John Rees

ABC of asthma

ABC of asthma / , ABC of asthma / , کتابخانه دیجیتالی دانشگاه علوم پزشکی و خدمات درمانی شهید بهشتی

Asthma control in adults

The prevalence of asthma has increased in most countries since the 1970s. Levels may have plateaued in developed countries but as prevalence is associated with urbanisation and a western lifestyle the problem worldwide is likely to increase over the next two decades (fig 1). About 300 million people worldwide have asthma and by 2025 it has been estimated that a further 100 million will be affected.1 Asthma accounts for one in every 250 deaths worldwide and 1% of all disability adjusted life years. In overall health terms chronic symptoms of asthma account for 8% of self reported poor health in 18-64 year olds and 3.5% of days of limited activity, putting asthma above diabetes but below arthritis as a chronic health problem.w1 Psychological distress and feelings of decreased control are high in people with asthma and strongly associated with physical health.w2 Well controlled asthma reduces the burden for patients and health services. Fig 2 Eosinophils in bronchial mucosa, part of inflammatory process in asthma Fig 1 Prevalence of clinical asthma worldwide. Reproduced from Masoli et al1 with permission of Blackwell Control of asthma may mean minimal symptoms and freedom from exacerbations for patients, normal peak flow or low scores on standard questionnaires for doctors, or composite measures in clinical trials. As definitions vary an American Thoracic Society taskforce is considering standard definitions for control and exacerbations.w3 This review looks at important issues in definition and control of asthma in adults. I searched Medline for articles on asthma in adults using the terms “asthma control” for 2004-6. I also searched Cochrane reviews, hand searched reference lists and conference proceedings, and discussed important current issues in asthma control with colleagues. Control is usually defined by severity of symptoms, simple tests such as peak expiratory flow, and prevention of exacerbations. Current guidelines …

New guidelines on asthma management

The British guidelines on the management of asthma first appeared in 1990 in the BMJ .1 2 Two years later revised guidelines, extended to cover asthma in childhood, were distributed to all hospitals and general practitioners in Britain.3 They have come to be widely respected as a clear and practical statement of best practice in the management of asthma. This month sees the publication of a review and a position statement commenting on the guidelines in the light of recent evidence.4 The participants for the latest review were those from the 1993 paper, if they wished to continue, or replacements as needed. Background papers were produced and subsequently published.5 The summary statement was discussed and agreed in 1995, and it is disappointing that publication has been delayed until 1997. The summary statement should be read in conjunction with the 1993 guidelines. Most of the 1993 advice remains valid, but there are important changes. The new guidelines reiterate the importance of a correct diagnosis and the dangers of escalation of treatment in other …

ABC of asthma. Asthma in children: treatment.

The aims of treatment should be: These can be achieved by prompt diagnosis, identification of trigger factors, evaluation of severity, establishment of a partnership of management with the asthmatic child and the family, and regular review. #### Assessment of management There has been much discussion recently about “self management” and “self management plans.” The term is slightly misleading and a better description is partnership in management. The aim is to develop a strategy for management which will help asthmatic children and their families to cope with the day to day care of their asthma. The strategy should be adapted to the severity of the asthma and to the home and school circumstances. Partnership in management comprises: Trained respiratory nurses working in asthma clinics and in schools have a vital role in partnership management. There are also many educational aids available including written material produced by lay organisations such as the National Asthma Campaign, videos, computer programs, and so on. They are valuable supplements to but not substitutes for regular personal contact between families and appropriately trained healthcare professionals. The avoidance of cigarette smoke is important. Families with asthmatic children should be encouraged not to acquire pets. Pets have to go when allergy has been …

ABC of Asthma: TREATMENT OF CHRONIC ASTHMA

The first line of treatment of mild intermittent asthma is one of the selective s2-stimulants taken by inhalation. s-stimulants are the most effective bronchodilator in asthma. They start to work quickly—salbutamol and terbutaline take effect within 15 minutes and last for four to six hours. If more than one daily dose is usually required then additional treatment must be considered. The dose response varies among patients as does the dose that will produce side effects, such as tremor. Patients should be taught to monitor their inhaler use and to understand that if they need it more or its effects lessen, these are danger signals. They indicate deterioration in asthmatic control and the need for further treatment. s-stimulants Some patients worry that s-stimulants may become slightly less effective with time, particularly if the dose is high. There is little evidence of appreciable tachyphylaxis for the airway effects in asthmatics. If it exists it is a minor effect that is quickly reversed either by stopping the treatment temporarily or by taking corticosteroids. Tremor, palpitations, and muscle cramps may occur but are rarely troublesome if the drug is inhaled and these adverse effects outside the lung often become less of a problem with continued treatment. The regular use of s-stimulants has in some studies been associated with increased bronchial reactivity, worsening asthma control, and accelerated decline of lung function. When the steps in the guidelines are followed, however, s-stimulants are not used regularly unless needed for control of symptoms. Bronchodilator response to oral salbutamol 200 μg (solid line) and inhaled salmeterol 50 μg (broken line). Long acting preparations of oral s-agonists have been available for some years. They are effective in nocturnal asthma but are associated with more adverse effects than inhaled agents. The oral agent bambuterol, a prodrug of terbutaline, provides a …

MYOCARDIAL OXYGEN CONSUMPTION OR AVAILABILITY

rats exposed to high concentrations. Our paper reported no deaths from nasal cancer compared with 1 07 expected among the cohort by the end of 1981, although altogether 1626 men had died. The April issue of Health and Safety at Work suggested that our study is inadequate, because it did not include information on morbidity. However, we have been informed of non-fatal cancer cases among men in this study through the national cancer registration scheme, and no living cases of nasal cancer have been notified to us. Our letter of May 12 (p 1066) mentioned our plan to do casecontrol studies of smoking and previous employment among the lung cancer cases and controls in one of the factories. Unfortunately, the information available in the factory records has proved scanty. Among 128 lung cancer cases and 640 controls (5 matched to each case) whose records, including medical records,