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Asthma/Bronchial Asthma
Published in Charles Theisler, Adjuvant Medical Care, 2023
Asthma is the leading chronic illness among children (20%–30%).1 The cause of asthma is unknown. Asthma is not curable and has become a serious challenge to clinical medicine with an increase in incidence, morbidity, and mortality in the past two decades.2 Goals in treating asthma include preventing asthma symptoms, maintaining nearly normal pulmonary function and activity levels, preventing asthmatic exacerbations, and avoiding adverse effects from asthma medications.
Risk factors – Treatable traits
Published in Vibeke Backer, Peter G. Gibson, Ian D. Pavord, The Asthmas, 2023
Vibeke Backer, Peter G. Gibson, Ian D. Pavord
Treatment of the associated asthma. It is unclear whether any treatment is better than others, or whether higher doses are needed. If travelling to polluted areas, people may need to consider increasing their treatment.
Pulmonary diseases in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Leah Lande, Abraham Sanders, Dana Zappetti
Asthma is characterized by either partial or completely reversible airway obstruction, with airway inflammation, bronchospasm, and mucous hypersecretion. Typical symptoms of asthma include dyspnea, cough, wheezing, and chest tightness. These may be worse at night and, with exercise, may occur in the setting of an upper respiratory tract infection or after exposure to environmental triggers such as hot or cold air, dust or pollen, house dust mites, cockroach antigens, pets, or other inhaled irritants. Asthma symptoms can also be triggered by gastroesophageal reflux that is estimated to occur in up to 50% of pregnant women (17) or by postnasal drip that is precipitated by hyperemia and glandular hyperactivity in the upper respiratory mucosa during pregnancy.
History of asthma in Canada
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2022
Asthma is thought to be due to a combination of genetic and environmental factors. The relatively steep rise in prevalence in developed countries in a short period of time cannot be a result of genetic changes and, therefore, must relate to environmental influences. A potential explanation is the hygiene hypothesis that suggests that increasing hygiene, including vaccinations, with reduced exposure to infectious agents and their products, leads to immune deviation toward the allergic phenotype.17 This is supported by documentation of lower asthma prevalence of asthma in farm children in Quebec.18 Supportive studies from post-unification Germany showed lower objective evidence of atopy, asthma and airway hyperresponsiveness (AHR) in children in Leipzig, East Germany compared to Munich in West Germany,19 a trend which was beginning to disappear 5 years later.20
Exposure to cleaning products and childhood asthma: more than just a link?
Published in Expert Review of Respiratory Medicine, 2020
As a complex disease, asthma is caused by a combination of environmental and genetic factors. In irritant-induced asthma, household cleaning products target the respiratory epithelium, causing bronchial hyper-responsiveness and wheeze as a result of chronic exposure [6]. Cleaning agents have been found to directly disrupt the barrier functionality of human bronchial epithelial cells, even in dilute concentrations [20]. Over time, this damage worsens, causing remodeling, reduced lung function, increased airway reactivity, and heightened sensitivity to future exposures. A compromised epithelial barrier increases a child’s vulnerability to viral infections, irritation or inflammation, and acquired immune response to future allergens. Many cleaning products also contain allergenic compounds which can increase sensitivity, particularly when exposed to an already-damaged epithelium.
Oral corticosteroid use, obesity, and ethnicity in children with asthma
Published in Journal of Asthma, 2020
Jennifer A. Lucas, Miguel Marino, Katie Fankhauser, Steffani R. Bailey, David Ezekiel-Herrera, Jorge Kaufmann, Stuart Cowburn, Shakira F. Suglia, Andrew Bazemore, Jon Puro, John Heintzman
We found that children identified as being overweight or obese received more prescriptions for oral steroid medications for asthma control than children who were not overweight or obese. Taken as an indication of condition severity and management, the elevated reliance on oral steroid medications among overweight children suggests that these patients may have worse outcomes and may have suboptimal management of asthma symptoms. Untreated asthma can lead to other adverse, acute and chronic, health outcomes. Furthermore, uncontrolled asthma can limit physical activity, which in turn may drive weight gain, and finally, worsen resting asthma symptoms in a negatively enforcing cycle. This finding is consistent with previous research, as asthma is often less effectively controlled in children with overweight and obesity than in healthy weight children, often due to decreased response to inhaled glucocorticoids (33–35). It is unclear why inhaled glucocorticoids do not work as well in obese patients as in patients who are at a healthy weight, although it is believed that systemic inflammation resulting from obesity may alter the function of the medication. Additionally, hormones produced by adipose tissue, such as leptin, may play a role in the differences in asthma control in those who are obese compared to those who are lean (4,7,34). Also, pressure on the chest and airways from excess weight can also contribute to decreased lung function and difficulty breathing (1,34).