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Latest & greatest articles for asthma
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on asthma or other clinical topics then use Trip today.
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admitted to hospital due to acute asthma should have daily pulmonary function tests to help establish parameters for safe discharge and drug doses. The inability to predict rapid deterioration in acute asthma is described in case-control series for fatal and near-fatal asthma. Controlled trials to evaluate the question of management of patients on the hospital ward versus the intensive care unit are neither ethical nor necessary. Intubated asthmatic patients clearly require admission to an intensive (...) saturation. Aust Clin Rev 1991 ; 11 : 20 -1. 16. Kerem E, Canny G, Tibshirani R, Resiman J, Bentur L, Schuh S, et al. Clinical-physiologic correlations in acute asthma of childhood. Pediatrics 1991 ; 87 : 481 -6. 17. Ortiz AI, Arreguin OL, Garcia CR. [Arterial oxygen saturation versus peak expiratory flow as predictive values in the course of asthmatic crises in children.] Saturación arterial de oxigeno contra flujo espiratorio maximo como valores predictivos en la evolución de la crisis asmatica en
Heart, Lung and Blood Institute. Guidelines for the diagnosis and management of asthma. Bethesda: Department of Health and Human Services; 1997. NIH publ 97-405. 3. The British guidelines on asthma management 1995: review and position statement. Thorax 1997;52(Suppl):S1-21. 4. Worth H. Patient education in asthmatic adults. Lung 1990 ; 168 (Suppl): 463 -8. 5. Kotses H, Stout C, Wigal JK, Carlson B, Creer TL, Lewis P. Individualized asthma self-management: a beginning. J Asthma 1991 ; 28 : 287 -9. 6 (...) , Rips J, Kaplan D, Levison MJ, et al. A school health education program for children with asthma age 8-11 years. Health Educ Q 1987 ; 14 : 267 -79. 27. Wilson SR, Scamages P, German DF, Hughes GW, Lulla S, Coss S, et al. A controlled trial of two forms of self-management education for adults with asthma. Am J Med 1993 ; 94 : 564 -76. 28. Fireman P, Friday GA, Gira C, Vierthaler WA. Teaching self-management skills to asthmatic children and their parents in an ambulatory care setting. Pediatrics 1981
Diagnosis and evaluation of asthma in adults Diagnosis and evaluation of asthma in adults | CMAJ Main menu User menu Search Search for this keyword Search for this keyword Article Diagnosis and evaluation of asthma in adults Three main features must be considered in the diagnosis of asthma: symptoms, variable airflow obstruction and airway inflammation.[ – ] Airway inflammation is not yet readily tested in routine clinical practice and will not be considered further here. However, skin testing (...) may be an adjunct to diagnosis and is discussed in this section. Symptoms Common symptoms of asthma include wheezing, chest tightness, dyspnea and cough. The characteristics of these symptoms, which are variable, often paroxysmal and provoked by allergic or nonallergic stimuli such as cold air and irritants, are useful in diagnosis. Nocturnal occurrence is common. Measuring the patient's response to a therapeutic trial may be helpful in diagnosis. Nonpulmonary symptoms that suggest
human rhinoviruses (HRV) as important agents in all age groups, and 1 study using this technique suggested a high prevalence of chronic Chlamydia infection in asthmatic children. How viruses or other agents provoke asthma is not clear. There is evidence of increased IgE production during viral infection. A recent study using a human B-cell culture system found that HRV-induced, double-stranded RNA activates an antiviral protein kinase that can induce Ig class switching to IgE, suggesting a mechanism (...) for viral provocation of allergy and asthma. This is consistent with a study of experimental HRV infection in asthmatic adults, which resulted in augmented eosinophilic inflammation (assessed in sputum) and enhanced bronchial responsiveness. In another controlled study of experimental HRV infection in people with allergic rhinitis (but no asthma) and a nonallergic control group, there was a significant increase in bronchial responsiveness to histamine in the allergic group. Rhinovirus infection
improves significantly in the last 4 weeks of pregnancy. Asthmatic pregnant women have been variably reported to have an increased risk of pregnancy-induced hypertension, pre-eclampsia, caesarian section, placenta previa and antepartum or postpartum hemorrhage.[ , – ] Poorly controlled asthma may affect maternal comfort and safety and pregnancy outcome for both mother and child. However, data from well-designed studies have shown that treated asthmatic women have fewer adverse infant and maternal (...) of asthmatic women: a prospective controlled analysis. Am J Respir Crit Care Med 1995 ; 151 : 1170 -4. 6. Schatz M. Asthma and pregnancy. Immunol Allergy Clin North Am 1996 ; 16 : 893 -916. 7. Demissie K, Breckenridge MB, Rhoads GG. Infant and maternal outcomes in the pregnancies of asthmatic women. Am J Respir Crit Care Med 1998 ; 158 : 1091 -5. 8. Schatz M, Zeiger RS, Harden KM, Hoffman CP, Forsythe AB, Chilingar LM, et al. The safety of inhaled beta-agonist bronchodilator during pregnancy. J Allergy
Med 1995 ; 152 : 1183 -8. 10. Ben-Noun L. Acute asthma associated with sustained-release verapamil. Ann Pharmacother 1997 ; 31 : 593 -5. 11. Harju T, Keistinen T, Tuuponen T, Kivela SL. Hospital admissions of asthmatics by age and sex. Allergy 1996 ; 51 : 693 -6. 12. Bellia V, Cuttitta G, Cibella F, Vignola AM, Crescimanno G, D'Accardi P, et al. Effect of aging on peak expiratory flow variability and nocturnal exacerbations in bronchial asthma. Eur Respir J 1997 ; 10 : 1803 -8. 13. Connolly MJ (...) , Crowley JJ, Charan NB, Nielson CP, Vestal RE. Reduced subjective awareness of bronchoconstriction provoked by methacholine in elderly asthmatic and normal subjects as measured on a simple awareness scale. Thorax 1992 ; 42 : 410 -3. 14. Jones FL, Ekberg NL. Exacerbation of asthma by timolol. N Engl J Med 1979 ; 301 : 270 . 15. Hill MR, Gotz VP, Harman E, McLeod I, Hendeles L. Evaluation of the asthmogenicity of propafenone, a new antiarrhythmic drug. Comparison of spirometry with methacholine challenge
Capacity of specific immunotherapy in prevention of allergic asthma in children: the Preventive Allergy Treatment Study (PAT). 9416551 1998 02 18 2013 07 31 1018-9068 7 5 1997 Sep-Oct Journal of investigational allergology & clinical immunology J Investig Allergol Clin Immunol Capacity of specific immunotherapy in prevention of allergic asthma in children: the Preventive Allergy Treatment Study (PAT). 369-70 Valovirta E E Turku Allergy Center, Turku, Finland. eng Clinical Trial Journal Article (...) Multicenter Study Randomized Controlled Trial Spain J Investig Allergol Clin Immunol 9107858 1018-9068 IM Adolescent Asthma prevention & control Child Child, Preschool Desensitization, Immunologic Female Humans Male 1998 1 7 1998 1 7 0 1 1998 1 7 0 0 ppublish 9416551
Randomised, dose-ranging, placebo-controlled study of chimeric antibody to CD4 (keliximab) in chronic severe asthma. There is substantial circumstantial evidence that CD4 lymphocytes have a role in the pathogenesis of chronic asthma. We investigated the efficacy and safety in severe corticosteroid-dependent asthma of a single intravenous infusion of keliximab (IDEC CE9.1), a chimeric monoclonal antibody to CD4.22 patients were recruited from two asthma clinics. In an ascending-dose design (...) adverse effects related to treatment. Two patients had mild exacerbations of eczema and one developed a transient maculopapular rash. All doses of keliximab were associated with a reduction from baseline in CD4 count.Our findings raise the possibility that T-cell-directed treatment may be an alternative approach to the treatment of severe asthma.
A comparison of active and simulated chiropractic manipulation as adjunctive treatment for childhood asthma. Chiropractic spinal manipulation has been reported to be of benefit in nonmusculoskeletal conditions, including asthma.We conducted a randomized, controlled trial of chiropractic spinal manipulation for children with mild or moderate asthma. After a three-week base-line evaluation period, 91 children who had continuing symptoms of asthma despite usual medical therapy were randomly (...) at two months and P=0.82 at four months). Symptoms of asthma and use of 3-agonists decreased and the quality of life increased in both groups, with no significant differences between the groups. There were no significant changes in spirometric measurements or airway responsiveness.In children with mild or moderate asthma, the addition of chiropractic spinal manipulation to usual medical care provided no benefit.
Effect of nebulized ipratropium on the hospitalization rates of children with asthma. Anticholinergic medications such as ipratropium improve the pulmonary function of patients with acute exacerbations of asthma, but their effect on hospitalization rates is uncertain.We conducted a randomized, double-blind, placebo-controlled study of 434 children (2 to 18 years old) who had acute exacerbations of moderate or severe asthma treated in the emergency department. All the children received (...) of hospitalization was lower in the ipratropium group (59 of 215 children [27.4 percent]) than in the control group (80 of 219 [36.5 percent], P=0.05). For patients with moderate asthma (indicated by a peak expiratory flow rate of 50 to 70 percent of the predicted value or an asthma score of 8 to 11 on a 15-point scale), hospitalization rates were similar in the two groups (ipratropium: 8 of 79 children [10.1 percent]; control: 9 of 84 [10.7 percent]). For patients with severe asthma (defined as a peak
Montelukast for chronic asthma in 6- to 14-year-old children: a randomized, double-blind trial. Pediatric Montelukast Study Group. Leukotrienes are important mediators of asthma by causing bronchoconstriction, mucous secretion, and increased vascular permeability. Studies using compounds that block leukotrienes have demonstrated improvement in asthma control in adults and adolescents, but children younger than 12 years, for whom asthma is the most common chronic disease, have not been (...) level of daytime asthma symptoms, and daily beta-agonist use. Concomitant inhaled corticosteroids at a constant daily dose were used by 39% of patients receiving montelukast and 33% receiving placebo.After a 2-week placebo run-in period, patients received either montelukast (5-mg chewable tablet) or matching-image placebo once daily at bed-time for 8 weeks.Morning FEV1 percent change from baseline.Mean morning FEV1 increased from 1.85 L to 2.01 L in the montelukast group and from 1.85 L to 1.93 L
Effect of long-term salmeterol treatment on exercise-induced asthma. With long-term administration of salmeterol, the extent of protection afforded by the drug against experimental precipitants of asthma such as methacholine and adenosine may decrease. Whether this effect extends to a clinically relevant stimulus such as exercise is unknown.We performed a random-order, double-blind, crossover trial in 20 patients with exercise-induced asthma. Each patient received inhaled salmeterol or placebo (...) and 18+/-2 percent in the evening). The morning dose of salmeterol attenuated the degree of bronchoconstriction at all times (decrease in FEV1 on day 1, 5+/-2 percent; on day 14, 10+/-3 percent; and on day 29, 9+/-3 percent; P=0.10). Its ability to act throughout the day, however, decreased with long-term administration (decrease in FEV1 from morning to evening on day 1, 6+/-2 percent; on day 14, 15+/-3 percent; and on day 29, 14+/-3 percent; P=0.003).Protection against exercise-induced asthma
Montelukast, a leukotriene-receptor antagonist, for the treatment of mild asthma and exercise-induced bronchoconstriction. Patients with mild asthma frequently have only exercise-induced bronchoconstriction, a symptom of inadequate control of asthma. We evaluated the ability of montelukast, a leukotriene-receptor antagonist, to protect such patients against exercise-induced bronchoconstriction.We randomly assigned 110 patients (age, 15 to 45 years) with mild asthma and a decrease in the forced (...) the washout period. After 12 weeks of treatment, patients in the montelukast group were more likely to rate their asthma control as better and less likely to require rescue therapy with a beta-agonist during or after exercise challenge. The rates of adverse events were similar in the two groups.As compared with placebo, once-daily treatment with montelukast provided significant protection against exercise-induced asthma over a 12-week period. Tolerance to the medication and rebound worsening of lung
Randomised placebo-controlled crossover trial on effect of inactivated influenza vaccine on pulmonary function in asthma. Despite current recommendations, many people with asthma do not receive annual vaccination against influenza, partly because of concern that vaccine may trigger exacerbations. Colds can trigger exacerbations, which may be mistaken for vaccine-related adverse events. We undertook a double-blind placebo-controlled multicentre crossover study to assess the safety of influenza (...) vaccine in patients with asthma, with allowance for the occurrence of colds.We studied 262 patients, aged 18-75 years, who recorded daily peak expiratory flow (PEF), respiratory symptoms, medication, medical consultations, and hospital admissions for 2 weeks before the first injection and until 2 weeks after the second injection. Order of injection (vaccine and placebo) was assigned randomly. There was an interval of 2 weeks between injections. The main outcome measure was an exacerbation of asthma
1998LancetControlled trial quality: predicted high
Does medical antireflux therapy improve asthma in asthmatics with gastroesophageal reflux: a critical review of the literature Does medical antireflux therapy improve asthma in asthmatics with gastroesophageal reflux: a critical review of the literature Does medical antireflux therapy improve asthma in asthmatics with gastroesophageal reflux: a critical review of the literature Field S K, Sutherland L R Authors' objectives To review the available evidence of the effects of antireflux therapy (...) on asthma control in asthmatics with gastrointestinal reflux. Searching MEDLINE was searched from 1966 to 1996 using the following keywords combined with 'asthma': 'gastro esophageal reflux', 'antacids', 'alginates', 'cimetidine', 'ranitidine', 'famotidine', 'nizatidine', 'cisapride', 'omeprazole', 'lansoprazole', 'pantoprazole', 'domperidone' and 'metoclopramide'. The search was restricted to studies published in the English language. The reference lists of these papers were also examined
of methotrexate, except for those asthmatics who are already experiencing substantial side-effects from corticosteroid therapy. Bibliographic details Aaron S D, Dales R E, Pham B. Management of steroid-dependent asthma with methotrexate: a meta-analysis of randomized clinical trials. Respiratory Medicine 1998; 92(8): 1059-1065 PubMedID Other publications of related interest 1. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical (...) trials: is blinding necessary? Control Clin Trials 1996;17:1-12. 2. Marin MG. Low-dose methotrexate spares steroid usage in steroid-dependent asthmatic patients. Chest 1997;112:29-33. Indexing Status Subject indexing assigned by NLM MeSH Asthma /drug therapy; Drug Administration Schedule; Drug Therapy, Combination; Glucocorticoids /administration & Humans; Immunosuppressive Agents /adverse effects /therapeutic use; Methotrexate /adverse effects /therapeutic use; Prednisone /administration
Active detection of chronic obstructive pulmonary disease and asthma in the general population: results and economic consequences of the DIMCA program Active detection of chronic obstructive pulmonary disease and asthma in the general population: results and economic consequences of the DIMCA program Active detection of chronic obstructive pulmonary disease and asthma in the general population: results and economic consequences of the DIMCA program van den Boom G, van Schayck C P, Rutten-van (...) of screening followed by monitoring for 6 months, 12 months and 2 years to detect cases of asthma and chronic obstructive pulmonary disease (COPD). The comparisons reported for the economic evaluation were: screening plus 6 month monitoring versus no screening; screening plus 12 month monitoring versus screening plus 6 month monitoring; and screening plus 24 month monitoring versus screening plus 12 month monitoring. Type of intervention Screening. Economic study type Cost-effectiveness analysis. Study
of acute asthmatic patients. Type of intervention Treatment. Economic study type Cost-effectiveness analysis. Study population The study population was patients with acute asthma presenting to an urban hospital emergency department (ED) whose acute asthma exacerbation could not be stabilised after 3 hours of ED therapy (the study population satisfied a wide list of inclusion and exclusion criteria). Setting Hospital. The economic study was carried out in Chicago, USA. Dates to which data relate (...) Emergency department observation unit versus hospital inpatient care for a chronic asthmatic population: a randomized trial of health status outcome and cost Emergency department observation unit versus hospital inpatient care for a chronic asthmatic population: a randomized trial of health status outcome and cost Emergency department observation unit versus hospital inpatient care for a chronic asthmatic population: a randomized trial of health status outcome and cost Rydman R J, Isola M L
Cost-effectiveness analysis of formoterol versus salmeterol in patients with asthma Cost-effectiveness analysis of formoterol versus salmeterol in patients with asthma Cost-effectiveness analysis of formoterol versus salmeterol in patients with asthma Rutten-van Molken M P, van Doorslaer E K, Till M D Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results (...) and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology The use of long acting inhaled beta 2-agonists, salmeterol and formoterol as a part of a treatment regimen for patients requiring regular treatment of asthma and for nocturnal asthma. Type of intervention Treatment. Economic study type Cost-effectiveness analysis. Study population Patients over the age of 18 with asthma who potentially might benefit from the use of long