Asthma update:
Saved in:
| Format: | Book |
|---|---|
| Language: | English |
| Published: |
Philadelphia [u.a.]
Saunders
1996
|
| Series: | Immunology and allergy clinics of North America
16,4 |
| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Physical Description: | XII S., S. 735 - 951 Ill., graph. Darst. |
Staff View
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| 245 | 1 | 0 | |a Asthma update |c Paul V. Williams, guest ed. |
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Record in the Search Index
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| adam_text | ASTHMA UPDATE
CONTENTS
Preface xi
Paul V. Williams
Pathophysiology
Nitric Oxide and Asthma 735
Anthony F. Massaro and Jeffrey M. Drazen
The free radical nitrous oxide functions as a signal transducer to
help control critical airway processes such as bronchodilation and
bronchovascular integrity. Increased nitric oxide concentrations
have been recovered in the expirate of asthmatic subjects. The
alteration in expired nitric oxide level in asthmatics may reflect a
homeostatic role of nitric oxide. Alternatively, nitric oxide reacts
rapidly with superoxide in the airway to form the potent oxidant
peroxynitrite which can potentiate airway inflammation. This ar¬
ticle reviews the postulated homeostatic and proinflammatory
roles of nitric oxide in the asthmatic airway. The potential use of
measurements of expired nitric oxide concentration as a noninva
sive indicator of airway inflammation is also reviewed.
Pharmacologic and Nonpharmacologic Therapy
Environmental Control of Asthma 753
C. Warren Bierman
Environmental control is an important step in the control of
asthma. Mites, cats and other pets, cockroaches, molds, and ciga¬
rette smoke are all important in the etiology of asthma. By de¬
creasing exposure to these factors, one can reduce the symptoms
IMMUNOLOGY AND ALLERGY CLINICS OF NORTH AMERICA
VOLUME 16 • NUMBER 4 • NOVEMBER 1996 V
of active disease. In addition, one can decrease the incidence of
asthma by avoiding exposure to mites from infancy.
High Dose Inhaled Steroids 765
Ricardo A. Tan and Sheldon L. Spector
High dose inhaled steroids are currently recommended for the
treatment of moderate to severe asthma. Although the dose
response relationship has not been conclusively established due
to varying study designs, high dose (more than 1000 meg daily)
inhaled steroids have been shown to be very effective in improv¬
ing lung function and symptoms in moderate to severe asth¬
matics. Hypothalamic pituitary adrenal axis suppression and ef¬
fects on bone metabolism have been observed with high doses,
but the clinical relevance of these effects has not been established.
Mild and reversible local effects include dysphonia and oral can
didiasis, which can be prevented with mouth rinsing and the use
of spacers.
Treatment of Steroid Resistant Asthma 777
Dennis K. Ledford
Asthma that requires chronic glucocorticoid therapy for control
or that does not improve with glucocorticoid therapy is a clinical
challenge. The mechanisms responsible for glucocorticoid depen
dent or glucocorticoid resistant asthma are varied. No single ther¬
apy is universally helpful in controlling asthma and permitting a
reduction of glucocorticoid side effects. Double blind, placebo
controlled trials of weekly, pulse methotrexate, gold salts, and
cyclosporine are available in the medical literature to support the
use of these agents. Additional information suggests the value of
other therapies, including troleandomycin, hydroxychloroquine,
dapsone, nonsteroidal anti inflammatory drugs, intravenous im
munoglobulin, and heparin. This author believes that oral gold
therapy with auranofin is the least toxic therapy with data sup¬
porting efficiency in glucocorticoid dependent or glucocorticoid
resistant asthma.
New Modalities for the Pharmacotherapy of Asthma:
Leukotriene Inhibitors and Antagonists 797
William R. Henderson, Jr
Airway inflammation in patients with asthma is characterized by
an influx of eosinophils into the lungs, bronchial epithelial dam¬
age, mucus secretion, smooth muscle hypertrophy, and mucosal
edema. The 5 lipoxygenase products of arachidonic acid termed
leukotrienes are important mediators of this inflammatory re¬
sponse in the lungs. New modalities for the therapy of asthma
are compounds that block either leukotriene formation or the
actions of leukotrienes by specific receptor antagonists. The leuko¬
triene pathway inhibitors and antagonists have demonstrated
Vi CONTENTS
efficacy in patients with asthma including decreases in exercise
and cold, dry air induced asthma and nocturnal wheezing.
Managed Care of Asthma
The Allergist and Asthma Disease Management 809
Kevin P. O Brien
Allergists claim expertise in disease management of asthma now
that there is appreciation that the condition is one of underlying
allergic/immunologic dysfunction. The majority of patient care
by allergists is in three conditions that tend to coexist: allergies,
sinusitis, and asthma. The field of allergy /asthma/immunology
(as reflected by name changes in the national societies) leads all
other specialties in asthma research, program development, and
cost effective care of asthma. In the managed care setting, new
options may become available for more efficient use of the exper¬
tise of the allergist in disease management of asthma.
Cost and Cost Effectiveness in Asthma: Use of
Pharmacoeconomics to Assess the Value of
Asthma Interventions 819
Sean D. Sullivan
This article informs the reader about the nature and extent of the
economic burden of asthma and describes the literature on the
cost effectiveness of many of the major treatment choices for
asthma. The author concludes that despite the many shortcom¬
ings, economic evaluations of asthma treatments need to be en¬
couraged and nurtured. Substantial improvements and standard¬
ization are needed in the study design, study duration, sample
size determination based on economic and health status end
points, selection of appropriate comparison therapies, and selec¬
tion and evaluation of costs and outcomes.
An Overview of Outcomes Measurement in Asthma Care 841
Robin Rose and Kevin B. Weiss
The increasing interest in outcomes evaluation among patients,
clinical providers, and health care organizations is driving the
need for useful, valid, and reliable outcomes measures for most
chronic illnesses. This article presents an overview of many of
the key issues in outcomes measurement for asthma care. Asthma
outcome measurement is discussed from the perspective of both
patient and health care organizational interests. This review high¬
lights some of the available tools as well as identifies directions
in which asthma outcomes measurement needs further improve¬
ment.
CONTENTS vii
Practical Approach to the Use of Outcomes in Asthma:
Traveling the Road to Better Asthmatic Care 859
Don A. Bukstein
This article explores the use of outcome information as the most
crucial part of following an asthmatic patient over time. This
article explains the different types of outcome measures used in
following asthmatic patients. Practical information is provided
that will aid physicians in tracking their asthmatic patients prog¬
ress over time as well as help in evaluating larger populations.
The article highlights the following usefulness of outcome infor¬
mation, describing the patient s overall state, screening for incipi¬
ent disease, setting treatment goals, monitoring disease progres¬
sion, tracking response to treatment, improving physician patient
communication, providing information and boundary guidelines
for asthma treatment, and helping the physician select the most
appropriate patient education.
Special Issues
Asthma and Pregnancy 893
Michael Schatz
Asthma is one of the most common medical problems to compli¬
cate pregnancy. Review of the literature suggests that equal pro¬
portions of women improve, worsen, and stay the same regarding
their asthma course during pregnancy. Review of the literature
also reveals that asthmatic women may be at increased risk of
adverse perinatal outcomes, but optimal control of asthma during
pregnancy appears to minimize this risk. Recommendations are
presented regarding the management of chronic and acute gesta
tional asthma.
Asthma and Scuba Diving 917
Karen B. Van Hoesen and Tom S. Neuman
Until recently, asthma or a past history of asthma has been
considered an absolute contraindication for scuba diving because
of the theoretical risk of developing acute airway obstruction
underwater and subsequent pulmonary barotrauma. Asthmatic
individuals are diving safely, however, and appear to be diving
without an increase in accidents compared with nonasthmatic
divers. Individuals with normal airway function are at low risk
for idiopathic pulmonary barotrauma. Proper screening with pul¬
monary function and exercise testing appear to be able to screen
out those asthmatic patients who should not dive while identi¬
fying those who can be considered for diving.
Cumulative Index 1996 929
Subscription Information Inside back cover
Viii CONTENTS
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| spelling | Asthma update Paul V. Williams, guest ed. Philadelphia [u.a.] Saunders 1996 XII S., S. 735 - 951 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Immunology and allergy clinics of North America 16,4 Asthme - physiopathologie Astma gtt Asthma Asthma physiopathology Bronchialasthma (DE-588)4069674-1 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Bronchialasthma (DE-588)4069674-1 s DE-604 Williams, Paul V. A. Sonstige oth Immunology and allergy clinics of North America 16,4 (DE-604)BV000645505 16,4 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=007472023&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Asthma update Immunology and allergy clinics of North America Asthme - physiopathologie Astma gtt Asthma Asthma physiopathology Bronchialasthma (DE-588)4069674-1 gnd |
| subject_GND | (DE-588)4069674-1 (DE-588)4143413-4 |
| title | Asthma update |
| title_auth | Asthma update |
| title_exact_search | Asthma update |
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| title_fullStr | Asthma update Paul V. Williams, guest ed. |
| title_full_unstemmed | Asthma update Paul V. Williams, guest ed. |
| title_short | Asthma update |
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| topic_facet | Asthme - physiopathologie Astma Asthma Asthma physiopathology Bronchialasthma Aufsatzsammlung |
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