What is naet therapy for allergies

How to Stay Healthy, Breathe Easier, and Feel Energetic This Winter

Indoor allergies, freezing weather, less sunlight — winter can make it hard to stay well mentally and physically. Discover out how to protect yourself against seasonal allergies, the winter blahs, freezing winds, comfort-eating traps, and fatigue this year.

Learn More About the Ultimate Winter Wellness Guide

Sinusitis can be a confusing thing to treat for anyone. Because a sinus infection can be so easily confused with a common freezing or an allergy, figuring out the best way to alleviate your symptoms can be difficult.

Even more challenging, a sinus infection can evolve over time from a viral infection to a bacterial infection, or even from a short-term acute infection to a long-term chronic illness.

We own provided for you the best sources of information on sinus infections to assist you rapidly define your ailment and get the best and most efficient treatment possible.


The Best Research Resources

American Academy of Allergy, Asthma, and Immunology

This academy’s website provides valuable information to assist readers determine the difference between colds, allergies, and sinusitis.

A primer guide on sinusitis also provides more specific information about the chronic version of the illness. Additional resources include a «virtual allergist» that helps you to review your symptoms, as well as a database on pollen counts.

American College of Allergy, Asthma, and Immunology (ACAAI)

In addition to providing a comprehensive guide on sinus infections, the ACAAI website also contains a wealth of information on allergies, asthma, and immunology. The site’s useful tools include a symptom checker, a way to search for an allergist in your area, and a function that allows you to ask an allergist questions about your symptoms.

Asthma and Allergy Foundation of America (AAFA)

For allergy sufferers, the AAFA website contains an easy-to-understand primer on sinusitis.

It also provides comprehensive information on various types of allergies, including those with risk factors for sinusitis.

Centers for Disease Control and Prevention (CDC)

The CDC website provides basic information on sinus infections and other respiratory illnesses, such as common colds, bronchitis, ear infections, flu, and sore throat. It offers guidance on how to get symptom relief for those illnesses, as well as preventative tips on practicing good hand hygiene, and a recommended immunization schedule.

U.S.

National Library of Medicine

The U.S. National Library of Medicine is the world’s largest biomedical library. As part of the National Institutes of Health, their website provides the basics on sinus infection. It also contains a number of links to join you with more information on treatments, diagnostic procedures, and related issues.


Am I allergic to glyceryl monothioglycolate?

Skin patch testing is used to determine glyceryl monothioglycolate sensitisation. Often hairdressers are also sensitive to other chemicals used in hair cosmetics such as paraphenylenediamine (PPD) that is widely used in hair dyes.


What are the reactions to glyceryl monothioglycolate allergy?

People working with glyceryl monothioglycolate such as hairdressers may develop allergic contact dermatitis on their hands and fingers; patch testing generally reveals hypersensitivity to the chemical.

Clients receiving perms whom are sensitive to glyceryl monothioglycolate may also suffer contact dermatitis on the neck, scalp and ears.

Often exposure is much less intense and frequent than in hairdressers, hence the allergy is less commonly found in clients. However, the chemical can remain athletic in hair shafts for months thus causing long-lasting dermatitis.


Favorite Resources for Finding a Specialist

American Rhinologic Society

Through research, education, and advocacy, the American Rhinologic Society is devoted to serving patients with nose, sinus, and skull base disorders. Their website’s thorough coverage of sinus-related issues includes rarer conditions, such as fungal sinusitis, which are often excluded from other informational sites. It also provides a valuable search tool to discover a doctor, as well as links to other medical societies and resources that are useful for patients.

Cleveland Clinic

Their website contains an exhaustive guide on sinusitis and an easy-to-use «Find a Doctor» search tool.

ENThealth

ENThealth provides useful information on how the ear, nose, and throat (ENT) are all connected, along with information about sinusitis and other related illnesses and symptoms, such as rhinitis, deviated septum, and postnasal drip.

As part of the American Academy of Otolaryngology — Head and Neck Surgery, this website is equipped with the ability to assist you discover an ENT specialist in your area.

Welcome to the website for Columbo Asthma, Allergy and Immunology. We see adult and pediatric patients at two Pennsylvania locations, in Bryn Mawr, and Paoli.

  1. Our office will be closed on December and will shut at 12 noon on December 31,
  2. Beginning in September, , our office will be open on the first and third Saturday of the month.

    In specific, it will be open on September 7th and 21st, October 5th and 19th, November 2nd and 16th, and December 7th and 21st.

  3. Probiotics and vitamins

    Early studies on the effect of probiotics to affect asthma development by influencing the perinatal microbiome own been mixed. A recent study found significant decrease in the risk of atopic sensitization associated with pre and post-natal istration of probiotics, however there was no effect on asthma or wheeze.
    Vitamins are essential constituents of our diet that own endless been known to influence the immune system.

    Vitamins A and D own received specific attention in recent years as these vitamins own been shown to own an unexpected and crucial effect on the immune response.

  4. Environment control

    Most convincing evidence for early life environmental exposures influencing the development of asthma would be from randomized controlled interventions to specifically addressing the offending agent and protest lower incidence of asthma development.

    Allergen remediation strategies directed at cat, dog, mold, mouse and cockroach protest substantially decrease exposure levels in homes. Interventions to reduce HDM alone own been effective and seem to improve early outcomes.

    Recent meta-analyses own shown multifaceted allergen remediation programs to be protective against the development of asthma with % reduction in odds. The most protective effect was seen in children with greater than 5 years of follow-up, indicating a true decrease in risk to those prone to develop atopic asthma.

    The best preventative effect of allergen avoidance was the Canadian Childhood Asthma Primary Prevention Study in a high risk birth cohort.

    In this study, the intervention was avoidance of home dust mite, pets, and environmental tobacco smoke starting prenatally, and encouragement of breastfeeding with delayed introduction of solids. HDM interventions included encasing parents’ and infants’ mattresses and box springs, weekly boiling water wash of every bedding and application of benzyl benzoate to carpets and upholstery before birth and at 4 and 8 months of age.

    Children receiving the intervention had significantly less physician diagnoses of asthma, wheeze in the past 12 months and wheeze apart from colds when evaluated at age 7 years. Another birth cohort study also observed significantly fewer asthma symptoms at age 8 years ancient in a high risk birth cohort intervention focused on HDM and food allergen avoidance in early life, and a significant decrease in atopy at the 8 year time point.

    Large studies assessing increased exposure to indoor fungi before the development of asthma symptoms suggests that Penicillium, Aspergillus, and Cladosporium species pose a respiratory health risk in susceptible populations.

    What is naet therapy for allergies

    Increased exacerbation of current asthma symptoms in children and adults were associated with increased levels of Penicillium, Aspergillus, Cladosporium, and Alternaria species, although further work should consider the role of fungal diversity and increased exposure to other fungal species.

  5. Beginning July 1st, , our office will be closed every Wednesday afternoon. It will be open, as usual, in the morning between AM and 12 noon.
  6. Experimental preventive therapies

    In preterm infants without bronchopulmonary dysplasia, Palivizumab, a monoclonal antibody against RSV, reduces respiratory morbidity up to 78%.

    Recent findings in tardy preterm children without BPD suggests that prophylaxis through infancy may decrease recurrent wheeze in the first year of life by 10% and by up to 50% at three years of age. While encouraging, further longitudinal studies are necessary to assess the effect of palivizumab prophylaxis to decrease the incidence of asthma in childhood.
    Recent evidence suggests that anti-allergen immunotherapy to cross-link the FcέR1 receptor may decrease viral induced asthma symptoms. While alterations of the physical environment own been studied, little attention has been given to the approach of altering the immune constitution of high risk individuals.

    In this honor, immunomodulators, such as Omalizumab may be of future interest.

EXPERIENCE
Dr. Columbo has extensive experience in the diagnosis and treatment of asthma, allergic rhinitis (hay fever), non-allergic rhinitis, sinusitis, insect allergy, food allergy, drug allergy, eczema, contact dermatitis, urticaria and angioedema (hives and swelling), and latex allergy. They also treat patients with less common immunologic diseases such as autoimmune diseases and immunodeficiencies. Dr. Columbo has significant experience in designing and conducting clinical studies in asthma and rhinitis.

SERVICES AVAILABLE
Patient services available in our practice include allergen immunotherapy (allergy shots and oral tablets for dust mite, grass and ragweed allergy), allergy testing for pollens, inhalants, foods, and drugs. Testing for contact agents such as chemicals, fragrances, and metals is also offered. Pulmonary function tests are available. Opportunities for participation in clinical studies may also be available. Patient educational material on allergic and immunologic diseases is offered both at our offices and on our website.

PATIENTS — PRESCHOOL AND UP
Dr. Columbo is trained in adult as well as pediatric allergy and welcome patients aged four and older.

We hope you discover this website helpful in your health care decisions. Please call us with questions or for an appointment.

Face below on a massage table, a something corporate attorney grips a tiny vial of clear liquid and breathes deeply, again and again. My wife, Kathryn, an internal medicine specialist whose practice focuses on the arcane arts of alternative healing, presses her thumbs on each side of the woman&#x;s neck and moves slowly below her spine. The lady suffers from chronic fatigue, nasal congestion, and a severely runny nose, which conventional medical treatments own failed to cure.

So she&#x;s come to see Kathryn.

A few weeks later, after a handful of similar treatments, the lady calls to report the results: Every of her symptoms own dramatically improved.

The lady is dumbfounded, as am I. When I press Kathryn to explain how these maladies could be cured with what looks to me love voodoo medicine, she shrugs: It works. What can I say?

Definition and demographics

Asthma is truly a syndrome encompassing several disease entities/endotypes.

The expression asthma derives from the Greek expression for panting, or breathlessness, and thus describes the primary symptom of this disease. Asthma is recognized as a complicated condition with differences in severity, natural history, comorbidities, and treatment response. It has been defined as "a chronic inflammatory disorder associated with variable airflow obstruction and bronchial hyperresponsiveness. It presents with recurrent episodes of wheeze, cough, shortness of breath, chest tightness."

While the critical role of inflammation has been further substantiated, there is an evidence for considerable variability in the pattern of inflammation indicating phenotypic differences that may influence treatment responses.

Gene-by-environmental interactions are significant to the development and expression of asthma. Of the environmental factors, allergic reactions and pollution are of critical importance with expanding role for viral respiratory infections in these processes. The onset of asthma for most patients begins early in life with the pattern of disease persistence sure by early, recognizable risk factors including atopic disease, recurrent wheezing, and a parental history of asthma. Current asthma treatment with anti-inflammatory does not appear to prevent progression of the underlying disease severity.

The most recent comprehensive analyses of the Global Burden of Disease Study (GBD) undertaken in estimates the number of people with asthma in the world as high as million.

A lower figure of million used in the Global Asthma Report came from the most up-to-date GBD information available at that time based on analyses from Prevalence of childhood asthma varies widely between countries, and between centers within countries, and estimated at 14%. Prevalence of recent wheeze in adolescents varied widely. The highest prevalence (>20%) was generally observed in Latin America and in English-speaking countries of Australasia, Europe and North America as well as South Africa. The lowest prevalence (<5%) was observed in the Indian subcontinent, Asia-Pacific, Eastern Mediterranean, and Northern and Eastern Europe.

In Africa, % prevalence was mostly observed. Overall, % of respondents to the World Health Survey aged in reported a doctor’s diagnosis of asthma, % had reported either a doctor’s diagnosis or that they were taking treatment for asthma, and % reported that they had experienced attacks of wheezing or whistling breath (symptoms of asthma) in the preceding 12 months.

Much less is known about the prevalence of asthma in middle-aged and older adults. This reflects both a paucity of survey data and the greater difficulty of distinguishing asthma from other respiratory conditions, such as chronic obstructive pulmonary disease (COPD) in older age groups. No standardized data on asthma prevalence in the elderly is currently available.

Clinical Classification

It is increasingly clear that asthma syndrome is divided into distinct disease entities with specific mechanisms.

The attempt for a new classification is made were "endotype" is proposed to be a subtype of a condition defined by a distinct pathophysiological mechanism. Criteria for defining asthma endotypes on the basis of their phenotypes and putative pathophysiology are suggested.

Currently asthma is classified into atopic and non-atopic types based on the onset of symptoms. Atopic refers to early-onset whereas non-atopic refers to late-onset.

Despite the differentiation, a significant degree of overlap exists between the two types. The severity of symptoms is further classified based on the GINA severity grades into mild intermittent, mild persistent, moderate persistent and severe persistent asthma. Furthermore asthma severity classification is diverse for various ages.

Prevention

Multifactorial disease requires multiple approaches in order to minimize development or progression of the clinical symptoms.

  • ITG Asthma Short Form (Bayliss et al. )
  • Require infrequent use (≤2 days a week) of inhaled SABA for quick relief of symptoms
  • Biomarkers of inflammation.

    The usefulness of measurements of biomarkers of inflammation (e.g., entire and differential cell count and mediator assays) in sputum, blood, urine, and exhaled air as aids to the diagnosis and assessment of asthma

  • Airflow obstruction is at least partially reversible.
  • LABAs are used in combination with ICSs for long-term control and prevention of symptoms in moderate or severe persistent asthma (step 3 care or higher in children ≥5 years of age and adults)
  • Chest x ray may be needed to exclude other diagnoses.
  • LABAs are not to be used as monotherapy for long-term control of asthma
  • Bronchoprovocation with methacholine, histamine, freezing air, or exercise challenge may be useful when asthma is suspected and spirometry is normal or near normal.

    For safety

  • Additional pulmonary function studies (e.g., measurement of lung volumes and evaluation of inspiratory loops) may be indicated, especially if there are questions about possible coexisting COPD, a restrictive defect, VCD, or possible central airway obstruction. A diffusing capacity test is helpful in differentiating between asthma and emphysema in patients, such as smokers and older patients, who are at risk for both illnesses.
  • Asthma Quality of Life Questionnaire (Katz et al. ; Marks et al. )
  • Prevent chronic and troublesome symptoms (e.g., coughing or breathlessness in the daytime, in the night, or after exertion)
  • Allergy testing
  • Of the adjunctive therapies available, LABA is the preferred therapy to combine with ICS in youths ≥12 years of age and adults
  • Control of environmental factors and comorbid conditions that affect asthma
  • Probiotics and vitamins

    Early studies on the effect of probiotics to affect asthma development by influencing the perinatal microbiome own been mixed.

    A recent study found significant decrease in the risk of atopic sensitization associated with pre and post-natal istration of probiotics, however there was no effect on asthma or wheeze.
    Vitamins are essential constituents of our diet that own endless been known to influence the immune system. Vitamins A and D own received specific attention in recent years as these vitamins own been shown to own an unexpected and crucial effect on the immune response.

  • Detailed medical history.
  • Episodic symptoms of airflow obstruction or airway hyperresponsiveness are present.
  • Asthma Quality of Life for Children (Juniper et al. )
  • reasons, bronchoprovocation testing should be carried out by a trained individual in an
  • Prevent progressive loss of lung function; for children, prevent reduced lung growth
  • SF (Bousquet et al.

    )

  • Prevent recurrent exacerbations of asthma and minimize the need for ED visits or hospitalizations
  • Experimental preventive therapies

    In preterm infants without bronchopulmonary dysplasia, Palivizumab, a monoclonal antibody against RSV, reduces respiratory morbidity up to 78%. Recent findings in tardy preterm children without BPD suggests that prophylaxis through infancy may decrease recurrent wheeze in the first year of life by 10% and by up to 50% at three years of age.

    While encouraging, further longitudinal studies are necessary to assess the effect of palivizumab prophylaxis to decrease the incidence of asthma in childhood.
    Recent evidence suggests that anti-allergen immunotherapy to cross-link the FcέR1 receptor may decrease viral induced asthma symptoms. While alterations of the physical environment own been studied, little attention has been given to the approach of altering the immune constitution of high risk individuals. In this honor, immunomodulators, such as Omalizumab may be of future interest.

  • Physical exam focusing on the upper respiratory tract, chest, and skin.
  • Maintain normal activity levels (including exercise and other physical activity and attendance at work or school)
  • Meet patients’ and families’ expectations of and satisfaction with asthma care
  • Environment control

    Most convincing evidence for early life environmental exposures influencing the development of asthma would be from randomized controlled interventions to specifically addressing the offending agent and protest lower incidence of asthma development.

    Allergen remediation strategies directed at cat, dog, mold, mouse and cockroach protest substantially decrease exposure levels in homes. Interventions to reduce HDM alone own been effective and seem to improve early outcomes.

    Recent meta-analyses own shown multifaceted allergen remediation programs to be protective against the development of asthma with % reduction in odds. The most protective effect was seen in children with greater than 5 years of follow-up, indicating a true decrease in risk to those prone to develop atopic asthma.

    The best preventative effect of allergen avoidance was the Canadian Childhood Asthma Primary Prevention Study in a high risk birth cohort.

    In this study, the intervention was avoidance of home dust mite, pets, and environmental tobacco smoke starting prenatally, and encouragement of breastfeeding with delayed introduction of solids. HDM interventions included encasing parents’ and infants’ mattresses and box springs, weekly boiling water wash of every bedding and application of benzyl benzoate to carpets and upholstery before birth and at 4 and 8 months of age. Children receiving the intervention had significantly less physician diagnoses of asthma, wheeze in the past 12 months and wheeze apart from colds when evaluated at age 7 years.

    Another birth cohort study also observed significantly fewer asthma symptoms at age 8 years ancient in a high risk birth cohort intervention focused on HDM and food allergen avoidance in early life, and a significant decrease in atopy at the 8 year time point.

    Large studies assessing increased exposure to indoor fungi before the development of asthma symptoms suggests that Penicillium, Aspergillus, and Cladosporium species pose a respiratory health risk in susceptible populations.

    Increased exacerbation of current asthma symptoms in children and adults were associated with increased levels of Penicillium, Aspergillus, Cladosporium, and Alternaria species, although further work should consider the role of fungal diversity and increased exposure to other fungal species.

  • Appropriate facility and is not generally recommended if the FEV1 is <65 percent predicted. A positive methacholine bronchoprovocation test is diagnostic for the presence of airway hyperresponsiveness, a characteristic feature of asthma that also can be present in other conditions (e.g., allergic rhinitis, cystic fibrosis, COPD, among others).

    Thus, although a positive test is consistent with asthma, a negative bronchoprovocation may be more helpful to law out asthma.

  • Maintain (near) “normal” pulmonary function
  • Education for a partnership in asthma care
  • Alternative diagnoses are excluded.
  • Mini Asthma Quality of Life Questionnaire (Juniper et al. a)
  • The beneficial effects of LABA in combination therapy for the grand majority of patients who require more therapy than low-dose ICS alone to control asthma (i.e., require step 3 care or higher) should be weighed against the increased risk of severe exacerbations, although unusual, associated with the daily use of LABAs (see discussion in text).
  • Spirometry to protest obstruction and assess reversibility, including in children 5 years of age or older.

    Reversibility is sure either by an increase in FEV1 of ≥12 percent from baseline or by an increase ≥10 percent of predicted FEV1 after inhalation of a short-acting bronchodilator.

  • Provide optimal pharmacotherapy with minimal or no adverse effects
  • SF (Ware et al. )
  • Wheezing—high-pitched whistling sounds when breathing out—especially in children. (Lack of wheezing and a normal chest examination do not exclude asthma.)

Treatment

Treatment with anti-inflammatory drugs can, to a large extent, reverse some of these processes; however, the successful response to therapy often requires weeks to achieve and, in some situations, may be incomplete.

The goals of asthma treatment include improving quality of life for people who own asthma in addition to controlling symptoms, reducing the risk of exacerbations, and preventing asthma-related death.

A recent large international trial demonstrated that significant reductions in the rate of severe exacerbations and improvements in quality of life were achieved by aiming at achieving guideline-defined asthma control and by adjusting therapy to achieve it.

It is significant, therefore, to examine how the disease expression and control are affecting the patient’s quality of life. Specific clinical assessment questionnaires were generated to help practicing physicians in asthma patient evaluation:

Asthma-Specific Quality of Life

  1. Mini Asthma Quality of Life Questionnaire (Juniper et al. a)
  2. Asthma Quality of Life Questionnaire (Katz et al. ; Marks et al. )
  3. ITG Asthma Short Form (Bayliss et al. )
  4. Asthma Quality of Life for Children (Juniper et al.

    )

Generic Quality of Life

  1. SF (Bousquet et al.

    What is naet therapy for allergies

    )

  2. SF (Ware et al. )

The change in emphasis from previous practice guidelines is in periodic assessment of asthma control. For initiating treatment, asthma severity should be classified, and the initial treatment should correspond to the appropriate category of severity. Once treatment is established, the emphasis is on assessing asthma control to determine if the goals for therapy own been met and if adjustments in therapy (step up or step down) would be appropriate.

Components considered essential to effective asthma management:
Measures of assessment and monitoring, obtained by objective tests, physical examination, patient history and patient report, to diagnose and assess the characteristics and severity of asthma and to monitor whether asthma control is achieved and maintained

  1. Education for a partnership in asthma care
  2. Control of environmental factors and comorbid conditions that affect asthma

Pharmacologic therapy
The goals of therapy are to achieve asthma control by reducing impairment and risk:

  1. Require infrequent use (≤2 days a week) of inhaled SABA for quick relief of symptoms
  2. Maintain (near) “normal” pulmonary function
  3. Prevent progressive loss of lung function; for children, prevent reduced lung growth
  4. Meet patients’ and families’ expectations of and satisfaction with asthma care
  5. Maintain normal activity levels (including exercise and other physical activity and attendance at work or school)
  6. Prevent recurrent exacerbations of asthma and minimize the need for ED visits or hospitalizations
  7. Prevent chronic and troublesome symptoms (e.g., coughing or breathlessness in the daytime, in the night, or after exertion)
  8. Provide optimal pharmacotherapy with minimal or no adverse effects

Patients’ detailed recall of symptoms decreases over time; therefore, the clinician may select to assess over a 2-week, 3-week, or 4-week recall period.

Symptom assessment for periods longer than 4 weeks should reflect more global symptom assessment, such as inquiring whether the patient’s asthma has been better or worse since the final visit and inquiring whether the patient has encountered any specific difficulties during specific seasons or events.

Low FEV1 is associated with increased risk of severe asthma exacerbations. Regular monitoring of pulmonary function is particularly significant for asthma patients who do not perceive their symptoms until airflow obstruction is severe.

There is no readily available method of detecting the “poor perceivers.” The literature reports that patients who had a near-fatal asthma exacerbation, as well as older patients, are more likely to own poor perception of airflow obstruction.

Long-term control medications
Corticosteroids:Block late-phase reaction to allergen, reduce airway hyperresponsiveness, and inhibit inflammatory cell migration and activation. They are the most potent and effective anti-inflammatory medication currently available.

ICSs are used in the long-term control of asthma. Short courses of oral systemic corticosteroids are often used to acquire immediate control of the disease when initiating long-term therapy; long-term oral systemic corticosteroid is used for severe persistent asthma.

Cromolyn sodium and nedocromil:Stabilize mast cells and interfere with chloride channel function. They are used as alternative, but not preferred, medication for the treatment of mild persistent asthma. They can also be used as preventive treatment prior to exercise or unavoidable exposure to known allergens.

Immunomodulators:Omalizumab (anti-IgE) is a monoclonal antibody that prevents binding of IgE to the high-affinity receptors on basophils and mast cells.

Omalizumab is used as adjunctive therapy for patients ≥12 years of age who own allergies and severe persistent asthma. Clinicians who ister omalizumab should be prepared and equipped to identify and treat anaphylaxis that may occur.

Leukotriene modifiers:Include two LTRAs are available—montelukast (for patients >1 year of age) and zafirlukast (for patients ≥7 years of age). The 5-lipoxygenase pathway inhibitor zileuton is available for patients ≥12 years of age; liver function monitoring is essential.

LTRAs are alternative, but not preferred, therapy for the treatment of mild persistent asthma (Step 2 care). LTRAs can also be used as adjunctive therapy with ICSs, but for youths ≥12 years of age and adults. Zileuton can be used as alternative but not preferred adjunctive therapy in adults.

LABAs:Salmeterol and formoterol after a single dose istration own at least 12 hours duration of bronchodilation. The use of LABA for the treatment of acute symptoms or exacerbations is not currently recommended.

  1. LABAs are not to be used as monotherapy for long-term control of asthma
  2. LABAs are used in combination with ICSs for long-term control and prevention of symptoms in moderate or severe persistent asthma (step 3 care or higher in children ≥5 years of age and adults)
  3. Of the adjunctive therapies available, LABA is the preferred therapy to combine with ICS in youths ≥12 years of age and adults
  4. The beneficial effects of LABA in combination therapy for the grand majority of patients who require more therapy than low-dose ICS alone to control asthma (i.e., require step 3 care or higher) should be weighed against the increased risk of severe exacerbations, although unusual, associated with the daily use of LABAs (see discussion in text).

For patients ≥5 years of age who own moderate persistent asthma or asthma inadequately controlled on low-dose ICS, the option to increase the ICS dose should be given equal weight to the option of adding LABA.

For patients ≥5 years of age who own severe persistent asthma or asthma inadequately controlled on step 3 care, the combination of LABA and ICS is the preferred therapy.

LABA may be used before exercise, but duration of action does not exceed 5 hours with chronic regular use. Frequent and chronic use of LABA for EIB is discouraged, because this use may disguise poorly controlled persistent asthma.

Methylxanthines: Sustained-release theophylline is a mild to moderate bronchodilator used as alternative, not preferred, adjunctive therapy with ICS (Evidence A).

Theophylline may own mild anti-inflammatory effects. Monitoring of serum theophylline concentration is essential.

Quick-relief medications
Anticholinergics:Inhibit muscarinic cholinergic receptors and reduce intrinsic vagal tone ofthe airway. Ipratropium bromide provides additive benefit to SABA in moderate-to-severeasthma exacerbations. May be used as an alternative bronchodilator for patients who donot tolerate SABA (Evidence D).

SABAs:Albuterol, levalbuterol, and pirbuterol are bronchodilators that relax smooth muscle.

Therapy of choice for relief of acute symptoms and prevention of EIB.

Systemic corticosteroids:Although not short acting, oral systemic corticosteroids are used for moderate and severe exacerbations as adjunct to SABAs to speed recovery and prevent recurrence of exacerbations.

Other treatments
Allergen Immunotherapy
Allergen injection immunotherapy is effective in allergic asthma as well as in allergic rhinoconjunctivitis and has been shown to lead to highly significant improvements in symptoms, reduction in save medication, and improvements in both allergen specific and non-specific bronchial hyperresponsiveness.

Immunotherapy is particularly effective in seasonal asthma, although less effective in perennial asthma. Bronchial asthma is a risk-factor for systemic reactions to immunotherapy and should not be considered in poorly-controlled asthmatics. Allergy management is superimposed upon other treatment modalities for long-term control at every levels of asthma. Concurrent upper airway disease, eg, allergic rhinitis, sinusitis, should be treated, and the entire dose of inhaled corticosteroids must be monitored.

Biological treatment: Omalizumab(monoclonal anti-IgE antibody) may be considered as adjunctive therapy in step 5 or 6 care for patients who own allergies and severe persistent asthma that is inadequately controlled with the combination of high-dose ICS and LABA.

Omalizumab is effective in reducing asthma exacerbations and hospitalizations in patients with increased levels of entire IgE. It is recommended for use in moderate to severe asthma patients as an adjunctive therapy to inhaled steroids and during steroid tapering, in patients with steroid-resistant asthma, and in patients who need to reduce or withdraw their inhaled steroids.

Bronchial thermoplasty (BT) is a novel therapy for patients with severe asthma. Using radio frequency thermal energy, it aims to reduce the airway smooth muscle mass.

Several clinical trials own demonstrated improvements in asthma-related quality of life and a reduction in the number of exacerbations following treatment with BT. In addition, recent data has demonstrated the long-term safety of the procedure as well as sustained improvements in rates of asthma exacerbations, reduction in health care utilization, and improved quality of life.

In the past 10 years, there own been substantial advances in the understanding of asthma genetics, airway biology, and immune cell signaling.

These advances own led to the development of little molecule therapeutics and biologic agents that may improve asthma care in the future. Several new classes of asthma drugs—including ultra endless acting β agonists and modulators of the interleukin 4 (IL-4), IL-5, IL, and IL pathways—have been evaluated in randomized controlled trials. Other new drug classes—including dissociated corticosteroids, CXC chemokine receptor 2 antagonists, toll-like receptor 9 agonists, and tyrosine kinase inhibitors—remain in earlier phases of development.

Other co-morbid conditions treatment
In every patients, symptomatic therapies are also given, to be used on an as needed basis.

The goal in every of these patients is to tailor the medicines and their doses to control the level of the disease, always trying for optimal control with the lowest effective dose of medications.
At least half of US adults with asthma own at least 1 other chronic condition. Having asthma and other chronic conditions are associated with poorer asthma outcomes. Several studies considered the relationship between asthma and other specific chronic conditions; results of these studies indicated that having depression or anxiety and/or panic disorder is associated with an increased risk of developing a new asthma diagnosis and with poorer asthma outcomes.

In addition, results of these studies indicated that having asthma is associated with an increased risk of developing a new depression or anxiety and/or panic disorder diagnosis.

Causes of Asthma

The allergic asthma phenotype dominates in early life. The paradigm for allergen induction of asthma is from allergen exposure → allergic sensitization → asthma development. While a variety of ambient and indoor allergic exposures own been implicated in the development and exacerbation of childhood asthma, the indoor environment has greatest influence on asthma development.

Children sensitized to aeroallergens at a young age are likely to own persistent asthma symptoms into tardy childhood and adulthood and show poorer lung function than those not sensitized. Home dust mite (HDM), furred pets, cockroach, rodent and mold, with regional variation, account for the large proportion of aeroallergens associated with sensitization and asthma. In numerous cases, exposure and sensitivity follow a. Evidence supporting dose-response relationship is particularly strong for dust mite and cat.

The steady increase in population trends towards urban centers also shares the trajectory of increasing air pollution. Indoor and ambient air pollution own been associated with a variety of adverse cardiopulmonary health effects including asthma symptoms, exacerbations and decline in lung function.

The pollutants best studied are the gases nitrogen dioxide (NO2), ozone (O3), volatile organic compounds (VOCs), and particulate matter (PM) that comprises soot.

Recent evidence has demonstrated elevated pollution exposure in utero and in the first year of life may influence the development of asthma in young children. Exposure to indoor pollution of PM and VOCs is directly correlated with asthma inflammatory markers in schoolchildren with and without asthma, indicating potential induction of allergic airway inflammation with these exposures.

Environmental tobacco smoke (ETS) is an independent determinant of the development of asthma.

Tobacco smoke contains numerous VOCs and NO2, which are likely to serve as the conduits to poor respiratory outcomes. In vivo studies also propose that exposure to ETS is associated with IL and greater serum IgE in children with asthma compared to non-exposed asthmatic children and controls, suggesting an augmentation of the Th2 immunophenotype with exposure.

Since the early s the inverse relationship between farming, particularly traditional dairy farming lifestyle, and the development of asthma has been demonstrated early in life and appears to hold true well into adulthood.

Children living on farms also had reduced rates of sensitization and other atopic conditions. Farm studies own implicated the wealthy diversity of microbial exposure both in the animal and home environments are strongly and inversely associated with asthma, implying that the early and persistent microbial environment influences the development of the immune system away from allergic and asthmatic predisposition.

The intestinal microbiome likely influences the immune system in a manner similar to that related to farm exposure.

Because limiting exposure to allergens and allergy immunotherapy are both specifically helpful in treating allergic asthmatic subjects, a careful search for possible allergies is indicated in almost every asthmatics, certainly every persistent asthmatics.
In addition to allergen-induced asthma, numerous other factors and conditions such as exercise, infection, occupational chemical exposures, side effects to medications such as beta adrenergic blocking agents, bronchitis, and Churg-Strauss allergic granulomatosis can also cause asthma.

Sinusitis, GERD, hyperthyroidism, pregnancy and infections may complicate asthma.

Signs and Symptoms of Asthma

To establish a diagnosis of asthma, the clinician should determine that:

  1. Episodic symptoms of airflow obstruction or airway hyperresponsiveness are present.
  2. Airflow obstruction is at least partially reversible.
  3. Alternative diagnoses are excluded.

Recommended methods to establish the diagnosis are:

  1. Detailed medical history.
  2. Physical exam focusing on the upper respiratory tract, chest, and skin.
  3. Spirometry to protest obstruction and assess reversibility, including in children 5 years of age or older.

    Reversibility is sure either by an increase in FEV1 of ≥12 percent from baseline or by an increase ≥10 percent of predicted FEV1 after inhalation of a short-acting bronchodilator.

Additional studies are not routinely necessary but may be useful when considering alternative diagnoses:

  1. Bronchoprovocation with methacholine, histamine, freezing air, or exercise challenge may be useful when asthma is suspected and spirometry is normal or near normal.

    For safety

  2. reasons, bronchoprovocation testing should be carried out by a trained individual in an
  3. Biomarkers of inflammation. The usefulness of measurements of biomarkers of inflammation (e.g., entire and differential cell count and mediator assays) in sputum, blood, urine, and exhaled air as aids to the diagnosis and assessment of asthma
  4. Chest x ray may be needed to exclude other diagnoses.
  5. Appropriate facility and is not generally recommended if the FEV1 is <65 percent predicted. A positive methacholine bronchoprovocation test is diagnostic for the presence of airway hyperresponsiveness, a characteristic feature of asthma that also can be present in other conditions (e.g., allergic rhinitis, cystic fibrosis, COPD, among others).

    Thus, although a positive test is consistent with asthma, a negative bronchoprovocation may be more helpful to law out asthma.

  6. Allergy testing
  7. Additional pulmonary function studies (e.g., measurement of lung volumes and evaluation of inspiratory loops) may be indicated, especially if there are questions about possible coexisting COPD, a restrictive defect, VCD, or possible central airway obstruction.

    A diffusing capacity test is helpful in differentiating between asthma and emphysema in patients, such as smokers and older patients, who are at risk for both illnesses.

  8. Wheezing—high-pitched whistling sounds when breathing out—especially in children. (Lack of wheezing and a normal chest examination do not exclude asthma.)

It is significant to consider a diagnosis of asthma if certain elements of the clinical history are present – they are not diagnostic by themselves but increase the probability of a diagnosis of asthma:

Treatment

Treatment with anti-inflammatory drugs can, to a large extent, reverse some of these processes; however, the successful response to therapy often requires weeks to achieve and, in some situations, may be incomplete.

The goals of asthma treatment include improving quality of life for people who own asthma in addition to controlling symptoms, reducing the risk of exacerbations, and preventing asthma-related death.

A recent large international trial demonstrated that significant reductions in the rate of severe exacerbations and improvements in quality of life were achieved by aiming at achieving guideline-defined asthma control and by adjusting therapy to achieve it.

It is significant, therefore, to examine how the disease expression and control are affecting the patient’s quality of life. Specific clinical assessment questionnaires were generated to help practicing physicians in asthma patient evaluation:

Asthma-Specific Quality of Life

  1. Mini Asthma Quality of Life Questionnaire (Juniper et al. a)
  2. Asthma Quality of Life Questionnaire (Katz et al. ; Marks et al. )
  3. ITG Asthma Short Form (Bayliss et al. )
  4. Asthma Quality of Life for Children (Juniper et al.

    )

Generic Quality of Life

  1. SF (Bousquet et al. )
  2. SF (Ware et al. )

The change in emphasis from previous practice guidelines is in periodic assessment of asthma control. For initiating treatment, asthma severity should be classified, and the initial treatment should correspond to the appropriate category of severity. Once treatment is established, the emphasis is on assessing asthma control to determine if the goals for therapy own been met and if adjustments in therapy (step up or step down) would be appropriate.

Components considered essential to effective asthma management:
Measures of assessment and monitoring, obtained by objective tests, physical examination, patient history and patient report, to diagnose and assess the characteristics and severity of asthma and to monitor whether asthma control is achieved and maintained

  1. Education for a partnership in asthma care
  2. Control of environmental factors and comorbid conditions that affect asthma

Pharmacologic therapy
The goals of therapy are to achieve asthma control by reducing impairment and risk:

  1. Require infrequent use (≤2 days a week) of inhaled SABA for quick relief of symptoms
  2. Maintain (near) “normal” pulmonary function
  3. Prevent progressive loss of lung function; for children, prevent reduced lung growth
  4. Meet patients’ and families’ expectations of and satisfaction with asthma care
  5. Maintain normal activity levels (including exercise and other physical activity and attendance at work or school)
  6. Prevent recurrent exacerbations of asthma and minimize the need for ED visits or hospitalizations
  7. Prevent chronic and troublesome symptoms (e.g., coughing or breathlessness in the daytime, in the night, or after exertion)
  8. Provide optimal pharmacotherapy with minimal or no adverse effects

Patients’ detailed recall of symptoms decreases over time; therefore, the clinician may select to assess over a 2-week, 3-week, or 4-week recall period.

Symptom assessment for periods longer than 4 weeks should reflect more global symptom assessment, such as inquiring whether the patient’s asthma has been better or worse since the final visit and inquiring whether the patient has encountered any specific difficulties during specific seasons or events.

Low FEV1 is associated with increased risk of severe asthma exacerbations. Regular monitoring of pulmonary function is particularly significant for asthma patients who do not perceive their symptoms until airflow obstruction is severe. There is no readily available method of detecting the “poor perceivers.” The literature reports that patients who had a near-fatal asthma exacerbation, as well as older patients, are more likely to own poor perception of airflow obstruction.

Long-term control medications
Corticosteroids:Block late-phase reaction to allergen, reduce airway hyperresponsiveness, and inhibit inflammatory cell migration and activation.

They are the most potent and effective anti-inflammatory medication currently available. ICSs are used in the long-term control of asthma. Short courses of oral systemic corticosteroids are often used to acquire immediate control of the disease when initiating long-term therapy; long-term oral systemic corticosteroid is used for severe persistent asthma.

Cromolyn sodium and nedocromil:Stabilize mast cells and interfere with chloride channel function. They are used as alternative, but not preferred, medication for the treatment of mild persistent asthma.

They can also be used as preventive treatment prior to exercise or unavoidable exposure to known allergens.

Immunomodulators:Omalizumab (anti-IgE) is a monoclonal antibody that prevents binding of IgE to the high-affinity receptors on basophils and mast cells. Omalizumab is used as adjunctive therapy for patients ≥12 years of age who own allergies and severe persistent asthma. Clinicians who ister omalizumab should be prepared and equipped to identify and treat anaphylaxis that may occur.

Leukotriene modifiers:Include two LTRAs are available—montelukast (for patients >1 year of age) and zafirlukast (for patients ≥7 years of age).

The 5-lipoxygenase pathway inhibitor zileuton is available for patients ≥12 years of age; liver function monitoring is essential. LTRAs are alternative, but not preferred, therapy for the treatment of mild persistent asthma (Step 2 care). LTRAs can also be used as adjunctive therapy with ICSs, but for youths ≥12 years of age and adults. Zileuton can be used as alternative but not preferred adjunctive therapy in adults.

LABAs:Salmeterol and formoterol after a single dose istration own at least 12 hours duration of bronchodilation. The use of LABA for the treatment of acute symptoms or exacerbations is not currently recommended.

  1. LABAs are not to be used as monotherapy for long-term control of asthma
  2. LABAs are used in combination with ICSs for long-term control and prevention of symptoms in moderate or severe persistent asthma (step 3 care or higher in children ≥5 years of age and adults)
  3. Of the adjunctive therapies available, LABA is the preferred therapy to combine with ICS in youths ≥12 years of age and adults
  4. The beneficial effects of LABA in combination therapy for the grand majority of patients who require more therapy than low-dose ICS alone to control asthma (i.e., require step 3 care or higher) should be weighed against the increased risk of severe exacerbations, although unusual, associated with the daily use of LABAs (see discussion in text).

For patients ≥5 years of age who own moderate persistent asthma or asthma inadequately controlled on low-dose ICS, the option to increase the ICS dose should be given equal weight to the option of adding LABA.

For patients ≥5 years of age who own severe persistent asthma or asthma inadequately controlled on step 3 care, the combination of LABA and ICS is the preferred therapy.

LABA may be used before exercise, but duration of action does not exceed 5 hours with chronic regular use. Frequent and chronic use of LABA for EIB is discouraged, because this use may disguise poorly controlled persistent asthma.

Methylxanthines: Sustained-release theophylline is a mild to moderate bronchodilator used as alternative, not preferred, adjunctive therapy with ICS (Evidence A). Theophylline may own mild anti-inflammatory effects.

Monitoring of serum theophylline concentration is essential.

Quick-relief medications
Anticholinergics:Inhibit muscarinic cholinergic receptors and reduce intrinsic vagal tone ofthe airway. Ipratropium bromide provides additive benefit to SABA in moderate-to-severeasthma exacerbations. May be used as an alternative bronchodilator for patients who donot tolerate SABA (Evidence D).

SABAs:Albuterol, levalbuterol, and pirbuterol are bronchodilators that relax smooth muscle.

Therapy of choice for relief of acute symptoms and prevention of EIB.

Systemic corticosteroids:Although not short acting, oral systemic corticosteroids are used for moderate and severe exacerbations as adjunct to SABAs to speed recovery and prevent recurrence of exacerbations.

Other treatments
Allergen Immunotherapy
Allergen injection immunotherapy is effective in allergic asthma as well as in allergic rhinoconjunctivitis and has been shown to lead to highly significant improvements in symptoms, reduction in save medication, and improvements in both allergen specific and non-specific bronchial hyperresponsiveness.

Immunotherapy is particularly effective in seasonal asthma, although less effective in perennial asthma. Bronchial asthma is a risk-factor for systemic reactions to immunotherapy and should not be considered in poorly-controlled asthmatics. Allergy management is superimposed upon other treatment modalities for long-term control at every levels of asthma. Concurrent upper airway disease, eg, allergic rhinitis, sinusitis, should be treated, and the entire dose of inhaled corticosteroids must be monitored.

Biological treatment: Omalizumab(monoclonal anti-IgE antibody) may be considered as adjunctive therapy in step 5 or 6 care for patients who own allergies and severe persistent asthma that is inadequately controlled with the combination of high-dose ICS and LABA.

Omalizumab is effective in reducing asthma exacerbations and hospitalizations in patients with increased levels of entire IgE. It is recommended for use in moderate to severe asthma patients as an adjunctive therapy to inhaled steroids and during steroid tapering, in patients with steroid-resistant asthma, and in patients who need to reduce or withdraw their inhaled steroids.

Bronchial thermoplasty (BT) is a novel therapy for patients with severe asthma. Using radio frequency thermal energy, it aims to reduce the airway smooth muscle mass. Several clinical trials own demonstrated improvements in asthma-related quality of life and a reduction in the number of exacerbations following treatment with BT.

In addition, recent data has demonstrated the long-term safety of the procedure as well as sustained improvements in rates of asthma exacerbations, reduction in health care utilization, and improved quality of life.

In the past 10 years, there own been substantial advances in the understanding of asthma genetics, airway biology, and immune cell signaling. These advances own led to the development of little molecule therapeutics and biologic agents that may improve asthma care in the future. Several new classes of asthma drugs—including ultra endless acting β agonists and modulators of the interleukin 4 (IL-4), IL-5, IL, and IL pathways—have been evaluated in randomized controlled trials.

Other new drug classes—including dissociated corticosteroids, CXC chemokine receptor 2 antagonists, toll-like receptor 9 agonists, and tyrosine kinase inhibitors—remain in earlier phases of development.

Other co-morbid conditions treatment
In every patients, symptomatic therapies are also given, to be used on an as needed basis. The goal in every of these patients is to tailor the medicines and their doses to control the level of the disease, always trying for optimal control with the lowest effective dose of medications.
At least half of US adults with asthma own at least 1 other chronic condition.

Having asthma and other chronic conditions are associated with poorer asthma outcomes. Several studies considered the relationship between asthma and other specific chronic conditions; results of these studies indicated that having depression or anxiety and/or panic disorder is associated with an increased risk of developing a new asthma diagnosis and with poorer asthma outcomes. In addition, results of these studies indicated that having asthma is associated with an increased risk of developing a new depression or anxiety and/or panic disorder diagnosis.

Causes of Asthma

The allergic asthma phenotype dominates in early life. The paradigm for allergen induction of asthma is from allergen exposure → allergic sensitization → asthma development.

While a variety of ambient and indoor allergic exposures own been implicated in the development and exacerbation of childhood asthma, the indoor environment has greatest influence on asthma development. Children sensitized to aeroallergens at a young age are likely to own persistent asthma symptoms into tardy childhood and adulthood and show poorer lung function than those not sensitized. Home dust mite (HDM), furred pets, cockroach, rodent and mold, with regional variation, account for the large proportion of aeroallergens associated with sensitization and asthma. In numerous cases, exposure and sensitivity follow a.

Evidence supporting dose-response relationship is particularly strong for dust mite and cat.

The steady increase in population trends towards urban centers also shares the trajectory of increasing air pollution. Indoor and ambient air pollution own been associated with a variety of adverse cardiopulmonary health effects including asthma symptoms, exacerbations and decline in lung function. The pollutants best studied are the gases nitrogen dioxide (NO2), ozone (O3), volatile organic compounds (VOCs), and particulate matter (PM) that comprises soot.

Recent evidence has demonstrated elevated pollution exposure in utero and in the first year of life may influence the development of asthma in young children.

Exposure to indoor pollution of PM and VOCs is directly correlated with asthma inflammatory markers in schoolchildren with and without asthma, indicating potential induction of allergic airway inflammation with these exposures.

Environmental tobacco smoke (ETS) is an independent determinant of the development of asthma. Tobacco smoke contains numerous VOCs and NO2, which are likely to serve as the conduits to poor respiratory outcomes. In vivo studies also propose that exposure to ETS is associated with IL and greater serum IgE in children with asthma compared to non-exposed asthmatic children and controls, suggesting an augmentation of the Th2 immunophenotype with exposure.

Since the early s the inverse relationship between farming, particularly traditional dairy farming lifestyle, and the development of asthma has been demonstrated early in life and appears to hold true well into adulthood.

Children living on farms also had reduced rates of sensitization and other atopic conditions. Farm studies own implicated the wealthy diversity of microbial exposure both in the animal and home environments are strongly and inversely associated with asthma, implying that the early and persistent microbial environment influences the development of the immune system away from allergic and asthmatic predisposition.

The intestinal microbiome likely influences the immune system in a manner similar to that related to farm exposure.

Because limiting exposure to allergens and allergy immunotherapy are both specifically helpful in treating allergic asthmatic subjects, a careful search for possible allergies is indicated in almost every asthmatics, certainly every persistent asthmatics.
In addition to allergen-induced asthma, numerous other factors and conditions such as exercise, infection, occupational chemical exposures, side effects to medications such as beta adrenergic blocking agents, bronchitis, and Churg-Strauss allergic granulomatosis can also cause asthma.

Sinusitis, GERD, hyperthyroidism, pregnancy and infections may complicate asthma.

Signs and Symptoms of Asthma

To establish a diagnosis of asthma, the clinician should determine that:

  1. Episodic symptoms of airflow obstruction or airway hyperresponsiveness are present.
  2. Airflow obstruction is at least partially reversible.
  3. Alternative diagnoses are excluded.

Recommended methods to establish the diagnosis are:

  1. Detailed medical history.
  2. Physical exam focusing on the upper respiratory tract, chest, and skin.
  3. Spirometry to protest obstruction and assess reversibility, including in children 5 years of age or older.

    Reversibility is sure either by an increase in FEV1 of ≥12 percent from baseline or by an increase ≥10 percent of predicted FEV1 after inhalation of a short-acting bronchodilator.

Additional studies are not routinely necessary but may be useful when considering alternative diagnoses:

  1. Bronchoprovocation with methacholine, histamine, freezing air, or exercise challenge may be useful when asthma is suspected and spirometry is normal or near normal. For safety
  2. reasons, bronchoprovocation testing should be carried out by a trained individual in an
  3. Biomarkers of inflammation. The usefulness of measurements of biomarkers of inflammation (e.g., entire and differential cell count and mediator assays) in sputum, blood, urine, and exhaled air as aids to the diagnosis and assessment of asthma
  4. Chest x ray may be needed to exclude other diagnoses.
  5. Appropriate facility and is not generally recommended if the FEV1 is <65 percent predicted.

    A positive methacholine bronchoprovocation test is diagnostic for the presence of airway hyperresponsiveness, a characteristic feature of asthma that also can be present in other conditions (e.g., allergic rhinitis, cystic fibrosis, COPD, among others). Thus, although a positive test is consistent with asthma, a negative bronchoprovocation may be more helpful to law out asthma.

  6. Allergy testing
  7. Additional pulmonary function studies (e.g., measurement of lung volumes and evaluation of inspiratory loops) may be indicated, especially if there are questions about possible coexisting COPD, a restrictive defect, VCD, or possible central airway obstruction.

    A diffusing capacity test is helpful in differentiating between asthma and emphysema in patients, such as smokers and older patients, who are at risk for both illnesses.

  8. Wheezing—high-pitched whistling sounds when breathing out—especially in children. (Lack of wheezing and a normal chest examination do not exclude asthma.)

It is significant to consider a diagnosis of asthma if certain elements of the clinical history are present – they are not diagnostic by themselves but increase the probability of a diagnosis of asthma:

  • Recurrent difficulty in breathing
  • Strong emotional expression (laughing or crying hard)
  • Atopic dermatitis/eczema or any other manifestation of an allergic skin condition.
  • Exercise
  • Changes in weather
  • Increased nasal secretion, mucosal swelling, and/or nasal polyps.
  • Mold
  • Sounds of wheezing during normal breathing, or a prolonged phase of forced exhalation (typical of airflow obstruction).

    Wheezing may only be heard during forced exhalation, but it is not a dependable indicator of airflow limitation.

  • Gastro-esophageal reflux or laryngopharyngeal reflux, and
  • Recurrent wheeze
  • Smoke (tobacco, wood)
  • Rhinosinusitis,
  • Airborne chemicals or dusts
  • Symptoms happen or worsen in the presence of:
    1. Viral infection
    2. Wheezing—high-pitched whistling sounds when breathing out—especially in children. (Lack of wheezing and a normal chest examination do not exclude asthma.)
    3. Menstrual cycles
    4. Animals with fur or hair
    5. History of any of the following:
      1. Cough, worse particularly at night
      2. Symptoms happen or worsen at night, awakening the patient.

        Spirometry is needed to establish a diagnosis of asthma.

        Physical examination should be focused on upper respiratory tract, chest, and skin. Certain findings present on physical exam increase the probability of asthma, while their absence does not law it out, because the disease is by definition variable, and signs of airflow obstruction are often absent between attacks:

        1. Hyperexpansion of the thorax, especially in children; use of accessory muscles; appearance of hunched shoulders; and chest deformity.
        2. House-dust mites (in mattresses, pillows, upholstered furniture, carpets)
        3. Recurrent chest tightness
        4. Pollen
        5. Bronchitis or smoking.

Early in the disease, symptoms may include a vague, heavy feeling of tightness in the chest and in the allergic patient, there may be associated rhinitis and conjunctivitis symptoms.

Typical symptoms which patients experience include coughing, wheezing, chest tightness and dyspnea. Cough in asthma is generally non-productive, but it may progress to expectoration of viscous, mucoid sputum which is hard to clear. If the sputum turns purulent or discolored, an infection may be present, as the sputum in asthma is generally clear to light yellow in color.

There is a subgroup of asthmatics whose asthma is characterized solely by cough, without overt wheezing, the "cough variant of asthma". Monitoring of PEF or methacholine inhalation challenge, to clarify whether there is bronchial hyperresponsiveness consistent with asthma, may be helpful in diagnosis.

The diagnosis of cough variant asthma is confirmed by a positive response to asthma medication.

In the completely asymptomatic patient, results of chest examination will be normal, although head, eye, ear, nose, and throat examination may reveal concomitant serous otitis media, allergic conjunctivitis, allergic rhinitis, nasal polyps, paranasal sinus tenderness, signs of postnasal drip, or pharyngeal mucosal lymphoid hyperplasia. Clubbing of the fingers is extremely rare in uncomplicated asthma, and this finding should direct the physician's attention toward diseases such as bronchiectasis, cystic fibrosis, pulmonary neoplasm, or cardiac disease.

Numerous symptomatic asthmatics can be diagnosed by careful auscultation of the chest which reveals the presence of expiratory wheezing and a somewhat prolonged expiratory phase.

Exacerbations of asthma are acute or subacute episodes of progressively worsening shortness of breath, cough, wheezing, and chest tightness—or some combination of these symptoms. Exacerbations are characterized by decreases in expiratory airflow that can be documented and quantified by simple measurement of lung function (spirometry or PEF), can vary widely among individuals and within individuals from rare to frequent.

It is significant to understand that the severity of disease does not necessarily correlate with the intensity of exacerbations, which can vary from mild to extremely severe and life-threatening.

Patients at any level of severity, even intermittent asthma, can own severe exacerbations. For example, a person who has intermittent asthma can own a severe exacerbation during a viral illness or when exposed to allergens to which he or she is sensitized or to noxious fumes and irritants.

In fact the final classification “mild intermittent asthma” was changed to “intermittent asthma”, emphasizing that patients at any level of severity — including intermittent — can own severe exacerbations. The frequency of exacerbations requiring intervention with oral systemic corticosteroids now changed to classification of persistent, rather than intermittent asthma. The duration of exacerbations may vary from a few hours to a few days.

These unpredictable variations in exacerbations can present treatment dilemmas in clinical practice.

Assessment of severity requires assessing the following components of current impairment:

Early in the disease, symptoms may include a vague, heavy feeling of tightness in the chest and in the allergic patient, there may be associated rhinitis and conjunctivitis symptoms. Typical symptoms which patients experience include coughing, wheezing, chest tightness and dyspnea.

Cough in asthma is generally non-productive, but it may progress to expectoration of viscous, mucoid sputum which is hard to clear. If the sputum turns purulent or discolored, an infection may be present, as the sputum in asthma is generally clear to light yellow in color.

There is a subgroup of asthmatics whose asthma is characterized solely by cough, without overt wheezing, the "cough variant of asthma". Monitoring of PEF or methacholine inhalation challenge, to clarify whether there is bronchial hyperresponsiveness consistent with asthma, may be helpful in diagnosis.

The diagnosis of cough variant asthma is confirmed by a positive response to asthma medication.

In the completely asymptomatic patient, results of chest examination will be normal, although head, eye, ear, nose, and throat examination may reveal concomitant serous otitis media, allergic conjunctivitis, allergic rhinitis, nasal polyps, paranasal sinus tenderness, signs of postnasal drip, or pharyngeal mucosal lymphoid hyperplasia.

Clubbing of the fingers is extremely rare in uncomplicated asthma, and this finding should direct the physician's attention toward diseases such as bronchiectasis, cystic fibrosis, pulmonary neoplasm, or cardiac disease. Numerous symptomatic asthmatics can be diagnosed by careful auscultation of the chest which reveals the presence of expiratory wheezing and a somewhat prolonged expiratory phase.

Exacerbations of asthma are acute or subacute episodes of progressively worsening shortness of breath, cough, wheezing, and chest tightness—or some combination of these symptoms.

Exacerbations are characterized by decreases in expiratory airflow that can be documented and quantified by simple measurement of lung function (spirometry or PEF), can vary widely among individuals and within individuals from rare to frequent. It is significant to understand that the severity of disease does not necessarily correlate with the intensity of exacerbations, which can vary from mild to extremely severe and life-threatening.

Patients at any level of severity, even intermittent asthma, can own severe exacerbations.

For example, a person who has intermittent asthma can own a severe exacerbation during a viral illness or when exposed to allergens to which he or she is sensitized or to noxious fumes and irritants. In fact the final classification “mild intermittent asthma” was changed to “intermittent asthma”, emphasizing that patients at any level of severity — including intermittent — can own severe exacerbations. The frequency of exacerbations requiring intervention with oral systemic corticosteroids now changed to classification of persistent, rather than intermittent asthma.

The duration of exacerbations may vary from a few hours to a few days. These unpredictable variations in exacerbations can present treatment dilemmas in clinical practice.

Assessment of severity requires assessing the following components of current impairment:

  • Quality-of-life assessments
  • Lung function, measured by spirometry: FEV1, FVC (or FEV6), FEV1/FVC (or FEV6 in adults). Spirometry is the preferred method for measuring lung function to classify severity. Peak flow has not been found to be a dependable variable for classifying severity.
  • Attitudes and beliefs about taking medications
  • The Genetics of Asthma and Allergic Disease: A 21st Century Perspective
    Carole Ober, Tsung-Chieh Yao.

    Immunol Rev. Author manuscript; available in PMC July 1. Published in final edited form as: Immunol Rev. July; (1): doi:/jXx PMCID: PMC

  • Asthma endotypes: a new approach to classification of disease entities within the asthma syndrome.Lötvall J1, Akdis CA, Bacharier LB, Bjermer L, Casale TB, Custovic A, Lemanske RF Jr, Wardlaw AJ, Wenzel SE, Greenberger PA. J Allergy Clin Immunol. Feb;(2) doi: /
  • Severe airflow obstruction, as detected by spirometry
  • Global strategy for asthma management and prevention: GINA executive n ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M et al. Eur Respir J 31(1) DOI/ PMID:
  • Asthma in the elderly: what we know and what we own yet to know.

    Anahí Yáñez, Sang-Hoen Cho, Joan B Soriano, Lanny J Rosenwasser, Gustavo J Rodrigo, Klaus F Rabe, Stephen Peters, Akio Niimi, Dennis K Ledford, Rohit Katial, Leonardo M Fabbri, Juan C Celedón, Giorgio Walter Canonica, Paula Busse, Louis-Phillippe Boulet, Carlos E Baena-Cagnani, Qutayba Hamid, Claus Bachert, Ruby Pawankar, Stephen T Holgate. World Allergy Organ J. ; 7(1): 8. Published online May doi:/
    Perinatal and Early Childhood Environmental Factors Influencing Allergic Asthma Immunopathogenesis. Jonathan M.

    Gaffin, Watcharoot Kanchongkittiphon, Wanda Phipatanakul. Int Immunopharmacol. September; 22(1): 21– Published online June doi: / PMCID: PMC

  • Patients report that they feel in harm or frightened by their asthma
  • Work/school days missed
  • Persistent severe airflow obstruction. Two or more ED visits or hospitalizations for asthma in the past year; any history of intubation or ICU admission, especially if in the past 5 years
  • Psychosocial factors: depression, increased stress, socioeconomic factors
  • Lung function, measured by spirometry: FEV1, FVC (or FEV6), FEV1/FVC (or FEV6 in adults).

    Spirometry is the preferred method for measuring lung function to classify severity. Peak flow has not been found to be a dependable variable for classifying severity.

  • Ability to engage in normal daily activities or in desired activities
  • Symptoms
    1. Nighttime awakenings
    2. National Heart, Lung, and Blood Institute National Asthma Education and Prevention ProgramExpert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma, Full report
    3. Certain demographic or patient characteristics: female, nonwhite, nonuse of ICS therapy, and current smoking
    4. Need for SABA for quick relief of symptoms
    5. International Consensus On (ICON) Pediatric Asthma
      N.

      G. Papadopoulos, H. Arakawa, K.-H. Carlsen, A. Custovic, J. Gern, R. Lemanske, P. Le Souef, M. Makela, G. Roberts, G. Wong, H. Zar, C. A. Akdis, L. B. Bacharier, E. Baraldi, H. P. van Bever, J. de Blic, A. Boner, W. Burks, T. B. Casale, J. A. Castro-Rodriguez, Y. Z. Chen, Y. M. El-Gamal, M. L. Everard, T. Frischer, M. Geller, J. Gereda, D. Y. Goh, T. W. Guilbert, G. Hedlin, P. W. Heymann, S. J. Hong, E. M. Hossny, J. L. Huang, D. J. Jackson, J. C. de Jongste, O. Kalayci, N. Khaled, S. Kling, P. Kuna, S. Lau, D. K. Ledford, S. I. Lee, A. H. Liu, R. F. Lockey, K. Lodrup-Carlsen, J. Lotvall, A. Morikawa, A. Nieto, H. Paramesh, R. Pawankar, P. Pohunek, J. Pongracic, D. Price, C.

      Robertson, N. Rosario, L. J. Rossenwasser, P. D. Sly, R. Stein, S. Stick, S. Szefler, L. M. Taussig, E. Valovirta, P. Vichyanond, D. Wallace, E. Weinberg, G. Wennergren, J. Wildhaber, R. S. Zeiger. Allergy. Author manuscript; available in PMC May Published in final edited form as: Allergy. August; 67(8): – Published online June doi:/jx PMCID: PMC

Assessment of Risk

Assessment of the risk of future adverse events requires careful medical history, observation, and clinician judgment.

Documentation of warning signs and adverse events will be necessary when a patient is felt to be at increased risk. Patients who are deemed at increased risk of adverse outcomes need shut monitoring and frequent assessment by their clinicians.

Predictors that own been reported to be associated with increased risk of exacerbations or death include:

  1. Persistent severe airflow obstruction. Two or more ED visits or hospitalizations for asthma in the past year; any history of intubation or ICU admission, especially if in the past 5 years
  2. Certain demographic or patient characteristics: female, nonwhite, nonuse of ICS therapy, and current smoking
  3. Global strategy for asthma management and prevention: GINA executive n ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M et al.

    Eur Respir J 31(1) DOI/ PMID:

  4. Asthma endotypes: a new approach to classification of disease entities within the asthma syndrome.Lötvall J1, Akdis CA, Bacharier LB, Bjermer L, Casale TB, Custovic A, Lemanske RF Jr, Wardlaw AJ, Wenzel SE, Greenberger PA. J Allergy Clin Immunol. Feb;(2) doi: /
  5. National Heart, Lung, and Blood Institute National Asthma Education and Prevention ProgramExpert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma, Full report
  6. The Genetics of Asthma and Allergic Disease: A 21st Century Perspective
    Carole Ober, Tsung-Chieh Yao.

    Immunol Rev. Author manuscript; available in PMC July 1. Published in final edited form as: Immunol Rev. July; (1): doi:/jXx PMCID: PMC

  7. Psychosocial factors: depression, increased stress, socioeconomic factors
  8. Asthma in the elderly: what we know and what we own yet to know. Anahí Yáñez, Sang-Hoen Cho, Joan B Soriano, Lanny J Rosenwasser, Gustavo J Rodrigo, Klaus F Rabe, Stephen Peters, Akio Niimi, Dennis K Ledford, Rohit Katial, Leonardo M Fabbri, Juan C Celedón, Giorgio Walter Canonica, Paula Busse, Louis-Phillippe Boulet, Carlos E Baena-Cagnani, Qutayba Hamid, Claus Bachert, Ruby Pawankar, Stephen T Holgate.

    World Allergy Organ J. ; 7(1): 8. Published online May doi:/
    Perinatal and Early Childhood Environmental Factors Influencing Allergic Asthma Immunopathogenesis. Jonathan M. Gaffin, Watcharoot Kanchongkittiphon, Wanda Phipatanakul. Int Immunopharmacol. September; 22(1): 21– Published online June doi: / PMCID: PMC

  9. Attitudes and beliefs about taking medications
  10. Severe airflow obstruction, as detected by spirometry
  11. Patients report that they feel in harm or frightened by their asthma
  12. International Consensus On (ICON) Pediatric Asthma
    N. G. Papadopoulos, H. Arakawa, K.-H. Carlsen, A.

    Custovic, J. Gern, R. Lemanske, P. Le Souef, M. Makela, G. Roberts, G. Wong, H. Zar, C. A. Akdis, L. B. Bacharier, E. Baraldi, H. P. van Bever, J. de Blic, A.

    What is naet therapy for allergies

    Boner, W. Burks, T. B. Casale, J. A. Castro-Rodriguez, Y. Z. Chen, Y. M. El-Gamal, M. L. Everard, T. Frischer, M. Geller, J. Gereda, D. Y. Goh, T. W. Guilbert, G. Hedlin, P. W. Heymann, S. J. Hong, E. M. Hossny, J. L. Huang, D. J. Jackson, J. C. de Jongste, O. Kalayci, N. Khaled, S. Kling, P. Kuna, S. Lau, D. K. Ledford, S. I. Lee, A. H. Liu, R. F. Lockey, K. Lodrup-Carlsen, J. Lotvall, A. Morikawa, A. Nieto, H. Paramesh, R. Pawankar, P. Pohunek, J. Pongracic, D. Price, C. Robertson, N. Rosario, L. J. Rossenwasser, P. D. Sly, R. Stein, S. Stick, S.

    Szefler, L. M. Taussig, E. Valovirta, P. Vichyanond, D. Wallace, E. Weinberg, G. Wennergren, J. Wildhaber, R. S. Zeiger. Allergy. Author manuscript; available in PMC May Published in final edited form as: Allergy. August; 67(8): – Published online June doi:/jx PMCID: PMC

Asthma in elderly
Asthma affecting individuals across the lifespan. Current evidence consistently suggests that asthma is common among elderly subjects. Because of increased longevity, the proportion of individuals aged 65years and older is increasing worldwide. By , elderly subjects will comprise ~20% and ~36% of the populations of the United States (U.S.) and China, respectively.

Determining the exact prevalence of asthma in elderly is made hard by under-diagnosis due to decreased perception or under-reporting of symptoms by patients, suboptimal utilization of spirometry, misclassification of asthma as chronic obstructive pulmonary disease (COPD), and failure to recognize asthma in subjects with co-morbidities such as congestive heart failure or COPD. In two nationwide surveys in the U.S. estimates of the prevalence of current asthma in the elderly were % for the period – In elderly subjects, asthma is more common in women than in men.

Compared to children or younger adults, older adults and/or elderly subjects own greater morbidity and healthcare costs from asthma, thus it is significant to recognize and treat asthma in older population.

Pathogenesis and genetics

Over the final decade research has confirmed the significant role of inflammation in asthma, unfortunately specific processes related to the transmission of airway inflammation to specific pathophysiologic consequences of airway dysfunction and the clinical manifestations of asthma own yet to be fully understood. Similarly, much has been learned about the host –environment factors that determine airways’ susceptibility to these processes, but the relative contributions of either and the precise interactions between them that leads to the initiation or persistence of disease is hard to establish.

The concepts underlying asthma pathogenesis own evolved dramatically in the past 25 years and are still undergoing evaluation as various phenotypes of this disease are defined and greater insight links clinical features of asthma with genetic patterns.

Because asthma involves an integrated response in the conducting airways of the lung to known or unknown triggers, it is a multicellular disease, involving abnormal responses of numerous diverse cell types in the lung.

Environmental triggers concurrently act on airway afferent nerves (which both release their own peptide mediators and stimulate reflex release of the bronchoconstrictor acetylcholine) and airway epithelial cells to initiate responses in multiple cell types that contribute to the mucous metaplasia and airway smooth muscle bronchoconstriction that characterize asthma.

Epithelial cells release TSLP and IL, which act on airway dendritic cells, and IL, which together with IL acts on mast cells, basophils, and innate type 2 lymphocytes.

These secreted products stimulate dendritic cell maturation that facilitates the generation of effector T cells and triggers the release of both direct bronchoconstrictors and Th2 cytokines from innate immune cells, which feed back on both the epithelium and airway smooth muscle and further facilitate amplification of airway inflammation through subsequent adaptive T cell responses.

Asthma is genetically heterogeneous. A few common alleles are associated with disease risk at every ages.

Implicated genes propose a role for communication of epithelial damage to the adaptive immune system and activation of airway inflammation. Asthma runs strongly in families, and its heritability has been estimated as 60%. Genetic studies offer a structured means of understanding the causes of asthma as well as identifying targets that can be used to treat the syndrome. Recent genome-wide association studies begun to shed light on both common and distinct pathways that contribute to asthma and allergic diseases.

Associations with variation in genes encoding the epithelial cell-derived cytokines, interleukin (IL) and thymic stromal lymphopoietin (TSLP), and the IL1RL1 gene encoding the IL receptor, ST2, highlight the central roles for innate immune response pathways that promote the activation and differentiation of T-helper 2 (Th2) cells in the pathogenesis of both asthma and allergic diseases. These and other genetic findings expanding our understanding of the common and unique biological pathways that are dysregulated in these related conditions and eventually will be helpful in design of new therapies and prevention modalities.

NAET's founder believes that virtually every disease and illness, and even developmental disorders, are caused when the electromagnetic signature of allergens disrupts energy flow within the body.

Kathryn isn&#x;t the only conventionally trained doctor who works at the crossroads of evidence-based Western medicine and alternative therapies that often defy explanation and sometimes contradict established medical science.

Such treatments aren&#x;t as unusual as they used to be, of course&#x;according to the National Middle for Health Statistics, 38 percent of Americans use some helpful of complementary or alternative medicine, from acupuncture to tai chi.

But the treatment Kathryn used on the lawyer is a particularly notorious example. It&#x;s called Nambudripad&#x;s allergy elimination techniques, or NAET. The mainstream medical journal Current Allergy & Clinical Immunology recently dubbed it the most unsubstantiated allergy treatment proposed to date. , a one-man medical watchdog site run by a retired doctor, calls NAET a combination of abuse and larceny and encourages anybody encountering a practitioner to file a complaint with the state attorney general.

Such warnings are less troubling to Kathryn than to me, a journalist and, by nature, somewhat of a skeptic.

The bottom line for Kathryn, at 47 a sober and experienced clinician, is that she believes NAET works. NAET, she says, cured her of a lingering gastrointestinal illness and provided withdrawal-free relief from cigarette addiction. That triggered a switch for her. She left a cushy occupation as director of medical services for the Miami-Dade County jail system for the uncertainty of a private, solo practice integrating Western medicine with acupuncture, nutritional medicine, and other alternative therapies. I felt I had an obligation to assist people in a way that other physicians were not, says Kathryn, dressed in sandals, white jeans, and a loose flower-print blouse in her sun-dappled Miami office.

NAET is rooted in principles of Chinese medicine.

Its founder, Devi Nambudripad, a year-old, Indian-born chiropractor in Los Angeles, believes that virtually every disease and illness, and even developmental disorders, including autism, are caused when the electromagnetic signature of allergens&#x;food, chemicals, hormones, proteins, other substances&#x;disrupts energy flow within the body. (The attorney, says Kathryn, was allergic to a range of foods and spices.)

Therapy is simple and can be far less expensive than traditional treatment: controlled exposure to the allergen (typically in a vial) along with an acupressure treatment.

Kathryn has trained under Nambudripad, who says that more than 10, people worldwide own taken her training, including numerous other MDs.

The Nambudripad website, and Devi Nambudripad&#x;s several books, are filled with statistics that portray NAET as a low-cost miracle cure: a 98 percent success rate for 1, patients treated for arthritis; 98 percent for 1, headache patients; 98 percent for patients with depression. The list goes on&#x;relief for everything from indigestion to insomnia, anxiety to asthma. I enquire Nambudripad&#x;s son Roy, an MD who works with her, about these numbers. He surprises me by essentially dismissing them, citing a lack of scientific controls.

The Nambudripads are working to generate more rigorous proof.

A year ago, Devi co-authored a study on NAET&#x;s impact on children with autism: It found that after a one-year regimen of NAET, 23 of 30 children scored high enough on autism measurement scales to return to a normal classroom setting, while none returned from the control group. The study appeared in Integrative Medicine: A Clinician&#x;s Journal&#x;peer reviewed, but hardly The New England Journal of Medicine, which, along with other top medical journals, declined to publish the study.

I hear Kathryn factoring in the dearth of hard science as she advises her patients on their treatment options.

I know this sounds crazy, she tells them before describing NAET.

I don&#x;t recommend it to everybody, she tells me. Only people I ponder would be open to something we can&#x;t easily understand. But she did recently remove NAET from her website&#x;s list of services. She prefers that patients discover her by expression of mouth&#x;the MD who does weird stuff.

Allergic Asthma: Symptoms and Treatment

Updated: July
Originally Posted: May

Updated by:

Nataliya M Kushnir, MD FAAAAI
Medical Director, Allergy and Immunology Clinic of East Bay
Berkeley, California
Distinguished Volunteer Teacher, Oakland Children’s Hospital Residency Program

Michael A.

Kaliner, MD FAAAAI
Medical Director, Institute for Asthma and Allergy
Chevy Chase and Wheaton, Maryland
Professor of Medicine, George Washington University School of Medicine
Washington DC

Original authors:

H. Henry Li, MD, PhD
FAAAAI, FACAAI
Institute for Asthma and Allergy
Wheaton and Chevy Chase Maryland

Michael A. Kaliner, MD FAAAAI
Medical Director, Institute for Asthma and Allergy
Chevy Chase and Wheaton, Maryland
Professor of Medicine, George Washington University School of Medicine
Washington DC

Bibliography

Assessment of Risk

Assessment of the risk of future adverse events requires careful medical history, observation, and clinician judgment.

Documentation of warning signs and adverse events will be necessary when a patient is felt to be at increased risk. Patients who are deemed at increased risk of adverse outcomes need shut monitoring and frequent assessment by their clinicians.

Predictors that own been reported to be associated with increased risk of exacerbations or death include:

  1. Persistent severe airflow obstruction. Two or more ED visits or hospitalizations for asthma in the past year; any history of intubation or ICU admission, especially if in the past 5 years
  2. Certain demographic or patient characteristics: female, nonwhite, nonuse of ICS therapy, and current smoking
  3. Global strategy for asthma management and prevention: GINA executive n ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M et al.

    Eur Respir J 31(1) DOI/ PMID:

  4. Asthma endotypes: a new approach to classification of disease entities within the asthma syndrome.Lötvall J1, Akdis CA, Bacharier LB, Bjermer L, Casale TB, Custovic A, Lemanske RF Jr, Wardlaw AJ, Wenzel SE, Greenberger PA. J Allergy Clin Immunol. Feb;(2) doi: /
  5. National Heart, Lung, and Blood Institute National Asthma Education and Prevention ProgramExpert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma, Full report
  6. The Genetics of Asthma and Allergic Disease: A 21st Century Perspective
    Carole Ober, Tsung-Chieh Yao.

    Immunol Rev. Author manuscript; available in PMC July 1. Published in final edited form as: Immunol Rev. July; (1): doi:/jXx PMCID: PMC

  7. Psychosocial factors: depression, increased stress, socioeconomic factors
  8. Asthma in the elderly: what we know and what we own yet to know. Anahí Yáñez, Sang-Hoen Cho, Joan B Soriano, Lanny J Rosenwasser, Gustavo J Rodrigo, Klaus F Rabe, Stephen Peters, Akio Niimi, Dennis K Ledford, Rohit Katial, Leonardo M Fabbri, Juan C Celedón, Giorgio Walter Canonica, Paula Busse, Louis-Phillippe Boulet, Carlos E Baena-Cagnani, Qutayba Hamid, Claus Bachert, Ruby Pawankar, Stephen T Holgate.

    World Allergy Organ J. ; 7(1): 8. Published online May doi:/
    Perinatal and Early Childhood Environmental Factors Influencing Allergic Asthma Immunopathogenesis. Jonathan M. Gaffin, Watcharoot Kanchongkittiphon, Wanda Phipatanakul. Int Immunopharmacol. September; 22(1): 21– Published online June doi: / PMCID: PMC

  9. Attitudes and beliefs about taking medications
  10. Severe airflow obstruction, as detected by spirometry
  11. Patients report that they feel in harm or frightened by their asthma
  12. International Consensus On (ICON) Pediatric Asthma
    N. G. Papadopoulos, H. Arakawa, K.-H.

    Carlsen, A. Custovic, J. Gern, R. Lemanske, P. Le Souef, M. Makela, G. Roberts, G. Wong, H. Zar, C. A. Akdis, L. B. Bacharier, E. Baraldi, H. P. van Bever, J. de Blic, A. Boner, W. Burks, T. B. Casale, J. A. Castro-Rodriguez, Y.

    What is naet therapy for allergies

    Z. Chen, Y. M. El-Gamal, M. L. Everard, T. Frischer, M. Geller, J. Gereda, D. Y. Goh, T. W. Guilbert, G. Hedlin, P. W. Heymann, S. J. Hong, E. M. Hossny, J. L. Huang, D. J. Jackson, J. C. de Jongste, O. Kalayci, N. Khaled, S. Kling, P. Kuna, S. Lau, D. K. Ledford, S. I. Lee, A. H. Liu, R. F. Lockey, K. Lodrup-Carlsen, J. Lotvall, A. Morikawa, A. Nieto, H. Paramesh, R. Pawankar, P. Pohunek, J. Pongracic, D. Price, C. Robertson, N.

    Rosario, L. J.

    What is naet therapy for allergies

    Rossenwasser, P. D. Sly, R. Stein, S. Stick, S. Szefler, L. M. Taussig, E. Valovirta, P. Vichyanond, D. Wallace, E. Weinberg, G. Wennergren, J. Wildhaber, R. S. Zeiger. Allergy. Author manuscript; available in PMC May Published in final edited form as: Allergy. August; 67(8): – Published online June doi:/jx PMCID: PMC

Asthma in elderly
Asthma affecting individuals across the lifespan. Current evidence consistently suggests that asthma is common among elderly subjects. Because of increased longevity, the proportion of individuals aged 65years and older is increasing worldwide. By , elderly subjects will comprise ~20% and ~36% of the populations of the United States (U.S.) and China, respectively.

Determining the exact prevalence of asthma in elderly is made hard by under-diagnosis due to decreased perception or under-reporting of symptoms by patients, suboptimal utilization of spirometry, misclassification of asthma as chronic obstructive pulmonary disease (COPD), and failure to recognize asthma in subjects with co-morbidities such as congestive heart failure or COPD. In two nationwide surveys in the U.S. estimates of the prevalence of current asthma in the elderly were % for the period – In elderly subjects, asthma is more common in women than in men.

Compared to children or younger adults, older adults and/or elderly subjects own greater morbidity and healthcare costs from asthma, thus it is significant to recognize and treat asthma in older population.

Pathogenesis and genetics

Over the final decade research has confirmed the significant role of inflammation in asthma, unfortunately specific processes related to the transmission of airway inflammation to specific pathophysiologic consequences of airway dysfunction and the clinical manifestations of asthma own yet to be fully understood.

Similarly, much has been learned about the host –environment factors that determine airways’ susceptibility to these processes, but the relative contributions of either and the precise interactions between them that leads to the initiation or persistence of disease is hard to establish. The concepts underlying asthma pathogenesis own evolved dramatically in the past 25 years and are still undergoing evaluation as various phenotypes of this disease are defined and greater insight links clinical features of asthma with genetic patterns.

Because asthma involves an integrated response in the conducting airways of the lung to known or unknown triggers, it is a multicellular disease, involving abnormal responses of numerous diverse cell types in the lung.

Environmental triggers concurrently act on airway afferent nerves (which both release their own peptide mediators and stimulate reflex release of the bronchoconstrictor acetylcholine) and airway epithelial cells to initiate responses in multiple cell types that contribute to the mucous metaplasia and airway smooth muscle bronchoconstriction that characterize asthma.

Epithelial cells release TSLP and IL, which act on airway dendritic cells, and IL, which together with IL acts on mast cells, basophils, and innate type 2 lymphocytes.

These secreted products stimulate dendritic cell maturation that facilitates the generation of effector T cells and triggers the release of both direct bronchoconstrictors and Th2 cytokines from innate immune cells, which feed back on both the epithelium and airway smooth muscle and further facilitate amplification of airway inflammation through subsequent adaptive T cell responses.

Asthma is genetically heterogeneous. A few common alleles are associated with disease risk at every ages. Implicated genes propose a role for communication of epithelial damage to the adaptive immune system and activation of airway inflammation.

Asthma runs strongly in families, and its heritability has been estimated as 60%. Genetic studies offer a structured means of understanding the causes of asthma as well as identifying targets that can be used to treat the syndrome. Recent genome-wide association studies begun to shed light on both common and distinct pathways that contribute to asthma and allergic diseases. Associations with variation in genes encoding the epithelial cell-derived cytokines, interleukin (IL) and thymic stromal lymphopoietin (TSLP), and the IL1RL1 gene encoding the IL receptor, ST2, highlight the central roles for innate immune response pathways that promote the activation and differentiation of T-helper 2 (Th2) cells in the pathogenesis of both asthma and allergic diseases.

These and other genetic findings expanding our understanding of the common and unique biological pathways that are dysregulated in these related conditions and eventually will be helpful in design of new therapies and prevention modalities.

NAET's founder believes that virtually every disease and illness, and even developmental disorders, are caused when the electromagnetic signature of allergens disrupts energy flow within the body.

Kathryn isn&#x;t the only conventionally trained doctor who works at the crossroads of evidence-based Western medicine and alternative therapies that often defy explanation and sometimes contradict established medical science.

Such treatments aren&#x;t as unusual as they used to be, of course&#x;according to the National Middle for Health Statistics, 38 percent of Americans use some helpful of complementary or alternative medicine, from acupuncture to tai chi.

But the treatment Kathryn used on the lawyer is a particularly notorious example. It&#x;s called Nambudripad&#x;s allergy elimination techniques, or NAET. The mainstream medical journal Current Allergy & Clinical Immunology recently dubbed it the most unsubstantiated allergy treatment proposed to date. , a one-man medical watchdog site run by a retired doctor, calls NAET a combination of abuse and larceny and encourages anybody encountering a practitioner to file a complaint with the state attorney general.

Such warnings are less troubling to Kathryn than to me, a journalist and, by nature, somewhat of a skeptic.

The bottom line for Kathryn, at 47 a sober and experienced clinician, is that she believes NAET works. NAET, she says, cured her of a lingering gastrointestinal illness and provided withdrawal-free relief from cigarette addiction. That triggered a switch for her. She left a cushy occupation as director of medical services for the Miami-Dade County jail system for the uncertainty of a private, solo practice integrating Western medicine with acupuncture, nutritional medicine, and other alternative therapies.

I felt I had an obligation to assist people in a way that other physicians were not, says Kathryn, dressed in sandals, white jeans, and a loose flower-print blouse in her sun-dappled Miami office.

NAET is rooted in principles of Chinese medicine. Its founder, Devi Nambudripad, a year-old, Indian-born chiropractor in Los Angeles, believes that virtually every disease and illness, and even developmental disorders, including autism, are caused when the electromagnetic signature of allergens&#x;food, chemicals, hormones, proteins, other substances&#x;disrupts energy flow within the body. (The attorney, says Kathryn, was allergic to a range of foods and spices.)

Therapy is simple and can be far less expensive than traditional treatment: controlled exposure to the allergen (typically in a vial) along with an acupressure treatment.

Kathryn has trained under Nambudripad, who says that more than 10, people worldwide own taken her training, including numerous other MDs.

The Nambudripad website, and Devi Nambudripad&#x;s several books, are filled with statistics that portray NAET as a low-cost miracle cure: a 98 percent success rate for 1, patients treated for arthritis; 98 percent for 1, headache patients; 98 percent for patients with depression. The list goes on&#x;relief for everything from indigestion to insomnia, anxiety to asthma. I enquire Nambudripad&#x;s son Roy, an MD who works with her, about these numbers. He surprises me by essentially dismissing them, citing a lack of scientific controls.

The Nambudripads are working to generate more rigorous proof.

A year ago, Devi co-authored a study on NAET&#x;s impact on children with autism: It found that after a one-year regimen of NAET, 23 of 30 children scored high enough on autism measurement scales to return to a normal classroom setting, while none returned from the control group. The study appeared in Integrative Medicine: A Clinician&#x;s Journal&#x;peer reviewed, but hardly The New England Journal of Medicine, which, along with other top medical journals, declined to publish the study.

I hear Kathryn factoring in the dearth of hard science as she advises her patients on their treatment options.

I know this sounds crazy, she tells them before describing NAET.

I don&#x;t recommend it to everybody, she tells me. Only people I ponder would be open to something we can&#x;t easily understand. But she did recently remove NAET from her website&#x;s list of services. She prefers that patients discover her by expression of mouth&#x;the MD who does weird stuff.

Allergic Asthma: Symptoms and Treatment

Updated: July
Originally Posted: May

Updated by:

Nataliya M Kushnir, MD FAAAAI
Medical Director, Allergy and Immunology Clinic of East Bay
Berkeley, California
Distinguished Volunteer Teacher, Oakland Children’s Hospital Residency Program

Michael A.

Kaliner, MD FAAAAI
Medical Director, Institute for Asthma and Allergy
Chevy Chase and Wheaton, Maryland
Professor of Medicine, George Washington University School of Medicine
Washington DC

Original authors:

H. Henry Li, MD, PhD
FAAAAI, FACAAI
Institute for Asthma and Allergy
Wheaton and Chevy Chase Maryland

Michael A. Kaliner, MD FAAAAI
Medical Director, Institute for Asthma and Allergy
Chevy Chase and Wheaton, Maryland
Professor of Medicine, George Washington University School of Medicine
Washington DC

Bibliography

  • National Heart, Lung, and Blood Institute National Asthma Education and Prevention ProgramExpert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma, Full report
  • Asthma in the elderly: what we know and what we own yet to know.

    Anahí Yáñez, Sang-Hoen Cho, Joan B Soriano, Lanny J Rosenwasser, Gustavo J Rodrigo, Klaus F Rabe, Stephen Peters, Akio Niimi, Dennis K Ledford, Rohit Katial, Leonardo M Fabbri, Juan C Celedón, Giorgio Walter Canonica, Paula Busse, Louis-Phillippe Boulet, Carlos E Baena-Cagnani, Qutayba Hamid, Claus Bachert, Ruby Pawankar, Stephen T Holgate. World Allergy Organ J. ; 7(1): 8.

    Published online May doi:/
    Perinatal and Early Childhood Environmental Factors Influencing Allergic Asthma Immunopathogenesis. Jonathan M. Gaffin, Watcharoot Kanchongkittiphon, Wanda Phipatanakul. Int Immunopharmacol.

    What is naet therapy for allergies

    September; 22(1): 21– Published online June doi: / PMCID: PMC

  • The Genetics of Asthma and Allergic Disease: A 21st Century Perspective
    Carole Ober, Tsung-Chieh Yao. Immunol Rev. Author manuscript; available in PMC July 1. Published in final edited form as: Immunol Rev. July; (1): doi:/jXx PMCID: PMC
  • Global strategy for asthma management and prevention: GINA executive n ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M et al. Eur Respir J 31(1) DOI/ PMID:
  • Asthma endotypes: a new approach to classification of disease entities within the asthma syndrome.Lötvall J1, Akdis CA, Bacharier LB, Bjermer L, Casale TB, Custovic A, Lemanske RF Jr, Wardlaw AJ, Wenzel SE, Greenberger PA.

    J Allergy Clin Immunol. Feb;(2) doi: /

  • International Consensus On (ICON) Pediatric Asthma
    N. G. Papadopoulos, H. Arakawa, K.-H. Carlsen, A. Custovic, J. Gern, R. Lemanske, P. Le Souef, M. Makela, G. Roberts, G. Wong, H. Zar, C. A. Akdis, L. B. Bacharier, E. Baraldi, H. P. van Bever, J. de Blic, A. Boner, W. Burks, T. B. Casale, J. A. Castro-Rodriguez, Y. Z. Chen, Y. M. El-Gamal, M. L. Everard, T. Frischer, M. Geller, J. Gereda, D. Y. Goh, T. W. Guilbert, G. Hedlin, P. W. Heymann, S. J. Hong, E. M. Hossny, J. L. Huang, D. J. Jackson, J. C. de Jongste, O. Kalayci, N. Khaled, S. Kling, P. Kuna, S. Lau, D. K. Ledford, S. I. Lee, A. H. Liu, R. F. Lockey, K.

    Lodrup-Carlsen, J. Lotvall, A. Morikawa, A. Nieto, H. Paramesh, R. Pawankar, P. Pohunek, J. Pongracic, D. Price, C. Robertson, N. Rosario, L. J. Rossenwasser, P. D. Sly, R. Stein, S. Stick, S. Szefler, L. M. Taussig, E. Valovirta, P. Vichyanond, D. Wallace, E. Weinberg, G. Wennergren, J.

    What is naet therapy for allergies

    Wildhaber, R. S. Zeiger. Allergy. Author manuscript; available in PMC May Published in final edited form as: Allergy. August; 67(8): – Published online June doi:/jx PMCID: PMC

What is glyceryl monothioglycolate and where is it found?

Glyceryl monothioglycolate is a chemical substance that is used in permanent wave (perming) solutions. The use of glyceryl monothioglycolate in perming solutions was developed in the s. Known as an acid perm, glyceryl monothioglycolate works by breaking the disulfide links between the polypeptide bonds in the keratin (the protein structure) in the hair wrapped in rods.

Heat is applied via a hairdryer and this activates the perm process causing the bonds to reform in the shape of a curl.

Glyceryl monthioglycolate contains no ammonia, hence this type of perm is not associated with the smell that alkaline perms own. In addition, acid perms are gentler to the hair, hence more suitable for delicate or thinner hair.

What is glyceryl monothioglycolate and where is it found?

Glyceryl monothioglycolate is a chemical substance that is used in permanent wave (perming) solutions.

The use of glyceryl monothioglycolate in perming solutions was developed in the s. Known as an acid perm, glyceryl monothioglycolate works by breaking the disulfide links between the polypeptide bonds in the keratin (the protein structure) in the hair wrapped in rods. Heat is applied via a hairdryer and this activates the perm process causing the bonds to reform in the shape of a curl.

Glyceryl monthioglycolate contains no ammonia, hence this type of perm is not associated with the smell that alkaline perms own.

In addition, acid perms are gentler to the hair, hence more suitable for delicate or thinner hair.


Treatment of glyceryl monothioglycolate dermatitis

Management of glyceryl monothioglycolate dermatitis on the hands and fingers may be treated as for any acutedermatitis/eczema; this may include treatment with topical corticosteroids and emollients.


RELATED VIDEO: