Items in AFP with MESH term: Asthma
Therapeutic Uses of Magnesium - Article
ABSTRACT: Magnesium is an essential mineral for optimal metabolic function. Research has shown that the mineral content of magnesium in food sources is declining, and that magnesium depletion has been detected in persons with some chronic diseases. This has led to an increased awareness of proper magnesium intake and its potential therapeutic role in a number of medical conditions. Studies have shown the effectiveness of magnesium in eclampsia and preeclampsia, arrhythmia, severe asthma, and migraine. Other areas that have shown promising results include lowering the risk of metabolic syndrome, improving glucose and insulin metabolism, relieving symptoms of dysmenorrhea, and alleviating leg cramps in women who are pregnant. The use of magnesium for constipation and dyspepsia are accepted as standard care despite limited evidence. Although it is safe in selected patients at appropriate dosages, magnesium may cause adverse effects or death at high dosages. Because magnesium is excreted renally, it should be used with caution in patients with kidney disease. Food sources of magnesium include green leafy vegetables, nuts, legumes, and whole grains.
Vocal Cord Dysfunction - Article
ABSTRACT: Vocal cord dysfunction involves inappropriate vocal cord motion that produces partial airway obstruction. Patients may present with respiratory distress that is often mistakenly diagnosed as asthma. Exercise, psychological conditions, airborne irritants, rhinosinusitis, gastroesophageal reflux disease, or use of certain medications may trigger vocal cord dysfunction. The differential diagnosis includes asthma, angioedema, vocal cord tumors, and vocal cord paralysis. Pulmonary function testing with a flow-volume loop and flexible laryngoscopy are valuable diagnostic tests for confirming vocal cord dysfunction. Treatment of acute episodes includes reassurance, breathing instruction, and use of a helium and oxygen mixture (heliox). Long-term management strategies include treatment for symptom triggers and speech therapy.
ABSTRACT: The Expert Panel Report 3 of the National Asthma Education and Prevention Program represents a major advance in the approach to asthma care by emphasizing the monitoring of clinically relevant aspects of care and the importance of planned primary care, and by providing patients practical tools for self-management. Treatment of asthma should be guided by a new system of classification that assesses severity at initial evaluation and control at all subsequent visits. Asthma severity is determined by current impairment (as evidenced by impact on day-to-day activities) and risk of future exacerbations (as evidenced by frequency of oral systemic corticosteroid use), and allows categorization of disease as intermittent, persistent-mild, persistent-moderate, and persistent-severe. Initial treatment is guided by the disease-severity category. The degree of control is also determined by the analysis of current impairment and future risk. Validated questionnaires can be used for following the impairment domain of control with patients whose asthma is categorized as "well controlled," "not well controlled," and "very poorly controlled." Decisions about medication adjustment and planned follow-up are based on the category of disease control. Whereas a stepwise approach for asthma management continues to be recommended, the number of possible steps has increased.
The New Asthma Guidelines - Editorials
Addition of Long-Acting Beta Agonists for Asthma in Children - Cochrane for Clinicians
Climbing One Step at a Time - From The Editor
ABSTRACT: Proper care of patients with asthma involves the triad of systematic chronic care plans, self-management support, and appropriate medical therapy. Controller medications (inhaled corticosteroids, long-acting beta2 agonists, and leukot- riene receptor antagonists) are the foundation of care for persistent asthma and should be taken daily on a long-term basis to achieve and maintain control of symptoms. Inhaled corticosteroids are the preferred controller medication; studies have demonstrated that when inhaled corticosteroids are used consistently, they improve asthma control more effectively than any other single long-term control medication. Combining long-acting beta2 agonists and inhaled corticosteroids is effective and safe when inhaled corticosteroids alone are insufficient, and such combinations are an alternative to increasing the dosage of inhaled corticosteroids. For patients with mild persistent asthma, leukotriene receptor antagonists are an alternative, second-line treatment option. They are easy to use, have high rates of compli- ance, and can provide good symptom control in many patients. Leukotriene receptor antagonists can also be used as an adjunctive therapy with inhaled corticosteroids, but for persons 12 years and older the addition of long-acting beta2 agonists is preferred. Inhaled short-acting beta2 agonists are the most effective therapy for rapid reversal of airflow obstruction and prompt relief of asthmatic symptoms. Increasing the use of short-acting beta2 agonists or using them more than two days per week or more than two nights per month generally indicates inadequate control of asthma and the need to initiate or intensify anti-inflammatory therapy. Oral systemic corticosteroids should be used to treat moderate to severe asthma exacerbations.
Acute Bronchitis - Article
ABSTRACT: Acute bronchitis is a lower respiratory tract infection that causes reversible bronchial inflammation. In up to 95 percent of cases, the cause, is viral. While antibiotics are often prescribed for patients with acute bronchitis, little evidence shows that these agents provide significant symptomatic relief or shorten the course of the illness. In a few small studies, bronchodilators such as albuterol have been found to relieve some symptoms of acute bronchitis. Increased attention is being given to the role of Chlamydia species in acute bronchitis and adult-onset asthma. Studies in progress may help to clarify the importance of these organisms in acute bronchitis and to determine whether early treatment can prevent or ameliorate asthma.
ABSTRACT: Immunotherapy has been used for over 80 years. It is a safe and effective therapeutic intervention for allergic rhinitis, but its use in the treatment of asthma is more controversial. Patients with unstable asthma are at increased risk of adverse effects from immunotherapy; therefore, if immunotherapy is used in such patients, it should be instituted cautiously. Indications for immunotherapy include evidence of IgE-mediated disease and positive results on skin tests or radioallergosorbent test (RAST). In addition, before immunotherapy is considered, measures to avoid exposure to offending agents and drug therapy should have failed to provide relief of symptoms. Before administering immunotherapy in the office, physicians should be knowledgeable about the use of immunotherapy and the treatment of anaphylaxis, and should have ready access to the equipment needed to avert anaphylaxis.