Foods to eat when you have Asthma

Asthma Free Forever

With Asthma Free Forever, asthma sufferers worldwide will learn how they can cure asthma easily, naturally, and permanently in Asthma Free Forever. This guide was written by Jerry Ericson, an alternative medical practitioner and former asthma sufferer. Inside this guide, users will discover the methods that helped the author cure his asthma without useless and harmful medications. This treatment is based on proven medical research, so users can be sure that it's safe and guaranteed to work. It's also affordable, so they can save money. Asthma sufferers need just apply the info that they will learn from this guide and they can breathe easily without coughing and congestion. They can strengthen their respiratory system and live a healthy and active lifestyle again. Asthma Free Forever has helped hundreds of people with asthma reduce their symptoms quickly and get rid of this disease easily and forever. The main e-book is itself a good value, but the additional bonuses that teach people to adopt a healthy lifestyle are just another weapon against asthma. With this productArticle Search, asthma sufferers can take their first steps toward a healthy life. Continue reading...

Asthma Free Forever Overview


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Pediatric Asthma Case Study

A 14-year-old African-American female is brought to the pediatrician's office by her mother. She has just started running on her high school track team, but has been complaining to her mother that her running feels different this year. When she ran in middle school she could race longer distances without becoming winded. She now says her chest burns and she is running fewer miles before she has to stop to catch her breath. Her girlfriend told her she could hear her wheezing and she should go to the nurse. The school nurse confirmed her wheezing and notified her mother to come pick her up from school. There is no history of asthma in the family but her parents both smoke cigarettes. The school nurse advised that cigarettes could be contributing to the child's respiratory complaints. At the pediatrician's office her peak flow is 380 L min, which is within 5 of her predicted value for her height and weight. She does complain of coughing at night. Her lung sounds are now clear with no...

Theophylline Derivatives

Theophylline Action Kinetics Theophyllines stimulate the CNS, directly relax the smooth muscles of the bronchi and pulmonary blood vessels (relieve bronchospasms), produce diuresis, inhibit uterine contractions, stimulate gastric acid secretion, and increase the rate and force of contraction of the heart. Response to the drugs is highly individualized. The-ophylline is well absorbed from un-coated plain tablets and PO liquids. Theophylline salts Onset 1 5 hr, depending on route and formulation. Therapeutic plasma levels 10 20 mcg mL. tV2 3 15 hr in nonsmoking adults, 4 5 hr in adult heavy smokers, 1 9 hr in children, and 20 30 hr for premature neo nates. An increased tV2 may be seen in individuals with CHF, alcoholism, liver dysfunction, or respiratory infections. Because of great variations in the rate of absorption (due to dosage form, food, dose level) as well as its extremely narrow therapeutic range, theophylline therapy is best monitored by determination of the serum levels. If...

Asthma Introduction

Asthma in children is a reversible airway-reactive disease characterized by bronchospasm, increased mucus production, and edema of the mucosa of the bronchioles. The result is obstruction, air trapping, and respiratory distress. Asthma is the leading chronic disorder in children. Most children experience their first attacks between 2 and 7 years of age with the onset of the most severe cases occurring after the age of 7. The onset of an attack may be gradual or immediate continuous, with wheezing present at all times or spasmodic, with intermittent attacks separated by intervals without symptoms. As an attack progresses, alveoli that are hyperinflated and poorly ventilated may lead to impaired gas exchange, hypoxemia, hypercapnia, and eventual respiratory acidosis and failure. The two types of asthma are extrinsic (immune mechanisms) and intrinsic (imbalance in the autonomic nervous system), both of which affect the bronchial tissue and mast cell function that produce the...

Assessment Of T Cell Function And Airway Inflammation

Table 15.18.2 indicates some of the assays that provide useful information about the immune status of animals with airway inflammation, although it is not a complete list. Experimental objectives will dictate the choice of assay(s) to be used. Assays are typically performed either on the same day as the measurement of lung function (day 12, for the Alternate Protocol) or the next day (day 33, for the Basic Protocol).

Introduction Asthma An Allergic Response

Like an autoimmune disease or the rejection of a transplanted organ, allergic asthma is the result of an unwanted immune response. Characterized by episodes of usually reversible obstruction of the airways, bronchial hyperresponsiveness, and chronic inflammation with lung infiltration by lymphocytes, eosinophils, and mast cells, asthma is a respiratory response to a variety of stimuli. This disease is manifested by thickening of the bronchial mucosa and narrowing of airways, and most commonly results in coughing, wheezing, chest tightness, and shortness of breath (Koren and O'Neill 1998 Saltini et al. 1998).

Asthma An Increasingly Common Childhood Disease with an Unknown Cause

More than one-third of the 15 million Americans with asthma are children, and the biggest increase in cases since 1980 has been in preschool-age children (Donovan and Finn 1999). Indeed, most asthmatics are diagnosed by the age of five, with symptoms first occurring during infancy and early childhood (Croner and Kjellman 1992 Yunginger et al. 1992). Although the reason for the increasing prevalence of asthma in young children is unclear, several factors play an exacerbating role in the incidence of disease. These include environmental triggers, such as house dust mites, cockroaches, mold, and animal dander, as well as genetic factors.

Asthma The Role of Atopy Risk Factors and Maternal Exposures

People with atopy are genetically predisposed to produce IgE antibodies in response to common household allergens and have at least one atopic disease (i.e., asthma, allergic rhinitis, or atopic eczema) (Kay 2001). Most patients with asthma are atopic, although a minority have intrinsic, nonatopic asthma that often has a later onset and a more protracted course than atopic asthma. Recent studies indicate that there are more similarities than differences in the airway abnormalities of atopic and nonatopic asthma (Humbert et al. 1999). A large body of evidence shows that allergen exposure influences the atopic phenotype, and many studies indicate that allergen or toxicant exposure during critical windows of immune system development (in utero and early infancy) may influence a sensitization process that can lead to childhood asthma (reviewed in Landrigan 1998). Epidemiological data support the findings from these studies and highlight the role of maternal factors (Donovan and Finn 1999...

Asthma Toward a Molecular Understanding

The purpose of this chapter is to address the influence of maternal fetal immu-notoxicant exposure on the development of asthma. To understand how developmental exposure can lead to postnatal asthma onset or affect the sensitivity to triggers of asthmatic attacks, one must have an awareness of the timeline of immunologic development, as well as an understanding of the cellular and molecular characteristics of asthma. Because developmental timelines were discussed in detail earlier in this textbook, this chapter will examine the relationship between developmental exposures to common allergens and toxicants and the cellular and molecular factors involved in asthmagenesis. The data on common asthma triggers such as dust mites and molds will be explored, and those on less common allergens such as foods and vaccines will be reviewed. In addition, the knowledge base on maternal exposure to environmental immunotoxicants such as heavy metals, pesticides, and industrial chemicals will be...

Cytokines Involved in Promoting Allergic or Asthmatic Inflammation

Inflammation is often described in the context of TH1 responses, particularly with regard to classical TH1-derived inflammatory cytokines such as TNFa and IFNg. However, asthmatic inflammation involves cytokines whose actions typically oppose the actions of cytokines involved in the inflammation of other inflammatory diseases. Inflammation of the airways in asthma, although not exclusively so, is primarily a TH2-mediated phenomenon. Overproduction of GM-CSF in the airway mucosa of patients with asthma enhances MHC class II-restricted Ag presentation by dendritic cells and increases the accumulation of bronchoalveolar macrophages (Holt et al. 1999 Kay 2001), which further present allergen to CD4+ T cells and stimulate the production of TH2-type cytokines (Larch et al. 1998). Reports of TH2 cytokines involved in asthmatic inflammation have implicated IL-4 and IL-13 in stimulating the production of IgE and vascular-cell adhesion molecule 1 (VCAM-1), IL-5 and IL-9 in the development of...

Cytokines Involved in Regulating or Inhibiting Allergic or Asthmatic Inflammation

Asthma is an inflammatory disease of the peripheral airway, and several groups have been able to demonstrate an association of asthma severity with TH2 polarization in peripheral blood (Fingerle-Rowson et al. 1998 Gately et al. 1998 Humbert et al. 1997 Nurse et al. 1997). Involved in this polarization is the TH2 cytokine IL-10, but this anomalous interleukin should be considered a regulatory cytokine more than a promoting cytokine because of its inhibitory effects on allergic reactions (Figure 14.1). IL-10 has been shown to induce long-term hyporesponsiveness of allergen-specific CD4+ T cells and to decrease mast cell numbers in addition to inhibiting the production of eosinophils (Akdis et al. 1998 Borish 1998 Mackay and Rosen 2001). Moreover, IL-10 has been shown to inhibit eosinophil survival and IL-4-induced IgE synthesis (Takanaski et al. 1994), and in an animal model, IL-10 was shown to inhibit the late-phase response and the influx of eosinophils and lymphocytes after allergen...

Genetics Epigenetics and Asthma

Without a doubt, genetics plays a role in the development of asthma. However, family and population studies show that asthma is a complex genetic disorder (Saltini et al. 1998). The genetic studies of asthma generally take one of two approaches either phenotypic markers are used to search for asthma genes, or Human Leukocyte Antigen (HLA) genes are associated with responsiveness to specific proteins or peptide allergens. As noted in a review by Saltini and colleagues, the phenotypic markers most commonly used in the search for asthma gene(s) include 1.) total serum IgE levels 2.) immediate reactivity in skin tests to aeroallergens and specific IgE levels 3.) bronchial hyperresponsiveness to physical and pharmacological stimuli and 4.) a history of wheezing in the clinical diagnosis of asthma (Saltini et al. 1998). In that review, it was noted that the genetic loci tentatively associated with asthma are on chromosome 11q13 in close proximity to the IgE receptor, on chromosome 5q31 near...

Fetal Exposure To Toxicants And Development Of Childhood Asthma

As discussed in the previous section, when allergens are introduced to the intrauterine environment, a fetus can become sensitized. Maternal toxicant exposure has the potential to affect the sensitization process in various ways. Whereas in utero sensitization usually provides neonates with healthy immune responses, hyperresponsiveness can also occur. Moreover, environmental toxicants concom-itantly encountered during in utero sensitization have the potential to deviate normal physiologic processes to pathological outcomes, including asthma. These processes potentially include isotype switching by fetal B cells functional maturation of fetal APCs, B cells, and T cells expression of adhesion molecules on inflammatory cells, thus affecting migration to the airways a change in the cytokine secretion profiles of T cell subsets epigenetic changes affecting fetal programming and modulation of biochemical signal transduction pathways and transcription factors in any of the cells involved in...

Relationship between Allergens and Development of Asthma

In developed countries, such as the U.S., 80 of childhood asthmatics are allergic to indoor allergens (National Academy of Sciences 2000). A growing body of evidence suggests that increased exposure to these types of allergens may be relevant to the increased incidence and severity of asthma in children. Asthma manifests as a set of symptoms ranging from mild to severe. However, displays of asthma-like symptoms in infancy may or may not lead to persistent atopic childhood asthma. Furthermore, while the development of childhood asthma is agreed to result from an interplay of genetics and environment, that interplay is poorly understood. What is known is that most childhood asthma results from allergen sensitization in a genetically predisposed individual. Moreover, immunoregulatory mechanisms may be altered at mucosal surfaces in ways that promote a TH2-mediated allergic inflammatory response, and these alterations may be influenced by cofactors such as tobacco smoke and air pollutants...

Asthmatic Inflammation

Asthma is a chronic inflammatory disease of the airways. Asthmatic inflammation involves complex interactions between the cytokines and signaling pathways of many cell types. In adults and children, T cells are known to be integrally involved in this process (Azzawi et al. 1990 Corrigan and Kay 1990 Wardlaw et al. 1988). The maintenance of airway inflammation is attributed, in adults, to chronically activated memory T cells sensitized against a variety of allergens (Corrigan and Kay 1990) and, in children, to elevated soluble IL-2 receptor levels (Warner et al. 1998). In general, asthma is associated with cytokines secreted by TH2 cells for instance, IL-5 is involved with the recruitment and activation of eosinophils, while IL-4 plays a role in programming B cells to secrete IgE. It should be noted, however, that CD8+ T cells have also been implicated in IgE class switching through the actions of IL-13 (rather than IL-4) (Punnonen et al. 1997). Moreover, TH1 cytokines such as IL-2,...

Theophylline Enhanced Elimination

Acute theophylline toxicity Acute charcoal hemoperfusion indications Theophylline level > 90 mcg mL at any time. Theophylline level > 40 mcg mL when combined with Seizures Hypotension, refractory to fluid loading Ventricular dysrhythmias Protracted vomiting, refractory to antiemetics Chronic theophylline toxicity Monitor theophylline levels every 4-6 hours until < 20 mcg kg.

Signaling Pathways and Transcription Factors Involved in Asthma Pathogenesis

Soluble mediators may play important roles in the sensitization and triggering of asthmatic responses, but they only do so by acting through specific receptors. Binding to a specific receptor by any cognate ligand normally transduces a signal to the nucleus to transcribe, or block the transcription of, a gene or genes via one or more intracellular biochemical pathways. Steps along a pathway are referred to as pathway intermediates, and those intermediates directly responsible for binding to DNA elements in the nucleus and affecting mRNA expression are called transcription factors. When a toxicant is encountered during pregnancy, the potential exists for signal transduction pathways involved in allergic sensitization to be altered. Alterations could exist in many forms, including receptor blockade, receptor antagonism (sending a negative signal), inhibition or activation of pathway intermediates, or interference with the activity of transcription factors. Any of these events has the...


Asthma, which affects 3 of the population, is also a cause of sudden and unexpected death in the medical examiner's population.65 Deaths from it, while uncommon, do occur, with death rates of from 1.1 to 7 reported. Since 1960, there has been an increase in the incidence of deaths from asthma, either because of increased prevalence of the disease or an increase in severity. Deaths in blacks are twice that of whites. Sudden, unexpected death can occur in asthmatics without long-term deterioration or a prolonged attack. The frequency of death from asthma is increased at night or in the early morning, possibly due to a pronounced diurnal variation in airflow limitation. Up to one fourth of deaths from asthma occur within 30 min of onset of the attack. In acute asthmatic attacks, there is a reduced airflow rate, air trapping, and a ventilation-perfusion imbalance that leads to decreased oxygenation of the blood, elevated carbon dioxide, increased pulmonary vascular resistance, a right...


Oral theophylline has a slower onset of action than inhaled beta2 agonists and has limited usefulness for treatment of acute symptoms. It can, however, reduce the frequency and severity of symptoms, especially in nocturnal asthma, and can decrease inhaled corticosteroid requirements. 2. When theophylline is used alone, serum concentrations between 8-12 mcg mL provide a modest improvement is FEV1. Serum levels of 1520 mcg mL are only minimally more effective and are associated with a higher incidence of cardiovascular adverse events. exacerbations of asthma unresponsive to bronchodilators.

Responses Asthma

Asthma An Allergic Asthma An Increasingly Common Childhood Disease with an Asthma The Role of Atopy, Risk Factors, and Maternal Exposures 231 Asthma Toward a Molecular Sensitization to Allergens and the Development of Asthmatic Mechanisms of Asthmatic Inflammation Inter- and Intracellular Cytokines Involved in Promoting Allergic or Asthmatic or Asthmatic in Asthma Genetics, Epigenetics, and Fetal Exposure to Toxicants and Development of Childhood Asthma 260 Relationship between Allergens and Development of Asthma 260

See also aggregation bias

For example, in a given country the number of deaths from severe asthma increased proportionally to the sales of a new anti-asthmatic drug. Before concluding that this drug is associated with an increased risk of death, it would be best to rule out, at the individual level, possibility of a prescription bias, i.e. that the drug was mainly prescribed to very severe asthmatics.

Decontamination Cathartics

Use Most organic and inorganic materials, ASA, acetaminophen, barbiturates, glu-tethamide, phenytoin, theophylline, TCAs. Dose Early (within 1-4 hours) administration of a flavored 8 1 water slurry, 10 1 AC drug, 1-2 g kg body weight (bw). Side effects Vomiting, aspiration, diarrhea, later constipation, possibly small bowel obstruction (SBO) AC is usually combined with a cathartic, particularly 70 sorbitol preferred over Mg citrate.

Clinical Development Plan

Have each issued guidelines on good clinical practices. For example, the FDA promulgated a number of regulations and guidelines governing the conduct of clinical studies from which data will be used to support applications for marketing approval of drug products. The FDA regulations refer to those regulations specified in 21 CFR Parts 50, 56, 312, and 314, while the FDA guidelines are guidelines issued for different drug products such as Guidelines for the Clinical Evaluation of Anti-Anginal Drugs and Guidelines for the Clinical Evaluation of Bronchodilator Drugs. On the other hand, the European Community established the principles for their own GCP standard in all four phases of clinical investigation of medicinal products in July 1990. Basically these guidelines define the responsibilities of sponsors, monitors, and investigators in the initiation, conduct, documentation, and verification of clinical studies to establish the credibility of data and to protect the rights and...

Evaluation of Eyelid Lesions

Fluid Filled Cyst Eyelid

Current and past illnesses should be reviewed. Of importance in patients presenting with rash-like symptoms is the recognition of atopy (as manifest by hay fever or asthma) as this history is suggestive of atopic dermatitis. Inquiry regarding past allergic reactions to food or medications is essential. Any systemic condition that may suppress the immune system and thus predispose the patient to cutaneous infections or neoplasia (such as HIV and diabetes) should be questioned.

Gender Ethnicracial And Life Span Considerations

Anaphylactic shock can occur at any age and in both men and women, but women seem a little more susceptible than men. Individuals with food allergies (particularly shellfish, peanuts, and tree nuts) and asthma may be at increased risk for having a life-threatening anaphylactic reaction. People at the ends of the lifespan are most at risk. To prevent infants and children from experiencing severe allergic reactions, pediatricians carefully plan vaccines and diet to limit the risk of allergic reaction until a child's immune system is more mature. Severe food allergy is more common in children than in adults, but diagnostic contrast, insect stings, and anesthetics are more common in adults than in children. Teenagers with food allergies and asthma may be at high risk for an allergic reaction because they are more likely to eat outside the home and less likely to carry their medications. Older people also have a great risk of anaphylaxis, and their risk of death is high owing to the...

Asian Proprietary Medicine or Asian Patent Medicine

Several studies of the chemical composition of these preparations have found that they frequently contain potentially toxic ingredients. Recent data indicate that approximately one-third of these products contain drugs or dangerous metals. Drugs that have been found include diazepam (Valium), steroids, and prescription asthma medications. Toxic metals sometimes found in these products are arsenic, mercury, lead, and cadmium.

Dehydroepiandrosterone DHEA

Glucagon is a linear polypeptide hormone with 29 amino acids synthesized in the a cells of the islets of Langerhans and secreted into the portal vein in response to fasting, starvation, glucogenic amino acids, CCK, gastrin, cortisol, exercise, infections, stress, beta-adrenergic stimulators, theophylline, or acetylcholine. Secretion is inhibited by glucose, insulin, somatostatin, secretin, free fatty acids, ketones, pheny-toin, alpha-adrenergic stimulators, GABA. It stimulates gluconeogenesis, glycogenolosis, lypolysis, and ketogenesis in the liver.

Primary Nursing Diagnosis

Although oxygen therapy is required to treat the hypoxemia that accompanies respiratory acidosis, a fraction of inspired air (FiO2) of less than 0.40 is desirable. Oxygen concentrations greater than 0.80 are toxic to the lung over a 5 to 6-day time period. Caution The use of oxygen for patients with COPD and hypercapnia may remove the stimulus for respiration and result in respiratory depression. If the PaCO2 is greater than 60 mm Hg or the PaO2 is less than 50 mm Hg with high levels of supplemental oxygen, intubation and mechanical ventilation are required. Pharmacologic therapy for respiratory acidosis depends on the cause and severity of acidosis. The administration of sodium bicarbonate is controversial for a pH greater than 7.0. If the pH is below 7.0, sodium bicarbonate administration is recommended. Bronchodilators may be used to decrease bronchospasms. Antibiotics are prescribed for respiratory infections, but sedatives that depress respirations are...

Discharge And Home Healthcare Guidelines

Asthma DRG Category 096 Mean LOS 5.2 days Description MEDICAL Bronchitis and Asthma, Age > 17 with CC Asthma is classified as an intermittent, reversible, obstructive disease of the lungs. It is a growing health problem in the United States, with approximately 20 million people affected. In the past 20 years, the number of children with asthma has increased markedly, and it is not the leading serious chronic illness in children. Unfortunately, approximately 75 of children with asthma continue to have chronic problems in adulthood. The total deaths annually from asthma has increased by over 100 since 1979 in the United States. Asthma is a disease of the airways that is characterized by airway inflammation and hyperreactivity (increased responsiveness to a wide variety of triggers). Hyper-reactivity leads to airway obstruction due to acute onset of muscle spasm in the smooth muscle of the tracheo-bronchial tree, thereby leading to a narrowed lumen. In addition to muscle spasm, there...

Systems Biology And Future Health Care

Integrative genomics therefore has the potential for ultimately mapping causal associations between gene expression profiles and disease states of the underlying cellular networks 51 . The etiologies of complex adult diseases, such as cancer, diabetes, asthma, and neurodegenerative conditions are determined by multiplex gene-environment interactions. Thus the promise of toxi-cogenomic modeling of risk factors for environmentally responsive disease is of particular importance and has resulted in the establishment of the Environmental Genome Project by the National Institute of Environmental Health Sciences, to provide a focus for development of a systems toxicology perspective for personalized medicine 83 . This paradigm shift for the field of drug safety evaluation and predictive risk assessment is reflected in the significant efforts to fund research that integrates toxicology, systems biology, and genomics, including initiatives that extend from the database level up to the exchange...

Cholinergic Toxidrome

Anticholinergic Toxidrome

SLUDE Muscarinic features Salivation, Lacrimation, Urination, Defecation, Emesis, plus miosis, bronchorrhea and broncho-spasm DUMBBELS Diarrhea, Urination, Miosis, Bronchorrhea, Bronchospasm, Emesis, Lacrimation, and Salivation. Nicotinic features Weakness, fascicula-tions, sweating, tachycardia, hypertension.

Adverse Effects of Antiplatelet Drugs

All antiplatelet drugs increase the risk of bleeding. Even at the low ASA doses used to inhibit platelet function (100 mg d), ulcerogenic and bronchocon-strictor (aspirin asthma) effects may occur. Ticlopidine frequently causes diarrhea and, more rarely, leukopenia, necessitating cessation of treatment. Clo-pidogrel reportedly does not cause he-matological problems.

Pulmonary Thromboemboli

Gonzales et al. list asthma and pulmonary embolus as causes of asphyxia.59 These two conditions are not fatal as often as they formerly were, but still represent a significant number of deaths due to respiratory disease. Death from massive pulmonary thromboembolus is due to impaction of dislodged thrombi in the pulmonary artery or its main tributaries (Figure 3.14). Thrombosis has been classically described as being caused by three factors stasis, injury to a vein, and hypercoagulability. Most pulmonary thromboem-boli originate in the deep veins of the lower extremities. Occasionally, they will arise in the pelvic veins, especially in pregnant women. In one case, the source of the embolus was a pelvic vein in a woman who had a serocystad-enoma the size of a basketball pressing on the vein. Any trauma to the lower extremities or pelvis may injure a vein and cause the formation of thrombi, which can be subsequently dislodged.

Studies in MS and Other Conditions

Chiropractic therapy has been investigated in other conditions. Among neurologic disorders, small or single-case studies note beneficial responses in people with headaches and spinal cord injury. These studies are too small to be conclusive. Chiropractic therapy sometimes is recommended for many other conditions, including asthma, ear infections, and gastrointestinal disorders. No strong evidence supports its use in these conditions.

Epidemiology of Reproductive Toxicology

Antimicrobials, antiemetics, theophylline, caffeine, ethanol, and nicotine. From 15 to 25 of pregnant women report licit drug use (ethanol > nicotine), or illicit drug use (marijuana > cocaine > heroin), or have positive urine drug screens during pregnancy. Analgesics, vitamins, iron, antibiotics, theoph-ylline, and psychotropic medications account for 50 to 80 of all reported toxic ingestions by pregnant women.

What Kind Of Responses To Trauma Should Mental Health Practitioners Be Concerned About

In most discussions of long-term pathologic responses following a traumatic event, there is an implicit assumption that the critical outcome being referred to is PTSD. Yet, PTSD is but one among several possible outcomes following trauma exposure. Trauma survivors, compared to persons who have not experienced trauma, are at increased risk for the development of other mental disorders, such as major depression, panic disorder, generalized anxiety disorder, and substance abuse, as well as persistent anxiety symptoms and distress that do not meet criteria for a specific psychological disorder 3 . Furthermore, they are at risk for developing somatic symptoms and physical illnesses, particularly hypertension, asthma, chronic pain syndromes and other psychosomatic illnesses. Interestingly, the focus of most investigations in the wake of disasters that affect large numbers of persons, whether they be natural or man-made events, has been related to PTSD, even though this disorder is neither...

Sympathomimetic Toxidrome

Features Fight or flight hypertension, tachycardia, sweating, fever, excitation-psychomotor agitation, tremor, seizures, dilated pupils. Causes Amphetamines diet drugs, cocaine, theophylline, caffeine, methylphenidate, mono-amine oxidase inhibitors over-the-counter cold medications, especially those containing phenylpropanolamine (PPA), ephedrine, and pseudoephedrine.

Atopic Eczema Dermatitis

Rash From Figs Eaten

In most patients there is a family history of eczema or of other atopic diseases, such as asthma or allergic rhinitis. Atopic eczema usually presents during infancy and, often, may resolve during childhood, whereas in others it may persist into adult life. Atopic eczema usually affects the face, wrists, and the flexural aspects of the elbows and knees (Fig. 2). There may be some involvement of the trunk, and the rash may become generalized. The eczema may be complicated by bacterial infection, and there is evidence to suggest that many exacerbations of atopic eczema may be due to occult infection with Staphylococcus aureus. Eczematous skin is also more prone to infections with wart viruses, molluscum contagiosum, and herpesviruses. Patients with atopic dermatitis may develop a widespread and potentially fatal rash, eczema herpeticum, following the development of herpes simplex or following contact with individuals affected with herpes simplex.

Inhaled corticosteroids

Regular use of an inhaled corticosteroid can suppress inflammation, decrease bronchial hyperresponsiveness and decrease symptoms. Inhaled corticosteroids are recommended for treatment of patients with mild or moderate persistent asthma as well as those with severe disease.

Sleep Wake Cycle and Hypnotics

Pharmacotherapeutic measures are indicated only when causal therapy has failed. Causes of insomnia include emotional problems (grief, anxiety, stress), physical complaints (cough, pain), or the ingestion of stimulant substances (caffeine-containing beverages, sympa-thomimetics, theophylline, or certain antidepressants). As illustrated for emotional stress (B2), these factors cause an imbalance in favor of excitatory influences. As a result, the interval between going to bed and falling asleep becomes longer, total sleep duration decreases, and sleep may be interrupted by several waking periods.

Leukotriene modifiers

Montelukast (Singulair) is modestly effective for maintenance treatment of intermittent or persistent asthma. It is taken once daily in the evening. It is less effective than inhaled corticosteroids, but addition of montelukast may permit a reduction in corticosteroid dosage. Montelukast added to oral or inhaled corticosteroids can improve symptoms. 3. Zafirlukast (Accolate) is modestly effective for maintenance treatment of mild-to-moderate asthma It is less effective than inhaled corticosteroids. Taking zafirlukast with food markedly decreases its bioavailability. Theophylline can decrease its effect. Zafirlukast increases serum concentrations of oral anticoagulants and may cause bleeding. Infrequent adverse effects include mild headache, gastroin

Differential Diagnosis Drug Induced Bradycardia

Angina Reduce anginal attacks and decrease post-myocardial infarction mortality. Tachydysrhythmias Used in theophylline overdose, butadenosine preferred over P-blockers. Tremor Propanolol over prescribed agitation, stage fright, and panic attacks (shakes). Migraine headaches. Bronchospasm Nonselectives prevent bron-chodilation and promote bronchospasm in chronic obstructive pulmonary disease (COPD) patients.

Elicitor Embden MeyerhofParnas Pathway

Elixicon A trade name for theophylline, a bron-chodilator that inhibits phosphodiesterase and increases cAMP concentration. Elixomin A trade name for theophylline, a bron-chodilator that inhibits phosphodiesterase and increases cAMP concentration. Elixophyllin A trade name for theophylline, a bronchodilator that inhibits phosphodiesterase and increases cAMP concentration.

Unclassified Adenosine

A naturally occurring nucleoside and G-pro-tein with its own specific adenosine receptors IV boluses of adenosine are indicated to rapidly terminate reentrant and theophylline-induced SVTs. Toxicities Transient asystole, atrial fibrillation, hypotension, bronchospasm. All toxicities are potentiated by the antiplatelet agent, dipyri-damole, an adenosine uptake inhibitor. Higher doses are required for methylxanthine overdoses due to adenosine receptor blockade. Treatment of toxicity Supportive.

Mechanism and toxicity

Toxicity Gastrointestinal (nausea, vomiting, diarrhea) > allergic manifestations > CNS Allergy 5 manifest penicillin sensitivities local pruritus, asthma 1 develop ana-phylaxis. Treatment O2, epinepherine-nor-epinepherine, P2-agonists, steroids, H1- and H2-blockers, theophylline, fluids. Consider glucagon for severe hypotension. CNS Seizures due to inhibition of GABA-to-receptor binding. Treatment benzodi-azapines > barbiturates.

Cytokine Growth Factor and Chemokine Ligand Database

Cytokines and growth factors are widely used terms which describe a diverse group of soluble proteins and peptides that play a key role in the regulation of a number of physiological processes, including regulation of both innate and acquired immune responses to foreign and self-antigens, microbial pathogens, and cancer cells. These polypeptides, which include established cytokines and chemokines, and growth factors, including hormones and other soluble mediators, operate at extremely low concentrations to modulate the biological and molecular functions of cells, tissues, and or entire organ systems. Cytokines and growth factors typically mediate interactions between cells via direct and indirect mechanisms regulating various immune and physiological processes. This regulation can occur either locally through cell-cell interactions within a specific tissue microenvironment or systemically via circulating cytokines in a fashion similar to that observed in hormone-mediated responses....

Development of QL questionnaires

The daily diary card (DDC) grew out of the idea that, in chemotherapy for lung cancer, it was felt that the main side effects were known but not their duration or the pattern of severity. Thus, the daily diary card was developed based on previous work in other conditions, such as the assessment of night cough in asthma patients and vaginal bleeding patterns. As patients complete the card each evening it was considered imperative to keep the number of questions to a minimum and for practical reasons to use a four or five point categorical scale. In the first MRC trial to use DDCs the consensus opinion was that the questions should address overall QL, a functional measure (physical activity), the main expected side-effect (nausea and vomiting) and two psychological items (mood and anxiety). These questions were changed in subsequent MRC trials depending on the research question.

Diagnostic testing

Labs Complete blood count (CBC) is useful in patients with acute exacerbation of COPD if pneumonia is suspected. The hematocrit is frequently elevated as a result of chronic hypoxemia. A serum theophylline level should be obtained in patients who are taking theophylline. Each milligram per kilogram of theophylline raises the serum theophylline level by about 2 mcg mL.

Pharmacotherapy for patient stabilization

Theophylline has a relatively narrow therapeutic index with side effects that range from nausea, vomiting, and tremor to more serious side effects, including seizures and ventricular arrhythmias. Dosage of long-acting theophylline (Slo-bid, Theo-Dur) is 200-300 mg bid. Theophylline preparations with 24-hour action may be administered once a day in the early evening. Theo-24, 100-400 mg qd 100, 200, 300, 400 mg . 1. Acute exacerbations are treated with systemic steroids, antibiotics, and inhaled beta-agonists with combined ipratropium. Lack of improvement should prompt addition of theophylline, salmeterol, noninvasive ventilatory support (BIPAP), or intubation with mechanical ventilatory support. 2. Chronic and stable COPD is treated with scheduled doses of ipratropium in combination with albuterol. Salmeterol and theophylline are added when symptom control is difficult. Addition of an inhaled steroid may be beneficial in selected patients. Continuous oxygen therapy has clear...

Critical Parameters and Troubleshooting

Anticoagulants such as CTAD (citrate theophylline adenosine dipyridimole) or added platelet activation inhibitors, such as prostacyclin or apyrase, can minimize formation of spontaneous LPAs, but these methods will alter agonist responsiveness and may even result in dissaggregation of existing LPA. Samples should never be exposed to temperatures < 15 C, as rewarming will result in platelet degranulation and LPA formation.

[KLOHnihdeen Pregnancy Category C

Epidural use causes analgesia at presynaptic and postjunctional al-pha-2-adrenergic receptors in the spinal cord due to prevention of pain signal transmission to the brain. tv2, distribution, epidural 19 min elimination 22 hr. Uses Oral, Transdermal Mild to moderate hypertension. A diuretic or other antihypertensive drugs, or both, are often used concomitantly. Non-FDA Approved Uses Alcohol withdrawal, atrial fibrillation, attention deficit hyperactivity disorder, constitutional growth delay in children, cyclosporine-associated nephro-toxicity, diabetic diarrhea, Gilles de la Tourette's syndrome, hyperhidrosis, hypertensive emergencies, mania, menopausal flushing, opiate detoxification, diagnosis of pheochromocy-toma, postherpetic neuralgia, psychosis in schizophrenia, reduce allergen-induced inflammatory reactions in extrinsic asthma, restless leg syndrome, facilitate smoking cessation, ulcerative colitis.

Adenosine Producing Stem Cell Therapy

Adenosine (Figure 4) is an endogenous neuromodulatory agent that has anticonvulsant activity in a variety of animal models.45 Using hippocampal microdialysis probes, adenosine levels were found to be increased 6-31-fold in patients with intractable complex partial epilepsy during seizures,46 suggesting that compounds that mimic adenosine effects, e.g., synthetic adenosine analogs, or facilitate its actions, e.g., adenosine kinase (AK) inhibitors, may be potent and effect AEDs.47 However, as in many other therapeutic areas where modulation of adenosine function has been viewed as a therapeutic option, e.g., neuropathic pain, stroke, asthma, chronic obstructive pulmonary disease (COPD), sleep promotion (see 6.06 Sleep), etc., the efficacy of adenosine and its analogs have been accompanied by unmanageable side effects including sedation and hypotension.48 A novel approach to circumventing the side effects of adenosine has been an 'ex vivo gene therapy' approach, tailoring the local...

Carvedilol and Heart Failure Banging our Heads against the Textbooks

Likewise, the 'bible' of pharmacology, Goodman and Gilman The Pharmacological Basis of Therapeutics,30 the leading teaching textbook of pharmacology for the biomedical sciences, highlighted special precautions for beta blockers, including the fact that ''heart failure that may develop suddenly or slowly usually in severely compromised heart'' with the use of these drugs. Likewise, Harrison's Principals of Internal Medicine31 lists as adverse effects of beta blockers ''the precipitation of heart failure in patients whom cardiac compensation depends upon enhanced sympathetic drive,'' and in the Textbook of Medicine3 the suggestion is made that ''beta adrenoceptor blockers should not be used in patients with Asthma, COPD chronic obstructive pulmonary disease or congestive heart failure.''

Tea Camellia sinensis Theaceae

Camellia has eighty-two species, yet only one has a dominant role in various cultures and has risen to dominate worldwide beverage markets. Camellia sinensis is an evergreen shrub or tree, kept artificially small by the harvesting and plucking of top, terminal leaf shoots. These leaves, variously processed, contain caffeine (1 to 5 percent) and traces of theophylline, theobromine, and other xanthine alkaloids however, it is the essential oils that are responsible for the flavors. Polyphenols (5 to 27 percent) are responsible for the dark brown tannin color.

Antipyretic Analgesics

Antipyretic Mechanism Action

Hence, the duration of the effect depends on the rate of enzyme resynthesis. Furthermore, salicylate may contribute to the effect. ASA irritates the gastric mucosa (direct acid effect and inhibition of cy-toprotective PG synthesis, p. 200) and can precipitate bronchoconstriction (aspirin asthma, pseudoallergy) due to inhibition of PGE2 synthesis and overproduction of leukotrienes. Because ASA inhibits platelet aggregation and prolongs bleeding time (p. 150), it should not be used in patients with impaired blood coagulability. Caution is also needed in children and juveniles because of Reye's syndrome. The latter has been observed in association with febrile viral infections and ingestion of ASA its prognosis is poor (liver and brain damage). Administration of ASA at the end of pregnancy may result in prolonged labor, bleeding tendency in mother and infant, and premature closure of the ductus arteriosus. Acidic nonsteroidal antiinflammatory drugs (NSAIDS...

Protecting Your Lungs

Lung disease is directly related to specific risk factors such as cigarette smoking and working in occupations that carry risks for developing lung disease. Plastics, wood, metal, and textile workers bakers millers farmers poultry handlers miners grain elevator workers laboratory technicians drug manufacturers dry cleaners and detergent manufacturers are all exposed to airborne agents that can cause occupational asthma, lung cancer, and other respiratory disorders.

Neurotoxic Shellfish Poisoning

Larization (opposite of saxitoxin and tetrodo-toxin TTX ). Vectors Clams > oysters. Incubation 15 minutes to 3 hours. Symptoms Mild ciguatera-like symptoms with perioral paresthesias and temperature reversal rarely nausea and diarrhea unique conjunctivitis, rhinitis, and or asthmatic bronchitis from aerosolized brevetoxins in breaking surf. Diagnosis By history, TLC or HPLC. Treatment Supportive only. Prognosis Full recovery in 48 hours. Prevention Monitor shellfish bed dinoflagel-late counts adhere to shellfish consumption advisories.

Disorders That Obstruct Air Flow

The flow of air from the lungs can be limited or obstructed by a variety of structural changes in the lungs. Chronic obstructive pulmonary disease (COPD), a major cause of disability and death in men, refers to asthma, chronic bronchitis, and emphysema. With COPD the airway obstruction is generally irreversible. With asthma the obstruction is reversible with treatment, although the disease itself may not be cured. Asthma Asthma affects the lining of the bronchi and the bronchioles. These airways become inflamed and produce extra mucus. Smooth muscle tissue in the airways contracts, narrowing the passageways even further. Common symptoms of asthma include wheezing (a faint whistling noise that occurs with each breath), shortness of breath, chest tightness (feeling as if someone is squeezing your chest), and coughing. Signs of an asthma emergency include extreme difficulty breathing, bluish tinge (cyanosis) to the lips and face, severe anxiety, rapid pulse, and sweating. People who do...

Disorders of the Esophagus

Certain medications can interfere with the action of this muscle, including nitrates, calcium channel blockers, theophylline, and anticholinergics. Smoking and diet also contribute to GERD. Excessive consumption of chocolate, peppermint, coffee, alcohol, and fried or fatty foods can weaken the lower esophageal sphincter.

Garlic Allium sativum Alliaceae

In the fourth book of the Bible, it is reported that the Jews returning to Sinai had nostalgia for the eating of garlic, which they had known and appreciated in Egypt. In ancient Greece and Rome, it was claimed to have additional uses, such as repelling scorpions, treating dog bites and bladder infections, and curing leprosy and asthma. By 1000 ad garlic was grown in virtually the entire known Medieval world, and was universally recognized as a valuable plant. Many cultures elevated garlic beyond a dietary staple, and suggested that it had medicinal and even spiritual uses. Philosophers and scholars credited garlic with many virtues. Aristophanes suggested that athletes and those going into battle should eat garlic to enhance their courage. Pliny wrote about garlic's ability to cure consumption and numerous other ailments. Virgil commented that garlic enhanced and sustained the strength of farm workers. Celsius recommended garlic as a cure for fever. Hippocrates thought it was a good...

Major Depressive Disorder

Elimination half-life of approximately 6 weeks when considered with its potent metabolite norfluoxetine. Sertraline, citalopram, and escitalopram have few potential drug-drug interactions, but all can have gastrointestinal side effects including nausea, vomiting, and diarrhea, as well as sleep alterations, weight changes, sexual dysfunction, and extrapyramidal effects such as a high-frequency, low-amplitude tremor. The tricyclics produce significant anticholinergic effects and may induce delirium, cognitive slowing, urinary retention, dry mouth, and orthostasis these are not recommended for routine use in this vulnerable population. Similarly, monoamine oxidase inhibitors are not recommended for patients with HIV and AIDS. This class of medications poses an extraordinary risk, since persons with HIV and AIDS are often on complex and frequently changing drug regimens and also have the concurrent risk of hypertensive crisis if exposed to certain foods or other medications. These include...

Ephedra Ma huang Ephedra sinica Ephedraceae

Ephedra sinica represents one of the oldest medicinal plants in China, where it is known by the name of ma huang. It is estimated that its use began 4,000 years ago, particularly in northern China and Mongolia. Ephedra was used in ethnomedicine as a stimulant, to increase perspiration, and as an anti-inflammatory. In the Chinese school of medicine, a preparation called mimahuang, containing roasted honey and chopped dried aerial parts of this species, is claimed to be an effective treatment for flu and respiratory tract inflammations. Ephedra, which contains ephedrine and similar alkaloids, has been used extensively in the ancient pharmacy as an antihistaminic in the treatment of asthma and as a natural decongestant. It has become a very popular ingredient in herbal combinations for allergies and hay fever. Since it is a central nervous system stimulant and increases the metabolism and increases body temperature, it has been used to control weight and to help prevent sleep, and by...

Scombroid Fish Poisoning

Symptoms Sudden warm facial flushing and sunburn-like rash, metallic-peppery taste, perioral burning and blistering sensations then urticaria, pruritus, bronchospasm, palpitations, tachycardia, hypotension fewer gastrointestinal symptoms of abdominal cramps, nausea, vomiting, and diarrhea. gas chromatography mass spectrometry, high serum and urine histamine and saurine levels. Treatment Severe poisoning gastric emptying, then AC gut decontamination otherwise, Hj-and H2-blockers, P-agonists for bronchospasm with wheezing, and consider corticosteroids for allergic bronchospasm and urticaria pruritus. Prognosis Symptoms resolve in 12-24 hours even without treatment.

Secondary Sleep Disorders

Secondary Sleep Disorders

Sleep can be impaired by dementia, Parkinson disease, dys-tonia, respiratory disturbances secondary to neuromuscular disease (muscular dystrophy, amyotrophic lateral sclerosis), epilepsy (nocturnal attacks), and headache syndromes (cluster headaches, migraine). Fatal familial insomnia is a genetic disorder of autosomal dominant inheritance (p. 252). Sleep disorders due to systemic disease. Sleep can be impaired by pulmonary diseases (asthma, COPD), angina pectoris, nocturia, fibromyalgia, and chronic fatigue syndrome.

Elevated Eosinophil and Basophil Counts

Reactive Bronchial Cells

Bacterial and viral infections are both unlikely ever to lead to eosinophilia except in a few patients with scarlet fever, mononucleosis, or infectious lymphocytosis. The second most common group of causes of eosinophilia are allergic conditions these include asthma, hay fever, and various dermatoses (urticaria, psoriasis). This second group also includes drug-induced hypersensitivity with its almost infinitely multifarious triggers, among which various antibiotics, gold preparations, hydantoin derivatives, phenothiazines, and dextrans appear to be the most prevalent. Eosinophilia is also seen in autoimmune diseases, especially in scleroderma and panarteritis. All neoplasias can lead to paraneoplastic eosinophilia, and in Hodgkin's disease it appears to play a special role in the pathology, although it is nevertheless not always present.

Developmental Exposures and Lead Induced Immunotoxicity

Th2 balance appear to be influenced by both environmental and genetic factors and have both biological and clinical ramifications. Th2 activity and IgE levels have been recognized as an important consideration in airway responsiveness and asthma (Sears et al. 1991, Umetsu and DeKruyff 1997 Lutz et al. 1999). Likewise, genetic-related risk factors have been identified for asthma and hyperreactive airways. At least some of the identified genetic polymorphisms seem to influence T helper cell balance as well (Lee et al. 2002a). The interaction between genotype and environmental exposure is coming under increased examination relative to the risk of asthma (Sengler et al. 2002). There is a strong link between the lead-induced increase in Th2 activity and the associated increases in cytokine and IgE levels. Obviously, segments of the population can vary genetically relative to Th1 vs. Th2 bias. Therefore, for a subpopulation already genetically predisposed more toward Th2...

Gen Indapamide M Lozide M [Rx Classification Diuretic thiazide type

Action Kinetics Onset 1-2 weeks after multiple doses. Peak levels 2 hr. Duration Up to 8 weeks with multiple doses. tVi 14 hr. Nearly 100 is absorbed from the GI tract. Excreted through the kidneys (70 with 7 unchanged) and the GI tract (23 ). Uses Alone or in combination with other drugs for treatment of hypertension. Edema in CHF. Contraindications Hypersensitivity, asthma, severe hepatic disease, severe renal disease. Special Concerns Dosage has not been established in children. Geriatric clients may be more sensitive to the hypotensive and electrolyte effects.

Ketorolac tromethamine

Uses PO Short-term (up to 5 days) management of severe, acute pain that requires analgesia at the opiate level. Always initiate therapy with IV or IM followed by PO only as continuation treatment, if necessary. IM IV Ketorolac has been used with morphine and meperidine and shows an opioid-sharing effect. The combination can be used for breakthrough pain. Ophthalmic Relieve itching caused by seasonal allergic conjunctivitis. Reduce ocular pain and photo phobia following inci-sional refractive surgery. Contraindications Hypersensitivi-ty to the drug, incomplete or partial syndrome of nasal polyps, an-gioedema, and bronchospasm due to aspirin or other NSAIDs. Use in Additional Side Effects CV Vasodilation, pallor. Oral Dry mouth, stomatitis. GI GI pain, peptic ulcers, nausea, dyspepsia, flatulence, GI fullness, excessive thirst, GI bleeding (higher risk in geriatric clients), perforation. CNS Headache, nervousness, abnormal thinking, depression, euphoria. Hypersensitivity Bronchospasm,...

Whole bowel irrigation

Hemodialysis Indications include ingestion of phenobarbital, theophylline, chloral hydrate, salicylate, ethanol, lithium, ethylene glycol, isopropyl alcohol, procainamide, and methanol, or severe metabolic acidosis. E. Hemoperfusion May be more effective than hemodialysis except for bromides, heavy metals, lithium, and ethylene glycol. Hemoperfusion is effective for disopyramide, phenytoin, barbiturates, theophylline.

Antithyroid Drug Therapy

Although MMI and PTU promptly inhibit hormone formation, they do not inhibit hormone release. Thus, levels of circulating thyroid hormones may remain elevated for several weeks as stored hormone is released. Until circulating levels of thyroid hormones normalize, the signs and symptoms of hyperthyroidism may be controlled with beta-blockers such as atenolol (25 or 50 mg, QD or BID) or propranolol (2.5-10 mg b.i.d. or t.i.d.). If the child has reactive airway disease, beta-blocker therapy may trigger acute exacerbations of asthma. In this setting we have had success using metoprolol, which is a cardiac-selective beta-blocker.

Animal Models of Airway Sensitization

Airway inflammation and airway hyperresponsiveness (AHR) are hallmarks and distinguishing features of bronchial asthma. In studying the pathophysiology of the inflammatory response and the development of AHR, for practical and ethical reasons it is frequently necessary to use animal models. In particular, murine models of allergen-induced AHR are widely used, since the immunology of mice is well described and many immunological tools and genetically altered strains are available. In most models of induced allergic asthma, animals are systemically sensitized to specific antigens and then, after a period of time, challenged with the same allergen administered via the airways (see Basic Protocol). In most studies ovalbumin has been used as the standard allergen to sensitize and challenge animals, although other antigens, including ragweed and the recombinant major cat allergen, FelDl, have been used as well. Besides systemic sensitization to allergen followed by airway provocation, mice...

Induction Of Airway Hyperresponsiveness By Systemic Sensitization And Airway Challenge With Ovalbumin

This section describes the most widely used method to induce AHR, repeated systemic sensitization followed by subsequent airway challenge with the same antigen. In this way sensitization and airway provocation with allergen are separated and can be manipulated individually. Repeated injection of allergen mixed in aluminum hydroxide (alum) as an adjuvant induces strong, sustained sensitization with a preferential TH2-type immune response and production of allergen-specific IgE and IgG1 (Beck and Spiegelberg, 1989). Airway provocation of presensitized mice with the same allergen induces airway inflammation with preferential eosinophilic infiltration and, as a consequence, AHR. Control

Background Information

Animal models of altered airway function following allergen sensitization and challenge have contributed significantly to the understanding of the pathogenesis of human asthma. Different species have been used as models, with selection based on the ability to monitor airway responsiveness, often including both early- and late-phase responses. In many of these species, however, the immunologic analyses and manipulations available are limited compared to those of mice, for which many reagents and immunologically deficient strains exist. The development of means to assess airway function in mice together with the capacity to influence immune reactivity has spawned many murine studies in the last several years. It remains somewhat unclear how appropriate animal models are for studying allergic diseases of the human lung. Nevertheless, important insights into mechanisms and possible therapeutic modalities are often gained.

Angioedema and Urticaria

Angioedema Pictures Eyelids

INTRODUCTION Angioedema and urticaria are common transient phenomena that result from mast cell degranulation with the release of mediators that promote vascular permeability, causing proteins and fluids to extravasate into the extracellular space. In urticaria fluid collects within the dermal tissue, whereas in angioedema fluid collects in the deeper subcutaneous space. The causes of mast cell degranulation are varied and include both immunologic and nonimmunologic mechanisms. Systemic involvement may include rhinitis, bronchospasm, or anaphylaxis. Severe reactions may lead to syncope, bronchial asthma, and hypotension. In rare cases both urticaria and angioedema may be triggered by exercise. Acute cases reach a peak in one to three days and usually fade in 7-21 days. In chronic cases the condition waxes and wanes for months or may even persist for years. There may be recurrent attacks separated by months to years. Inciting allergens are numerous and include foods, cosmetics,...

Library screening for structures similar to albuterol

Rapid screening of structure databases have been carried out among the 21000 organic structures for several drugs.11-15'29-32 For example, the results found for the first five structures found in the screening for structures similar to Albuterol are listed in Table 9. The first five, the most similar structures, are all known bronchodilators like Albuterol.14 The rank ordering in similarity is not necessarily expected to reflect the rank ordering in activity since the structure similarity is not based on a model of activity. Subsequent to library screening, rank ordering could be done with a QSAR model.

Drugs Used to Influence Smooth Muscle Organs

Smooth Muscle Spasm

Narrowing of bronchioles raises airway resistance, e.g., in bronchial or bronchitic asthma. Several substances that are employed as bronchodilators are described elsewhere in more detail 2-sympathomimetics (p. 84, given by pulmonary, parenteral, or oral route), the methylxanthine theo-phylline (p. 326, given parenterally or orally), as well as the parasympatholytic ipratropium (pp. 104, 107, given by inhalation). Bronchial asthma Bronchial asthma Theophylline 0

Library screening for structures with molecular connectivity indices

A database with compounds in seven different pharmacological classes of activity was used for development of discriminant models of each activity class. The classes included analgesic, antiviral, bronchodilator, antifungal, hypolipidemic, hypoglycemic, and beta-blocking activity. Galvez developed separate discriminant models for each class by using molecular connectivity indices. Based on each model, activity was predicted for a list of structures as both a prediction and a subsequent experimental test. In some cases, compounds were also tested experimentally. Compounds predicted to be active were generally known from the literature to be active or tested in the laboratory.

Nase I in NonCF Respiratory Diseases

Highly viscoelastic lung mucus causes many other respiratory disorders like atelectasis, bronchiectasis, bronchiolitis, bronchitis, and primary ciliary dyskinesia (PCD), giving rise to suffering and even morbidity. Under these conditions, the high viscidity of the lung secretions is often also due to high DNA concentrations, a result of a neutrophil-dominated airway inflammation. Consequently, rhDNase I may be of benefit to these patients. However, unlike the situation in CF, only a few controlled clinical trials have evaluated the efficacy of rhDNase I in these non-CF respiratory diseases. Most of the evidence of benefits are based on case reports or the experience of small groups of

Physiology and Pathophysiology

Normal mucociliary functioning usually protects respiratory epithelium from bacterial invasion, however, certain respiratory viruses appear to exert a direct cytotoxic effect on the cilia.3 Alteration of the number, morphology, and function of cilia in the respiratory epithelium may facilitate secondary bacterial infection of the paranasal sinuses. Ciliary activity may also be impaired with alterations in mucosal secretions, as cilia can only beat in a fluid medium. Thickened secretions typically seen in systemic disorders such as cystic fibrosis or asthma have the potential to impair ciliary movement. Purulent secretions from an infected sinus may also affect ciliary movement, however, reports on this are conflicting.9'10

Adverse Effects Interactions and Pharmacokinetics

Dosages of up to 30 mg rhDNase I per day were well tolerated in healthy volunteers and CF patients 69,87 . Severe bronchospasms or anaphylactic reactions, as seen after inhalation of bovine DNase I, have never been observed with rhDNase I. The most common adverse effects reported after daily inhalation of 2.5 mg rhDNase I were voice alterations (hoarseness), pharyngitis, rash, laryngitis, and conjunctivitis 74,76,78 . All these events are generally mild and transient. In patients with severe pulmonary disease (FVC < 40 ), rhinitis, fever, dyspepsia, dyspnea, and an FVC decrease of > 10 have also been reported 76,88 . Facial edema has been reported to an exceptional degree in patients receiving 2.5 or 10 mg rhDNase I twice daily 70 . It has also been shown that rhDNase I may increase airway inflammation by releasing elastase and proinflammatory cytokines that are bound to DNA in the airway secretions 89-91 . However, other studies did not confirm this observation 92-94 . Antibodies...

Medical Complications Direct Results of Cocaine

In terms of pulmonary effects, pneumomediastinum and cervical emphysema have been reported after smoking cocaine due to alveolar rupture with prolonged deep inspiration and Valsalva's maneuver (Aroesty, Stanley, & Crockett, 1986). Other respiratory complications of inhaling or smoking freebase cocaine include abnormal reductions in carbon monoxide diffusing capacity (Itkonen, Schnoll, & Glassroth, 1984), granulomatous pneumonitis (Cooper, Bai, Heyderman, & Lorrin, 1983), pulmonary edema (Allred & Ewer, 1981), thermal airway injury, pulmonary hemorrhage, hypersensitivity reactions, interstitial lung disease, obliterative bronchiolitis, asthma, and persistent gas-exchange abnormalities (Laposata & Mayo, 1993). Respiratory manifestations include shortness of breath, cough, wheezing, hemoptysis, and chest pains. Severe respiratory difficulties have been reported in neonates of abusing mothers. Inhalation of hot cocaine vapors may also result in bilateral loss of eyebrows...

Gastrointestinal decontamination and systemic drug removal

Activated charcoal premixed with sorbitol, 50 gm PO or via nasogastric tube q4h around-the-clock until theophylline level is less than 20 mcg mL. Maintain head-of-bed at 30 degrees to prevent charcoal aspiration. 3. Indications for charcoal hemoperfusion Coma, seizures, hemodynamic instability, theophylline level > 60 mcg mL rebound in serum levels may occur after discontinuation of hemoperfusion.

Metered Dose Inhaler

Adults and children over 12 years of age Two inhalations q.i.d. at regular intervals in order to provide 14 mg day. If the client is under good control on q.i.d. dosing (i.e., requiring inhaled or oral beta agonist no more than twice a week or no worsening of symptoms occur with respiratory infections), a lower dose can be tried. In such instances, the dose should first be reduced to 10.5 mg day (i.e., used t.i.d.) then, after several weeks with good control, the dose can be reduced to 7 mg day (i.e., used b.i.d.).

Allergies to Medications

During an anaphylactic reaction, the body releases massive amounts of histamine and other powerful chemicals in response to the presence of the allergen. The blood vessels widen, causing a sudden, severe decrease in blood pressure. Other symptoms can include hives (itchy, raised, red patches on the skin) swelling of the lips, tongue, and throat abdominal pain diarrhea and difficulty breathing due to bronchospasm (narrowing of the airways in the lungs).

The Common Cold and the

The flu is a viral infection of the nose, throat, and lungs. It is usually mild in young and middle-aged adults but can be life-threatening in older people and people who have a chronic illness such as heart disease, emphysema, asthma, bronchitis, kidney disease, or diabetes. The flu also can lead to more serious, potentially life-threatening infections such as pneumonia (see page 250). Because pneumonia is one of the five leading causes of death among older people, it is important for older people to take steps to prevent the flu. The best preventive measure is a flu shot (see page 93), given each fall at the beginning of the flu season. A pneumonia shot (see page 252) is another preventive measure available for older people and people who have a chronic illness the pneumonia shot is given only once.

Sleep Disturbance In

Methylphenidate and other psychostimulants used to treat apathy and fatigue in HIV-infected patients can cause insomnia, although restriction of dosing schedules to the earlier part of the day should avoid this side effect. Insomnia and non-restful sleep have been-reported early in treatment with efavirenz and may also cause more chronic sleep difficulty. Studies have found longer sleep latency and shorter duration of deep sleep in patients treated with efavirenz compared with controls as well as higher efavirenz plasma levels in patients with insomnia and or reduced sleep efficiency than in those being treated with efavirenz who did not have sleep complaints (Gallego et al., 2004). In addition, efavirenz has been associated with vivid dreams and nightmares (American Psychiatric Association, 2000) that may result in disturbed and less restful sleep. Abacavir, stavudine, didanosine, and zi-dovudine (AZT) have also been linked to insomnia, with placebo-controlled studies showing more...

Death in the Dental Chair

Central nervous system depressant drugs such as barbiturates and phenytoin. General anesthetics can also produce asthma-like attacks that are not as apparent in an unconscious patient. Other problems involving anesthesia in the dental office include failure to monitor the patient's vital functions and failure to have the proper drugs and equipment to resuscitate an individual who is having difficulty.

NOC Family Coping

Offers support to families with child suffering from asthma. Assess interpersonal relationships within the family and support systems, with emphasis on the family's relationship with the child diagnosed with asthma intervene appropriately with evidence of maladaptation refer to counseling if appropriate (specify). Instruct child and family on preventive treatment when applicable (specify, i.e., prevention of exercise-induced asthma can be accomplished by use of certain medications prophylactically).

Fetal Sensitization and Subsequent Immune Responses in Childhood

Several groups have shown that responses set up during pregnancy can be predictive of subsequent allergic disease (Kondo et al. 1992 Prescott et al. 1998 Warner et al. 1994). Epidemiological data have been of particular importance in showing associations between various maternal factors and childhood asthma. Such maternal factors that are associated with an increased risk of childhood asthma include younger age (Anderson et al. 1986 Martinez et al. 1992 Schwartz et al. 1990), smoking (Martinez et al. 1992 Oliveti et al. 1996 Weitzman et al. 1990), lack of prenatal care, and weight gain of less than 20 pounds (9.1 Kg) during pregnancy (Oliveti et al. 1996 reviewed in Donovan and Finn, 1999). Experimental studies have shown that peripheral blood mononuclear cell sensitivity to allergens exists at birth (Kondo et al. 1992 Prescott et al. 1998 Warner et al. 1994 reviewed in Warner and Warner 2000). In particular, specific allergen-induced responses can be measured in the peripheral blood...

Biosynthesis Of Hypericin

Which is used to cure bronchial asthma. Theobromine is found in cocoa and related chocolate products (Dewick, 1998). Purine bases like adenine and guanine are transformed in these species to purine alkaloids. The biosynthesis of these compounds starts from xanthosine monophosphate methylation to give 7-methylxanthosine monophosphate. Alternatively the dephosphorylation of xanthosine monophosphate gives xan-thosine. The latter is the precursor of theophylline, whereas hydrolysis of the phosphate group of 7-methylxanthosine monophosphate gives 7-methylxanthosine. The latter compound undergoes cleavage of the ribose to yield 7-methylxanthine, which after successive methylations is transformed to theobromine and finally to caffeine. The hydrolysis of the phosphate ester of xanthosine monophosphate gives xanthosine. The latter compound, after cleavage of ribose and two methylations, is finally transformed to theophylline (Figure 7.31). Figure 7.31 Biosynthesis of the purine alkaloids...

Propranolol hydrochloride

Uses Hypertension (alone or in combination with other antihyper-tensive agents). Angina pectoris, hypertrophic subaortic stenosis, prophylaxis of MI, pheochromocytoma, prophylaxis of migraine, essential tremor. Cardiac arrhythmias. Anxiety, aggressive behavior. Contraindications Hypersensitiv-ity to propranolol, cardiogenic shock, 2nd or 3rd degree heart block, sinus bradycardia, congestive heart failure, cardiac failure. Bronchial asthma, bronchospasms including severe COPD. Special Concerns Children, diabetes mellitus, hepatic disease, hy-perthyroidism, hypotension, lactation, myasthenia gravis, peripheral vascular disease, renal disease. It is dangerous to use propranolol for pheochromocytoma unless an al-pha-adrenergic blocking agent is already in use.

The TH2Bias of the Neonatal Immune System

The observations that the in utero environment supports TH2-type immune responses has given rise to a hypothesis that atopy in children derives from a persistence of this bias beyond birth (Donovan and Finn 1999 Holt et al. 1992 Holt and Macaubas 1997 Prescott et al. 1998a Prescott et al. 1998b). Normally, a shift occurs in an infant's immune system shortly after birth to favor the adult TH1-mediated responses. This developmental phenomenon is termed immune deviation (Holt et al. 1999). Atopic infants instead may increase the TH2 cells that were primed in utero (Kay 2001). Because macrophages that engulf microbes secrete IL-12, a cytokine that induces Natural Killer (NK) cells to produce IFNg and in general promotes TH1-type cells, it is believed that microbes are the chief stimulus of protective TH1-mediated immunity (Kay 2001). This idea leads into the hygiene hypothesis discussed earlier proposing that lack of immune deviation is due to an overly clean environment, that is, one...

Dust Mites and Cockroaches

The National Academy of Sciences (NAS) stated in 2000 that there is sufficient evidence of causal relationship between exposure to house dust mite allergen and the development of asthma in susceptible children (National Academy of Sciences 2000), and good correlation has been shown between early high level exposure to house dust mite and the subsequent increase in the prevalence and severity of asthma (Sporik et al. 1990). Moreover, in spite of many nonasthmatics testing positive in skin tests for dust mite sensitivity, early sensitization has been associated with a greater probability of the persistence of bronchial hyperresponsiveness and symptoms of asthma in late childhood and adolescence (Peat et al. 1990). Similarly, cockroach antigen exposure is known to elicit a strong IgE response from B cells to induce sensitization, and the NAS has reported that 1.) sufficient evidence of causal relationship exists between cockroach (CR) allergen exposure and exacerbation of asthma in...

BAdrenoceptor Antagonists bBlockers

The first -adrenoceptor antagonist, dichloroisoproterenol, was described by I. Slater in 1957. The first clinically useful b-adrenoceptor antagonists, pronethalol and propranolol (Table 2), were discovered and developed by the British pharmacologist Sir James Black. Their usefulness in the treatment of hypertension was first demonstrated in patients by Prichard. Pronethalol was found to be carcinogenic in mice,25 while propranolol was marketed and is still used in the clinic. The discovery of subtypes of b-adrenoceptors, b1 and b2, facilitated the development of additional antagonists with various affinities for the two receptor subtypes. Propranolol is nonselective it has similar affinity for br and b2-adrenoceptors. Blockade of b2-adrenoceptors is likely to cause bronchial constriction, so that propranolol should not be used in patients with bronchial asthma. Propranolol enters the central nervous system and can produce vivid dreams as one of its side effects. Another nonselective...

Pet Dander Fungi Mold and Pollen

In general, evidence is weak or nonexistent supporting connections between pet dander or fungi and asthma development. Clearly, pet dander and fungi exacerbate asthma in individuals sensitized to a particular allergen, but evidence is lacking that pet dander contributes to asthma development, and only recently have preliminary studies started to make a connection towards fungi exposure and asthmagenesis (National Academy of Sciences 2000). 2 to 3 months of pregnancy is associated with much less birch pollen reactivity of the offspring than occurs if the exposure was between 3 and 6 months' gestation (Van Duren-Schmidt et al. 1997). As the authors of that study pointed out, of particular relevance is that IgG transfer across the placenta is maximal during the latter few months of pregnancy, so maternal fetal interactions may be playing a major role in this case. Moreover, other studies have shown that children are at increased risk for allergy to seasonal allergens if born shortly...

Carefully Edible Mushrooms Conclusions

Lepiota Subclypeolaria

Figure 14.8 Lycoperdon candidum (white puffballs). Common white puffballs (Lycoperdon candidum), release spores when crushed, which can cause acute bronchospasm or lycoperdonosis when inhaled. (Courtesy of Charles P. Sea, M.D., Department of Emergency Medicine, Ochsner Clinic Foundation Hospital, New Orleans, LA. Original Source U.S. Government Document, U.S. Forest Service Document, 1979, Wild Mushrooms of North America.) Figure 14.8 Lycoperdon candidum (white puffballs). Common white puffballs (Lycoperdon candidum), release spores when crushed, which can cause acute bronchospasm or lycoperdonosis when inhaled. (Courtesy of Charles P. Sea, M.D., Department of Emergency Medicine, Ochsner Clinic Foundation Hospital, New Orleans, LA. Original Source U.S. Government Document, U.S. Forest Service Document, 1979, Wild Mushrooms of North America.)

Environmental Toxicants and Maternal Exposure

This section reviews the available information on asthma and nonallergen environmental contaminants for which there is potential for exposure in both the general population and the developing fetus. Although there is great interest in the potential associations between maternal exposure to environmental contaminants, such as pesticides, polycyclic halogenated hydrocarbons, and heavy metals, and the development of asthma in offspring, there has been very little research in the area. One of the most prevalent environmental contaminants, environmental tobacco smoke, is reviewed in a subsequent section.

Polycyclic Halogenated Hydrocarbons

Polycyclic halogenated hydrocarbons (PHH) are persistent synthetic or man-made chemicals that are or were heavily used in industry or are by-products of industrial processes. The PHHs of highest concern are halogenated aromatic hydrocarbons, including polychlorinated biphenyls (PCBs) and polychlorinated dibenzo-p-dioxins (dioxins). Both PCBs and dioxins have been shown to be highly toxic to many organ systems in animal studies and are potent fetotoxins (Carpenter 1998 Mukerjee 1998). PCB dioxin immunotoxicity has been recently reviewed in two studies (Tryphonas 1998 Weisglas-Kuperus 1998). Occupational and transient highlevel exposure from industrial accidents show some immunomodulations in humans, however, only one study has examined endpoints indicative of hypersensitivity, rather than immunosuppression. In 2001, Karmaus and Kruse (Karmaus et al. 2001) conducted an epidemiological study of 340 children that investigated associations between exposures to several persistent...

Effects of ETS on Respiratory Health

There exists a significant body of research on the potential effects on respiratory health from exposure to environmental (passive) tobacco smoke (ETS) (reviewed in National Academy of Sciences 2000). Many components of ETS are known lung irritants. There have been direct associations shown between exposure to tobacco smoke and the development of lung cancer, obstructive airway disease, chronic bronchitis, ear infections, and asthma. It is small wonder that ETS is associated with so many disparate disorders, considering that tobacco smoke components include the carcinogens benzene, toluene, and 1,3-butadiene (Mitacek et al. 2002), toxicants such as nickel (Tobacco Research Implementation Group 1998) and polycyclic aromatic hydrocarbons (PAHs) (Besaratinia et al. 2002), and common household chemicals including ammonia, formaldehyde, and acetone (Tobacco Research Implementation Group 1998). Moreover, the effects of tobacco smoke are not limited to the active smoker but to anyone exposed...

Effects of Maternal Smoking

Active maternal smoking has been shown to be associated with many complications of fetal development, and several studies consistently link respiratory tract effects, the development of allergy, and impaired lung function in school-age children with maternal smoking (Cook and Strachan 1999 Lodrup Carlsen and Carlsen 2001 National Academy of Sciences 2000). Fetal exposure to ETS in utero differs both qualitatively and quantitatively from exposure of young children to airborne ETS. It must be emphasized that these types of studies are difficult to interpret because most mothers who smoke during pregnancy also continue to smoke after a child is born (National Academy of Sciences 2000). Having said that, however, at least one study has found a stronger influence of in utero exposure than exposure encountered postnatally (Hu et al. 1997). Although maternal smoking clearly negatively impacts the respiratory health of offspring, the effects of ETS on the development of allergy and asthma are...

[theeOFFihlin Pregnancy Category C

Immediate-release Capsules, Tablets, Liquid Products Accurbron, Aquaphyllin, Asmalix, Bronkodyl, Elix-omin, Elixophyllin, Lanophyllin, Lixolin, Pulmophylline M, Quibron-T SR M, Quibron-T Dividose, Slo-Phyllin, Solu-Phyllin, Somnophyllin-T, Theo, Theo-clear-80, Theolair, Theolixir M, Theo-mar, Theostat-80, Truxophyllin. Timed-release Capsules and Tablets Aerolate III, Aerolate Jr., Aerolate Sr., Apo-Theo LA M, Quibron-T SR Divid-ose, Respid, Slo-Bid Gyrocaps, Slo-Phyllin Gyrocaps, Somophyllin-CRT, Sustaire, Theo-24, Theo 250, Theobid Duracaps, Theoclear L.A.-130 Cenu-les, Theoclear L.A.-260 Cenules, Theocot, Theochron, Theochron-SR M, Theo-Dur, Theo-SR M, Theolair M, Theolair-SR, Theospan-SR, Theo-Time, Theophylline SR, Theovent Long-Acting, Uni-Dur, Uniphyl Rx Classification Antiasthmatic, bron-chodilator See also Theophylline Derivatives. Action Kinetics Time to peak serum levels, oral solution 1 hr uncoated tablets 2 hr chewable tablets 1-1.5 hr enteric-coated tablets 5 hr...

Dealing With Asthma Naturally

Dealing With Asthma Naturally

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