New Home Remedy for Asthma

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...

Asthma Free Forever Overview


4.7 stars out of 13 votes

Contents: EBook
Author: Jerry Ericson
Official Website:
Price: $37.00

Access Now

My Asthma Free Forever Review

Highly Recommended

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

If you want to purchase this book, you are just a click away. Click below and buy Asthma Free Forever for a reduced price without any waste of time.

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...

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...

Environmental risk factors for the development of asthma

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

Genetic risk factors for the development of asthma

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

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.


Because n-3 PUFAs exhibit anti-inflammatory activity and epidemiological evidence has demonstrated a correlation between fish intake and a decreased risk of asthma and improved lung function, they have been used in the management of asthma (Wong 2005). Recent evidence suggests this protective effect may extend back as far as adequate fetal n-3 EFA exposure and a reduced incidence of asthma in the offspring (Salam etal 2005). A 2002 Cochrane review of nine RCT conducted between 1986 and 2001 concluded that there was no consistent effect on any of the analysable outcomes forced expiratory volume in 1 second, peak flow rate, asthma symptoms, asthma medication use or bronchial hyperreactivity (Woods et al 2002). One of the RCTs, conducted with children, showed that when fish oil supplementation was combined with dietary changes, positive results were obtained, as evidenced by improved peak flow and reduced asthma medication use. Since then, a number of positive studies have been...

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...

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.

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...

Answers To Patients Frequently Asked Questions

Albizia is a traditional Ayurvedic medicine used to reduce allergic conditions, such as allergic rhinitis and urticaria. It is also used for atopic conditions, such as eczema and asthma, when indicated. Controlled trials have not been conducted, so it is uncertain whether it is effective. When will it start to work This is uncertain because insufficient research data are available. It is advised that people with asthma be monitored by a healthcare professional.

History and Physical Examination

Past Medical History (PMH) Past diseases, surgeries, hospitalizations medical problems history of diabetes, hypertension, peptic ulcer disease, asthma, myocardial infarction, cancer. In children include birth history, prenatal history, immunizations, and type of feedings.

Contact Urticaria Syndrome

Contact urticaria syndrome (CUS) represents a heterogeneous group of inflammatory reactions that appear, usually within a few minutes to an hour, after contact with the eliciting substance. Clinically, erythematous wheal-and-flare reactions are seen, and sensations of burning, stinging, or itching are experienced. These are transient, usually disappearing within a few hours. In its more severe forms, generalized urticaria or extracutaneous manifestations, such as asthma, nausea, abdominal cramps, and even anaphylactic shock, may occur. Diagnosis may be achieved by a variety of skin tests the open test is the simplest of these and is the ''first-line'' test.

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.

Children in Homeless Families

The health of children in homeless families has been the focus of relatively little research. Some but not all studies of these children have found an increased prevalence of behavioral and mental health problems compared to children in housed low-income families (Bassuk, et al., 1997 Vostanis, et al., 1998). Infectious diseases are a significant concern in these children (Ligon, 2000). Up to 40 of children in homeless families in New York City suffer from asthma, a rate six times higher than the national rate in children (McLean, et al., 2004c).

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...

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...

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.

Health Burdens Experienced By Economically And Socially Deprived Urban Populations

Studies of individual and population health for those living in urban areas have consistently demonstrated the variation in health status by context, race, income, and gender. While patterns of disparity differ for various outcomes, a consistent relationship of increased morbidity and mortality has been observed for economically disad-vantaged urban populations compared to their less deprived counterparts for outcomes such as cardiovascular disease, homicide, mental health, asthma, and premature mortality (Brunner and Marmot, 1999 Geronimus, et al. 1999 Shaw, et al, 1999. Weil, 1999 Aligne, et al., 2000 Grant, et al., 2000 House, et al., 1978 Cooper, et al. 2001 Geronimus, 2003 Kreuger, et al., 2004 McGruder, et al, 2004).

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.

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.

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).

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...

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).

How Cities Affect Lgbt Health

Move into deserted or dilapidated areas (Florida, 2002 Simon, 2002). The impact of these settlement patterns on LGB health is unknown, but research increasingly suggests that urban physical environments can have deleterious health effects (Ambrose, 2001 Cohen, et al., 2003 Cummins and Jackson, 2001 Krieger, et al., 2000 Lawrence, 1999 Satterthwaite, 1993). Living in older, unrenovated buildings, for example, is associated with a higher prevalence of asthma (Krieger and Higgins, 2002).

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.

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.

Mortality and morbidity considerations

It is worth focusing on the changes in disease indices during the past generation in order to evaluate the effect of preventive and health promotion programs during this period (Table 9.2). 3 The messages are to harness and promote with renewed vigour those strategies that are working, such as prevention of death from coronary artery disease and motor vehicle accidents, and to reevaluate those important areas such as Aboriginal mortality, HIV infection, cancer, suicide and asthma which are bad news

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.

Cardiovascular Effects

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

Respiratory Disorders

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

Monitoring in anaesthesia

An important source of anaesthetic-related morbidity and mortality remains human error. All anaesthetists have tales of drug administration errors and near-misses those anaesthetists who claim never to have problems are either doing insufficient work or are economical with the truth. A critical incident register is recommended in every anaesthetic department. A critical incident is an untoward event, which if left uncorrected, would have led to anaesthetic-related mortality or morbidity. It includes many events ranging from disconnection of the breathing circuit to unrecognised oesophageal intubation and severe bronchospasm. It is hoped that better monitoring will reduce the incidence of these complications.

Clinical Manifestations

The most commonly reported symptoms affect the nose and eyes (rhinitis and conjunctivitis). The symptoms include sneezing, nasal congestion and discharge, redness of the conjunctiva, and itching, watery eyes. If the lower airways are affected, then the presenting symptoms are those of asthma, with cough, wheezing, production of sputum, and shortness of breath. Pooled data from 13 studies revealed a consistent picture of symptom distribution.3 Of 10 persons with symptoms of LAA, about eight will have rhinoconjunctivitis (range 53 to 100 ), about four will have skin reactions (13 to 70 ), and about three to four will have asthma (13 to 71 ). Subsequent studies of symptom incidence suggests this 2 1 1 ratio of symptoms remains typical.25 29 There is inevitably overlap between symptoms most subjects have more than one affected target organ, and asthma rarely occurs in the absence of the prior development of rhinoconjunctivitis (see Figure 7.2).29,49

Chronic Obstructive Pulmonary Disease

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. Chest trauma, noncompliance with medications. Medications Bronchodilators, prednisone, ipratropium. Differential Diagnosis COPD, chronic bronchitis, asthma, pneumonia, heart failure, alpha-1-antitrypsin deficiency, cystic fibrosis.

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.

Adverse Reactions

A number of adverse reactions are reported for topical application, including systemic toxicity in a 6-year-old girl, and urticaria, contact dermatitis and skin irritation in other cases (Darben 1988). However, when considering the risks of topical application of eucalyptus oil the state of the skin must be considered as well as the individual's susceptibility to atopic conditions such as eczema and asthma. Allergic reactions to lozenges have also been reported anecdotally. Inhalations may irritate the eyes and mucus membranes.

Allergic Fungal Rhinosinusitis

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

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...

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.

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).

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.

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).

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...

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.

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...


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

Mast Cells and Basophils

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

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)

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.

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.

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.

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).

Reflection of Effects on Th1 Th2 and Treg Differentiation

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

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....

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.

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...

ErbB Proteins and Pathological Conditions

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

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.

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.

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...

Aspirin nsaid hypersensitivity

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

Agerelated Changes in Respiratory Mechanics

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

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.

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...

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.

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 .

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...

Controlled exposure studies

Important insights can be gleaned from a tunnel study in which subjects were exposed for a relatively short time to a high concentration of a real traffic-related pollution mix 20 allergic asthmatic subjects were exposed during rest for 30 minutes in a busy city road tunnel, to study the effects of air pollution on allergen responsiveness (Svartengren et al., 2000). In the tunnel, the median levels of pollutants were 303 pg m3 nitrogen dioxide (range 203-362 pg m3), 170 pg m3 PM10 (range 103-613 pg m3) and 95 pg m3 PM2.5 (range 62-218 pg m3). Four hours after exposure, an allergen provocation was performed and lung function responses measured. Subjects exposed to nitrogen dioxide levels of 300 pg m3 or more had a significantly greater early reaction following allergen exposure, as well as lower lung function and more asthma symptoms during the late phase, compared to the reference exposure. Subjects exposed to 100 pg m3 PM2.5 or more also had a slightly increased early reaction,...

Pulmonary Disease States Associated With Advanced

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

Animal Models and Insights into Mechanisms of Lung Senescence

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

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.

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...

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...

Pathological Conditions

Pneumothorax primary spontaneous pneumothorax occurs most commonly in 30 to 40 year old tall, thin males. They are most often due to rupture of blebs or bullae on the apical parts of the upper lobes. Rate of recurrence is 25 . Secondary pneumothorax occurs in chronic obstructive pulmonary disease, cystic fibrosis, asthma, tuberculosis, idiopathic pulmonary fibrosis, lymphangioleiomyomatosis, Langerhans histiocytosis and pneumocystis carinii pneumonia (PCP). Catamenial pneumothorax is associated with menstruation and may be due to focal endometrial deposits on the pleura. Traumatic pneumothorax can be iatrogenic, e.g., secondary to biopsy or otherwise, e.g., penetrating chest trauma.

Environmental Protection Laws

The adverse health effects of environmental pollution are well known. Air pollution increases deaths from cardiopulmonary diseases, (Peters and Pope, 2002) and is associated with increases in asthma incidents (Cummins and Jackson, 2001) and infant mortality. (Kaiser, et al., 2004) When traffic was reduced in Atlanta for the 1996 Olympic Games, peak ozone concentrations decreased by 27.9 and the number of asthma medical emergencies fell by 41.6 . (Friedman, et al., 2001) Water can be contaminated with either chemical carcinogens or bacteria (Frumkin, et al., 2004 Savitch, 2000). Indoor toxins such as asbestos, lead from paint, molds, and irritant chemicals can cause cancer, asthma, and learning disabilities or mental impairments (Samet and Spengler, 2003). Finally, toxins from industrial solid waste disposal sites can have significant harmful effects on nearby residents (Lord, 1995).

Adverse Effects and Toxicity

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

Chronic obstructive pulmonary disease COPD

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


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...

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....

Experiential Learning

At three Urban Research Centers funded by the US Centers for Disease Control and Prevention, medical, public health, nursing and social work students joined participatory research teams in Seattle, Detroit and New York City. The teams included neighborhood residents, community leaders, service providers, and researchers, who used community-based participatory research methods to study such issues as social stress and family health, asthma, substance abuse, and immigrant health (Metzler, et al., 2003). These experiences provided students an opportunity to collect data on urban community health problems, learn from community residents, plan interventions, and interact with researchers from several disciplines.

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.

Other Special Situations

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

Pharmacological Toxicological Effects 51 Pharmacology

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

The Platinum Group of Elements Palladium Platinum Rhodium

Pt is a highly corrosive-resistant, catalytic, and strong metal, which has been used for a long time in various applications, mainly in the form of complex salts, for example, platinum chloride, platinum dichloride, platinum dioxide, and platinum sulfate. Platinum complexes, in the form of platinum (II) compounds, cisplatin and carboplatin, are among the most important chemothera-peutic drugs. Biological reactivity, especially hypersen-sitivity, is limited to charged compounds that contain reactive ligands, halogenated Pt salts, and the sensitizing potential increases with the number of chlorine atoms. The sodium and potassium salts of hexachlorplatinic (IV) acid and tetrachlorplatinite (II) are the most potent sensitizers (Ravindra et al., 2004). Symptoms of allergic-like reactions such as lacrimation, sneezing, rhinorrhea, cough, dyspnea, and frank asthma in workers exposed to soluble complex platinum salts have been observed since the early 19th century and were called platinosis...

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).

Atopic dermatitis OMIM 603165

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

Other Agents For Agitation

Cotman (1995) have published the most recent study, reporting that some measures of aggression improved in 8 of 12 patients with dementia who received low doses of propranolol (30 to 80 mg day). The likelihood of adverse reactions in this population, including bradycardia, hypotension, worsening of congestive heart failure, or asthma, as well as others, is high. As there are no placebo-controlled, randomized studies of this class of agents, it probably is relegated to rare, unconventional use.

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.

Risk Factor Surveillance and Medical Room Utilization

Room was limited to simple manual tallies. Because these encounters were documented on a paper record, there was no ready way to generate reports by type of complaint or diagnosis, view other data about students during a consultation (such as attendance, vision screening, immunization records), or track students over time, especially if the student moved within the school system, a relatively common occurrence. To address this, an ambitious effort was undertaken to automate the school health record. The Automated School Health Record (ASHR) also produces reports, so that the nurse can generate, for example, a list of all children who failed the vision exam, or have asthma or diabetes.

Strategies Directed at Communities with Greatest Need

The catchment area for each DPHO ranges between 225,000 and 500,000. East and Central Harlem comprises about 225,000 residents. Most residents are black (56 ) or latino (35 ) and poor, with 37 living in poverty (as compared to the citywide average of about 20 ) (Karpati, et al., 2003). Its health profile reveals a high rate of obesity, diabetes and childhood asthma. Initial activities identified by the DPHO staff include better management of childhood asthma and the promotion of physical activity. Staff have partnered with the New York City Department of Parks and Recreation to offer Shape Up New York, a free family exercise program. Asthma activities have focused on the development of an asthma registry in schools. In their role as coordinator of public health activities within the community, the DPHOs have housed and provided support to the agency's public health detailing program, a door-to-door direct marketing program for prevention targeting health care settings. In the last...

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...

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...

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

Conclusions and outlook

A reduction in transport-related air pollution may have a direct health benefit in reducing acute asthma attacks and related medical care, as observed in children. The intervention studies of long-term changes reported several health benefits, such as a decline in bronchial hyperactivity, a decline in the average annual trends in deaths from all causes and from respiratory and cardiovascular diseases, and a gain in life expectancy. Owing to the limited amount of evidence, however, one should still be reluctant to draw firm conclusions about the health benefits of these particular changes.

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...

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...

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.

Medical management of postpartum hemorrhage

If uterine massage and oxytocin are not effective in correcting uterine atony, methylergonovine (Methergine) 0.2 mg can be given IM, provided there is no hypertension. If hypertension is present, 15-methyl prostaglandin F2-alpha (Hemabate), one ampule (0.25 mg), can be given IM, with repeat injections every 20min, up to 4 doses it is contraindicated in asthma.

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.

Coping with Asthma

Coping with Asthma

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

Get My Free Ebook