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Adult Asthma
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Flavia CL Hoyte, Eugene M Choo, Rohit K Katial
Treatment for an acute asthma exacerbation includes bronchodilator therapy and systemic corticosteroids (oral or parenteral). Bronchodilator therapy should be with albuterol or levalbuterol at a dose not more than 10 mg per hour of albuterol or 5 mg per hour of levalbuterol. Recent studies have also demonstrated that albuterol Metered Dose Inhalers (MDIs) used with a spacer device are at least comparable to nebulized delivery (Cates et al. 2006). Anticholinergic therapy with ipratropium bromide used in combination with bronchodilator therapy has been shown to decrease hospitalization rates in children (Qureshis et al. 1997).
The patient with shortness of breath
Published in Andrew Stewart, Rory Mackinnon, Pocket On Call, 2015
Andrew Stewart, Rory Mackinnon
Immediate diagnostic clarity may be easier said than done in the presence of a complex patient who is struggling to breathe, but the following are amongst the most common you are likely to see: COPD exacerbation.Pneumonia.Asthma exacerbation.Acute left ventricular failure (LVF) causing pulmonary oedema.Acute respiratory distress syndrome (ARDS).Pneumothorax.Anaphylaxis.Exacerbations of other respiratory disorders (e.g. bronchiectasis or cystic fibrosis).
Diagnosis of Asthma in Older Children and Adults
Published in Jonathan A. Bernstein, Mark L. Levy, Clinical Asthma, 2014
In mild asthma, a physical examination is usually not helpful, as it is normal under stable conditions, but becomes characteristically abnormal during asthma exacerbations. Typical physical signs during an asthma exacerbation are wheezing on auscultation, cough, and signs of acute hyperinflation (e.g., poor diaphragmatic excursion at percussion and use of the accessory muscles of respiration). In some asthmatics, wheezing may only be detectable on forced expiration, or it may even be absent in the presence of very severe airflow obstruction. In these patients, however, the severity of their asthma is mostly indicated by other signs, such as cyanosis, drowsiness, difficulty in speaking, tachycardia, a hyperinflated chest, use of the accessory muscles, and intercostal recession.
Determining the optimal threshold for medication adherence in adult asthma patients: an analysis of British Columbia administrative health database in Canada
Published in Journal of Asthma, 2022
Michael Asamoah-Boaheng, Jamie Farrell, Kwadwo Osei Bonsu, William K. Midodzi,
We conducted an observational cohort study using Canadian administrative population based-health databases from British Columbia (BC), Canada. The Population Data BC (PopData BC) includes health records of all BC residents registered in the province’s publicly funded universal insurance program (20). The PopData BC is a multi-university, data, and education resource that facilitates interdisciplinary research on the determinants of human health, well-being, and development (21). We obtained the requested data from PopData BC for the fiscal years 1998 to 2018 (a 20-year observational administrative data). We used the first two years, that is, the period between January 1, 1998, to December 31, 1999, as the ‘wash-in’ period to allow sufficient time for the prevalent cases of physician-diagnosed asthma to be identified. We defined the index period (1998–1999) as the time a patient was first identified in the database with a diagnosis of asthma. As such, subsequent asthma exacerbation outcomes were determined within 18 years follow-up period spanning from January 1, 2000, to December 31, 2018.
Outdoor air pollution and the risk of asthma exacerbations in single lag0 and lag1 exposure patterns: a systematic review and meta-analysis
Published in Journal of Asthma, 2022
Junjun Huang,, Xiaoyu Yang,, Fangfang Fan, Yan Hu,, Xi Wang,, Sainan Zhu,, Guanhua Ren,, Guangfa Wang,
A meta-analysis confirmed the association between the aforementioned six air pollutants and increased risk of ER visits and hospitalizations for asthma (9). Nonetheless, there are numerous pollutant types to be monitored, and each pollutant has different effects on asthma exacerbation. Therefore, there is a need for a comprehensive pollution index that can represent the various pollutant effects and facilitate estimation of the air pollution level by the general public. The air quality index (AQI) is a useful comprehensive index that was adopted by the US Environmental Pollution Administration for daily air quality reporting to the general public in 1999 (10). The AQI includes sub-indices for PM2.5, PM10, SO2, NO2, CO, and O3 (11). Pan et al. (12) reported an association between AQI and increased risk of hospitalization for childhood asthma. In contrast, Letz et al. (13) reported no significant correlation between AQI and ER visits for asthma in the basic military trainee population. There have been inconsistent findings regarding AQI and the risk of asthma exacerbation. In addition, multiple lag estimates, including single and cumulative lags, were selected for the overall analysis of the aforementioned meta-analysis. Lag exposure sensitivity analyses have employed different single-lag patterns for different pollutants (9). However, there is a need to understand if pollutants contribute to asthma exacerbation on the same day or have lag effects. Furthermore, other asthma exacerbation outcomes (e.g. symptoms) should be considered.
The rescue intervention strategy for asthma patients under severe air pollution: a single-center prospective randomized controlled trial
Published in Journal of Asthma, 2022
Xiaoyu Yang, Junjun Huang, Yan Hu, Sainan Zhu, Cuiyan Guo, Xi Wang, Zhao Yang, Zhu Tian, Guangfa Wang
Asthma is a common chronic airway inflammatory disease, and more than 45 million adults in China have asthma (2). Asthma exacerbation accelerates disease progression and increases the incidence of hospitalizations and deaths. Furthermore, air pollution can cause asthma exacerbations (3). Unfortunately, few treatment strategies have been recommended to reduce severe air pollution-related asthma exacerbations. Inhaled corticosteroids (ICSs)/long-acting β-agonists (LABAs) with single maintenance and relief therapy (SMART) significantly reduce asthma exacerbations (4). The SMART strategy might relieve the airway inflammation by a symptom-driven additional use of ICSs/formoterol and then prevent the onset of asthma exacerbations (5). Our previous HEART study found that air pollution led to a delayed inflammatory burst in lung (6), which provide a critical interventional time window to prevent the formation of inflammatory response. Once the respiratory symptoms occur, it means that the airway injury and inflammation induced by air pollution have already developed.