Natural Asthma Cure and Treatment

Asthma Free Forever By Jerry Ericson

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Asthma and Allergy Foundation of America A

Patient organization dedicated to improving the quality of life for children with asthma and allergies through education, advocacy, and research. The Asthma and Allergy Foundation of America (AAFA) a not-for-profit organization founded in 1953, provides practical information, community-based services, support, and referrals through a national network of chapters and educational support groups. AAFA also sponsors research toward better treatments and a cure for asthma and allergic diseases. (For contact information, see Appendix I.)

Exacerbations of allergic asthma

Exacerbations of asthma result in an acute decrement in lung function and can be caused by many inhaled environmental or infectious insults. Asthma exacerbations are an important clinical problem and contribute significantly to use of healthcare resources, quality of life and challenges in asthma management 103-105 . Both bacterial and viral infections are major factors associated with exacerbations of allergic asthma (review 106 ), although the specific components of these pathogens which results in a worsening clinical status have not been extensively studied. Severe asthmatics can present with relatively high numbers of neutrophils in the airways 24 . Therefore, the mechanisms leading to exacerbations of asthma could be related to either enhanced allergic inflammation (TH2) or recruitment of neutrophils (Th1) into the airways, or both. Given the potential of TLR signaling to both enhance allergic responses and promote neutrophil recruitment, it is reasonable to propose an...

Mechanisms of tolldependent regulation of allergic asthma

TLR-mediated activation of the innate immune system can either diminish or exacerbate asthma, depending on the dose, timing, duration of the exposure to the TLR ligand, and the genetic background of the affected individual. TLR agonists can act as adjuvants during sensitization. Epidemiologic and murine data support the theory that chronic exposure to TLR agonists early in life protects against the future development of asthma. Activation of the innate immune system with acute exposures to TLR agonists can adversely affect airways disease in patients with existing lung disease by either promoting the recruitment of inflammatory cells into the lung or enhancing the proinflammatory response to inhaled allergen. Therefore, TLR-dependent signaling can modify allergic inflammation by at least four independent mechanisms depending on dose, duration of exposure and host factors. These four independent mechanisms of regulation of allergic inflammation include as an adjuvant during...

Asthma

Asthma is a chronic lung condition that causes breathing difficulties and wheezing when air passages become inflamed and narrow. Some people have only occasional, mild symptoms, while others have nearly constant symptoms with severe, life-threatening flare-ups. Circadian-related changes constrict the airway during the overnight hours, often causing nocturnal asthma attacks that rouse the sleeper abruptly. Breathing difficulties or fear of having an attack may make it more difficult to fall asleep. One study found that nearly 75 percent of people with asthma experienced frequent awakenings every week. Medications (bronchodilators and anti-inflammatory drugs) can usually control asthma attacks, reducing nighttime awakenings. However, they have stimulant side effects and may cause difficulty falling asleep.

Triad Asthma

This disease gets its name from its three associated problems asthma, aspirin sensitivity, and nasal polyps. Triad asthma, which is also referred to as Samter's triad or aspirin-induced asthma, is a relatively common disorder, thought to occur in up to 10 percent of those with asthma. People with triad asthma have an overactive enzyme that leads to chronic inflammation of the mucous membranes in the sinuses and lungs. This enzyme, called 5-lipoxygenase, results in the overproduction of certain inflammation-causing substances called leukotrienes. Although those with triad asthma do not have a true allergy to aspirin in the sense of an immune-triggered response, ingestion of even one aspirin can cause a serious asthma attack. Non-steroidal anti-inflammatory drugs, such as ibuprofen (Advil, The polyps associated with triad asthma usually grow so large that they obstruct nasal breathing and impair sense of smell. Although postnasal drainage is typically present, pain is usually minimal or...

Alexander Graham Bell Association for the Deaf

A family history of allergic rhinitis is the greatest known risk factor for the condition. other risk factors include higher social class, male gender, breast-feeding for more than one month, being the first born, having a mother with asthma, and having a dog in the home.

Americans with Disabilities Act ADA

As with other penicillins, some children may be allergic to this medication. Hypersensitivity reactions are more likely to occur in children who have previously demonstrated hypersensitivity to penicillins and in those with a history of allergy, asthma, hay fever, or hives. Nausea and vomiting also are common side effects.

Differential Diagnosis1

Hyperinflation as seen on chest x-ray. In addition, pancreatic insufficiency and failure to thrive are also common characteristics of the disease. In most cases, the diagnosis of CF involves elevated Na+ and Cl sweat concentrations as measured by quantitative pilocarpine iontophoresis. Elevated sweat tests can be seen in patients with other disorders such as fucosidosis, glycogen storage disease type 1 mucopolysaccharidosis, hypothyroidism, celiac disease, malnutrition, and asthma. These diseases are clinically distinguishable from CF, and an elevated sweat test (> 60 mmol L) is usually sufficient for CF diagnosis. However, atypical CF cases have been described in which the sweat chloride values were below 60 mmol L.2 The sensitivity of sweat chloride determined by quantitative pilocarpine iontophoresis using a cutoff of 60 mmol L is 98 with a specificity of 83 . One drawback of sweat analysis is that a minimum weight of sweat collected (75 mg) is required to ensure accurate results...

Methylmercury A Case Study

The example of methylmercury clearly illustrates the serious impact of just one environmental risk factor. The influences of many other environmental risk factors on health have not been fully documented, and evidence of the influence of environmental factors for some health conditions like asthma is rapidly accumulating (Trust for America's Health, 2001). The association between certain chronic diseases and environmental causes is devastatingly clear, yet knowledge about the scope of environmental health risks and their impact on the public's health is limited. Most states do not track environmental risk factors like pesticides and other hazards or most chronic diseases (such as asthma) and birth defects (Pew Environmental Health Commission, 2001). Certainly, a significant amount of work remains to be done to address the physical environment's powerful influence on health status. A great deal about health determinants in the built and natural environments has been learned in recent...

Racial and Ethnic Disparities in Health

Rates of illness such as asthma are much higher among African Americans than among whites, as are levels of obesity, diabetes, and other cardiovascular risk factors that are often established in adolescence and young adulthood. For example, the prevalence of obesity among African Americans is 29.3 percent and that among Hispanics is 21.5 percent, whereas it is 18.5 percent among whites (CDC, 2002). In 2000, the rate of diabetes-related mortality in non-Hispanic African Americans was 49.4 (per 100,000), whereas it was 32.4 in Hispanics and 20.8 in non-Hispanic whites (CDC, 2001b). Rates of death due to HIV AIDS are 31.9 among African Americans and 3.7 among whites (CDC, 2000). be uninsured than white children and are less likely to have a usual source of health care (Weinick and Krauss, 2000). Recent research indicates that disparities in access persist even after controlling for socioeconomic circumstances and health insurance coverage status (Roetzheim et al., 1999 Weinick and...

The Structure Of Clinical Toxicology Testing

Theophylline Theophylline cylate are critical because salicylate poisoning is a common occurrence and early symptoms do not correlate well with prognosis. Theophylline levels are valuable because there is a narrow margin between a safe dose and a toxic dose and a patient may have minor symptoms that can abruptly escalate to major problems such as respiratory and cardiac arrest. A high level is sometimes a major prognostic factor for severe toxicity. Carboxyhemoglobin must be measured because carbon monoxide is a relatively common toxin and CO concentration is suggestive of the severity of exposure. Phenytoin, digoxin, theophylline, lithium Therapeutic drug levels that should be offered but not STAT

Food Allergy Symptoms

'Early allergy' (allergy Type I, II or III) may affect the mucous membrane of the oral cavity (OAS), the stomach (a surface or erosion-like mucous membrane inflammation), or the intestines (inflammatory changes of various degrees of intensity, from eosinophilic infiltration to ulceration or enteritis granuloma Caffarelli et al., 1998 ). Systemic manifestations may have a dramatic course, sometimes leading to death due to anaphylactic shock, which can develop in few minutes after food consumption. Early allergies may also affect internal organs, most frequently the upper respiratory tract (manifested as bronchial asthma). Delayed symptoms may affect the skin (nettle rash), joints (inflammations of single or numerous joints), muscles (myalgia), kidneys (nephrosis), and may also manifest as otitis media and recurrent pneumonia. They may also lead to changes in the central nervous system that cause character and mood changes, hypermotility or tiredness syndrome, headaches, 'chronic...

Arsenic is everywhere

The Romans knew of arsenic materials, as did the contemporary civilizations of China and India. The Chinese used them to kill flies and rodents, and the Indians used them to preserve paper from attack by insects. The Roman writer Dioscorides (40-90) wrote De Materia Medica Medical Matters in which he listed scores of remedies, mainly of the herbal kind, but also of the mineral variety and among these he mentioned orpiment and realgar, both of which are natural arsenic sulphides. The former he called arsenikon, which he said could be used to repress 'excrescencies', in other words warts and other skin eruptions, although he did warn that using it might cause the hair to fall out. The latter he called sandarache and recommended it for 'spitters of rotten matter' and wrote that it should be mixed with rosin and heated and the smoke that evolved should be breathed in, thereby curing such coughs and also asthma.

TLR and common inhaled environmental toxins

Els of endotoxin have been found in dust from the home environment, tobacco smoke, indoor ventilation systems, particulate matter in air pollution and in a wide variety of workplace environments 15, 16, 35-40 . Although bacterial DNA is also ubiquitous in the environment and can be isolated from both home and farm dust 41 , the presence of endotoxin is better documented, in part because the limulus amebocyte assay can detect very low levels of endotoxin. It is possible that other TLR ligands are as ubiquitous as endotoxin but have not been as widely detected as the assays used to measure their concentrations are generally less sensitive. In addition, the environmental levels at which individual TLR ligands can impact on asthma is currently not known. Inhalation of ambient particulate matter (PM10) has long been known to exacerbate airway disease. Epidemiological studies have shown that asthma-related hospital emergency room visits increase during periods of increased PM10 levels 42-44...

TLR ligands during allergen challenge

In addition to their effects on sensitization, TLR ligands can also affect allergic responses when given during the challenge phase of the model 76, 78, 80, 81 . Generally, these ligands are proinflammatory and increase the allergic response when the period of challenge is relatively short 76, 78, 80, 82 . Recruitment of TH2 cells into the lung associated with endotoxin exposure can occur independent of a specific allergic antigen 82 . In contrast, during prolonged challenges, low doses of endo-toxin can suppress allergic inflammation in both mice 83-85 and rats 77, 86-88 . Similar suppression of allergic inflammation in murine models has been observed with ligands of TLR2 89, 90 , TLR9 91 , and with ligands of TLR4 other than endotoxin 92 . This suppression of experimental asthma by chronic low doses of TLR ligands is consistent with the hygiene hypothesis and provides a model to investigate mechanisms underlying this phenomenon. Unlike TLR2 and TLR4, sig naling through TLR9...

Multifactorial and Polygenic Disorders

Multifactorial conditions are believed to have both environmental and genetic components. Multiple genes may play a role in the expression of the condition (polygenic inheritance). Height and skin color are good examples of conditions in which multiple genes and the environment are involved in phenotypic expression. Many isolated birth defects such as pyeloric stenosis, clubfoot, scoliosis, and neural tube defects are believed to have a multifactorial etiology. Common illnesses in adults, such as diabetes, asthma, hypertension, epilepsy, and mental disorders are also thought to have multiple genetic and environmental factors at the root of their expression.

Erasistratus of Chios

Epinephrine is sometimes injected as an emergency treatment for a heart that has stopped beating and is used to treat anaphylactic shock (a severe allergic reaction) and acute asthma attacks. it can be used during surgery to reduce bleeding, and when combined with a local anesthetic, it prolongs the numbing effect by slowing down the rate at which the anesthetic spreads into adjoining tissue.

Generalist Or Specialist

Despite their specialized focus, emergency physicians are, in a way, true gener-alists. Although some may categorize these physicians as jack of all trades, master of none, emergency physicians do have their own area of expertise knowing the most important (i.e., acute or life-threatening) presentations of problems across the entire medical spectrum. They must be as comfortable with a gynecologic emergency as with a pediatric trauma patient. In a single work shift, an EM doctor can deliver a baby, stabilize an accident victim, evaluate a possible case of appendicitis, manage a traumatic airway, treat an asthma attack, and diagnose congestive heart failure. No other specialty of medicine, not even EM's closest cousin family practice matches the breadth of acute problems that these physicians must be prepared for. Because emergency medicine physicians really get to do it all, students who enter this specialty like the fact that they will be real doctors. You will know what to do if...

Emergency Medicine Requires Many Skills

While one case is being stabilized, many more are waiting patiently (and often impatiently) for evaluation, treatment, discharge, or admission. The emergency physician constantly juggles many tasks at once, whether acquiring data, making decisions, or performing procedures. Patients, lab results, nurses, chest x-rays, family members, and other physicians all vie simultaneously for your immediate attention. Because you are doing so many things at once, emergency care sometimes requires knee-jerk action, after which additional thinking is necessary. In a short amount of time, you coordinate a wide range of treatment plans, from readjusting an asthma patient's medications to suturing wounds of another patient who also just received a chest tube. With recent advances in medicine, more and more patients are coming to the emergency room with complex problems, such as unusual drug interactions, or complications from procedures that did not exist before, like organ transplants. Now, emergency...

Brightfield microscopy Optical microscopy in

Bronchodilators Substances that dilate airways by relaxing the smooth muscle of the bronchial wall, thus relieving breathlessness caused acutely by asthma or chronically by obstructive pulmonary disease. Often administered by inhalation. Examples include sympathomimetic drugs (salbuterol), antimuscarinic drugs, and xanthines (theo-phylline).

Food Allergy vs Food Intolerance

A food allergy occurs when the immune system reacts to a certain food. The most common form of an immune system reaction occurs when the body creates immunoglobulin E (IgE) antibodies to the food. When these IgE antibodies react with the food, histamine and other chemicals cause hives, asthma, or other symptoms of an allergic reaction.

Epidemiology and Environmental Public Health

Improved disease reporting, surveillance, and epidemiologic studies of these diseases are needed. Little information exists about either the chronic effects of acute exposure to these marine toxins or about the long-term effects of chronic exposures, e.g., elderly populations in coastal retirement communities experiencing annual HABs. Little information is available about the environmental health effects, e.g., asthma exacerbations, from exposure to these toxins.

Allergy and Immunology

Millions of people suffer from allergies, which ultimately affects their workplace productivity and results in billions of dollars lost each year. These reactions include respiratory diseases (asthma, sinusitis, rhinitis), adverse drug effects, and unusual skin rashes. Because allergies have an underlying immunologic component, these specialists are also experts on antibodies, antigens, and other complex A career in allergy and immunology offers immense intellectual satisfaction, as well as good working hours. Here, there is a strong bond between basic laboratory research and its clinical application. When treating patients (both kids and adults), these specialists witness dramatic improvements in physical functioning. Results are usually fast, positive, and much appreciated. Today, more and more people suffer from asthma and other allergic disorders. As such, there is an extremely high demand for internists with formal training in this discipline. Career options are broad and include...

Pulmonology and Critical Care

Despite taking care of the most critically ill patients, these technically superb specialists never lose their cool under pressure. Although considered two separate subspecialties, most clinicians undergo training in both fields. Pulmonology entails the diagnosis and treatment of diseases of the lungs and upper airways, whether infectious, inflammatory, or cancerous in origin. Every day, they interpret arterial blood gas studies and pulmonary function tests. These specialists often serve as consultants to patients requiring expert management of emergent problems like pulmonary hypertension, hemoptysis, and pulmonary embolism. Continuity of care is also important in pulmonary medicine, particularly for patients with chronic problems such as asthma, emphysema, and occupational lung damage. In the multidisciplinary world of critical care, these physicians deal with more than just disorders of the lung. They take care of very sick patients who have life-threatening multi-organ system...

Definition of the Disease

ABPA is an immunologically mediated lung disease that is found primarily in individuals with persistent asthma, cystic fibrosis (CF), or both. In patients with persistent asthma the incidence of ABPA is 1-2 for patients with CF the incidence is higher, with reports ranging from 2 to 15 .2,3 This disease also has an increased association with particular HLA genotypes, HLA-DR2 and HLA-DR5.4 Colonization or infection of the lungs by Aspergillus is initiated by inhalation of airborne spores that are small enough to reach the alveoli. Repeated inhalation of these spores leads to colonization of the airway, and the individual becomes sensitized to the organism. Once sensitized, a Th2-type immune response is induced, resulting in an increase in total serum IgE concentration, Aspergillus-specific antibodies, and significant eosinophilic infiltration. In addition, fungal proteases may damage the bronchial epithelial cells directly. This exaggerated host response and direct damage due to...

Differential Diagnosis

A variety of pulmonary disorders may present with similar findings, including acute exacerbation of asthma. Patients with steroid-dependent asthma should be evaluated for ABPA. Bacterial, viral, and fungal pneumonia should also be considered in patients with pulmonary infiltrates. Typically these patients are acutely ill with fever, and often have purulent sputum. Importantly, there is radiologic similarity between ABPA and tuberculosis, and patients with ABPA may receive antituberculous therapy for an extended period of time while lung damage due to poorly controlled ABPA continues. The absence of fever and the negative culture results from our patient's sputum sample are two clues that lead away from acute bacterial, viral, or fungal pneumonia. Churg-Strauss syndrome, eosinophilic pneumonia, and hypersensitivity pneumonitis may result in peripheral blood eosinophilia. ABPA can be a difficult diagnosis and should not be based on a single clinical or laboratory finding. For instance,...

Common effects of industrial chemicals on workers

These effects can be avoided by the use of containment, protective clothing, and barrier creams. Simply handling a metal like nickel can cause dermatitis (nickel-itch). This can also result from wearing jewellery made from nickel. Lung damage due to chemicals results from inhalation of dusts, vapours, or gases. These may primarily affect the lungs themselves, especially if they are irritant, but can also lead to absorption of the chemical into the blood and damage to other organs. As with the skin, the repeated inhalation of certain chemicals can lead to sensitization which causes occupational asthma. Other breathing disorders, such as emphysema, can result from inhaling irritant or damaging chemicals, for example cadmium fumes or asbestos. Again this can be avoided by con

Immune suppressive therapies See immunosuppression

There are three types of granulocytes eosinophils, basophils, and neutrophils. They are known as granulocytes because they contain toxic granules that destroy invading pathogens. They travel in the blood and lymph system. When they are located in tissues of the body, they are called mast cells. Eosinophils are involved in allergic responses and make up approximately 2 percent of leukocytes. Basophils are only about 1 percent of granulocytes and are involved in immediate response to antigens, as in asthma. Neutrophils are the predominant type of leukocytes, making up approximately 55 percent-70 percent.

Pancreatic Injury By Dlcs

A recent study in F344 N rats of theophylline, a nonspecific phospho-diesterase inhibitor that produces excessive vasodilation, also resulted in periarteritis of the mesenteric and pancreatic arteries that appeared morphologically similar to the arteritis in the TCDD studies.20 The periadven-titial acinar tissue close to the affected arteries was chronically inflamed. This finding suggests the possibility that the arteritis observed in our investigation was caused by the vasoactive effects of the compounds on the affected arteries, although the potential vasoactive effects of these compounds in rats are unknown. Dioxin has been reported to increase mean tail-cuff blood pressure in mice,30 but this increase implies vasoconstrictor rather than vasodilator activity.

Ophthalmology As A Hightech Field

Pharmacologic treatments are important in ophthalmology. Primary open angle glaucoma, for instance, remains one of the largest causes of blindness in the world, affecting over 5 million people.2 Traditionally, topical beta-blocking medicine provided the main form of therapy, but several side effects limited their usefulness in certain patient populations such as asthmatics. Several new medications, including topical carbonic anhydrase inhibitors, alpha-2 agonists, and prostaglandin agonists, have made the medical treatment of glaucoma far more effective. In addition, advances in surgical techniques and the use of anti-metabolites, such as 5-fluorouracil and mitomycin C, have greatly improved filtration surgeries and dramatically improved postoperative wound healing. These advances have greatly improved the chances that patients with glaucoma will live into old age with their vision preserved.

Research in a vulnerable group trial into the causes of sudden infant death syndrome

It is often argued that the only way to research hypotheses about the bad consequences of risky behaviour is to use observational methods of research, for example, into the hypothesis that living near a busy traffic junction causes asthma in young children, or that smoking cigarettes causes lung cancer, because it would not be ethical to set up an experimental trial by, say, moving some children to live near a busy junction and seeing whether they contracted asthma or not. The fact that there is a concern with the risk of the exposure means that it can only be measured in an observational model. By contrast, the babies' deliberate exposure to 15 oxygen was an attempt to create the environment which the researchers believed may have been the cause of sudden infant death syndrome. The infants were placed in that environment in order to see what the effect was.

Box 243 Pharmacogenetics

The emerging field of pharmacogenomics involves the study of human genetic differences that contribute to differences in reactions to drugs. In some cases, such as malignant hyperthermia, the variability may take the form of an iatrogenic, or drug-induced, illness. In other cases, there may be a difference in response to the drug, as has been seen in the cases of some asthma sufferers who do not respond to an asthma medication because they have a mutation that changes the receptor protein that binds the drug. One form of glaucoma results when individuals who are susceptible to the effects of corticosteroids are exposed to dexamethasone, which causes elevated intraocular pressure that will lead to glaucoma if left untreated (see Figure 24.1). In addition, some patients do not respond to one or more of the glaucoma medications they are given, possibly because of genetic differences in the body's ability to react to the drug. Often, the real array of variability in response to a drug is...

Selected single compounds

An alkaloid present in Ephedra sinica, commonly known as ma huang used as anti-asthmatic, nasal decongestant, weight-reducing agent, and a stimulant. The plant is a component of many dietary supplements advertised as energy-boosters and calorie-burning. Ma huang also contains other alkaloids such as (+)-pseudoephedrine, (-)-norephedrine, (+)-norpseudoephedrine, (-)-N-methylephedrine, and (+)-N-methylpseudoephedrine. For each of these compounds an enantiomer is possible, which, however, does not occur in the plant. Therefore, detection of (+)-ephedrine, (-)-pseudoephedrine, or a racemic ephedrine suggests that a given extract or preparation might have been adulterated fortified with less expensive and less active synthetic alkaloids 50,51,53 .

Overview of Pharmacogenetics and Pharmacogenomics

An important application of pharmacogenetics and pharmacogenomics to public health is the ability to determine a priori who will respond favorably (or unfavorably) to a given type of drug treatment. A major challenge is the inter-individual variability (population variance) and intra-individual repeatability in a clinical outcome measure (efficacy or safety) in a target population. There is substantial variability in treatment response, and data already exist to indicate that a component of variability is genetic in nature. Repeatability of a clinical response in a given subject with a chronic recurrent disease requiring continued therapy (e.g., asthma) reflects the heritability in that subject that modulates the response.4 A challenge of future pharmacogenetic clinical trials will lie in designing the research in a way that provides information both on population variance and individual repeatability. Pharmacogenetics and pharmacogenomics allow one to look at research with a fresh...

Metabolic and Inhibitory Interactions

The most clinically significant interaction between some fluoroquinolones and other drugs occurs with xanthine derivatives, most importantly with theophylline but also with caffeine. Inhibition of the cytochrome P450 system and resulting reduction in plasma clearance may cause nausea, vomiting, and, almost exclusively with enoxacin, convulsions during coadministration of theophylline 112 . The reduction in clearance is most pronounced with enoxacin and grepafloxacin, less so with pefloxacin and ciprofloxacin, and either absent or insignificant (< 10 ) with later derivatives 108,113,114 . Neither sparfloxacin, levofloxacin, trovafloxacin, moxifloxacin, nor gatifloxacin significantly inhibit theophylline metabolism 34 . Enoxacin must not be coadministered with theophylline, and dosage of the latter, especially the intravenous form, should either be discontinued or closely monitored (with appropriate modification) during coadministration of ciprofloxacin or pefloxacin. Fluoroquinolones...

Dual recognition hypothesis

G-protein-coupled receptors for prostaglandin D(2) with opposite effects. DPI activation tends to ameliorate the pathology in asthma DP2 is preferentially expressed on type 2 lymphocytes, eosinophils and basophils, and is thought to be important in the promotion of Th2-related inflammation. 2. Cell cycle-regulating transcription factors (DP-1 and DP-2) exist in humans, and there are additional isoforms, DP-lalpha, 278 aa DP-lbeta, 357aa. Form a heterodimer with E2F and regulate progression through the cycle. 3. Gene of pneumococcal bacteriophage (Dp-1) encoding Pal amidase.

Being An Advocate For Children

In every field of medicine, physicians act as advocates for their patients. This role is especially important in pediatrics, where your patients are only beginning to find their voice. With every new issue, pediatricians are always asking themselves, What is it that brought this child here and more specifically, What are the family dynamics at home and the living conditions that may have contributed to this issue Whether taking a careful history when a child suffers a burn, working with community leaders to make homes safer, or just asking about environmental exposures for a child with asthma, pediatricians are always looking for answers that will make a real difference in a child's life.

Critical Care Medicine

Critical care medicine is the perfect fit for pediatricians who prefer an acute fix-it-now-type setting. These subspecialists perform lots of procedures like placing chest tubes, central lines, and endotracheal tubes. They are the experts of physiology and medicine as managers of the ventilators, ventriculostomies, and invasive heart monitors. The ability to think quickly is of paramount importance as they assess and treat patients suffering from head trauma, postoperative cardiac surgery with complex physiology, sepsis, severe asthma, end-stage cancer, and more. Critical care pediatricians also must have a great deal of compassion, sympathy, and the ability to speak with families when their child is dying. The death of a child is especially sad, and parents cope with this tragedy with fear, anger, and frustration. Your empathy and patience help serve as the foundation for their process of grieving, healing, and coming to terms with the loss they are about to experience.

Manipulative and Body Based Methods

Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.

Benzoic acid and benzoates

This group of chemicals, which are found naturally in many fruits, are used as preservatives, a function that they also perform within fruit. Ben-zoic acid itself may be used, or more commonly sodium benzoate (a salt) or ethyl or methyl para-hydroxybenzoate, also known as parabens. They have sometimes associated with adverse effects. Anaphylaxis-like reactions have been reported as well as urticaria. About 4 per cent of people who suffer from asthma may experience breathlessness and wheezing when exposed to benzoates. Parabens are often used as preservatives in cosmetics.

Drug deposition in the respiratory tract

Pathological conditions of the lung, especially obstructive airway diseases such as asthma, chronic bronchitis, or emphysema, may also diminish penetration into peripheral pulmonary regions. Physical mechanisms of particle deposition within the respiratory tract include inertial impaction, sedimentation, diffusion, interception, and electrostatic attraction. Particles with an MMAD between 1 and 6 m generally provide optimum delivery to the lungs, and this fraction is sometimes referred to as the respirable fraction (RF) or fine particle fraction (FPF). Particles larger than 6 m will deposit mainly in the oropharynx those smaller than 1 m will be exhaled during normal tidal breathing. The amount of aerosol deposited in the lung will depend on both the efficiency of aerosol generation and the fine particle fraction.

Membrane bound regulators

The second membrane bound regulator to be identified was ST2, also known as T1, Fit1 and DER4. ST2 is also a member of the IL-1 receptor family possessing three immunoglobulin domains extracellularly 26-28 . Although ST2 is a member of the IL-1R family it does not bind to IL-1a, IL-1P or the IL-1R antagonist 29, 30 . It is an orphan receptor with no known functional ligand. In both mouse and humans differential mRNA processing of the ST2 gene gives rise to two main forms a soluble (sST2) form predominately expressed by fibroblasts 31 and also a membrane bound form of ST2 (ST2L) which possesses a TIR domain and is expressed primarily on haematopoietic cells but also on immune cells such as basophiles, mast cells and selectively on Th2, not Th1, cells. ST2L has been implicated in Th2 cell function as treatment of mice with an antibody to ST2 enhanced Th1 cell responses in mice 32 and neutralization of ST2 inhibits allergic airway inflammation 33 . The soluble form but not the...

Rifampicin See rifampin

Rifampin An antibiotic synthesized from rifamycin B, which is produced by fermentation of Streptomyces mediterranei. It is used in treating Mycobacterium tuberculosis and carriers of neisseria meningitis. It is administered orally. Rifampin decreases the blood levels of such common drugs as atovaquone, Coumadin, corticosteroids, cyclosporine, dapsone, digoxin, fluconazole, keto-conazole, levothyroxine, oral contraceptives, quinidine, propanolol, and theophylline. It is also called rifampicin. (Trade names are Rimactane and Rifadin.)

Basic Pulmonary Anatomy And Physiology

From the trachea to the terminal alveolar sac there are 23 branching events. Three hundred million alveoli are found in each lung. Cartilage content decreases as the diameter of these pulmonary tubes decreases and the cartilage is replaced by smooth muscle. Bronchioles are completely encircled by smooth muscle that sometimes undergoes spasms in the disorder known as asthma.

Reflections On Mental Illness And Psychiatry

Many colleagues in medicine who do not look highly upon psychiatry consider its treatments less effective than those in other areas of medicine. The evidence seemingly refutes this misperception. With its wide array of powerful drugs, treatment in modern psychiatry surpasses conventional therapies found in other areas of medicine. In a study by the National Institutes of Mental Health, the success rates (defined as substantial reduction or remission of symptoms) in treating mental illness were superior to certain medical procedures. It looks like psychiatrists have the edge over cardiologists the success rates for treatment of depression (60 to 65 ), schizophrenia (60 ), and panic disorder (80 ) were significantly higher compared to acute coronary syndromes treated with angio-plasty (40 ) and atherectomy (50 ).3 In a similar study, the success rates of therapy for addictive disorders, such as alcoholism (50 ) and cocaine dependence (55 ), were on the same level as chronic medical...

Chronic Poisoning With Pulmonary Toxicants

The term chronic refers to injury arising from repeated exposure to a disease cause and the time frame of the organ damage is over a relatively long period. Cancer is a good example of a disease process that usually occurs from chronic conditions. Both obstructive and restrictive pulmonary conditions may occur from chronic injury. Asthma is a chronic condition that is induced by sensitivity to many different chemicals. Toluene diisocyanate (Figure 11.3) is a chemical that causes chronic asthma and also causes the patient to be more sensitive to other chemical asthma-causing agents. The bronchoconstriction characteristic of asthma is only one of the hypersensitivities found with airway disease. A hypersensitivity pneumonitis is a chronic condition associated with dyspnea, fever, and chills. Chronic exposure to

Clinical Presentation and Diagnosis

Most children with complete vascular ring malformations present with symptoms of stridor and respiratory distress in early infancy. Older children may present with a seal bark cough and a history of recurrent respiratory tract infections. These malformations are often misdiagnosed as childhood- or exercise-induced asthma. Symptoms of feeding intolerance or dysphagia may be present, especially when the infant is transitioned to solid foods. The diagnosis is suspected on a plain chest radiograph demonstrating a right aortic arch. A barium esophagogram can reliably diagnose a vascular ring and differentiate this from other anatomic causes of airway obstruction (Fig. 36.12). Determining the exact type of vascular ring malformation requires vascular imaging. A contrast-enhanced CT scan or MRI will reliably differentiate the various arch patterns. There is little role for cardiac catheterization.

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A more persistent enhanced physiologic tremor can be seen with many prescription medications or with hyperthyroidism and, unlike the above, may bring the patient to medical attention. More often than not, it proves to be an asymptomatic physical finding. If patients on theophylline, lithium, valproic acid, or tricyclic antidepressants (among others) extend their arms, most will have a subtle tremor of very low amplitude (less than 1 cm) and high frequency.

Answers and Discussion

Q1. (Answer b) Respiratory rate increases during exercise. An intense sport such as ice hockey will cause a greatly increased minute volume. This is equivalent to exposure to a much higher concentration by a sedentary subject. Pre-existing pulmonary conditions would be important but there is no record of such a condition in this patient. Asthmatics, in particular, Q2. (Answer a) 2400 g m3 1.3 ppm. This is well above the 1 hour air quality standard in Sweden (where this incident occurred) of 110 g m3. Bronchoconstriction can occur in normal subjects at 5000 g m3 and in those with asthma at just 500 g m3. Bronchial hyperactivity may occur in normal subjects at 2000 g m3 and in asthmatics at just 10 of that level.

Chronic Respiratory Disease

Hereditary influences on common respiratory conditions (such as asthma) are just beginning to be elucidated. It is most likely that several genes are involved, with gene expression influenced by environmental exposures to allergens, air pollutants, and smoking. The major single gene contributors to respiratory disease are cystic fibrosis and alpha-1-antitrypsin deficiency. Individuals with Young syndrome or Kartagener syndrome may have chronic sinopulmonary infections. Cystic fibrosis should also be considered in individuals who appear to have Young syndrome or Kartagener syndrome. All four conditions are autosomal recessive. The carrier frequency of cystic fibrosis is common enough in some ethnic populations that it is not unusual to see cystic fibrosis occur in more distantly related family members (for example, related as a cousin, niece, or nephew to a person with cystic fibrosis). An

Concha Bullosa Or Silent Reflux

Anaphylaxis serious allergic reaction involving the onset of hives, swelling of the throat, and difficulty breathing occurs rarely as a side effect to certain medications and foods caused by aspirin in people with triad asthma aspirin-induced asthma see triad asthma Samter's triad see triad asthma Systemics individuals on the Sinusitis Spectrum whose disease is caused by a diffuse or generalized disorder often associated with illnesses affecting other areas of their bodies as well, such as asthma triad asthma a cause of chronic sinusitis characterized by three problems asthma, aspirin sensitivity, and nasal polyps also known as Samter's triad or aspirin-induced asthma

Targeting TLRs with specific ligands

Multiple Phase I human clinical trials have been designed to explore the safety and immunostimulatory properties of CpG ODNs administered alone, or in combination with vaccines, antibodies or allergens. Several Phase II studies are also underway to evaluate the therapeutic potential of CpG ODNs in the treatment of cancer, allergy and asthma, or as vaccine adjuvants. Studies have investigated the use of CpG ODNs to reduce allergic rhinitis and immunization of allergen mixed with CpG ODN, allergen-CpG ODN conjugates, and CpG ODN alone have proved effective in the reduction of the allergic phenotype in mice 59 . Preliminary results using vaccines containing allergen-CpG ODN conjugates in human patients show that this combination reduces allergic symptoms with relatively few adverse reactions 60 . Clinical trials have used CpG ODNs as vaccine adjuvants coadministered with the Engerix B hepatitis B vaccine and the Fluarix influenza vaccine 61, 62 . Healthy adult volunteers were immunized...

Personalized Medicine for Pain Management

Chronic sinusitis is one of the most prevalent chronic illnesses that can affect people of all age groups. In the United States, chronic sinusitis affects approximately 32 million people each year and accounts for 11.6 million visits to physicians' offices.1 Chronic sinusitis is defined as a sinus infection that persists for more than 3 months.1 Common symptoms of chronic sinusitis include nasal congestion, cough, postnasal drip, facial tenderness, and pressure. Most cases are continuations of unresolved acute sinusitis. Allergic and nonallergic rhinitis, anatomic obstruction in the osteomeatal complex, and immunologic disorders are known risk factors.1 The diagnosis of sinusitis is usually confirmed using imaging techniques such as ultrasonography, computed tomography, or magnetic resonance imaging. Medical treatment usually consists of antibiotics, decongestants, and pain medications. However, persistent frontal pain and edema may indicate disease progression and require surgical...

TLR ligands during allergic sensitization

On the surface, findings related to the actions of TLRs in allergic asthma appear highly contradictory as endotoxin has been reported to both exacerbate asthma and diminish its incidence. Multiple epidemiologic studies have shown that exposure to TLR ligands in childhood is protective against developing asthma later in life. Examples of this include individuals living on farms who have a reduced risk of developing hay fever or asthma 66-68 , the inverse relationship shown between prior measles infection and allergic disease 69 , episodes of fever early in life affect the natural history of asthma by preventing the development of atopy 70 , the risk of developing asthma is decreased with increased numbers of siblings 71 and levels of endotoxin in the bed linen of school-aged children are inversely proportional to the incidence of hay fever and atopic asthma 72 . This general epidemiological observation, that exposure to pathogens or their products early in life protects against the...

Individual drug review

A few unfavorable metabolic effects of bBs were reported. bBs might exacerbate glucose intolerance 5,45,46 , increase triglycerides, and decrease high-density lipoproteins 47 . These effects on surrogate end points should not prevent us from using bBs in diabetic patients who have hypertension. Caution should be taken when using bBs in diabetic patients who are at risk for severe hypoglycemia, although there is no convincing evidence that b1-selective blockers increase the risk of masking hypoglycemia symptoms 48-50 . High dosages of selective b1-block-ers should be avoided in patients who have asthma or severe obstructive lung diseases. bBs should not be used in patients who have advanced heart block or sinus node disease without a pacemaker.

Clinical Aspects Of Iliocaval Obstruction

Ivc Obstruction Collaterals

Patients frequently report dyspnea on exertion, even in the absence of any history of pulmonary embolus or respiratory ailments. They may have been told they have asthma. One patient presented with hematuria due to bladder varicosities. In two young patients, presenting at age 17 and 21 years, caval occlusion probably occurred near birth, since each had a single left kidney with compensatory hypertrophy. The common use of central lines in premature and young infants has created a juvenile population with the sequela of central venous thrombosis. The incidence of catheter-related deep vein thrombosis is estimated to be 3.5 per 10,000 hospital admissions, whereas the IVC is affected in approximately 10 of pediatric DVT cases.43 In a longitudinal study, 40 children, diagnosed with IVC thrombosis between birth and 13 years of age, were followed for up to 20 years after recognition of an early thrombotic event.44 Among the patients, 21 were identified with...

Acquired Amnesia In Children

The first of Vargha-Khadem et al.'s (1997) three cases was a 14-year-old girl, Beth. After birth Beth remained without a heartbeat for 7-8 min before resuscitation. Memory difficulties were noticed on entrance into mainstream school. The second case, Jon, was a 19-year-old boy. He had been delivered prematurely at 26 weeks, had breathing difficulties and was in an incubator, on a ventilator, for 2 months. At the age of 4, he had two protracted seizures. Memory difficulties were noted by his parents at age 5.5 years. The third case was a 22-year-old, Kate, who for 3 days at the age of 9 had received a toxic dose of theophylline, a drug being given for her asthma. This led to respiratory arrest and loss of consciousness. Upon physical recovery, she displayed amnesia.

Tartrazine sensitivity

The mechanisms underlying sensitivity to tartrazine are unknown but some observations may suggest a possible cause. Tartrazine is broken down by the bacteria that normally live in the digestive system, giving rise to several products. It has been shown that the urine of animals that have been fed tartrazine, and presumably containing these products, is mutagenic. This means, for example, that when bacteria were exposed to the urine mutations occurred in the genetic material. This suggests that a chemically reactive substance (or substances) is present that reacts with DNA. This reactive substance might be expected to interact with proteins also and (although this is hypothetical) hence produce altered proteins. Altered proteins may be recognized by the body as foreign. The presence of foreign proteins (antigens) can stimulate the immune system to produce antibodies directed against these antigens. This may lead to allergic reactions and other responses of the immune system, that is,...

Potassium the essential deadly poison

Claire Peck was in hospital suffering from an asthmatic attack so severe that doctors had inserted a tube into her throat to help her breathe. The little girl suddenly had a heart attack and Allitt was the only nurse in the ward at the time. The emergency team rushed to help the young girl and revived her, but soon after they left the child, again under Allitt's sole care, she immediately had another attack. This time they could not revive her and Claire Peck died. An autopsy now included analysis of her blood and this showed an unnaturally high level of potassium. The hospital authorities called in the police, and they arrested Allitt.

Circulating immune complexes 103

Ciprofloxacin (Cipro) An oral antibiotic approved for the treatment of many common bacterial infections. It is sometimes administered to treat mac in combination with other drugs. Possible side effects include gastrointestinal upset, seizures, and rash. concomitant administration of antacids like Mylanta or Amphogel that contain aluminum or magnesium hydroxide can lead to the formation of insoluble chelates (heterocyclic chemical compounds) that prevent the drug's absorption, reducing its level in the blood. Sucralfate, a stomach ulcer remedy, has a similar effect and should not be taken with ciprofloxacin. ciprofloxacin, in contrast, can increase the absorption and blood levels of theo-phylline, an asthma remedy.

Dialysis and Hemoperfusion

Dialysis is the process in which the blood is circulated through a bath in which a semipermeable membrane separates the components of the blood from the constituents of the dialysis fluid (Figure 3.1). In dialysis the various substances in blood will diffuse across into the dialysis bath provided that they are small enough (low molecular weight) to transit the membrane and their concentration is lower in the bath than in blood. Many factors relate to the potential effectiveness of dialysis. Tissue binding of the toxin, high volume of distribution for the toxin, and high molecular weight are three factors which diminish the efficacy of dialysis. Lithium, methanol, isopropanol, salicylates, theophylline, and ethylene glycol are examples Methanol Methotrexate Methyldopa Oxalic acid Phenobarbital Potassium chloride Quinidine Theophylline

Healthy versus Neurotic Use of Interpersonal Orientations

Interpersonal orientations influence physical health, too. Horney reported that repressed hostility may cause physical symptoms, such as headaches and stomach problems (1945, p. 58). Research confirms that excessive dependency puts people at increased risk for many physical diseases, including ulcers, asthma, epilepsy, and heart disease (Bornstein, 1998). High levels of hostility (moving against orientation) contribute to coronary heart disease (T.Q. Miller et al., 1996 Roemer, 1987). If these relationships were found only after people became ill, we might dismiss them as only indicating that sick people become dependent. The fact that the relationships are also found in prospective studies (that is, that earlier dependency predicts later illness) indicates that the dependency-illness relationship is not simply an artifact of the sick role.

The Wheezing Woodsman

A 29-year-old man presented to his physician with a history of mild asthma since childhood. His asthma had been managed with periodic use of an albuterol inhaler. He had never required admission to a hospital because of wheezing. He had a chronic morning cough. His asthmatic symptoms worsened after he moved to a very old log-cabin house in a wooded area, 8 months ago. Four months prior to admission he reported chest pain and shortness of breath, particularly after working in his yard and laying ground mulch. Three weeks prior to admission he experienced onset of left-sided chest pain with increased productive cough, night sweats, and weight loss of 2.6 kg. At this time he went to his physician and was treated for pneumonia with a course of azithromycin. A tuberculin skin test was negative. His symptoms did not improve, and he was admitted to the hospital. Table 44.1 Diagnostic Criteria for ABPA Asthma

Shortness of Breath with Productive Cough

The patient's general health had otherwise been fair, and he had no history of allergies. He gave no history of eczema or childhood asthma. He had been hospitalized 4 times during the last 5 years with acute exacerbations of shortness of breath, cough, and increased sputum production. On each occasion, he was treated and discharged from the hospital after about one week the last admission was approximately 4 months ago. His current medications consisted of inhaled bronchodilators (ipratropium and metaproterenol) as well as the diuretic furosemide taken as oral tablets.

Phase I Metabolizing Enzymes Cytochrome P450s

Toxic or nontoxic products.19,47 All of the presented enzymes have been linked to the activation of various nitrosamines and of a broad spectrum of xenobiotics, including carcinogens and therapeutic agents.13,17,20,22,23,48 The expression of CYP enzymes has been studied immunohistochemically and with molecular biological methods in cultured human ductal and islet cells and in tissue specimens from the normal pancreas, chronic pancreatitis, and pancreatic cancer. In 1985, Acheson et al. examined the phar-macokinetics of antipyrine and of theophylline, which are validated probes for CYP activities, in a series of patients with chronic pancreatitis and pancreatic cancer.49 The half-life of each drug was significantly lower, and its clearance faster, in patients than in controls and this pattern was detected in the subgroups with acute pancreatitis, chronic pancreatitis, or pancreatic cancer. Their data suggest an induction of CYPs in all forms of exocrine pancreatic diseases. The enzyme...

TLR polymorphisms and association studies of allergic disease

Given the opposing effects of endotoxin, it is perhaps not unexpected that some studies have not revealed an effect of the common TLR4 polymorphism (D299G) on the overall incidence of asthma 116-118 . Individuals having this polymorphism have a blunted airway response 21 and reduced systemic inflammation 119 in response to inhaled endotoxin. Consistent with these observations, a study of asthma specifically associated with endotoxin in house dust showed that people with the TLR4 polymorphism (D299G) had a decreased risk of bronchoreactivity 117 . These observations are consistent with the hypothesis that endotoxin can exacerbate existing airway inflammation and that individuals with the D299G polymorphism have diminished pulmonary responses to endotoxin. However, other studies found that asthmatic individuals with the D299G polymorphism have an increased severity of atopy 120 and an increased incidence of atopic asthma 121 . Each of these associations with common polymorphisms of TLR4...

Cholesterol emboli syndrome

Chiropractic has fought a long battle with orthodox medicine that has included hunger strikes by imprisoned practitioners and prolonged legal battles, but it is now generally accepted as a form of therapy. Strong scientific evidence supporting the efficacy of chiropractic is limited to a few conditions. Many studies have compared chiropractic manipulation with other forms of treatment for back pain. An overall synthesis of the many studies, often with conflicting conclusions and interpretations, is that chiropractic treatment improves low back pain and neck pain in the short term but is not useful for other medical problems such as asthma. Churg-Strauss syndrome A rare type of vasculitis described by Churg and Strauss in 1951 that is probably a variant of Wegener's granulomatosis and causes asthma, eosinophilia, and vasculitis. The cause of Churg-Strauss syndrome is not known but it seems to be associated with allergy. Most patients have a history of preceding nasal allergy....

Hyoscine and the screaming mandrake root

Scopolamine and plants containing it, such as thornapple, mandrake, and jimsonweed, can have a powerful sedative effect if used at the correct dosage. It has been used also for the treatment of epilepsy and asthma. Poisonous doses will lead to respiratory depression and symptoms such as dry mouth, dilated pupils, and restlessness. At high doses the victim suffers convulsions, delirium, coma, respiratory failure, and death. Jimsonweed, or Jamestown weed, was the cause of many fatal poisonings in 1666 in the American colony in Jamestown, Virginia, when soldiers suffering from hunger during a famine ate the weed.

Arsenic useful drug or deadly poison

Fowler's solution was recommended for other ailments, such as asthma and common neuroses. It was also found to be successful in the treatment of malaria, and was used to destroy nerves in teeth in dentistry. It was still being described for such purposes in a textbook of Materia Medica and Therapeutics published in i92i.4 Arsenic was also used in cosmetics because it was believed to improve the complexion, imparting to it a 'milk rose' appearance.

Consequences of the metabolic syndrome

The metabolic syndrome is associated with increased risk of a variety of disease outcomes, including diabetes, peripheral arterial disease (the association with cardiovascular disease is discussed in Chapter 10), fatty liver and non-alcoholic steatohepatosis (discussed in Chapter 11), polycystic ovary syndrome (discussed in Chapter 12), gallstones, asthma, sleep apnoea and selected malignant diseases.

Complications

Left untreated, allergic rhinitis also can lead to other serious conditions, including asthma, recurrent middle ear infections, sinusitis, sleep disorders, and chronic cough. Appropriate management of rhinitis is an important part of effectively managing these coexisting or complicating respiratory conditions. toms occur with wheezing and shortness of breath, the allergy may have progressed to asthma, which can be a serious condition.

Food Allergies

There is no cure for allergies, but it is possible to treat the symptoms. The easiest way is to eliminate exposure to allergens. If that is not possible, then medications may be given, such as antihistamines or a nasal spray steroid. In some cases, an allergist may recommend allergy shots to help desensitize a child. If a child is extremely sensitive to a particular food, or if the child has asthma in addition to the food allergy, his doctor will probably recommend that parents carry injectable epinephrine (Epipen) to counteract the allergic reaction in the event of an inadvertent exposure.

Analyte

A 13-year-old Caucasian male presented to the clinic with a past medical history remarkable for asthma and pneumonia that required hospitalization on several occasions. The patient complained of a chronic cough, which affected his daily activities along with chronic sputum production and failure to thrive. He developed shortness of breath during minimal exercise activities. No hemoptysis was noted. GI evaluation indicated voluminous stools once a day and loose at times. Pancreatic insufficiency was not suspected.

Hypnosis

In hypnosis, an individual (the subject) experiences a highly suggestible state, often called a trance, in which the suggestions of a hypnotist strongly influence what is experienced or recalled. The hypnotist may suggest that the subject's arm will rise in the air automatically, without the subject intending it, or that the subject will be unable to do something that is usually easy to do, like bending an arm. Suggestions can also alter perceptions, causing subjects to see things that are not there, to not see things that are there, or to not feel pain. In the popular mind, hypnosis can be used to compel people to do what they otherwise would not do, including criminal or sexual acts. In fact, the research evidence does not support these claims (Gibson, 1991), but through posthypnotic suggestion, in which the hypnotist suggests that a particular action or experience (sensation) will occur when the hypnotic trance is ended, therapeutic benefits can occur. For example, a hypnotist may...

Heroin

Clearly addiction to or dependence on the drug is an adverse effect. Although the drug, heroin, itself may not be especially hazardous in the doses needed to cause a pleasurable effect or 'high' in a naive subject, repeated use of the drug will lead to both addiction or dependence and tolerance (see below) which increase the likelihood of toxic effects occurring. For example, the increasing doses needed due to tolerance may lead to suppression of breathing and a reduction in the sensitivity of the brain to carbon dioxide so that breathing may stop, for example during sleep. Other drugs that have a depressant effect, such as alcohol, will increase the likely toxicity if taken together with morphine or heroin. Other effects are constipation and the possibility of causing asthma in susceptible individuals.

Bioavailability

Biofeedback A technique of monitoring minute, normally imperceptible metabolic changes in one's own body, such as temperature changes, heart rate, and muscle tension, with the aid of sensitive machines, for the purposes of exerting control over them consciously. By visualizing, relaxing, or imagining, while observing light, sound, or metered feedback, one is said to be able to learn to make subtle adjustments to achieve a more balanced internal state. For some people this can be an effective way of controlling pain. The technique is also used for stress-related conditions, such as asthma, migraines, insomnia, and high blood pressure.

St Johns wort

This herb (Hypericum) is widely used for the treatment of mild depression indeed, in Germany it outsells the synthetic drug Prozac. It has been shown to be effective and adverse effects do not seem to be a problem. However, it does interfere with the disposition of other drugs. In particular, it will generally reduce the activity of certain other drugs which may lead to a failure of treatment. This occurs because St John's wort is able to induce the enzymes that metabolize other drugs. The amount of the enzyme is thus increased, which leads to increased metabolism and excretion of the other drugs. Therefore a drug given after the herb has been used may not reach the required therapeutic concentration, or will not be active for so long, or conversely more of an active or toxic metabolite could be produced (see p. 34 for further explanation of this effect). Thus drugs used for the treatment of blood clots (warfarin), asthma, and heart disease, and the contraceptive pill, can all be...

Bugchaser

Bronchoalveolar lavage (BAL) The introduction, by use of a fiberoptic bronchoscope, of a sterile saline fluid into the lung in order to remove secretions, cells, and protein from the lower respiratory tract. In HIV it is used to diagnose pneumo-cystis carinii pneumonia (PCP). BAL is also used to treat cystic fibrosis, pulmonary alveolar pro-teinosis, and severe asthma with bronchial obstruction due to mucus plugging.

Vocabulary Builder

Bradykinin A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. nih

Gaps in Surveillance

Existing surveillance activities contain notable gaps. In particular, little information is routinely collected on chronic diseases and conditions, such as asthma and diabetes, even though chronic diseases account for four of every five deaths in the United States and annually cost the nation approximately 325 billion in health care and lost worker productivity (Pew Environmental Health Commission, 2000). Similarly, environmental pollutants and toxins are monitored primarily for the purposes of environmental protection and regulation, but no surveillance and tracking system monitors the health outcomes, such as birth defects and developmental disorders, that are potentially linked to toxic exposures. With an improved awareness of these health risks and a more comprehensive understanding of the health status of the population, public health agencies from the federal to the local level would be able to design better interventions and prevention efforts. The Pew Environmental Health...

Industrial Chemicals

Industrial diseases have existed ever since humans began manufacturing on a large scale, and during the Industrial Revolution they were common. Before that, certain occupations, like mining, were hazardous. In ancient times those working in arsenic or lead mines would undoubtedly have suffered from the adverse effects of the minerals they mined. Arsenic mines in Pantus in ancient Greece were described by Strabo, the Greek historian, as follows 'the air in the mines is both deadly and hard to endure on account of the grievous odour of the ore, so that the workmen are doomed to a quick death.'1 Some occupational diseases were common, and had well-known names, such as hatter's shakes (see below), farmer's lung (allergic lung damage asthma from inhaling fungal spores in hay), and phossy jaw (fragile jawbone from phosphorus exposure).

Histamine

It is well known that, in humans, the classical antihistamines, which are Hj-receptor antagonists, used to treat asthma and allergy cause sedation and drowsiness, and one would therefore expect that HA's effect on waking would be mediated by this receptor. Mepyramine, an Hj-receptor antagonist, causes an increase in cortical slow waves, a decreased latency to SWS, and a prolongation of SWS that is associated with decreases in both waking and REM sleep in the cat (25). Activation of the Hx receptor with selective agonists, on the other hand, markedly increases wakefulness and decreases all phases of sleep in rats (26,27). It has recently been shown that knockout (KO) mice lacking either the HA-synthesizing enzyme histidine decarboxylase or the Hj receptor are unable to stay awake in response to environmental changes. In the beginning of the lights-off period, wild-type mice spend a comparatively large amount of time awake, and if they are transferred to another cage, they may stay...

Adolescent Medicine

In this growing subspecialty, prominent areas of prevention and treatment include substance abuse, eating disorders, acne, sexually transmitted diseases, pregnancy, and depression. In addition, adolescent medicine emphasizes the management of chronic diseases that begin in childhood and continue into adulthood, such as asthma, cystic fibrosis, congenital heart disease, and diabetes. Practice settings include high school- and university-based student care centers, mobile clinics, and outpatient clinics. Many adolescent medicine specialists work within large academic medical centers or in the public health sector.

Aerosolization

The use of aerosols for pulmonary delivery of peptides and proteins is discussed in Chapter 9. In this section, the stability issues for peptide and protein drugs related to the unique operational mechanism of aerosols are discussed. An aerosol may be generated by a nebulizer, a metered dose inhaler (MDI), or a dry powder inhaler. The MDI uses chlorofluorocarbons as propellants and is currently the most common form of inhalation aerosol. With each actuation of the MDI, a precise volume dose is delivered through a metered valve. Conventional drugs currently marketed as MDIs include metaproterenol, triamcinolone, beclomethasone, terbutaline, dexametha-sone, isoproterenol, phenylephrine, cromolyn, epinephrine, ergotamine, and albuterol, among others.

Trials in homeopathy

Twenty-eight patients with allergic asthma, most of them sensitive to house-dust mite, were randomly allocated to receive either oral homeopathic immunotherapy to their principal allergen or identical placebo. The test treatments were given as a complement to the unaltered conventional care. A daily visual analogue scale of overall symptom intensity was the outcome measure. A difference in visual analogue score in favour of homeopathic immunotherapy appeared within one week of starting

Information campaign

Inhalant A prescription, volatile drug, chemical, or other substance inhaled for the effect of its vapor. The device used by asthmatics to inhale medicine is called an inhaler, or bronchodilator. The device used to inhale medicines in a more concentrated form, a procedure that involves usually going to a doctor's office or hospital, is called a nebulizer. There is a tube connected from a patient's nose to the substance with an aerosol or other spray mechanism. Patients inhale as the tube delivers a concentrated medicine that has been nebulized. Dry or moist air, vapor, gases such as oxygen, or anesthetics are among the substances introduced into the lungs for therapeutic purposes.

Latin America 277

Latex allergy Allergy to the fluid or sap produced by some plants. people with this allergy could be allergic to such simple things as balloons, doctors' gloves or condoms made out of latex. This is a potential problem for doctors, fast-food workers, toll takers, janitors, police officers, and especially health care workers who routinely wear latex gloves as protection against AIDS. Mild sensitivity can produce a skin rash. Extreme sensitivity can include symptoms similar to hay fever or asthma. Severe allergic reactions to latex can include ana-phylactic shock and death. Medical and dental personnel should ask every patient about the possibility of latex allergy, especially those scheduled for surgery. patients who have had multiple surgeries are at high risk. Also at high risk are those allergic to bananas, chestnuts, avocados, and some tropical fruits. potential sexual partners should also be queried about latex allergy. The government has yet to set standards on safer alternatives.

Box

The product allows employees and their families to assess, record and improve their health on a daily basis. It includes general and gender-specific health risk assessment tools that cover past health issues, family history, and lifestyle habits a secure location for individuals to create, gather, and store health records a source of education information on conventional and alternative treatment options for important health topics such as allergies, asthma, depression, diabetes, cancer, and stress and interactive, self-paced programs designed to assist individuals in achieving positive, healthful change such as quitting smoking, improving nutrition and fitness, or preparing for a healthy pregnancy.

Generalities

What is that said I, putting on my stern look which I call up but once a year. Well, eat and grow fat, become ugly, asthmatic and die of melted fat. I will make a note of your case and you shall figure in my second edition. Ah I see, one phrase has overcome you, and you beg me to suspend the thunderbolt. Be easy, I will prescribe your diet and prove how much pleasure is in the grasp of one who lives to eat.

Pulmonology

Almost every disease process can affect a child's breathing and lung function, making pulmonology a very busy and exciting field. With infants, the pulmonologist helps to determine whether repeated wheezing episodes are from environmental triggers or due to aspiration from a swallowing dysfunction or gas-troesophageal reflux. For toddlers, they get to use bronchoscopes to remove small Lego pieces that have been aspirated and polysomnograms to diagnose sleep apnea. Children of any age acquire complicated pneumonias that may form loculated pleural effusions needing a chest tube for drainage. When a child has asthma severe enough to cause more than one admission to a hospital, a pulmonologist is consulted and continues to see them as an outpatient, providing important education and treatment that will help save the patient's life.

Tartrazine

The food colour tartrazine is a well-known food additive which is currently still in use, although it was removed from many products as a result of consumer pressure. Known also as E102 in Europe and FD& C yellow no. 5 in the USA, tartrazine is an azo dye with an intense yellow orange colour. Its similarity in colour to natural orange juice has meant that it is used extensively in the soft drink industry, and it has been also used in products as wide-ranging as breadcrumbs and medicines. It is one of the colours most frequently implicated in food intolerance studies and also in reactions to pharmaceutical preparations to which it was sometimes added. Effects occur most commonly in children, and it is thought that i in i0,000 children are sensitive to tartrazine. According to Feingold and his team, adverse reactions to tartrazine seem to occur most commonly in subjects who are also sensitive to aspirin and salicylic acid, a finding that has been confirmed by other studies.4...

Other food colours

While tartrazine seems to be the food colouring most frequently associated with adverse reactions, other colouring agents are also known to cause mental and or physical ill effects, for example cochineal, a natural agent Ponceau 4R (E124) and erythrosine (E127). Both erythrosine and cochineal have been associated with hyperactivity in children, while Ponceau 4R should be avoided by those with asthma and those who are sensitive to aspirin, a salicylate.

Service

Academia engages in service to the community in many ways. One approach to service is through various centers and institutes. For example, in 2002 the University of Washington's Center for Ecogenetics and Environmental Health conducted a town meeting to engage in discussions with the community on racial disparity, poverty, and pollution. Activities brought together researchers, legislators, and community members to discuss the health risks of pesticides to agricultural workers and their families, contamination of seafood by marine toxins and chemical pollutants, hazardous waste sites, culturally appropriate research strategies, and links between indoor and outdoor air pollution and asthma. These discussions led to a number of projects designed to address community-identified concerns and needs.

Premature babies 413

With age (by 50 postconceptional weeks, apnea is rare). All premature babies are monitored for apnea if it occurs, the baby is gently stimulated to restart breathing. If apnea occurs frequently, the infant may require medication (most commonly caffeine or theophylline) and a special nasal device that blows a steady stream of air into the airways to keep them open.

Right to know 427

Rifabutin An oral drug approved by the U.S. food AND DRUG ADMINISTRATION for preventing mycobacterium avium complex (MAC) in people with aids and CD4 cell counts of less than 75. Rifabutin is also used in combination with other drugs for the treatment of active MAC infection. Rifabutin seems to have fewer drug interactions than rifampin, yet like isoniazid (INH) can change liver enzyme production and thus alter the metabolism of Coumadin, Dilantin, Tegretol, theophylline, and the benzodiazepines (Atavin, Valium). Other

Angiogenic Disorders

After birth, angiogenesis still contributes to organ growth, but during adulthood most blood vessels remain quiescent angiogenesis only occurs in the cycling ovary and placenta during pregnancy. However, endothelial cells (ECs) retain the remarkable ability of dividing rapidly in response to a physiological stimulus, such as hypoxia and inflammation. Angiogenesis is also reactivated during wound healing and repair. In many disorders, however, this stimulus becomes excessive, and the balance between stimulators and inhibitors is disturbed, resulting in an angiogenic switch. The best-known conditions in which angiogenesis is switched on are malignant, ocular and inflammatory disorders, but many additional processes are affected-such as atherosclerosis, asthma, diabetes, cirrhosis, multiple sclerosis, endometriosis, acquired immunodeficiency syndrome (AIDS), bacterial infections and autoimmune diseases (Table 1). In obesity, adipose tissue may also show excessive growth. A high-fat diet...

Gas Exchange

In the broadest sense, pulmonologists divide lung disease into two types of conditions. Restrictive conditions are associated with decrease in elasticity of lung tissue that leads to a reduction in maximum flow rate and a reduction in total volume exhaled. An example of a restrictive disease is pulmonary fibrosis. The second type of condition is obstructive disease such as asthma, chronic bronchitis, or emphysema. In obstructive disease, there is an obstacle to air flow. In restrictive disease, both FEV1 and FVC are reduced, but the FEV1 FVC is normal or even increased. It is said that the hallmark of restrictive disease is reduction in lung volumes. Measurement of lung volumes enables one to assess the severity of restrictive disease. As stated above, obstructive disease is manifested by a decrease in expiratory airflow. In these conditions the FEV1 is reduced much more than the FVC causing a low FEV1 FVC . Thus, measurement of these parameters enables a physician to improve

Therapeutic Area

For life-threatening indications such as oncology, many participants felt that there is more willingness in clinical practice to stratify on the basis of pharmacogenetics and pharma-cogenomics. In other therapeutic areas in which many effective agents are already available and physicians are accustomed to titrating the dose in individual patients (e.g., depression), it was thought that there was less willingness to stratify on the basis of phar-macogenetics and pharmacogenomics until differences in response are linked to genotype differences. For many other therapeutic areas (e.g., asthma and respiratory), there is some interest in using pharmacogenetics and pharmacogenomics for stratification.

The B7H3 Pathway

The in vivo function of B7-H3 is currently under debate. In the presence of CD3 mAb, immobilized or surface expressed B7-H3 was found to be either costimulatory (105,109) or inhibitory (110) or no effect (108) for T-cell proliferation and cytokine production in vitro. B7-H3-deficient mice developed more severe Thl-mediated hypersensitivity in an airway inflammation model (110), supporting an inhibitory role of B7-H3 in vivo. In contrast, expression of B7-H3 showed costimulatory antitumor activity in mouse tumor models. Intratumoral injection of mouse B7-H3 expression plasmid into EL-4 led to complete regression of 50 tumors mediated by CD8+ T-cells and natural killer (NK) cells (111). Expression of B7-H3 in P815 tumor costimulated expansion of antigen-specific CD8+ CTL clone and led to enhanced recognition and destruction of tumor cell by CTL in vivo (109). Therefore, B7-H3 is a potential candidate for cancer therapy.

Massage therapy

Mast cell A cell resident in connective tissue just below epithelial surfaces, serous cavities, and around blood vessels, including those in bone marrow. They synthesize and store histamines. When stimulated, they release mediators of inflammation. They are also important in producing the signs and symptoms of immediate hypersensitivity reactions (e.g., drug anaphylaxis, urticaria, insect stings, allergic reactions, and certain forms of asthma).

Dealing With Asthma Naturally

Dealing With Asthma Naturally

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