than respiratory) effects of exposure.

Myocardial Infarction

PGs play important roles in a number of organ systems, including the central nervous system, blood platelets (as described in this chapter), smooth muscles of the respiratory tract (also described here in connection with asthma), peripheral nervous system, gastrointestinal tract, and cardiovascular system. In the kidney, PGs, possibly mainly PGAs, produce vasodilation and accelerate the removal of sodium ion into the urine. PGs apparently can act in the opposite direction by stimulating the renin-angiotensin-aldosterone system. In this case, as in many others, opposing actions of PGs occur as a homeostatic mechanism. Nonsteroidal anti-inflammatory drugs, if administered chronically, can compromise the hypotensive activity of PGs in the kidney.

Primary Deficiency

This may result from malabsorption syndromes, cancer, liver cirrhosis and alcoholism, hyperthyroidism, congestive heart failure or medicine use, such as OCP, isoniazid, hydralazine, penicillamine, theophylline or MAO inhibitors (Beers & Berkow 2003, Bratman & Kroll 2000, Wardlaw et al 1997).

Live Attenuated Varicella Vaccine

Outbreaks of varicella in young vaccinated children have recently been reported in the United States 31-33 . There are a number of possible explanations for these outbreaks. Improper storage of this labile vaccine may account for primary vaccine failure in some children. The ability to mount a protective immune response may be impaired in children with asthma 34 . Children immunized at less than 14 months old may have higher rates of breakthrough varicella than those immunized when they were older 31, 32 . When varicella vaccine is administered less than 1 month after another live vaccine, the incidence of breakthrough varicella increases 35 . A recent outbreak of varicella in a day care center in New Hampshire identified an interval of over 3 years since vaccination as the only significant risk for developing breakthrough disease 33 . This small study is the only one that suggests that waning immunity may be a factor in breakthrough disease. However, the children involved were very...

Resolution Of The Acute Inflammatory Process

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

Identified health effects

As to cardiovascular morbidity, exposure has been shown to increase the risk of myocardial infarction. In addition, evidence implicates air pollution in adverse outcomes of pregnancy, such as premature birth and low birth weight. There is insufficient evidence to draw firm conclusions about the association oftransport-related air pollution with elevated incidence of cancer, although certain occupational groups with higher- and longer-than-aver-age levels of exposure (such as professional drivers and railway workers) show an increased incidence of and mortality from lung cancer. The risks are not equally distributed in the population. Children and elderly people and people with preexisting chronic diseases show increased susceptibility to the adverse effects ofair pollutants.

GPCR Target Validation

Other human GPCRs in which a naturally occurring single point mutation results in an inactive receptor and association with a disease31 are the R16G mutant of the p2-adrenergic receptor (nocturnal asthma),35 the W64R mutant of the p3-adrenergic receptor (obesity),36 and the R60L mutant of thromboxane A2 (bleeding disorders).37 A deletion mutation of the human P2Y12 purinergic receptor is associated with bleeding disorders,38 and an autosomal recessive mutation in the canine orexin-2 receptor was found to underlie narcolepsy in dogs,39 suggesting a role for orexin in human narcolepsy. Montelukast Singulair Asthma Allergies Duragesic Pain

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

Nature Nurture Human Development

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

Gpcrtractability Current Therapeutics

Based simply on the sales successes of drugs targeting these receptors, GPCRs are attractive targets. In 2003, total sales for the top 200 prescription drugs were over 218 billion worldwide. Forty-seven of these drugs target GPCRs and comprise almost 23 of the sales at 47 billion.9 Table 3.1 depicts the 20 best-selling GPCR-targeted drugs of 2003 including salmeterol, an antiasthmatic p2-adrenergic agonist olanzapine, an antipsychotic 5-HT2 dopamine receptor antagonist and clopidrogel, an antithrombotic P2Y12-purinergic receptor antagonist, all with annual sales near 4 billion. Several GPCRs have multiple top-selling drugs targeted at them including H1-antihistamines (fexofenadine, cetirizine, and desloratadine) and antihypertensive angiotensin II receptor antagonists (losartan, valsartan, cardesartan, and irbesartan). This demonstrates the attractiveness of such targets to pharmaceutical companies. Asthma Asthma Asthma Asthma Asthma, Over-active

Physiologic Effects Of Acupuncture

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

Hormones Regulate Fat Mobilization

Fat Mobilization

The hormones that act rapidly in promoting lipoly-sis, ie, catecholamines, do so by stimulating the activity of adenylyl cyclase, the enzyme that converts ATP to cAMP. The mechanism is analogous to that responsible for hormonal stimulation of glycogenolysis (Chapter 18). cAMP, by stimulating cAMP-dependent protein kinase, activates hormone-sensitive lipase. Thus, processes which destroy or preserve cAMP influence lipolysis. cAMP is degraded to 5'-AMP by the enzyme cyclic 3',5'-nucleotide phosphodiesterase. This enzyme is inhibited by methylxanthines such as caffeine and theophylline. Insulin antagonizes the effect of the lipolytic hormones. Lipolysis appears to be more sensitive to changes in concentration of insulin than are glucose utilization and esterification. The antilipolytic effects of insulin, nicotinic acid, and prostaglandin E1 are accounted for by inhibition of the synthesis of cAMP at the adenylyl cyclase site, acting through a Gi protein. Insulin also stimulates...

Allergy and Dermatitis

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

Biowaiver Courier Ma Gujarati Natak

Brocklebank D, Ram F, Wright J, et al. Comparison of the effectiveness of inhaler devices in asthma and chronic obstructive airways disease a systematic review of the literature. Health Technol Assess 2001 5(26) 1-149. Goldenheim PD, Conrad EA, Schein LK. Treatment of asthma by a controlled-release theophylline tablet formulation a review of the North American experience with nocturnal dosing. Chronobiol Int 1987 4(3) 397-408. Michele TM, Knorr B, Vadas EB, Reiss TF. Safety of chewable tablets for children. J Asthma 2002 39(5) 391-403.

Proton pump inhibitors

Proton pump inhibitors do have a potential for drug interactions, through the P-450 system 3 , although this is mostly confined to omeprazole and lan-soprazole. PPI elimination is not significantly affected by renal impairment or hepatic dysfunction, and no dosage adjustments are recommended, giving this medication an advantage in older individuals 2 , 61 , 71 , 76 . There are a few potential drug interactions, including digoxin, metoprolol, calcium-channel block-kers, benzodiazepines, phenytoin, theophylline, and warfarin 3 , 61 , 71 . These interactions, however, have not been found to have clinical relevance.

Intravenous Administration

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

Overview Of Biomarkers

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

Pharmacological Toxicological Effects

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

Sensitivity Of Respiratory Centers And Clinical Symptoms

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

Vulvar Vestibulitis Syndrome

Treatment for vestibulitis is typically guided by the medical model. This model follows a traditional strategy of starting with conservative, non-invasive treatments and progressing to more invasive ones (89). Palliative interventions (e.g., sitz baths) to reduce the pain are the first-line treatment choice for dyspa-reunia. If these are not effective, treatment progresses to topical interventions (e.g., lidocaine, corticosteriods), systemic medications (e.g., oral corticosteriods, antifungals), followed by injectable medical treatments (e.g., interferon), neuro-physiological treatments (e.g., biofeedback, pharmacotherapy), and ending with surgical intervention (e.g., vestibulectomy). However, there is little evidence to support the use of topical, systemic, or injectable treatments. Although one placebo-controlled study of the effectiveness of cromolyn cream (90) and one randomized trial of fluconazole (91) found these treatments to be ineffective for relieving the symptoms of vulvar...

The Genetic History of Tristan da Cuna

In the fall of 1993, geneticist Noe Zamel arrived at Tristan da Cuna, a small remote island in the South Atlantic ( Figure 23.1). It had taken Zamel 9 days to make the trip from his home in Canada, first by plane from Toronto to South Africa and then aboard a small research vessel to the island. Because of its remote location, the people of Tristan da Cuna call their home the loneliest island, but isolation was not what attracted Zamel to Tristan da Cuna. Zamel was looking for a gene that causes asthma, and the inhabitants of Tristan da Cuna have one of the world's highest incidences of hereditary asthma more than half of the islanders display some symptoms of the disease. The high frequency of asthma on Tristan da Cuna derives from the unique history of the island's gene pool. The population traces its origin to William Glass, a Scot who moved his family there in 1817. They were joined by some shipwrecked sailors and a few women who migrated from the island of St. Helena but, owing...

Clinical Manifestations

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

Adjunctive Medical Therapy

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

Small Molecule Screens In Oncology

polypharmacy, drugs developed for one purpose may have advantages in other diseases against other targets, the data was examined for unexpected side activities and novel properties. Glivec, designed to target BCR ABL, for instance has described activity against pdgf and c-kit as well, which are the justification for pursuing Glivec in GIST and asthma. In this experiment, interesting cross-activities for other, less well characterized small molecule kinase inhibitors currently under clinical investigation were discovered. The pan-p38 inhibitor BIRB796 was shown to block Tie2, a protein implicated in promoting angiogenesis. Extending the inhibitor's activity to Tie2 could potentially increase the utility of this compound in cancer treatment. In another example, the dual inhibitor of Src-family kinases, BMS-354825, inhibited several Ephrin receptors implicated in both tumor angiogenesis and tumor cell survival (Brantley-Sieders and Chen, 2004 Brantley-Sieders et al., 2004 Kullander and...

Indications and Contraindications

The NCP system cannot be inserted in patients who have undergone a prior left cervical vagotomy. Furthermore, the safety of VNS has not been tested in several conditions in which impairment of vagus nerve function might produce deleterious effects. Thus, relative contraindications include progressive neurological or systemic diseases, pregnancy, cardiac arrhythmia, asthma, chronic obstructive pulmonary disease, active peptic ulcer disease, and insulin-dependent diabetes mellitus 1 .

Driving School Instructor

Shown clinically, as perilla seed oil significantly suppressed the generation of leukotrienes in asthma patients in an observational study comparing two groups of asthma patients, one of which received perilla oil for 4 weeks. Ventilatory parameters, such as PEF, FVC and FEV-,, increased significantly after 4 weeks' dietary supplementation in the treated group (Okamoto et al 2000). Seed extract Perilla seed extract, as well as its constituents luteolin, rosmarinic acid and chrysoeriol, have been shown to inhibit 5-lipoxygenase in vitro, and therefore leukotriene synthesis. Leukotrienes are associated with both allergic and inflammatory disorders, including hay fever, asthma and inflammatory bowel disorders. inhibit TNF-alpha and arachidonic acid and reduce oedema (Ueda et al 2002). In another inflammatory model, perilla dose-dependently reduced the allergic response in mice by over 40 . Rosmarinic acid was identified as the main active constituent (Makino et al 2001) and has been...

Anticoagulation During Cardiopulmonary Bypass

Protamine sulphate is a simple protein and is a strong base in characteristics, as against heparin which is acid. Therefore, it forms electrostatic complexes with the molecules of heparin and neutralises its action by inhibition of anti-thrombin III. It acts on all stages of the coagulation cascade. Protamine is extracted from a fish sperm and can show cross-immunity by giving a hypersensitivity reaction in patients who are allergic to fish protein. Protamine can also, by the same mechanism, give rise to allergic reactions in those who have a history of testicular trauma or procedures like vasectomy, in which there is a breach in the blood-sperm barrier. Patients, who are on protamine containing insulin preparations (PZI, NPH insulin), can also elicit strong reactions to protamine. Apart from minor reactions like skin rash, nausea, and lassitude it can give rise to some major reactions like hypotension, hypertension, bradycardia, and severe bronchospasm. Urticaria with severe...

Health Policies and the Physical Environment

The health effects of exposure to hazardous agents, whether they are introduced into the environment or occur naturally, are well understood. Air, polluted by a number of agents, has a direct, measurable effect on such diseases as asthma, emphysema, and lung cancer and on the aggravation of cardiovascular disease. Asbestos, which can still be found in buildings constructed prior to its ban, causes pulmonary disease. Lead-based paint, when ingested, causes permanent neurological defects in infants and young children. This paint is still found in older buildings and is especially concentrated in poorer urban communities.

Of Overweight Patients

The clinician or therapist who sees an overweight patient needs to obtain certain basic information which is relevant to assessing its risk (Table 9) (100-108). This includes an understanding of the events that led to the development of obesity, what patients have done to deal with the problem, and how successful and unsuccessful they were in these efforts. Several of these items are listed in Table 10. The family constellation is important for identifying attitudes about obesity and the possibility of finding rare genetic causes. Information about the amount of weight gain ( 20 lb or 10 kg) since age 18-20 and the rate of weight gain is important because this is related to the risk of developing complications from obesity (109). The type and regularity of physical activity are also important since physical inactivity increases cardiovascular risk, particularly in overweight individuals (110). Information about comorbid conditions such as diabetes, hypertension, heart disease, sleep...

Centers or Institutes on Urban Health

Centers offer several organizational advantages for addressing urban health. Their express purpose is to meet needs and seize opportunities not addressed by traditional academic departments. They are thus more flexible and often more open to interdisciplinary approaches and Center activities are also less likely to elicit hostile reactions from turf-defending departments. For educators, centers also provide opportunities to offer courses that transcend traditional boundaries. Urban health centers have offered continuing education courses for practicing professionals, certificates for community health workers, special programs for high school students, and seminars for researchers and doctoral students. This ability to operate at several educational levels in a variety of settings simultaneously - a capacity most academic departments lack - provides centers the ability to address urban health problems, e.g., expanding HIV testing and counseling or improving asthma or diabetes...

Competencies for Urban Clinicians

Physicians, nurses, dentists, psychologists, and other urban clinicians should be able to describe how different types and levels of exposure to urban living conditions affect well-being. Depending on their discipline and specialty area, they should also be able to explain how urban living influences the clinical course and management of common illnesses (e.g., asthma, depression, hypertension,

Adverse Reactions

Rosemary is generally recognised as safe for human consumption in quantities used as food. Consuming large amounts of rosemary may cause stomach and intestinal irritation, as well as seizures, owing to the high content of highly reactive monoterpene ketones, such as camphor (Burkhard et al 1999). Topically, rosemary is not considered to be highly allergenic however allergic contact dermatitis from rosemary has been reported (Fernandez et al 1997, Hjorther et al 1997, Inui & Katayama 2005), as has asthma from repeated occupational exposure (Lemiere et al 1996). Rosemary essential oil should be diluted before topical application to minimise irritation.

Answers To Patients Frequently Asked Questions

Beta-carotene supplementation will ensure you maintain adequate vitamin A levels, as well as possibly assist in preventing cancer and cardiovascular disease, help maintain a healthy immune system, prevent sunburn and photoageing of the skin, assist with asthma, and deal with oxidative stress. When will it start to work

HIV and Pulmonary Diseases

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

Pre Placement Assessment Assessing Risk

Atopy is a genetic predisposition to develop specific IgE and allergic reactions (e.g., skin rashes, rhinoconjunctivitis, asthma).9 The majority of studies have indicated that workers who have a personal history of atopy are more likely to develop LAA, although this has not been a universal finding.10 Some investigators have identified an association between family history of atopy and the development of LAA, but others have found no association.10 It is likely that any association between family history and the development of LAA is weak. Pre-placement assessment is still worthwhile. It is the first opportunity to assess the vulnerability of the candidate and counsel him or her on the measures he or she should take to minimize the risk of developing allergy. It is an opportunity to establish baseline data and carry out baseline investigations against which future assessments can be compared. Serum banking is, however, not recommended.6 Some candidates will have a history of exposure...

Ethical Issues in the Quality of Care

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

Allergic rhinosinusitis

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

Acute and Chronic Altitude Hypoxia

Studies at altitude have relevance in clinical situations at sea level. Tissue hy-poxia is a feature of many diseases, such as asthma, emphysema, coronary artery disease, and cancer. Knowledge of compensatory autonomic mechanisms to hypoxia may be harnessed to alleviate the symptoms of pathogenic hypoxia.

Crohns Disease and Hidradenitis Suppurativa CoOccurrence A Rationale for AntiTNF Therapy

Antibody formation can be seen with long-term use and is inversely proportional to total infliximab dose. The concern regarding the development of antibodies to infliximab with long-term use follows the observation that 13 of Crohn's patients treated with repeated infusions had indeed formed antibodies 22 . As expected, loss of clinical efficacy accompanies the antibody formation, as does the development of infusion-related chest pain, bronchospasm, and anaphylactic shock. The development of antibodies can be reduced by treating the patients on a scheduled, regular basis (i.e., every 8 weeks) and with the concomitant use of low-dose im-munosuppressants 16 .

Clinical Characteristics

Exacerbation of asthma Studies examining the role of hMPV with respect to exacerbations of asthma have yielded conflicting results Jarrti, 2002 Williams, 2004 Rawlinson, 2003 . Although there is no doubt that some patients with asthmatic exacerbations have hMPV infection, whether or not the virus is associated more frequently than other respiratory viruses with these exacerbations is not yet clear. Remarkably, a history of asthma or a family member with asthma was more often associated with hMPV (16 and 67 , resp.) than with hRSV (0 and 30 , resp.) Peiris, 2003 . It is currently not known whether hMPV infection leads to an increased susceptibility to secondary bacterial infections.

Differential Diagnosis of Atrial Fibrillation

Lone Atrial Fibrillation No underlying disease state. Cardiac Causes Hypertensive heart disease with left ventricular hypertrophy, heart failure, mitral valve stenosis or regurgitation, pericarditis, hypertrophic cardiomyopathy, coronary artery disease, myocardial infarction, aortic stenosis, amyloidosis. Noncardiac Causes Hypoglycemia, theophylline intoxication, pneumonia, asthma, chronic obstructive pulmonary disease, pulmonary embolism, heavy alcohol intake or alcohol withdrawal, hyperthyroidism, systemic illness, electrolyte abnormalities. Stimulant abuse, excessive caffeine, over-the-counter cold remedies, illicit drugs.

Current Promoted Uses

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

Other Special Situations

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

Initial Medical Management

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


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

Perfecting Case And Outbreak Detection

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

Computerinterpretable Case Definitions

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

Intraarticularintralesional 440 mg up to

Antiinflammatory immunosuppressant 2-60 mg day PO in 1-4 divided doses to start, followed by gradual reduction in dosage to the lowest possible level consistent with maintaining an adequate response. PO 2-60 mg in 1-4 divided doses. IM (sodium succinate) 10-80 mg day once daily. IM (acetate) 40-120 mg every 1-2 weeks. IV (sodium succinate) 10-250 mg over several minutes repeated as needed every 4-6 hrs. Status asthmaticus load 2 mg kg dose IV (sodium succinate), then 0.5-1 mg kg dose every 6 hrs for up to 5 days.

Pharmacological Effects

Ephedrine, the predominant alkaloid in ephedra, is both an a and p stimulant. It directly stimulates a2 and px receptors and, because it also causes the release of norepinephrine from nerve endings, it also acts as a p2 stimulant. The resultant physiological changes are variable, depending on receptor distribution and receptor regulation (26). Tolerance to ephedrine's p agonist actions emerges rapidly, which is why ephedrine is no longer the preferred agent for treating asthma receptor downregulation quickly occurs and the bronchodilator effects are lost (27,28). Banner et al. summarized studies where the effects of ephedrine and ephedra were compared to placebo in controlled studies in humans. None of the controlled trials disclosed any evidence of cardiovascular toxicity when ephedrine was given in doses as high as 1 mg kg, even when it was administered to severe asthmatics with known cardiac arrhythmias (57). The trial reported by Banner et al. studied the respiratory and...

Cardiovascular Effects

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

Allergic Reactions And Other Toxicities

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

Case 22 Clinical Summary

The patient was a 34 year old African American woman, HIV negative, smoker (one pack per day for 20 years), asthmatic, with a history of positive PPD and tuberculous infection, treated with 4 antituberculous medications. As part of the work-up a CT scan of the chest was done, which revealed a large mass involving the middle and lower lobes of the right lung. In addition, a bronchial washing was reported positive for adenocarcinoma, and subsequently she underwent right pneumonectomy. The right lung as well as the mediastinal lymph nodes were involved by a moderately to poorly differentiated adenocarcinoma. Moreover, the lung showed focal emphysematous changes and several 0.5 cm arteriovenous malformations. After the operation she returned to work, but came back to the ER twice complaining of dyspnea and productive cough with yellow sputum. Jugular venous distension was absent and left breath sounds were clear. She was treated with albuterol and discharged on prednisone (20mg qd x 5...

Environmental Justice And Health

Air pollution, another environmental threat, has been identified as a risk factor for hospitalization for lung and heart disease, as well as respiratory disorder (Arif, et al., 2003 Zanobetti, et al., 2000). In general, results from multiple community sites suggest a positive relationship between outdoor air pollution smog and asthma (Clean Air Task Force, 2002 National Campaign Against Dirty Power, 1999). Outdoor air pollution has been implicated as a major trigger in increased respiratory-related emergency room visits and hospital admissions (Bullard, et al., 2000 National Campaign Against Dirty Power., 1999). Urban metropolitan areas, such as Atlanta, Georgia, have been found to be repeatedly in violation of the Clean Air Task Force, with cars, trucks and buses being the greatest source of air pollution (Bullard, et al., 2000).

Occupational exposure

A questionnaire-based study in Denmark (Raaschou-Nielsen et al., 1995) investigated the prevalence of respiratory diseases and other disease symptoms in street cleaners in Copenhagen. The street cleaners showed a significantly higher prevalence ofchronic bronchitis and asthma than cemetery workers, who are exposed to lower levels of pollution and served as controls. In the statistical analysis, adjusted for smoking and age, ORs for chronic bronchitis (2.5 95 CI 1.2-5.1) and asthma (2.3 95 CI 1.0-5.1) were significantly elevated for street cleaners.

Neoplastic Conditions

Carcinoid tumour single or multiple, carcinoid tumour is of intermediate-grade malignancy, metastatic potential relating to size ( 1-2 cm), angioinvasion, invasion beyond the submucosa and functionality. It produces vasoactive peptides, e.g., serotonin that cause vascular thickening and elastotic stromal fibrosis which distorts the bowel wall leading to subacute obstruction or intussusception. Metastatic deposits in the liver result in the peptides accessing the systemic venous circulation and carcinoid syndrome - facial flushing, asthma and thickening of cardiac valves. Carcinoid tumours can be ulcerated or nodular, and are usually yellow. Other neuroendocrine lesions occur in the duodenum and include gastrinoma as part of Zollinger-Ellison syndrome, somatostatinoma and gangliocytic paraganglioma, both of which may be associated with von Recklinghausen's syndrome (neurofibromatosis).

Studies on health effects

Few reported studies analyse the effects ofspecific interventions, and even fewerfocus on transport-related air pollution. They indicate that reducingthis pollution may directly reduce acute asthma attacks in children and the related medical care. Long-term decreases in air-pollution levels are associated with declines in bronchial hyperreactivity, in the average annual trend in deaths from all causes, and in respiratory and cardiovascular diseases. Such decreases are also associated with gains in life expectancy.

Agerelated Changes in Respiratory Mechanics

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

Receptor Subtypes As Novel Targets

The first division of adrenoceptors into two classes was based on the potency of a series of catecholamine derivatives to elicit functional responses in vascular and other smooth muscles and in the heart.10 a-Adrenoceptor activation elicited contraction of vascular smooth muscle and had little effect on the heart, while p-adreno-ceptor activation had positive inotropic and chronotropic effects on the heart and relaxed smooth muscle tissues. Further pharmacological adrenoceptor classifications allowed a distinction between -adrenoceptors predominantly responsible for cardiac stimulation and p2-adrenoceptors that mediate relaxation of vascular and bronchial smooth muscles.11 This distinction allowed the development of selective p1-adrenoceptor antagonists for hypertension and other cardiovascular indications and selective p2-adrenoceptor agonists for the symptomatic treatment of asthma.

Differential Diagnosis

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

Intraoperative management

Pain, emotional stress, or stimulation during light general anesthesia can precipitate bronchospasm. C. Reflex bronchospasm can be blunted prior to intubation by increasing the depth of anesthesia with additional induction agent or volatile agent, or by administering IV or IT lidocaine 1-2 mg kg. D. Intraoperative bronchospasm is usually manifest by wheezing, increasing peak airway pressure, decreased exhaled tidal volumes or a slowly rising wave form on the capnograph. Treatment includes deepening the level of anesthesia, and beta agonists delivered by aerosol or metered dose inhalers. Other causes may mimic bronchospasm include obstruction of the ETT from kinking, secretions, or an overinflated balloon endobronchial intubation active expiratory efforts (straining) pulmonary edema or embolism and pneumothorax.

Hydrocortisone Solu Cortef

Actions anti-inflammatory, antiallergic, mineralocorticoid effect stimulation of gluconeogenesis inhibition of peripheral protein synthesis membrane stabilizing effect. Indications adrenocortical insufficiency, inflammation and allergy, cerebral edema from CNS tumors, asthma. Dose (shock) adult 500 mg to 2 gm IV IM every 2-6 hrs ped 50 mg kg IV IM, may repeat in 4 hrs. Dose (stress coverage for surgery) 1.5-4 mg kg day IV as a continuous infusion beginning at the time of surgery and continuing for 24 hrs or 40100 mg m2 day divided every 6-8 hrs. Dose (status asthmaticus) 1-2 mg day dose IV every 6 hrs for 24 hrs, then maintenance of 0.5-1 mg kg IV every 6 hrs.

Social Welfare System

Most homeless people depend on their city's shelter system for housing, food, and other social services, and these shelters can therefore have a significant impact on the health of homeless people. The availability and quality of homeless shelters vary greatly. As noted previously, homeless people in cities with few shelter beds are more likely to live on the street or other places not intended for human habitation, with potentially adverse health effects. In addition, the staff at homeless shelters can play an important role in connecting homeless people to social services, job training, housing applications, and substance abuse treatment. The quantity and quality of food provided at shelters determines to a large extent the nutritional value of homeless people's diets, with potential downstream health effects (Dachner and Tarasuk, 2002). Finally, the physical environments at shelters range from extremely crowded, poorly ventilated, and unsanitary facilities to modern, clean, and...

Case Studies 41 Airborne Particles and Morbidity and Mortality

The upper airways and lungs, where deposited particles can cause both local and systemic injury. A substantial proportion of the population is considered to be at increased risk from inhaled particles, including infants and children whose lungs are still developing, children and adults with asthma whose lungs have increased responsiveness to environmental stimuli, adults with chronic heart and lung diseases, and the elderly.

Respiratory Disorders

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

Exposures in urban versus rural regions

Chapter 2 discusses the differences between urban and rural sites in the concentration of various pollutants and the possible contribution from traffic in detail. In general, most information on transport-related air pollution and estimates of population exposure for urban-versus-rural (or urban background) areas are for nitrogen dioxide. The multicentre study of acute pollution effects on asthmatic children (PEACE) that was carried out simultaneously in 14 European countries in the winter of 1993 1994, however, provides information on some other pollutants. The study summarized the city background ratios for all 14 countries 1.2, 1.4 and 1.8 for PM10, black smoke and nitrogen dioxide, respectively (Hoek et al., 1997). Moreover, a multimode assessment of transport users' exposure PM2.5 in London showed that mean personal exposure levels in road transport modes were about double the concentrations measured at an urban background site (Adams et al., 2001).

Pharmacological Toxicological Effects 51 Pharmacology

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

Shortterm changes in airpollution levels

The implementation of a modified transport strategy, to reduce traffic congestion during the 1996 Summer Olympic Games in Atlanta, Georgia, United States provided the opportunity to study the health impact of a short-term change in levels oftransport-related air pollution (Friedman et al., 2001). For a total ofmore than 10 weeks (4 weeks before, 17 days during and 4 weeks after the Games), data were registered for the number of medical emergency visits, the number of hospitalizations for asthma and non-asthma events, air quality, weather conditions, and traffic and public transportation. The air-quality data included measurements of PM10, nitrogen dioxide and ozone. The results of the analysis show a significant decrease in the number (41.6 ) and incidence of acute care events for asthma (RR 0.48 95 CI 0.44 0.86) during the Olympic Games. In the same period, air quality improved, with significant reductions in ozone (from 163 pg m3 to 117 pg m3 mean of one-hour daily maximum), carbon...

Adverse Effects and Toxicity

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

The Real World of Health Policy

SUMMARY This rule sets forth the initial air quality designations and classifications for all areas in the United States, including Indian country, for the fine particles (PM2.5) National Ambient Air Quality Standards (NAAQS). The EPA is issuing this rule so that citizens will know whether the air quality where they live and work is healthful or unhealthful. Health studies have shown significant associations between exposure to PM2.5 and premature death from heart or lung disease. Fine particles can also aggravate heart and lung diseases and have been linked to effects such as cardiovascular symptoms, cardiac arrhythmias, heart attacks, respiratory symptoms, asthma attacks, and bronchitis. These effects can result in increased hospital admissions, emergency room visits, absences from school or work, and restricted activity days.

Clinical Aspects

FIGURE 16-25 Outline of the reactions thought to occur in asthma. Abbreviations H, histamine PAF, platelet-activating factor LTB4, LTC4, and LTD4, leukotrienes B4, C4, and D4 EMBP, eosinophil major basic protein ECP, eosinophil cationic protein. Note that not all asthmatic subjects respond to cromolyn sodium or nedocromil sodium and that theophylline is only a second-line drug. Reproduced with permission from Rang, H. P., Dale, M. M., Ritter, J. M., and Gardner, P. (1995). Pharmacology. Churchill-Livingstone, New York. FIGURE 16-25 Outline of the reactions thought to occur in asthma. Abbreviations H, histamine PAF, platelet-activating factor LTB4, LTC4, and LTD4, leukotrienes B4, C4, and D4 EMBP, eosinophil major basic protein ECP, eosinophil cationic protein. Note that not all asthmatic subjects respond to cromolyn sodium or nedocromil sodium and that theophylline is only a second-line drug. Reproduced with permission from Rang, H. P., Dale, M. M., Ritter, J. M., and Gardner, P....


The other PGs and TXA2 also have effects on smooth muscle. PGD2, PGF2a, and TXA2 constrict, but PGE2 has a slight dilatory effect. PGDz, PGEz, and PGI2 add to the effects on the permeability of histamine and brady-kinin. Thus, while histamine gives a transient contraction of human lung smooth muscle in vitro, LTC4 and LTD4 cause prolonged responses and may be critical agents in asthma. ing the synthesis of a peptide (lipocortin annexin I) inhibitor of phospholipase Ay although the mechanism needs further clarification. This is the same reaction that was discussed in connection with prostaglandin-induced pain (Figure 16-17). Corticosteroid-resistant asthma is a very serious problem in which LTs may FIGURE 16-24 Mast cell mediators and airway obstruction in bronchial asthma. Reproduced from Kay, A. B. (1982). Eur. . Respir. Dis. 63 (Suppl. 122), 9-16. Copyright 1982 Munksgaard International Publishers Ltd., Copenhagen, Denmark. play an influential part. Prostaglandin relatives thus are...

Pulmonary Administration

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

Case Study of Multidimensional FCS Readout

A novel assay based on a multiparameter fluorescent readout is described below. A theophylline antitheophylline antibody interaction was chosen as a pharmacologically relevant assay system in order to demonstrate the full potential of EVOTEC's multidimensional fluorescence analysis based on its proprietary FCS+ detection platform. Theophylline therapy has been a cornerstone of asthma therapy through the years. Theophylline inhibits the breakdown enzyme phosphodiesterase with a resultant increase in cAMP concentrations, which results in smooth muscle cell relaxation of the bronchial tree. In view of the very small margin between therapeutic effects and toxicity, individualization of dose is mandatory with theophylline therapy. Therefore a strong demand for highly sensitive assays and detection technology exists in order to fine tune the theophylline level in serum 9-11 . Figure 5 FCS measurement of theophylline and antitheophylline interaction. The preliminary FCS studies indicated...

Firerelated Injuries And Fatalities

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

Pulmonary Function Tests

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

Additional Considerations

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

Rectal Administration

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

Chronic obstructive pulmonary disease COPD

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

Chemical Components

The composition of green tea varies according to the growing and harvesting methods, but the most abundant components are polyphenols, which are predominantly flavonoids (e.g. catechin, epicatechin, epicatechin gallate, epigallocatechin gallate, proanthocyanidins). Caffeine content in green tea varies but is estimated at about 3 , along with very small amounts of the other common methylxanthines, theobromine and theophylline (Graham 1992). It also contains many other constituents, such as tannin, diphenylamine, oxalic acid, trace elements and vitamins.

Systemic effects of ophthalmic drugs

Cholinergics (pilocarpine, acetylcholine) used to induce miosis toxicity may manifest in bradycardia or acute bronchospasm. D. Beta-blockers (timolol maleate) systemic absorption may cause beta-blockade (bradycardia, bronchospasm, or exacerbation of congestive heart failure). Betaxolol seems to be oculo-specific with minimal side effects.

Effects on organ systems

Respiratory ventilation is minimally affected with normal doses of ketamine. Ketamine is a potent bronchodilator. E. Drug interactions nondepolarizing muscle relaxants are potentiated by ketamine. The combination of ketamine and theophylline may predispose patients to seizures.

Measured and modelled exposure

Studies have sought an association between transport-related air pollution and allergic respiratory illness or symptoms. Using models for exposure, Brauer et al. (2002) detected associations with increased incidence of asthma in the first two years of life. Although not statistically significant, this association was in general robust, because the ORs were not altered to any great extent by the inclusion of potential confounding variables in the regression models or the sensitivity analyses. One must consider that the children observed were too young to have a reliable diagnosis of asthma, but the determination of wheeze, and its association with transport-related air pollution (also detected in this study), supports this diagnosis. The German part of the TRAPCA project, in which only a few asthma cases were reported, however, found no association of asthma incidence with transport-related air pollution (Gehring et al., 2002). Considering wheeze as a possible key asthma-related...

Dealing With Asthma Naturally

Dealing With Asthma Naturally

Do You Suffer From ASTHMA Chronic asthma is a paralyzing, suffocating and socially isolating condition that can cause anxiety that can trigger even more attacks. Before you know it you are caught in a vicious cycle Put an end to the dependence on inhalers, buying expensive prescription drugs and avoidance of allergenic situations and animals. Get control of your life again and Deal With Asthma Naturally

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