The Best Ways to Treat Asthma

The Big Asthma Lie

Through the help of skilled doctors who have been able to save the lives of up to 50 000 people all over the world, this product in the form of an E-book that contains 500 pages has all the information that you need to know about if you suffer from asthma or any health issues for your or your loved ones. It is going to make sure that you know about the truth that is hidden in the media of the prescription medication of asthma that cause you to feel tired all the time, no motivation, no life and no drive at all. These medications are killing you slowly and this guide is going dispell of all the information that harming your health. After purchasing this book which comes instantly after the successful transaction, you will be able to feel a lot better, feel and look younger, increase your drive in life, get rid of plaque buildup in arteries, reverse asthma and avid any cause of early death. You can finally enjoy the life that you have been dreaming about in this guide that contains all the information that you need to know about to get your health to its peak levels. More here...

The Big Asthma Lie Summary


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Highly Recommended

The writer presents a well detailed summery of the major headings. As a professional in this field, I must say that the points shared in this ebook are precise.

As a whole, this ebook contains everything you need to know about this subject. I would recommend it as a guide for beginners as well as experts and everyone in between.

Anti Asthmatic Activity

Early reports indicated that acute inhalation increased airway patency in healthy individuals (Tashkin et al., 1973 Vachon et al., 1973 Shapiro and Tashkin, 1976) and improved specific airway conductance in asthmatics (Tashkin et al., 1974, 1975b Vachon et al., 1976). However, there is good evidence that chronic smoking of cannabis restricts the airways and that, as with tobacco, unspecified irritants in the smoke can cause bronchospasm (Henderson et al., 1972). Aerosolised preparations of THC have produced bronchodilation in both healthy individuals and asthmatics (Tashkin et al., 1974, 1975a Abboud and Sanders, 1976 Williams et al., 1976) but in asthmatic subjects, bronchoconstriction has also been observed. For example, Abboud and Sanders (1976) administered aerosolised THC to six asthmatic patients, three of whom showed increases in specific airway conductance indicating bronchodilation the remaining three subjects showed a decrease in conductance and the overall mean, excluding...

Summary Chlamydia pneumoniae As An Asthma Inducer

A growing body of evidence (based on culture isolation, polymerase chain reaction (PCR) detection, serologic studies, and treatment results) links Cpn infection with asthma primarily in adults.(53,59,135) and in children as well.(54,56) Nonatopic asthma has been associated with an infectious initiation in general(27) and with Cpn infection in particular.(8,117,128) Cpn respiratory tract infections can initiate asthma(8) and are present in up to one-half of adults with asthma.(116) It is even possible that the contribution of Cpn infection to asthma is so great

Asthma exacerbation most likely diagnosis

Most people with acute asthma present with a constellation of symptoms consisting of cough, dyspnea, and wheezing. These typically occur simultaneously. Acute attacks are set of by some type of stimulant, and the patient has been exposed to some type of stimulant, which has produced an allergic response. An asthma exacerbation may or may not be accompanied by fever, depending on the initiating trigger. This patient is most likely having an acute asthma exacerbation, given her symptoms of shortness of breath, acute allergic symptoms, and the findings of wheezing on physical examination. Barnes Asthma and COPD Basic Mechanisms and Clinical Management, 1s Edition Chapter 65 - Acute Exacerbations of Asthma, Chakradhar Kotaru, 2002, Elsevier Science, pp. 669-692 When alveoli are filled with purulent material, as in pneumonia, there is consolidation in the alveoli causing dullness to percussion. Breath sounds in that area may be bronchial, or harsh, or even absent. Tactile fremitis is...

Diagnosis of exerciseinduced asthma and EIB

Exercise-induced asthma (EIA) is a condition with EIA symptoms, whereas EIB can be understood as the demonstration of EIB by lung function measurements after an exercise test or spontaneous exercise. EIA and EIB can be diagnosed in several ways. The optimal way is to employ a standardised exercise test and measure lung function before and after exercise. Standardisation is particularly important in the follow-up of EIA over time, when comparing different individuals and in epidemiological studies. Previously, EIB diagnosed by exercise testing was reported to be found in 70-80 of asthmatic patients 9 . However, presently this has changed dramatically with the widespread use of anti-inflammatory treatment of asthma with inhaled steroids. EIB is rapidly and markedly influenced by inhaled steroids 14-16 , and this puts increased demands upon the standardisation of exercise test with respect to work-rate (WR) and environmental factors. ambient temperature of 20-25 C, while running on a...


Asthma is a common condition a careful history and objective recording of simple severity markers, such as pulse and respiratory rate, blood pressure, speech, chest auscultation, mental state, and peak expiratory flow rate, should identify patients who require hospitalization or urgent treatment (Table 4) (12). Detainees with asthma should be allowed to retain bronchodilators for the acute relief of bronchospasm (e.g., salbutamol or the equivalent), with instructions left with the custody sergeant on other treatment if required.

Types Of Asthma

Asthma associated with specific allergic reactions avoidance is particularly relevant to managing this type of asthma. Asthma not associated with known allergy Some patients exhibit wheeze and breathlessness in the absence of an obvious allergen or atopy. They are considered to have intrinsic asthma and because of a lack of an identifiable allergen, allergen avoidance has no place in their management. Exercise-induced asthma Asthma associated with chronic obstructive pulmonary disease A number of patients who have persistent airflow obstruction exhibit considerable variation in airways resistance and hence in their benefit from bronchodilators drugs for asthma. It is important to recognise the coexistence of asthma with chronic obstructive pulmonary disease in some patients, and to assess their responses to bronchodilators or glucocorticoids over a period of time (as formal tests of respiratory function may not reliably predict clinical response in this setting).

Anti Asthmatic

Theophylline, a drug used in the treatment of asthma, has a narrow therapeutic window. Because of this narrow window, it is important to know the serum concentration in order to determine whether it is in the therapeutic or toxic range. Additionally, theophylline and the closely related compound, caffeine, are frequently used to treat apnea in newborns. Like the antiepileptic drugs, these compounds have been analyzed by either MEKC or CZE. MEKC allows direct injection of serum, urine, or saliva in a borate buffer, pH 9.0, in the presence of SDS with separation in about 15 min (73). We obtained a good correlation (r 0.98) to immunoassay when theophylline was measured by CZE in borate buffer, pH 8.5 (15). Zhao et al. (74) determined caffeine and its metabolites by MEKC, and Johansson et al. (75) used CZE to measure theophylline in phosphate-borate buffers. Caffeine, dyphylline, theobromine, and theophylline have also been separated by MEKC in borate buffer, pH 9.3 containing SDS and 30...


Jusko studied the effects of cannabis on the clearance of theophylline in two studies. In the first of these, fourteen cannabis smokers were recruited (Jusko et al., 1978). Cannabis users had smoked the drug at least twice weekly for several months. Seven of them smoked cannabis only, and seven smoked tobacco regularly as well. The half-life and clearance of aminophylline varied in each of the groups studied In the second study, the clearance of theophylline was compared in three different groups (Jusko et al., 1979). One hundred and seventy-seven patients that did not smoke cannabis had a clearance of 56 ml hr kg. Nine participants who smoked cannabis less than once a week had similar clearance values to non-users (54 ml hr kg). However, those who smoked cannabis at least twice per week had markedly elevated clearance of theophylline (83 ml hr kg). Smoking cannabis accelerates the elimination of theophylline, unless usage is very low. Jusko suggests that the method of administration...

Antiasthmatic Drugs

Antiasthmatic drugs, such as theophylline and theobromine, are used for treatment of neonatal breathing disorders or of respiratory conditions that affect adults or children, such as asthma. Theophylline's action is in bronchodilation and smooth muscle relaxation. Bronchodilation is the term for respiratory airway opening. Anti-asthmatic drugs are usually given intravenously for initial therapy, followed by a regimen of oral dosages. Toxicity causes nausea, vomiting, diarrhea, headache, cardiac rhythm problems, and seizures. Theophylline is commonly measured with immunoassay, while theobromine is generally measured by high-pressure liquid chromatography (HPLC).

Insights Respiratory Infections

The association between C. pneumoniae and asthma has gained much credence in recent years. D. Hahn has outlined a role for this organism as an inducer of asthma. Although there is some disagreement in the medical profession vis a vis diagnosing asthma versus chronic bronchitis or emphysema, the clinical manifestations such as wheezing, coughing, and shortness of breath are endpoints that can be useful in determining lung dysfunction. An intriguing theory is that chlamydial infection leads to the establishment of nonatopic asthma in some individuals (see ref. 11 for review). Perhaps the most convincing data in support of this is the amelioration of symptoms in patients treated with antibiotics effective against Chlamydia. Clinical studies have demonstrated a more rapid decline in lung function in patients with C. pneumoniae seroreac-tivity. Because of the increasing numbers of reactive airway diseases in recent decades, the possibility of reversing this trend with antibiotics is an...

Factors Affecting Myocardial Oxygen Supply

Sometimes acute and chronic bronchopulmonary disorders such as pneumonia, bronchitis, emphysema, tracheobronchitis, chronic asthmatic bronchitis, tuberculosis, and primary amyloidosis of the lung affect oxygen extraction and its supply to the heart, causing severe ischemia. Also, if the heart does not work as efficiently as it

Pharmacological Basis Of Drug Interactions

Pharmacokinetic interaction the drugs interact remotely from the target site to alter plasma (and other tissue) concentrations so that the amount of the drug at the target site of clinical effect is altered, e.g. enzyme induction by rifampicin will reduce the plasma concentration of warfarin enzyme inhibition by ciprofloxacin will elevate the concentration of theophylline.

Interactions During Metabolism

Cimetidine is an inhibitor of several cytochrome P450 isoenzymes and so potentiates a large number of drugs ordinarily metabolised by that system, notably, theophylline, warfarin, phenytoin and propranolol. Depending on the interacting drug, up to 50 inhibition of metabolism may occur when cimetidine 2000 mg d is taken. Erythromycin inhibits a cytochrome P450 isoenzyme and impairs the metabolism of theophylline, warfarin, carbamazepine and methylprednisolone. The mean reduction in drug clearance is 20-25 . Quinolone antimicrobials inhibit specific isoenzymes of P450 responsible for the metabolism of methylxanthines thus the clearance of theophylline is reduced by ciprofloxacin.

Initial Assessment And Resuscitation

Cardiac arrhythmia frequently accompanies poisoning, e.g. with tricyclic antidepressants, theophylline, -adrenoceptor blockers. Acidosis, hypoxia and electrolyte disturbance are often important contributory factors the emphasis of therapy should be to correct these and to resist the temptation to resort to an antiarrhythmic drug. If arrhythmia leads Rhabdomyolysis may result from prolonged pressure on muscles, from agents that cause muscle spasm or convulsions (phencyclidine, theophylline) or be aggravated by hyperthermia due to muscle contraction, e.g. with MDMA ('ecstasy'). Aggressive volume repletion and correction of acid-base abnormality may be needed, and urine alkalinisation may prevent acute tubular necrosis.

Druginduced myocardial damage

Several drugs of abuse have been associated with increases in cardiac troponin without evidence of ischemia. These include alcohol when heavily consumed (75), cocaine (76, 77), and amphetamines (7). Small clinical studies and case reports have documented increased cardiac troponin concentrations following CO exposure, theophylline overdose, snake bites, and during treatment with fluvastatin (7,78). Two case reports also documented an apparent propofol-induced cardiac and a skeletal muscle rhabdomyolysis both cases resulting in fatality (79).

Development Of Rituximab For Targeting Cd20 Cells

Rituximab is a chimeric anti-CD20 mAb (Figure 33.1), containing the mouse variable domains of the mAb 2B8 grafted to the human IgG1 constant domains. Rituximab kills CD20+ cells by several mechanisms, including (1) complement-dependent cellular cytotox-icity, (2) antibody-dependent cellular cytotoxicity, and (3) induction of apoptosis.32 Both early phase II testing and phase II pivotal testing of rituximab at 375 mg m2 per week X 4 in relapsed low-grade NHL demonstrated overall response rates of up to 48 (6 CR). The majority of toxic events were infusion related (hypotension, bronchospasm, rhinitis, pruritis, rash, urticaria, and tumor pain) and decreased with repeated dosing. Human antimouse antibodies (HAMA) were not observed. This led to Food and Drug Administration's approval of rituximab for indolent NHL. Its effect against indolent NHL was greatly enhanced by combining the drug with chemotherapy, with 95 overall response rates and 55 CR in patients receiving CHOP...

Innate Immune Cells

NKT cells produce both T helper 1 (Th1) and T helper 2 (Th2) cytokines, depending on their mode of activation, underscoring key regulatory roles for the cytokine milieu and glycolipid antigen repertoire present in the tumor microenvironment. Indeed, NKT cells can undermine tumor rejection in some tumor models through a mechanism that involves transforming growth factor P (TGF-P) production by Gr-1+ myeloid suppressor cells (Terabe et al., 2003). Studies have indicated that the CD4- NKT cells effectuate tumor rejection in the MCA-induced fibrosarcoma and B16F10 melanoma models, whereas CD4 + NKT cells contribute to the pathogenesis of inflammatory diseases (e.g., asthma) by the secretion of IL-4, IL-5, and IL-13 (Akbari et al, 2006 Crowe et al, 2005). A deeper understanding of the factors determining the induction of NKT cell subsets during tumor development is an important goal of further investigation.

Measurements And Events

Some endpoints assess events, while others provide a measurement of an outcome. Events occur at a specific point in time and their assessment is binary, i.e., either the event has occurred or it has not. Examples of events are death, stroke, cure of infection, progression to AIDS, myocardial infarction, or a flare of asthma. In contrast, measurements have several or many potential values that may change over time. Examples of measurements include blood pressure, strength, weight, CD4+ cell count, tumor size, quality of life scored on a standard scale, and visual acuity. Several factors may affect the decision to use a measurement-based or an event-based endpoint. Measurements can detect a broad range of change in the outcome measure in each patient therefore, measurement-based endpoints will often be more sensitive and yield greater power than event-based endpoints. Measurements, however, may detect very small changes, and therefore may raise more questions about clinical...

Helminthic infections

Diethylcarbamazine kills both microfilariae and adult worms. Fever, headache, anorexia, malaise, urticaria, vomiting and asthmatic attacks following the first dose are due to products of destruction of the parasite, and reactions are minimised by slow increase in dosage over the first 3 days.

Exploring Societys Contributions to Client Problems

As Minuchin and his coworkers began to accumulate research and clinical data and to redefine the problem in family terms, successful interventions involving the entire family became possible. Later research expanded to include asthmatic children with severe, recurrent attacks as well as anorectic children the additional data confirmed for Minuchin that the locus of pathology was in the context of the family and not simply in the afflicted individual (Goldenberg & Goldenberg, 2000, p. 197).

Answers To Case 19 Acute Bronchitis

Next step Bronchodilators. analgesics, antitussives antibiotics have not been consistently shown to be beneficial. The illness is usually self-limited. Common noninfectious causes of cough Asthma, chronic obstructive pulmonary disease (COPD), malignancy, postnasal drip, gastroesophageal reflux disease (GERD). medication side effect (e.g., angiotensin-converting enzyme inhibitors), congestive heart failure

Summary and conclusions

The possibility that the immune alterations are secondary to a more central dysfunction led to the formation of new hypotheses about the involvement of the CNS. There is some evidence that CFS patients may have a mild form of hypocortisolism which is associated with a centrally mediated increase in serotonin function. Neuroimaging studies have also found evidence for altered cerebral blood flow in CFS patients, while sleep studies suggest alterations in sleep patterns. However, there is great variability between studies and no distinct abnormality seems to distinguish CFS patients. A disrupted HPA axis seems to be the most plausible hypothesis at this stage as it could account for altered sleep patterns as well as changes in the immune system. However, as neuroendocrine changes similar to those found in CFS patients have been associated with both shift work and stress levels in healthy people, it is possible that the HPA disturbances are a result, rather than a cause of the illness....

Section 2 haplotype Analysis

In the research setting, haplotypes are commonly used to localize a disease-conferring gene or locus. Currently, much interest surrounds the use of genetic association studies because this study design is suggested to be more powerful than linkage studies in localizing susceptibility loci for common diseases (e.g., heart disease, asthma, diabetes, autoimmune disease, or cancer) that have moderate risk. Similar to the linkage study design, an association study design genotypes markers in affected and unaffected individuals, and it is expected that markers which co-occur or are associated with the disease phenotype either contribute to the phenotype or are associated with the disease susceptibility locus. In a candidate gene association study, a gene is chosen for study based on an educated guess of the location (usually by a linkage study), genetic studies in model organisms, or the biology of the disease locus in relation to the disease phenotype. The specific...

Walking for the assessment of patients with chronic obstructive pulmonary disease

Reasons for completing an exercise test include 1) identification of an individual's functional capacity 2) broad identification of the cause of exercise limitation (dyspnoea, leg fatigue, etc.) and 3) measurement of the response to an intervention (e.g. pharmacological or exercise therapy). Field tests are employed less frequently for the accurate diagnosis of the reason for a reported reduction in functional capacity or to identify exercise-induced asthma. These tests are commonly used in order to provide an outcome measure for pulmonary rehabilitation. They should, therefore, ideally have the potential to permit exercise prescription using established principles of exercise training as the field test is often the only exercise test employed. More recently, simple exercise tests have been employed to predict morbidity and mortality. It should be acknowledged, however, that performance of a field-based exercise test does not necessarily indicate that an individual is safe to proceed...

Response to intervention

The 6MWT has been widely used in many large cardiorespiratory disease trials in order to explore the benefits of rehabilitation, pharmacological intervention, oxygen supplementation and surgery. Redelmeier et al. 38 proposed that a meaningful difference in performance for patients with COPD was 54 m, thus indicating the level at which the patient would evidence an improvement in functional capacity. For such patients, however, the magnitude of change varies enormously despite similar intervention. It would be expected that the degree of improvement would be much greater after a bout of physical training than after bronchodilator therapy. Troosters et al. 39 reported a mean increase of 52 m in a study of the short- and longer-term benefits of pulmonary rehabilitation delivered over a 6-month period. Results from similar rehabilitation studies confirm this magnitude of change 40, 41 . Rehabilitation in patients with peripheral vascular disease also secured improvements in the...

Marine Invertebrates of the Andaman and Nicobar Islands

Siliquariaspongia japonica.239 Two chemotypes of marine bryozoan Bugula neritina were identified.240 A new polysaccharide exhibiting anti-HIV activity and made up of galactan sulfate was isolated from the marine clam Meretrix petechialis241 Dolastatin 15, a potent antineoplastic peptide from the mollusk Dolabella auriculata was undergoing clinical trials in Europe and North America.242 Two sesquiterpenes active against phytopathogenic fungus Cladosporium cucumerinum were isolated from a marine soft coral of the genus Heteroxenia243 A stereocontrolled synthesis of the antitumor agent (-)-laulimalide was achieved.244 Linckosides A and B, the new neuritogenic steroid glycosides were isolated from the Okinawan starfish Linckia laevigata.245 Three alkaloids having an unusual decahydroquinoline skeleton and showing significant and selective antiplasmodial and antitrypanosomal activities, were obtained from a new tunicate species of the genus Didemnum.246 These bioactive alkaloids may serve...

Airway Hyaluronan General Aspects

Numerous publications in the early 1970s examined the content of hyaluronan in human bronchoalveolar lavage (BAL) from normal and diseased lungs. Increased hyaluronan levels were found in asthmatic and chronic bronchitic patients, as well as in patients suffering from alveolar proteinosis and adult respiratory distress syndromes (13-15). Since hyaluronan is found in the extracellular matrix of the lung parenchyma, many of these studies interpreted an increase of soluble hyaluronan in BAL as a marker of interstitial lung damage

Muscle cardiovascular and respiratory abnormalities

Hyperventilation or over-breathing is yet another posited cause for CFS. Based on patients' perceptions of their feelings of shortness of breath following voluntary hyperventilation, Rosen and colleagues (Rosen et al. 1990) concluded that CFS was nothing more than chronic hyperventilation. Subsequent studies using more rigorous methods to measure hyperventilation, such as measuring decreased levels of carbon dioxide in the system, have shown that carbon dioxide levels cannot account for either the degree of symptoms nor functional impairment reported by CFS patients (Lavietes et al. 1996 Saisch et al. 1994). CFS patients with and without hyperventilation report the same severity of fatigue-related symptoms (Bazelmans et al. 1997). Saisch et al. (1994) also found that CFS patients with unequivocal hyperventilation had either panic disorder or asthma which would account for the decreased levels of carbon dioxide in their system. Consequently, while hyperventilation may contribute to the...

Pharmacokinetic Properties Some

Adverse reactions, which are mostly mild and reversible, include headache, dizziness, joint swelling, and leukopenia. Lomefloxacin, sparfloxacin, ofloxacin, and trovafloxacin alatrofloxacin cause photosensitization. Quinolones can affect the central nervous system by two mechanisms (1) accumulation of ingested xanthines, including caffeine and theophylline

Tissue Kallikrein and Hyaluronan Interaction and Enzyme Inhibition

Tissue kallikrein (TK) is a serine protease that generates lysyl-bradykinin in the airways by cleaving kininogens. Bradykinin is an important mediator of airway inflammation and has been implicated in the pathophysiology of asthma (29,30). Tissue kallikrein is made in submucosal gland cells and secreted into the airway, albeit with inhibited enzymatic activity. The inhibition of TK activity in the airway was a puzzle as it is relatively insensitive, at least in vitro, to known serine protease inhibitors found in the bronchial lumen (31). As TK activity should be suppressed in the airway lumen under normal conditions, it was concluded that enzyme activity was likely regulated by substrate availability. We have now shown, however, that hyaluronan inhibits bronchial TK activity by binding to it (32). Therefore, hyaluronan functions as a natural inhibitor for bronchial TK in the airway lumen. This finding was novel for bronchial TK in the airways, but hyaluronan and other...

Concluding Discussion

Receptors and their endogenous agonists in disease states. Given the known pharmacological properties of cannabis and cannabinoid receptor agonists and the distribution pattern of cannabinoid receptors, initial experiments should perhaps focus on the role of the endogenous cannabinoid system in disorders of cognition, memory, affect, motor control and immune function. The therapeutic potential of cannabinoid receptor ligands as anti-inflammatory agents and analgesics and in the control of glaucoma, bronchial asthma, epilepsy and or gastrointestinal motility disorders also merits attention (Hollister, 1986). Another important goal is to establish more fully the part played by cannabinoid receptors in tolerance. A summary of current information about the pathophysiology of cannabinoid receptors and about their role in the production of cannabinoid tolerance can be found elsewhere (Pertwee, 1997).

Concluding Remarks and Outlook

Forteza R, Abraham J, Hastie A, Peters S, Salathe M, Conner G. Segmental allergen challenge increases hyaluronic acid and tissue kallikrein in bronchoalveolar lavage of asthmatics. Am J Respir Crit Care Med 2000 161 A599. 13. Sahu S, Lynn WS. Hyaluronic acid in the pulmonary secretions of patients with asthma. Biochem J 1978 173 565-568. 17. Vignola AM, Chavez P, Campbell AM, Souques F, Lebel B, Enander I, Bousquet J. Airway inflammation in mild intermitent and persistent asthmatics. Am J Respir Crit Care Med 1998 157 403-409. 31. Christiansen SC, Zuraw BL, Proud D, Cochrane CG. Inhibition of human bronchial kallikrein in asthma. Am Rev Respir Dis 1989 139 1125-1131. 34. Fath MA, Wu X, Hileman RE, Linhardt RJ, Kashem MA, Nelson RM, Wright CD, Abraham WM. Interaction of secretory leukocyte protease inhibitor with heparin inhibits proteases involved in asthma. J Biol Chem 1998 273 13563-13569. Lackie P, Baker J, Gunthert U, Holgate S. Expression of CD44 isoforms is icreased in the...

Comparison of selfpaced and externally paced shuttle walking tests

Although the self- and externally paced SWTs are fundamentally different, attempts have been made to compare the two protocols. The original study describing the SWT included a comparison with the 6MWT 6 . The authors found that the distance completed in both tests was similar for the majority of patients, but that the pattern of response was different. More recently, Eiser et al. 73 compared the reliability, reproducibility and sensitivity to change of the 6MWT, 2MWT and ISWT in 57 moderate-to-severe COPD patients. The mean baseline distance for the 6MWT was significantly greater than that for the ISWT (424 versus 270 m, respectively). All three tests demonstrated satisfactory reproducibility and reliability, and established reprodu-cibility over successive days and a 2-week period. After nebulised bronchodilator administration, a significant change was detected for all three tests, although the 6MWT distance was below the previously defined threshold. The authors suggested that the...

Selectivity For Adrenoceptors

The following classification of sympathomimetics and antagonists is based on selectivity for receptors and on use. But selectivity is relative, not absolute some agonists act on both a- and p-receptors, some are partial agonists and, if enough is administered, many will extend their range. The same applies to selective antagonists (receptor blockers), e.g. a Pj-selective adrenoceptor blocker can cause severe exacerbation of asthma (a i2 effect) even at low dose. It is important to remember this because patients have died in the hands of doctors who have forgotten or been ignorant of it.3 a + p effects, nonselective adrenaline is used as a vasoconstrictor (a) with local anaesthetics, as a mydriatic and in the emergency treatment of anaphylactic shock, for which condition it has the right mix of effects (bronchodilator, positive cardiac inotropic, vasoconstriction at high dose). P effects, nonselective (i.e. pt + pj) isoprenaline (isoproterenol). Its uses as bronchodilator (P2), for...

Practicality of Conducting the Study

The measurements necessary to obtain a definable endpoint may be unobtainable in neonates and infants. Pulmonary function tests, for example, are not easily performed in subjects under the age of 6 years. This clearly can affect asthma studies and may cause the investigator to use alternative endpoints, such as asthma questionnaires that provide less objective data. Validated, subjective test procedures, such as measurements on a visual analog scale, are obviously impossible when a patient has not yet learned to speak. Hence, methodology, or lack thereof, may be crucial. Furthermore, it was only a short time ago that the clinical laboratory was adapted adequately to use the smaller volume of biological fluids available in pediatric patients to measure drug bioavailability, chemistries, electrolytes, and other parameters needed to evaluate drug safety and efficacy. Even now, many tests do not lend themselves to use in the pediatric population because of blood volume considerations in...

Infections Transmitted Through the Respiratory Route

Respiratory tract infections are common, usually mild, and self-limiting, although they may require symptomatic treatment with paracetamol or a nonsteroidal antiinflammatory. These include the common cold (80 rhi-noviruses and 20 coronaviruses), adenoviruses, influenza, parainfluenza, and, during the summer and early autumn, enteroviruses. Special attention should be given to detainees with asthma or the who are immunocompromised, because infection in these people may be more serious particularly if the lower respiratory tract is involved.

Trastuzumab Herceptin Trastuzu

Herceptin Chemical Structure

Adverse events from Trastuzumab administration are rare but can result in severe hy-persensitivity, including systemic anaphy-laxis, urticaria, bronchospasm, angioedema, or hypotension. A recent warning of cardiotox-icity has been issued for Trastuzumab, where its use in patients with cardiac dysfunction has resulted in congestive heart failure. This phenomenon is currently under further evaluation and investigation.

Serum Sample Preparation

For MEKC, if the drug concentration is high enough the serum can be simply diluted in buffer before injection onto the capillary (direct serum analysis), minimizing the matrix effects. This is because the small amounts of serum are solu-bilized by the micelles of the surfactant. Thormann and colleagues (12,13) have successfully applied this technique to the analysis of several drugs such as theophylline, caffeine, and barbiturates by directly injecting serum. Similarly, we applied this technique in the analysis of the new antiepileptic drug felbamate (1) (see Fig. 1). The simplicity, high resolving power, and the small sample size used for the assay render this method suitable for monitoring the levels of these drugs in pediatric patients (Fig. 1).

Pulmonary vasodilator drugs

The situation has been radically changed by the recent discovery of the role of nitric oxide as a physiological vasodilator.77 Nitric oxide is also a bronchodilator.78 It has now been shown that nitric oxide can vasodilate the pulmonary vascular bed when inhaled in concentrations of 10-80 p.p.m. (parts per million). The advantage of the inhalational route of administration is that the nitric oxide only dilates the pulmonary vessels supplying ventilated alveoli, and does not reach non-ventilated alveoli where vessels are constricted by hypoxia. Furthermore, it has no effect on systemic vessels because it is immediately deactivated by combination with haemoglobin.79 The inhalation of 18 p.p.m. of nitric oxide decreases pulmonary artery pressure and shunt in patients with ARDS, and the therapy has been continued for many days without apparent toxicity.80 An even more recent study has demonstrated a significant improvement in oxygenation without any reduction in pulmonary artery pressure...

The Role of Phosphatidylinositol 3Kinases and Lipid Phosphatases in Autophagy

Further support in favor of a role of PtdIns 3-kinase in the control of autophagy was obtained by the discovery that 3-methyladenine, the classical inhibitor of autophagic sequestration,91 proved to be an inhibitor of PtdIns 3-kinase.60,90 This provided a satisfactory explanation for its mechanism of action. Likewise, the cAMP phosphodiesterase inhibitor theophylline is also an inhibitor of PtdIns 3-kinase92 which may account for its ability to inhibit autophagy in hepatocytes.93

Field Amplified Injection in Presence of Salts

Sample injection is 17 of the capillary volume. The compounds iohexol (1), theophylline (2), and phenobarbital (3) were dissolved in (A) the separation buffer (borate 250 mM, pH 8.9, non-stacking), (B) the separation buffer at 25 mM, (C) acetonitrile-water (2 1 v v ), (D) acetonitrile-1 NaCl (2 1 v v ), Adapted with permission from ref. (18). (Note that usually the sample size is kept < 1 of the capillary volume to get sharp peaks. Here, the sample size is increased to 17 .) Fig. 3. Stacking by acetonitrile. Sample injection is 17 of the capillary volume. The compounds iohexol (1), theophylline (2), and phenobarbital (3) were dissolved in (A) the separation buffer (borate 250 mM, pH 8.9, non-stacking), (B) the separation buffer at 25 mM, (C) acetonitrile-water (2 1 v v ), (D) acetonitrile-1 NaCl (2 1 v v ), Adapted with permission from ref. (18). (Note that usually the sample size is kept < 1 of the capillary volume to get sharp peaks. Here, the...

Hyaluronan Size and Airway Pathophysiology

In the many airway pathologies, ROS and RNS production is increased and could therefore lead to hyaluronan degradation. Allergen challenge, for instance, causes bronchoconstriction, at least in part, via oxidative stress (62). We, therefore, examined the effects of segmental allergen challenge on the average airway hyaluronan size recovered in BAL from six human volunteers with allergic asthma in comparison with six healthy subjects (samples were kindly provided by Drs Hastie A and Peters S, Thomas Jefferson University, Philadelphia, PA). If our hypothesis that hyaluronan is degraded by oxidative stress applies as in other tissues, the size of recovered hyaluronan should decrease but the amount of soluble hyaluronan should increase due to ROS-mediated cleavage and at least partial release from the cell surface. Figure 1 Changes in hyaluronan size after allergen challenge BAL from asthmatic patients was collected before (a) and 24 h after (b) segmental allergen challenge. The lavages...

Some Pathophysiology

Asthma, like many of the common chronic disorders (hypertension, diabetes mellitus), is a polygenic disorder and already genetic loci linked to either increased production of IgE or bronchial hyperreactivity have been reported in some families with an increased incidence of asthma. Early in an attack there is hyperventilation so that Pa02 is maintained and PaC02 is lowered but with increasing airways obstruction the Pa02 declines and PaCOz rises, signifying a serious asthmatic episode.

Clinical Approach

PPH is defined as early and late, according to whether it occurs within the first 24 hr or after 24 hr, respectively. The most common cause of early PPH is uterine atony, with bleeding arising from the placental implantation site (see Table 47-1 for risk factors). The physical examination reveals a boggy uterus. The initial management should be uterine massage, best accomplished by bimanual compression with an abdominal hand as well as vaginal hand. Concurrently, intravenous dilute oxytocin is given. If these maneuvers are ineffective, intramuscular methylergonovine (Methergine) is given intramuscular prostaglandin F also may be given. Ergot alkaloids should not be given in women with hypertensive disease because of the risk of stroke. Prostaglandin F2a should not be administered to those with asthma because of the potential for bronchoconstriction. Rectal misoprostol may also be effective. If medical therapy is ineffective, then two large-bore intravenous lines should be placed, the...

Synopsis Of The Novel

Camus's The Plague, divided into five parts, chronicles the yearlong story of Oran, a dismal commercial seaport battling the plague. One fine April day in the 1940s Dr. Bernard Rieux, a 35-year-old physician preoccupied with sending his ailing wife to an out-of-town sanitarium, steps on a dead rat. Police magistrate M. Othon notices others. Later, Parisian journalist Raymond Rambert interviews Rieux for a story about lack of sanitation among the Arab population, but because the publication will compromise the truth, Rieux steers him to the dead rat story instead. Rieux's friend, Jean Tarrou, tells him about seeing more convulsing, dying rats. All but the doctor's mother, who comes to keep house for the doctor and his son, are unsettled by the events she has lived through war, depression, and a husband's death. Dead rats begin appearing by the thousands, then just when a sudden drop in the numbers causes the town to feel hopeful, the concierge M. Michel has fever, thirst, delirium, and...

Assessment of physical fitness in paediatric chronic lung diseases

EIB is a specific occurrence for bronchial asthma, although it has a low sensitivity 24 . This is the same for several other measures of indirect bronchial responsiveness. However, measures for direct bronchial responsiveness, such as responsiveness to metacholine, have a greater sensitivity but lower specificity. Also, in other chronic lung disorders, a moderate bronchial responsiveness to metacholine may be found, whereas this is not the case for EIB 24 . Therefore, testing specifically for EIB may be of differential diagnostic value, but otherwise has a minor role in the assessment of other chronic lung disorders. Cardiopulmonary exercise testing (CPET) is of value in children with chronic lung disorders, as it provides important information for assessing disease severity and the ability to perform physical exercise. However, it should be noted that the level of physical fitness in children with mild-to-moderate asthma has been found to be comparable to that of healthy children...

CoStimulation Through CD28 A Matter of Cell Fate

Full activation of T cells results in proliferation, which allows clonal expansion specific for the antigenic determinants causative of T cell APC recognition. This requires not only TCR-proximal signalling but also co-stimulation through CD28 with CD80 or CD86 (Acuto and Michel 2003 Rudd and Schneider 2003). CD28-deficient mice or mice treated with antagonists of CD28-CD80 CD86 interaction display reduced responses to an array of immune challenges, including infectious pathogens (Compton and Farrell 2002 King et al. 1996 Mittrucker et al. 2001 Shahinian et al. 1993), allograft antigens (Salomon and Bluestone 2001), graft versus host disease (Via et al. 1996), contact hypersensitivity (Krinzman et al. 1996) and asthma (Kondo et al. 1996). Correspondingly, the lack of CD28-mediated co-stimulation of T cells results in impaired proliferation in vitro and in vivo, reduced T helper cell differentiation (Gudmundsdottir et al. 1999 Lucas et al. 1995) and reduced expression of Th2-type...

Characterization of Th1 and Th2 cells

CD4+ T-lymphocytes are heterogeneous in terms of production of cytokines, and have different functions 19, 20 . Th1 cells secrete IL-2, IFN-y and lym-photoxin which explains their role in activating macrophages and cytotoxic cells and therefore in cell-mediated immune responses. Th1 cells also help B-cells in the production of some isotypes IgG2a in mice and IgG2b in rats. Th2 cells produce IL-4, IL-5, IL-6, IL-10 and IL-13, promote IgE and IgG1 switch (in rats and mice), and activate eosinophils and mast cells. Although there is no marker that allows to identify Th1 and Th2 cells, these subsets express different chemo-kine receptors 21 and display specific transcription factors c-maf, NIP-45 and GATA-3 characterize Th2 cells and control IL-4 and IL-5 gene transcription while T-bet is expressed by Th1 cells and is essential for IFN-Y expression (reviewed in 22 ). The Th1 Th2 cell dichotomy brought new insights in the pathogenic mechanisms responsible for immunopathological...

Affinity ligands have been described for CCR4

MDC (CCL22) and TARC (CCL17) (see Table 4.1). The role of the mouse ligand analogs has been studied in murine models of asthma. In ovalbumin-sensitized and -challenged mice, an anti-MDC antibody inhibits eosinophil recruitment to the lungs and protects against methacholine-induced bronchial hyperreactivity (168). Additionally, an anti-TARC antibody has been shown to attenuate an OVA-induced inflammation and airway hyper-responsiveness (169). In contrast to these results obtained from the neutralization of CCR4 ligands, the receptor knockout does not show any phenotype different from that of wild-type mice in the same models of allergic lung inflammation (170). In human tissues, CCR4 is expressed in all IL-4-positive cells in the bronchial mucosa of asthmatic patients that have been challenged 24 h before tissues were collected (171).In the same study, CCR4 ligands were found to be highly expressed by the airway epithelium in the same patient population. It has also been suggested that...

Wheezing Through Lungs Very Poor Air Intake Pale Cool And Clammy And Low Blood Pressure

Sensitization for Type I immediate hypersensitivity reactions occurs when antigen exposure leads to the production of IgE and subsequent binding to FceR on mast cells and basophils. The effector phase of Type I hypersensitivity reactions is caused by inflammatory mediators, (histamine, prostaglandins, leukotrienes, and platelet activating factor) released from mast cells and basophils following antigen binding to cell bound IgE. Skin testing identifies antigens causing immediate hypersensitivity reactions. Patients with severe reactions may be at risk when tested in this manner, and for these, an antigen specific radioallergosorbent (RAST) test is more appropriate. Clinical manifestations of immediate hypersensitivity reactions include allergic rhinitis, asthma, and anaphylaxis. Treatments include (i) minimizing the exposure to the antigens that trigger the reaction, (ii) pharmacological intervention, and (iii) desensitization.

Introduction Analysis Of Urinary Drugs In Clinical And Forensic Toxicology

Clinical and forensic toxicology is concerned with the detection, identification, and measurement of toxic compounds and their metabolites in human body fluids and tissues. Most often the toxic compounds are drugs taken either accidentally or intentionally in quantities sufficient to cause an adverse reaction or death. Analysis and identification of a possible drug or drug combinations, toxicological drug screening and confirmation should encompass as many different classes of drugs as possible. The most important classes being salicylate, paracetamol, antiepileptics, antidepressants, neuroleptics, hypnotics (benzodiazepines, barbiturates, diphenhydramine), digoxin, and theophylline, as well as many illicit drugs, such as opiates, methadone, D-lysergic acid diethylamide (LSD), cocaine, and or its major metabolite benzoylecgonine, cannabinoids and amphetamines. Currently, urinary drug monitoring has established itself as the basis of clinical and forensic toxicology. It is also the...

Mental institution correctional or longterm facilities etc The recommended doses of INH are 10mgkg for children and

Anticoagulants, acetaminophen, barbiturates, carbamazepin, cyclosporine, corticosteroides, diazepam, didanosine, disulfiram, flucitosine, ketoconazole, methyldopa, phenitoin, rifampicin, pyrazinamide, theophylline, vidarabine, zalcitabine t Didanosine, isoniazid, ketokonazole, viridazole, thiazine diuretics Analgesic, anticoagulants, anticonvulsant, azathioprine, barbiturates, beta-adrenergic blockers, chloramphenicol, oral contraceptives, corticosteroides, cyclosporine, dapsone, diazepam, digoxin, disopyramide, estrogens, haloperidol, methadone, protease inhibitors (saquinavir, ritonavir, indinavir, nelfinavir), quinidine, zidovudine I Didanosine, isoniazid, zalcitabine Less interaction than rifampicin. I clarithromycin, cyclosporine, protease inhibitors f Acyclovir, amphothericin, nephrotoxic beta-lactams, carboplatinum, cisplatinum, cyclosporine, loop diuretics, 5-fluorocytosine neuromuscolar blocking agents, NSAID, vancomycin

Ischemic Heart Disease and Systemic Atherosclerosis Including Stroke and PostAMI Therapy

Beta-blockers are the most effective antianginal drugs available.38 Their pharmacological action is directed toward the beta-1 receptor of the cardiomyocytes in the myocardium. This leads to a slowing of the heart rate and a reduction in myocardial contractility (i.e. negative chronotropic and negative inotropic effects). Thus an efficient reduction of myocardial oxygen demand is achieved, alleviating this trigger of ischemia.39 Cardioselective compounds are generally preferred in patients who have partial contraindications against beta-blockers, such as asthma, peripheral artery disease, and insulin-dependent diabetes mellitus. In addition to providing efficient relief of anginal symptoms, beta-blockers exert an antiarrhythmic and myocardial-protective effect, and are therefore also indicated in post-myocardial infarction patients.38

Summary Chlamydia pneumoniae and Lung Remodeling

Taken together, the studies reviewed in this section lay the groundwork for the hypothesis that persistent Cpn infection in lung tissue can accelerate the process of lung remodeling, the hallmark of COPD. Based on this evidence, an expanded model for the role of infection in the development of obstructive airways disease is presented in Figure 3. Since nonatopic asthma (i.e., the asthma syndrome most likely to be caused by infection) may account for up to 50 of cases, Cpn infection could potentially have a major public health impact on asthma, and ultimately perhaps also on the treatment and or prevention of other obstructive airways diseases such as chronic bronchitis and emphysema (COPD).

Fluid balance in the lung

Thoracic Extra Anatomic Air

Increased capillary hydrostatic pressure may result from overtransfusion, an obstruction to pulmonary venous outflow (for example, caused by left atrial myxoma) or to left heart failure resulting from mitral valve disease or severe dysrhythmias. It may occur when blood flow to a restricted vascular bed is suddenly increased by correction of an anatomical defect (for example, repair of Fallot's tetralogy), and may also be induced by extreme exercise, particularly if the vascular bed is already constricted by hypoxia (as in high altitude pulmonary oedema). High pressure oedema fluid has a low protein content. Extremely high pulmonary capillary pressures (in the region of 30-50 mm Hg) may create what has been termed stress failure of the pulmonary vasculature.92 Discontinuities appear in the bodies of endothelial and type I epithelial cells, whereas the basement membrane often remains intact, and these lesions permit leakage of fluid and protein into the alveoli. Similar abnormalities...

Hypercalcemia Harrison

Kastelik JA. Chronic cough in adults. Thorax 2003 58 901-907. Williams SG. Schmidt DK. Redd SC. et al. National Asthma Education and Prevention Program. Key clinical activities for quality asthma care. Recommendations of the National Asthma Education and Prevention Program. MMWR Recomm Rep 2003 52(RR-6) 1-8.

PAdrenergic Receptors in the Heart

And, more importantly, for the treatment of acute asthma (Sneader 2001). Over time, adrenaline was found to cause varied effects, including both vasoconstriction and vasodilation, but it wasn't until Ahlquist's discovery of a- and P-ARs in 1948 that these varying actions were understood (Ahlquist 1948). A principal target of cardiac sympathetic regulation is the sinoatrial node (SAN), which governs normal cardiac rate and is richly innervated by the SNS. However, all other regions ofthe heart receive sympathetic innervation, which can profoundly influence their electrical function.

Hh Uman biochemistry

The action of epinephrine and related agents forms the basis of therapeutic control of smooth muscle contraction. Breathing disorders, including asthma and various allergies, can result from excessive contraction of bronchial smooth muscle tissue. Treatment with epinephrine, whether by tablets or aerosol inhalation, inhibits MLCK and relaxes bronchial muscle tissue. More specific bronchodilators, such as albuterol (see figure), act more selec-

P2Adrenoceptors in the Heart

The p2-AR subtype is also found in the human heart (Brodde 1991), albeit to a lesser extent than p1 ARs. Agonists for p2-ARs include salbutamol (Kelman et al. 1969), terbutaline (Burnell and Maxwell 1971), and salmeterol (Ullman and Svedmyr 1988). p2-ARs are more responsive to isoproterenol as compared to norepinephrine. When heart transplant patients are given isoproterenol, an increase in heart rate is observed, even in the presence of the highly selective p1 antagonist bisoprolol (Hakim et al. 1997). Since the transplanted heart is not innervated, these observations cannot be due to reflex mechanisms. Interestingly, the greatest densities of p2 ARs are found in the SAN (Rodefeld et al. 1996), which suggests a particularly important role in mediating adrenergic influences on heart rate. This has been demonstrated by in vivo studies Despite the overall lesser amount of p2-ARs in the heart, Pi and p2 AR-stimulation increases heart rate to an equal degree (Brodde 1991 McDevitt 1989)....

Pharmacokinetic and Pharmacological Properties of pBlockers Relative to Choice of Agent

A variety of properties differentiate the various drugs available for therapeutic use as P-blockers (for review, see Shand 1983). The available agents differ in their selectivity for p1 versus p2-AR blockade, with atenolol and metoprolol being among the more p1-selective agents available. p1-Selectivity may help to avoid adverse effects (such as bronchospasm) in at-risk patients however, selectivity is never absolute and caution must still be used. Lipophilic agents are more readily able to cross the blood-brain barrier, potentially more likely to produce central nerve system (CNS) adverse effects but possibly having greater beneficial actions related to inhibition of CNS p-adrenergic neurotransmission. Lipophilic agents also tend to be eliminated more rapidly by hepatic biotransformation and to have shorter half-lives. Some p-blockers, such as propranolol and sotalol, may have direct membrane actions on cardiac ion channels that are independent of p-blockade. In the case of sotalol,...

Exercise testing in the prognostic evaluation of patients with lung and heart diseases

In COPD patients, several resting variables indices have been proven to predict mortality. The best known is the forced expiratory volume in one second (FEVl) 6 . More recently, other indices have been studied body mass index (BMI) 7, 8 inspiratory capacity total lung capacity ratio 9 arterial hypoxaemia during sleep 10 pulmonary arterial pressure 11 mixed venous oxygen pressure 12 and degree of breathlessness 13 . Since the mid 1990s, however, given the systemic nature of the disease, more and more attention has been paid to skeletal muscle dysfunction 14-16 and, therefore, to the prognostic value of correlates of exercise intolerance. Among CPET variables, Vo2,peak has been reported, in a large prospective series (n 150), to better predict mortality at 5 yrs than post-bronchodilator FEV1 (fig. 1) 17 .

Narrowing of the pulmonary vessels

Pulmonary blood vessels may also be narrowed by a decrease in transmural pressure caused by a reduction in lung volume or an increase in interstitial pressure resulting from pulmonary oedema. A more common cause of narrowing is an increase in alveolar pressure as a result of an increase in airway resistance. This appears to be an important cause of pulmonary hypertension in patients with asthma and chronic bronchitis.

Treating Hypertension

Depending on the patient's age (see above) use either a p Blocker or thiazide Diuretic as firstline therapy, unless there is a compelling reason to avoid these (e.g. asthma and gout, respectively). If the first drug is effective but not tolerated, switch to the other member of the pair i.e. ACE inhibitor (or AIIRA) instead of P-blocker, Calcium blocker instead of diuretic.

Persistent Infection And Aberrant Forms

Chlamydia Pneumoniae Diagnosis

C. pneumoniae is regarded as a common cause of respiratory tract infections and it can cause prolonged or chronic infections which may be due to persistence for months or years.(14,30) These persistent infections have been implicated in the development of a number of chronic diseases including atherosclerosis, asthma, and obstructive pulmonary diseases (see other chapter) . These persistent chlamydial infections can be established in vitro using several methods involving cytokines,(31-34) antibiotics,(35,36) and deprivation of certain nutrients.(37) Despite differences in treatment, chlamydiae respond to form inclusions containing atypical RBs, which occasionally have been shown to be pleomorphic forms, termed aberrant bodies (ABs). The ABs are generally larger in diameter than typical RBs, and display a sparse densinometric appearance (Fig. 12). No evidence of redifferentiation into EBs has been documented. However, when the growth inhibitory factors are removed, the ABs can be...

Clinical Effects Of Sulfur Mustard

Laboratory animal studies have shown that mustard is mutagenic and carcinogenic, and thus, it is not surprising that it is carcinogenic in man.7-9 Both Morgenstern et al. and Buscher and Green emphasize that chronic low-dose exposure over months to years in occupationally exposed workers leads to chronic bronchitis, bronchial asthma, hoarseness, aphonia, and hypersensitivity to smoke, dust, and fumes.10,11 Such individuals typically show persistent disability, with increased susceptibility to respiratory tract infections and evidence of bronchitis and bronchiectasis.10-12 Inhalation of mustard vapor primarily affects the laryngeal and tracheobronchial mucosa.12 Evidence exists to suggest that mustard inhalation causes sustained respiratory difficulties even after the acute lesions have healed. Clinical follow-ups on 200 Iranian soldiers who were severely injured by mustard during the Iran-Iraq War indicate that about one third had experienced persistent respiratory effects 2 years or...

Differential diagnosis of EIB

There are several important differential diagnoses relating to EIA or EIB in children and adolescents, and particularly in adolescents who participate in sports. One frequent differential diagnosis is exercise-induced inspiratory stridor or exercise-induced vocal cord dysfunction 28 . The symptoms are inspiratory stridor occurring during maximum exercise, which ceases when exercise is terminated unless hyperventilation is maintained. During exercise testing, audible inspiratory sounds can be heard arising from the laryngeal area, which is not alleviated by bronchodilators or other asthma medication. The condition most often occurs in young well-trained athletic females aged 15-16 yrs. Symptoms only occur during maximum exercise. One possible differential diagnosis of this syndrome is paradoxical movement of the vocal cords with adduction during inspiration. This may also occur without exercise. The diagnoses are made by direct fibreoptic laryngoscopy during exercise.

Sports Preparticipation Examination

Accounting for about one-third and anomalous coronary arteries for about one-fifth of cardiac anomalies. The history is the most important tool in screening for these abnormalities. All adolescents and their parents should be asked about personal history of exertional chest pain, dyspnea, syncope, history of heart murmurs, and family history of hypertrophic cardiomyopathy other congenital cardiac abnormalities or premature cardiac deaths. Other important historical information includes history of asthma or other pulmonary disorders, orthopedic injuries, heat-related illness, and absence of one of a paired organ (e.g single kidney, testicle, ovary, etc).

Conclusion Chlamydia pneumoniae Chronic Nonspecific Lung Disease Cnsld And The Dutch Hypothesis

Bronchitis, asthma, emphysema and irreversible or persistent obstructive lung disease. In 1961 Orie(23) proposed the Dutch Hypothesis which stated that CNSLD represented different expressions of a single disease entity characterized by an hereditary predisposition to develop allergy and bronchial hyper reactivity in response to environmental factors. Prior to the discovery of the Cpn-asthma association, the pros and cons of the Dutch Hypothesis were fully debated without the hypothesis being proven or disproven.(9,10) It should be obvious to the reader of this review that the discovery of Cpn as a potential factor in asthma and COPD casts new light on the importance of examining the concept of CNSLD as a pathophysiologic entity. It is now well established that acute Cpn infection can cause acute bronchitis and pneumonia(149,150) and additional evidence presented herein suggests that lower respiratory tract illnesses caused by acute Cpn infection can develop into asthma and chronic...

Effects of Current Therapy of Chronic Viral Hepatitis on Drug Metabolism

There have been a number of reported examples of IFN-drug interactions. Treatment with IFN-a was reported to potentiate the anticoagulant effects of warfarin (coumadin) in a woman with CHC (28). Also, influenza vaccination, which is known to increase endogenous production of IFNs, was reported to increase the anticoagulant effect of warfarin (29). IFN-a slows the clearance of some highly metabolized drugs, such as theophylline (30) for example, the clearance of theophylline was reduced by 33 in cancer patients treated with IFN-a (31).

Do We Need An Antic pneumoniae Vaccine

Whether there are sufficient benefits tojustify children's vaccination seems at present unlikely, since chlamydial respiratory tract infection in children is generally mild. However, transmission of infection to siblings or parents, and the consequences of infection in asthmatic pediatric patients may here be significant parameters to consider.(4) The prevention of arteriosclerosis by blocking C. pneumoniae infection is unlikely to provide a justification for a vaccine for children, until a truly causal role of C. pneumoniae in the development of atherosclerosis has been shown to exist. If C. pneumoniae is proven to be a cause of atherosclerosis, a therapeutic and effective vaccine would be of immense value. In fact, the development and use of an effective C. pneumoniae vaccine might provide the best experiment to investigate the role of C. pneumoniae in cardiovascular disease. An improved understanding of the biology of C. pneumoniae in adults is also necessary to justify a vaccine...

Side Effects Toxicity and Contraindications of the Macrolide Antibiotics

Thus, macrolides may have an impact on the drug level of other drugs using these enzymes for drug metabolism. For example, combined therapy with a macrolide and theophylline (a bronchodilator) or car-bamazepine (a psychotropic drug) causes an increase in the serum levels of the latter drugs. Cardiac arrhythmias such as ventricular tachycardia have been reported in patients receivingerythromycin A therapy. Thus, mac-rolides are contraindicated in patients receiving terfenadine therapy who have preexisting cardiac abnormalities (arrhythmia, bradycar-dia, QT interval prolongation, ischemic heart disease and congestive heart failure). Hepato-toxicity (132), ototoxicity (133), dermatologie effects (134), pancreatitis (135), cardiovascular toxicity such as QT prolongation (136) and induced hypotension (137), and hemolytic

Recreational Drugs and the Nervous System

Used legally to treat obesity, asthma, and narcolepsy. Herbal products containing ephedra, a drug originally procured from the Mah huang plant and also synthesized in laboratories, have been marketed as treatments for weight loss and for performance enhancement. Methamphetamine is an illegal amphetamine. A crystalline form of methamphetamine called ice is smoked to produce effects similar to crack cocaine.

Epigenetic Basis Of Disease

HATs have also been implicated in cardiac hypertrophy, which is characterized by an increased HAT activity (Gusterson et al., 2002). Consistent with this observation, p300 knockout mice show reduced expression of muscle proteins and cardiac structural defects (Yao et al., 1998). Apart from the acetylation of histone tails, p300 serves as a transcriptional coactivator for hypertrophy responsive transcriptional factors such as GATA-4, SRF and MEF2. Besides, cardiac hypertrophy, several airway diseases such as asthma and chronic obstructive pulmonary disease (COPD), have an indirect dependence on HATs through the pro-inflammatory transcription factor, NF-kB. NF-kB is known to associate with different HATs such as CBP p300, PCAF, GRIP-1 and SRC1. drugs using small molecular modulators of HATs was garcinol, a polyisoprenylated benzophenone derivative from Garcinia indica fruit rind. Garcinol was a potent inhibitor of p300 both in vitro and in vivo and a potent inducer of apoptosis in HeLa...

Multiple Chioce On Breast Cancer

A 31-year-old nurse presents to your office complaining about a painful lump in her right breast next to the nipple. She states it has been there for several months and won't go away. She recently started taking birth control pills after remarrying. Her past medical history is significant for asthma and two spontaneous vaginal deliveries. Family history reveals no breast or ovarian disorders. She denies any tobacco or drug use and drinks alcohol socially. On exam, you feel a 1-cm lump medial to her areola. It is round soft and very tender. There are no skin retractions and no palpable lymph nodes in the axilla. Her left breast also has a 4-cm soft lump medial to the areola that is not quite as tender. The patient states she hadn't noticed that area before. What type of breast mass is the most likely cause of her pain

Respiratory Disorders

As a result of chronic obstructive pulmonary disease (COPD), patients have irreversible structural changes in the lung causing problems in ventilation and specifically an inability to exhale air rapidly. This results from a variety of causes, including long-term cigarette smoking, inhalation of toxic particles or gases, severe asthma, and autoimmune diseases. Two specific diseases that fall within the COPD category are emphysema and chronic bronchitis.5

Treatment Of C pneumoniae Respiratory Infections

Data are limited on the treatment of respiratory infections due to C. pneu-moniae. Despite the fact that many antimicrobial agents have excellent activity in vitro, as described above, in vitro activity may not always predict in vivo efficacy. Early anecdotal data suggested that prolonged therapy (i.e., at least 2 weeks') was necessary since recrudescent symptoms have been described following 2-week courses of erythromycin and even after 30 days' tetracycline or doxycycline.(3435) However, practically all treatment studies of C. pneumoniae respiratory infection, including pneumonia, bronchitis, and asthma, presented or published to date have used serology alone for diagnosis, essentially limiting themselves to a clinical endpoint. Most studies have followed this premise if the patient has serologic evidence of infection and clinically improves, the organism is presumed to have been eradicated. In 1990, Lipsky et al.(36) Data on efficacy of antibiotic treatment of other respiratory...

Intravenous anaesthetics

Cardiovascular effects of ketamine are accompanied by an increase in plasma noradrenaline (norepinephrine) concentration. Because pharyngeal and laryngeal reflexes are only slightly impaired, the airway may be less at risk than with other general anaesthetic techniques. It is a potent bronchodilator and is sometimes used to treat severe bronchospasm in those asthmatics requiring mechanical ventilation. (See also Dissociative anaesthesia, p. 348.)

Anticholinergics Developed For Specific Uses

These structural features allow the Ipra-tropium molecule to attain a relatively selective bronchodilator effect on the cholinergi-cally innervated airways. By the inhalation route of application, this poorly absorbable quaternary ammonium derivative becomes selective to primarily affect the airway smooth muscle. Another advantage of ipratropium over atropine is that, in contract to the latter, it does not suppress mucociliary function.

Early And Late Childhood

Acrocyanosis Asthma

Tion is prolonged and accompanied by other signs such as stridor, cough, or rhonchi. In the presence of lower airway obstruction such as asthma, expiration is prolonged Childhood asthma is an extremely common condition throughout the world. Children with acute asthma present with varying severity and often have increased work of breathing. Expiratory wheezing and a prolonged expiratory phase, caused by reversible bron-chospasm, can be heard without the stethoscope and are apparent on auscultation.

VT breathing frequency and breath timing

As described in Chapters 1 and 2, in healthy individuals VT is primarily responsible for increases in ventilation at low levels of exercise 97 , with breathing frequency (fR) becoming progressively more important as peak WRs are approached 97, 98 . In COPD patients and also in highly fit subjects with very high ventilatory demands, VT may actually decrease asfR increases 99, 100 . Normal resting Vt varies with body height. At peak exercise, Vt normally plateaus (VT,max) at 50-60 of vital capacity (VC) however, there is considerable variation with an upper limit of the 95 CI 80 5, 15, 24, 50,101 . Early work suggested that the VT,max VC ratio could distinguish restrictive lung diseases from COPD 102 and pulmonary disorders from cardiac disorders 103 . However, more recent work has not demonstrated significant differences in VT,max VC between patients with COPD (44+15 ), interstitial lung diseases (54+11 ), bronchial asthma (56 + 12 ) and heart disease (54+ 12 ), leading to the...

Factors That Modulate ECG and Arrhythmic Manifestations of the Brugada Syndrome

Hypokalemia has been implicated as a contributing cause for the high prevalence of SUDS in the northeastern region of Thailand, where potassium deficiency is endemic (Nimmannit et al. 1991 Araki et al. 2003). Serum potassium in the northeastern population is significantly lower than that of the population in Bangkok, which lies in the central part of Thailand, where potassium is abundant in the food. A recent case report highlights the ability of hypokalemia to induce VF in a 60-year-old man who had asymptomatic Brugada syndrome, without a family history of sudden cardiac death (Araki et al. 2003). This patient was initially treated for asthma by steroids, which lowered serum potassium from 3.8 mmol l on admission to 3.4 and 2.9 mmol l on the seventh day and eighth day of admission, respectively. Both were associated with unconsciousness. VF was documented during the last episode, which reverted spontaneously to sinus rhythm.

The Thorax and Lungs Case Study

Mary is a 25-year-old telemarketer who presents to the emergency room for evaluation of shortness of breath. It started 1 week ago, right after a dust storm. She states that she starts coughing, but then she can't stop, so she feels like she can't breathe after a while. The coughing is so bad that she has vomited afterward. The cough is nonproductive. She denies fever or chills. She has noticed nasal congestion and a clear runny nose. She feels like her ears are stopped up and she has noticed increased sneezing in the past 3 days prior to the onset of the shortness of breath. She also has itchy, watery eyes. She has a childhood history of asthma, which she has outgrown. The last time she had an asthma attack, she was 15 years old. She takes oral contraceptives, but is not on any other medication. She has never had any surgeries. When she had asthma as a child, she was never intubated. Her mother has asthma and her father has high blood pressure.

Inborn Errors of Metabolism

MEKC has been applied to therapeutic drug monitoring. Using MEKC theophylline and its analogues have been separated in plasma. In addition, it has been used to detect and quantitate serum levels of digoxin (44,45). MEKC can also efficiently separate and quantitate antiepileptic drugs that are used in combination, especially ethosuxamide, phenobarbitol, pheny-toin, and carbamazepine (46). (See Chapter 17 for a detailed discussion of the use of CE in therapeutic drug monitoring.) CE has also been used in the clinical and forensic arena (see Chapter 19). In these cases, the use of urine to identify intoxication and or drug abuse of opiates, barbiturates, benzodi-azepines, stimulants, and doping screening is possible within a few minutes (47-51). It is also possible to use CE to screen post mortem fluids for illicit drugs or elevated levels of legal drugs (see Chapter 20). CE has also been applied to determine the tissue concentration of 5-Fluorouracil (5-Fl) in tumor and subcutaneous...

Past History

Childhood illnesses, such as measles, rubella, mumps, whooping cough, chicken pox, rheumatic fever, scarlet fever, and polio are included in the Past History. Also included are any chronic childhood illnesses. You should provide information relative to Adult Illnesses in each of four areas Medical (such as diabetes, hypertension, hepatitis, asthma, HIV disease, information about hospitalizations, number and gender of partners, at-risk sexual practices) surgical (include dates, indications, and types of operations) Obstetric gynecologic (relate obstetric history, menstrual history, birth control, and sexual function) and Psychiatric (include dates, diagnoses, hospitalizations, and treatments). You should also cover selected aspects of Health Maintenance, including Immunizations, such as tetanus, pertussis, diphtheria, polio, measles, rubella, mumps, influenza, hepatitis B, Haemophilus influenza type b, and pneumo-

The Linkage Approach

Mendelian disease genes has spawned large-scale efforts to track down genes involved in the more common complex disease phenotypes. This approach is not restricted to academic research groups many pharmaceutical and biotechnology companies have joined what many would perceive to be a 'genetic gold-rush', in an attempt to identify new drug targets for common diseases such as asthma, diabetes and schizophrenia, in a manner reminiscent of the rush to mine drug targets from expressed sequence tags (ESTs) in the late 1990s (Debouck and Metcalf, 2000). The application of a linkage approach to complex disease typically involves combining data from a large number of affected sib-pairs. Publicly available software for linkage analysis of sib-pairs is described in detail in Chapter 11.


Radioligand binding studies2 have shown that the receptor numbers do not remain constant but change according to circumstances. When tissues are continuously exposed to an agonist, the number of receptors decreases (down-regulation) and this may be a cause of tachyphylaxis (loss of efficacy with frequently repeated doses), e.g. in asthmatics who use adrenoceptor agonist bronchodilators excessively. Prolonged contact with an antagonist leads to formation of new receptors (up-regidation). Indeed, one explanation for the worsening of angina pectoris or cardiac ventricular arrhythmia in some patients following abrupt withdrawal of a (3-adrenoceptor blocker is that normal concentrations of circulating catecholamines now have access to an increased (up-regulated) population of p-adreno-ceptors (see Chronic pharmacology, p. 119). An action on the same receptor is not the only mechanism by which one drug may oppose the effect of another. Extreme bradycardia following overdose of a...

Concluding Remarks

Advancing the field of C. pneumoniae research will have numerous beneficial effects for both the medical and scientific communities. By developing sensitive and specific diagnostic tests for C. pneumoniae, infected patients can be reliably identified and appropriately treated. These tests must also be standardized as there are many laboratories using varied techniques (e.g. DNA isolation). This is particularly important in chronic diseases, such as atherosclerosis and asthma, with a potential infectious etiology where only a subset of patients may benefit from antibiotic therapy. Treatment, therefore, is crucial to reduce the impact of such diseases on society. New antimicrobials or antibiotic regimens must be developed to better combat persistently growing organisms. This is likely the state in which C. pneumoniae can be found in chronic disease sites. The impact of acute respiratory diseases must not be overlooked, however, as this is one means for the bacteria to enter the host and...


The objective of target tissue selectivity can sometimes be achieved by simple topical application, e.g. skin and eye, and by special drug delivery systems, as by intrabronchial administration of P2-adrenoceptor agonists or corticosteroids (inhaled pressurised metered aerosol for asthma). Selective targeting of drugs to less accessible sites of disease offers considerable scope for therapy as technology develops, e.g. attaching drugs to antibodies selective for cancer cells.


Hepatic metabolism increases, though not blood flow to the liver. Consequently, there is increased clearance of drugs such as phenytoin and theophylline, whose elimination rate depends on liver enzyme activity. Drugs that are so rapidly metabolised that their elimination rate depends on their delivery to the liver, i.e. on hepatic blood flow, have unaltered clearance, e.g. pethidine. Asthmatic attacks can be precipitated by p-adrenoceptor blockers.

Drug Interactions

The drug causes formation of tissue-sensitising IgE antibodies that are fixed to mast cells or leucocytes on subsequent administration the allergen (conjugate of drug or metabolite with tissue protein) reacts with these antibodies, activating but not damaging the cell to which they are fixed and causing release of pharmacologically active substances, e.g. histamine, leukotrienes, prostaglandins, platelet activating factor, and causing effects such as urticaria, anaphylactic shock and asthma. Allergy develops within minutes and lasts 1-2 hours.


Glutamate, an excitatory neurotransmitter that can be lethal to neurons upon hyperactivation of NMDA receptors, can also induce acute lung injury when added directly to perfused rat lungs. In addition, we have provided evidence that NMDA-type glutamate receptors are present in the lungs, and that activation of these receptors plays a major role in the pathogenesis of oxidant lung injury. We postulate that signaling via NMDA receptors may be a pathogenetic factor in the acute lung injury of ARDS (and may also be causally related to bronchial asthma 17 ). Recognition of the potential significance of glutamate toxicity could lead to the introduction of novel therapeutic approaches. The physiological role(s) of glutamate signaling in the lung remains to be determined.

Respiratory system

Such as simultaneous injuries in the chest. However, the 40 loss of vital capacity, due to the paralysis of the inter-costal muscles, is also of importance. The loss of sympathetically mediated bronchial dilatation may add further to the risk of developing respiratory failure. Inhalation of bronchodilators is usually used in the acute phase following spinal cord injury. In spite of this treatment, excessive mucus production and stagnation of secretion is seen. The autonomic nervous system imbalance might be life threatening during this condition, since a person with cervical injury who has a tendency to hypoxia might sustain a severe bradycardia or heart arrest during tracheal suc-tioning. Irritation of the trachea is a heavy stimulus of vagal outflow even in able-bodied people and the reaction in cord-injured patients might be an exaggeration of this reaction due to the loss of supraspinal control of the sympathetic nervous system. Pretreatment with anti-cholinergic drugs is...


G., Berry, G. J., Wahlstrom, J., Kronenberg, M., DeKruyff, R. H., and Umetsu, D. T. (2006). CD4+ invariant T-cell-receptor+ natural killer T cells in bronchial asthma. N. Engl. J. Med. 354, 1117-1129. Boon, T., and van der Bruggen, P. (1996). Human tumor antigens recognized by T lymphocytes. J. Exp. Med. 183, 725-729. Brandes, M., Willimann, K., and Moser, B. (2005). Professional antigen-presentation function by human gammadelta T Cells. Science 309, 264-268.


There is no report as of now regarding the expression of CD137 on basophils. CD137 expression on eosinophils could be observed in patients suffering from IgE-mediated allergic responses, but not in normal subjects or those patients suffering from non-IgE-mediated eosinophilic disorders (Heinisch et al., 2001). In both neutrophils and eosinophils, CD137 stimulation promoted apopto-sis in these cells, even in the presence of GM-CSF and or IL-5 survival factors (Heinisch et al., 2000). In this regard, CD137 stimulation may play an important role in regulating granulocyte survival during the initiation and resolution of an inflammatory response. Combined with a report showing CD137 transcript that was frequently found in mast cells, a key type of cells storing and releasing inflammatory mediators for allergy, CD137 may also participate in the control of asthma induced by extrinsic allergens.

Adverse Reactions

Urticaria, severe rhinitis and asthma occur in susceptible individuals, e.g. with nasal polyposis, who are exposed to NSAIDs, notably aspirin the mechanism may involve inhibition of synthesis of bronchodilator prostaglandins, notably PGE2 (see Pseudoallergie reactions, p. 146). Other effects on the skin include photosensitivity, erythema multiforme, urticaria, and toxic epidermal necrolysis.

C1inh Et Cannabis

The complaints of difficulty swallowing and breathing sound like the complaints of a hyperallergic individual and or asthmatic. This occurs when there is p-agonist activation of smooth muscles and airway spasm. Further questioning and lung function tests are used to determine if this is an allergic reaction. Lung function is determined by measuring conventional parameters. It turns out that Peter does not have asthma or a known allergy to environmental allergens. Indeed, while these might help explain these latest symptoms, they would not address the issue of the intermittent lip swelling.

Persia And Arabia

Cannabis has had a long association with Persia and Arabia. Indeed the term hashish is Arabian and is taken from the phrase hashish al kief (dried herb of pleasure). Several early manuscripts describe the popular use of cannabis for intoxication or medicinal purposes. In the Makhsanul aldawaiya, an ancient Arabic drug formulary, cannabis is described as a cordial, a bile absorber, and an appetizer, and its moderate use prolongs life. It quickens the fancy, deepens thought and sharpens judgement (Chopra and Chopra, 1957). In the Herbarium amboinence written in 1095 AD, Rumphius reported that the followers of Mohammed used cannabis to treat gonorrhoea and asthma. Cannabis was also claimed to reduce bile secretion and diarrhoea, and to alleviate the distress of a strangulated hernia (Chopra and Chopra, 1957).

First Visit

Abnormal bleeding tendencies such as nosebleeds, prolonged bleeding from minor cuts, spontaneous ec-chvmoses, tendency toward excessive bruising, and excessive menstrual bleeding should be cited. 7. History of allergy should be taken, including hay fever, asthma, sensitivity to foods, or sensitivity to drugs such as aspirin, codeine, barbiturates, sulfonamides, antibiotics, procaine, and laxatives, to dental materials such as eugenol or acrylic resins. < S. Information is needed regarding the onset of puberty and, for females, menopause, menstrual disorders, hysterectomy, pregnancies, and miscarriages. 9. Family medical history should be taken, including bleeding disorders and diabetes.


Amphetamine itself was synthesized in 1887 and first studied as early as 1910, but its stimulant effects were not discovered until about 1930. Amphetamine was independently resynthesized in 1927 by the noted psycho-pharmacologist Gordon Alles in a program to develop synthetic substitutes for ephedrine, a drug then being used as a bronchodilator for the treatment of asthma (6). The central stimulant effects of amphetamine were probably noted about 1930, when it appeared in nasal inhalers in Germany. The first medical use for amphetamine was in the treatment of

Laboratory tests

In addition, exercise testing can be performed for specific diagnostic purposes (e.g. exercise-induced asthma). Specific questions related to exercise capacity may be asked (e.g. in employment contexts). In addition, prediction of risk may be the reason for performing an exercise test (e.g. operability for lung resection and survival). Exercise intolerance has been shown to be one of the most important predictors of mortality in a broad range of diseases, including COPD, primary pulmonary hypertension, interstitial lung disease, primary pulmonary hypertension, chronic heart failure and cystic fibrosis 18-26 . A further specific indication is for quantification of the gains following interventions, such as medication, surgical procedures and rehabilitation.

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