The pathobiology of asthma: implications for treatment
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2000
|
| Schriftenreihe: | Clinics in chest medicine
21,2 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XIV S., S. 213 - 400 Ill., graph. Darst. |
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Datensatz im Suchindex
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| adam_text | THE PATHOBIOLOGY OF ASTHMA: IMPLICATIONS FOR TREATMENT
CONTENTS
Preface xiii
Sally E. Wenzel
Pathobiology
The Pathobiology of Acute Asthma 213
E.R. McFadden, Jr and Rana B. Hejal
Acute bronchial asthma is a common problem with immense medical and
economic impacts. It is estimated that this disease affects 12 to 14 million
people in the United States with costs in excess of $6 billion per year. Most
of the morbidity and all of the mortality of asthma tends to be associated
with acute exacerbations, and treatment of these events accounts for the
majority of expenditures in money and health care resources. Unfortu¬
nately, the factors that contribute to the destabilization of asthma are rarely
studied and much of the pathogenesis and pathobiology of acute asthma
remains unknown. This article examines these issues and suggests treat¬
ment for acute asthma.
The Pathology of Chronic Asthma 225
Shigeo Muro, Eleanor M. Minshall, and Qutayba A. Hamid
Bronchial asthma is a chronic inflammatory disorder characterized by an
eosinophilic inflammatory infiltrate. T lymphocytes and eosinophils play
a pivotal role in the pathophysiology of asthma and mediators from those
inflammatory cells orchestrate the local immune response. This article
reviews our current knowledge regarding the histopathology of asthma,
with specific reference to the inflammatory cells and cytokines that are
attracting particular interest.
Contributing Factors to the Pathobiology
Contributing Factors to the Pathobiology: The Genetics of
Asthma 245
Carole Ober and Miriam F. Moffatt
Genetic studies of asthma and other atopic phenotypes have progressed
rapidly in the past 5 years. The completion of genome wide screens in five
CLINICS IN CHEST MEDICINE
VOLUME 21 • NUMBER 2 • JUNE 2000 vii
population samples have identified at least 20 potential chromosomal
regions that show evidence for linkage in multiple studies. In some of
these regions, candidate gene studies have revealed associations with
asthma or asthma associated phenotypes in selected samples. Furthermore,
studies in mouse models have shown linkage to regions that are syntenic
to three of the linked regions in humans. These studies and the status of
our current understanding of the genetics of asthma are reviewed.
Contributing Factors to the Pathobiology of Asthma:
The Thl/Th2 Paradigm 263
Annette M. Colavita, Alan J. Reinach, and Stephen P. Peters
CD4+ helper T lymphocytes in murine and human models have been
divided into Thl and Th2 subclasses, characterized by the profile of cyto
kines they secrete: INF 7 (and perhaps IL 2 and TNF (3) by Thl cells, and
IL 4 (and perhaps IL 5, IL 6, IL 10, and IL 13) by Th2 cells. Although a
strict division into Thl and Th2 phenotypes in humans (unlike murine
systems) may not be possible, the asthmatic diathesis in humans appears
to be one largely characterized by inflammatory responses associated with
Th2 cells and their cytokines, particularly IL 4, IL 13, and IL 5. Other
pulmonary disorders, such as those associated with infectious diseases
including tuberculosis, appear to favor an immunologic response charac¬
teristic of Thl cells, and its defining cytokine IFN 7. This apparent
Thl/Th2 immune dysregulation in asthma is an area of active investiga¬
tion and forms the basis for ongoing attempts to change this phenotype
through a variety of approaches. These include immunotherapy with con¬
ventional antigens, designer peptides, oligonucleotides, and anti IgE, and
pharmacotherapy with immune modulating drugs, cytokines, cytokine
agonists and cytokine antagonists, and antibodies. This field of investiga¬
tion promises to usher in a whole new approach to our understanding of
asthma and ways to approach its treatment.
The Role of Viruses in Development or Exacerbation of Atopic
Asthma 279
Jiirgen Schwarze and Erwin W. Gelfand
Respiratory viral infections in early childhood have been linked to the
development of persistent wheezing and asthma. Epidemiologic data indi¬
cate that, for the majority of children, virus induced wheezing is a self
limited condition, with no long term consequences. This article reviews
the epidemiology of viral respiratory infections, inflammation, and virus
induced wheezing in asthma development.
The Role of Respiratory Viruses in Acute and Chronic Asthma 289
Amjad Tuffaha, James E. Gern, and Robert F. Lemanske, Jr
Respiratory tract infections caused by viruses have been implicated in the
pathogenesis of asthma. This article focuses on mechanisms by which
virus infections may lead to the development of asthma in infants and
children, and the mechanisms by which the virus infections may produce
acute asthmatic symptoms in patients who already have established dis¬
ease.
The Role of Bacterial Infections in Asthma 301
Monica Kraft
Bacteria are well known causative organisms in the exacerbation of asthma
and pose significant problems for patients and their clinicians. Bacterial
viii CONTENTS
organisms can increase airway hyper responsiveness and inflammation in
the patient with known asthma, but now the question arises whether these
same mechanisms may be responsible for the development of asthma.
This article presents evidence that specific organisms, Mycoplasma pneu
moniae and Chlamydia pneumoniae, are known to exacerbate asthma, but
may be involved in asthma pathogenesis.
Consequences of Long term Inflammation
Consequences of Long term Inflammation: The Natural History
of Asthma 315
Malcolm R. Sears
Childhood asthma often improves or remits, especially if mild; however,
impaired lung function, increased airway responsiveness, a greater degree
of atopy, and concurrent atopic disease all predispose to a poorer prognosis
and persistence into adulthood. Exposure to environmental and personal
tobacco smoke also contribute to a worse prognosis. Adults with asthma
rarely experience full remission, but show increased rates of decline of
lung function. The severity and duration of asthma, together with delay
in initiating appropriate treatment, all contribute to adverse outcomes,
with airway remodeling contributing to increasing and sometimes irrevers¬
ible airflow obstruction.
Consequences of Long term Inflammation: Airway Remodeling 331
Robert J. Homer and Jack A. Elias
Airway inflammation may not account for all the clinical manifestations
of asthma. Airway remodeling, which is thought to be a result of airway
chronic inflammation, may help fill this void. Remodeling is described for
fatal and nonfatal asthmatics including changes in smooth muscle, colla¬
gen deposition, noncollagenous matrix, and mucus glands. This article
also reviews the correlation of airway remodeling with clinical, physiologic
and biologic data, experimental models of airways remodeling, and effect
of therapy on airway remodeling. Throughout, it is emphasized that the
concept of airway remodeling is a dynamic process that is active and
potentially progressive in asthmatic patients but that may be prevented
by appropriate therapy.
Pathobiology based Assessment and Therapy
Noninvasive Measurement of Airway Inflammation Using
Exhaled Nitric Oxide and Induced Sputum: Current Status and
Future Use 345
Philip E. Silkoff
Airway inflammation is the focus of research into and therapy for asthma.
This article addresses new ways to detect and monitor airway inflamma¬
tion using induced sputum and exhaled nitric oxide. Induced sputum can
give valuable insights into the cellular and humeral components of airway
inflammation. Exhaled nitric oxide is raised in untreated asthma and falls
rapidly after inhaled or oral corticosteroids. Together, these two new ways
of monitoring asthma promise to revolutionize the way we monitor
asthma and other airway diseases.
Treatment of Acute Asthma: A New Look at the Old
and at the New 361
Robert Silverman
Along with the increasing prevalence of asthma comes an increase in acute
asthma flares and morbidity. More effective treatment strategies for the
CONTENTS ix
acutely ill patient are needed to prevent hospitalization and subsequent
relapse. This article explores the optimal use of commonly used therapeu¬
tic agents, highlights controversies regarding existing therapies, and identi¬
fies newer agents that hold promise in the management of the acutely ill
asthmatic patient. In addition, the pathobiology of acute asthma as it
relates to management strategies is described.
The Pathobiologic Implications for Treatment: Old and New
Strategies in the Treatment of Chronic Asthma 381
Todd Horiuchi and Mario Castro
An increased understanding of the pathobiology of asthma has led to
improved treatment for chronic asthma. This article discusses the old and
new strategies of asthma therapy based on a pathobiologic approach.
Therapeutic agents discussed include p adrenergic agonists, methylxan
thines, corticosteroids, cromolyn, nedocromil, leukotriene modifiers, and
new investigational agents.
Index 397
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| spelling | The pathobiology of asthma implications for treatment Sally E. Wenzel guest ed. Philadelphia [u.a.] Saunders 2000 XIV S., S. 213 - 400 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Clinics in chest medicine 21,2 Asthme - Thérapeutique Asthme - physiopathologie Astma gtt Biologische aspecten gtt Pathologie gtt Asthma Asthma Pathology Asthma pathology Bronchialasthma (DE-588)4069674-1 gnd rswk-swf Pathophysiologie (DE-588)4044898-8 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Bronchialasthma (DE-588)4069674-1 s Pathophysiologie (DE-588)4044898-8 s DE-604 Wenzel, Sally E. Sonstige oth Clinics in chest medicine 21,2 (DE-604)BV000001084 21,2 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=009031701&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
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| title | The pathobiology of asthma implications for treatment |
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| title_exact_search | The pathobiology of asthma implications for treatment |
| title_full | The pathobiology of asthma implications for treatment Sally E. Wenzel guest ed. |
| title_fullStr | The pathobiology of asthma implications for treatment Sally E. Wenzel guest ed. |
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