Asthma is a chronic condition (generally associated with humans but also controversially being diagnosed in housepets such as cats^[1]) involving the respiratory system in which the airway occasionally constricts, becomes inflamed, and is lined with excessive amounts of mucus, often in response to one or more triggers.^[2] These episodes may be triggered by such things as exposure to an environmental stimulant (or allergen) such as cold air, warm air, perfume,^[3] moist air, exercise or exertion, or emotional stress. In children, the most common triggers are viral illnesses such as those that cause the common cold.^[4] This airway narrowing causes symptoms such as wheezing, shortness of breath, chest tightness, and coughing. The airway constriction responds to bronchodilators. Between episodes, most patients feel well but can have mild symptoms and they may remain short of breath after exercise for longer periods of time than the unaffected individual. The symptoms of asthma, which can range from mild to life threatening, can usually be controlled with a combination of drugs and environmental changes. Asthma, Asthmatic or Asthma attack may refer to: Asthma, a disease of the respiratory system in which the airways constrict, become inflamed, and are lined with excessive amounts of mucus Allergic asthma, what the term asthma was created to mean Asthmatic, a song by Spineshank from their 2000 album Height... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // J00-J99 - Diseases of the respiratory system (J00-J06) Acute upper respiratory infections (J00) Acute nasopharyngitis (common cold) (J01) Acute sinusitis (J02) Acute pharyngitis (J03) Acute tonsillitis (J04) Acute laryngitis and tracheitis (J05) Acute obstructive laryngitis (croup) and epiglottitis (J050) Acute obstructive laryngitis (croup) (J051) Acute epiglottitis (J06) Acute upper... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Mendelian Inheritance in Man project is a database that catalogues all the known diseases with a genetic component, and - when possible - links them to the relevant genes in the human genome. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... In medicine, a chronic disease is a disease that is long-lasting or recurrent. ... This is a disambiguation page — a navigational aid which lists other pages that might otherwise share the same title. ... Binomial name Felis catus Linnaeus, 1758 Synonyms Felis lybica invalid junior synonym The cat (or domestic cat, house cat) is a small carnivorous mammal. ... Among quadrupeds, the respiratory system generally includes tubes, such as the bronchi, used to carry air to the lungs, where gas exchange takes place. ... Human respiratory system The lungs flank the heart and great vessels in the chest cavity. ... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... Mucus cells. ... An allergen is any substance (antigen), most often eaten or inhaled, that is recognized by the immune system and causes an allergic reaction. ... The term Exercise can refer to: Physical exercise such as running or strength training Exercise (options), the financial term for enacting and terminating a contract Category: ... In medical terms, stress is the disruption of homeostasis through physical or psychological stimuli. ... Acute viral nasopharyngitis, or acute coryza, usually known as the common cold, is a highly contagious, viral infectious disease of the upper respiratory system, primarily caused by picornaviruses or coronaviruses. ... A symptom is a manifestation of a disease, indicating the nature of the disease, which is noticed by the patient. ... Wheezes are continuous, coarse, whistling sounds produced in the respiratory airways during breathing. ... Dyspnea (R06. ... Wikipedia does not yet have an article with this exact name. ... This article does not cite any references or sources. ...

Public attention in the developed world has recently focused on asthma because of its rapidly increasing prevalence, affecting up to one in four urban children.^[5] World map indicating Human Development Index (as of 2004). ... In epidemiology, the prevalence of a disease in a statistical population is defined as the total number of cases of the disease in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population. ...

Signs and symptoms

In some individuals asthma is characterized by chronic respiratory impairment. In others it is an intermittent illness marked by episodic symptoms that may result from a number of triggering events, including upper respiratory infection, stress, airborne allergens, air pollutants (such as smoke or traffic fumes), or exercise. Some or all of the following symptoms may be present in those with asthma: dyspnea, wheezing, stridor, coughing, an inability for physical exertion. Some asthmatics who have severe shortness of breath and tightening of the lungs never wheeze or have stridor and their symptoms may be confused with a COPD-type disease. Dyspnea (R06. ... Stridor is a high pitched sound resulting from turbulent gas flow in the upper airway. ... Chronic obstructive pulmonary disease (COPD), also known as chronic obstructive airway disease (COAD), is a group of diseases characterized by limitation of airflow in the airway that is not fully reversible. ...

An acute exacerbation of asthma is commonly referred to as an asthma attack. The clinical hallmarks of an attack are shortness of breath (dyspnea) and either wheezing or stridor.^[6] Although the former is "often regarded as the sine qua non of asthma",^[6] some patients present primarily with coughing, and in the late stages of an attack, air motion may be so impaired that no wheezing may be heard. When present the cough may sometimes produce clear sputum. The onset may be sudden, with a sense of constriction in the chest, breathing becomes difficult, and wheezing occurs (primarily upon expiration, but can be in both respiratory phases). Dyspnea (R06. ... A wheeze is a continuous, coarse, whistling sound produced in the respiratory airways during breathing. ... Stridor is a high pitched sound resulting from turbulent gas flow in the upper airway. ... Sine qua non or condicio sine qua non was originally a Latin legal term for without which it could not be (but for). It refers to an indispensable and essential action, condition, or ingredient. ... This article does not cite any references or sources. ... In animal physiology, respiration is the transport of oxygen from the ambient air to the tissue cells and the transport of carbon dioxide in the opposite direction. ...

Signs of an asthmatic episode include wheezing, prolonged expiration, a rapid heart rate (tachycardia), rhonchous lung sounds (audible through a stethoscope), the presence of a paradoxical pulse (a pulse that is weaker during inhalation and stronger during exhalation), and over-inflation of the chest. During a serious asthma attack, the accessory muscles of respiration (sternocleidomastoid and scalene muscles of the neck) may be used, shown as in-drawing of tissues between the ribs and above the sternum and clavicles. In medicine, a sign is a feature of disease as detected by the doctor. ... This article or section does not cite any references or sources. ... An abnormal or adventitious sound heard when listening to the chest as the person breathes. ... Look up stethoscope in Wiktionary, the free dictionary. ... In medicine, a pulsus paradoxus (PP), also paradoxic pulse and paradoxical pulse, is a sign that is indicative of several conditions including cardiac tamponade and obstructive lung diseases (e. ... For other uses of Muscles, see Muscles (disambiguation). ... Biological tissue is a collection of interconnected cells that perform a similar function within an organism. ... The sternum (from Greek στέρνον, sternon, chest) or breastbone is a long, flat bone located in the center of the thorax (chest). ... Collarbone and collar bone redirect here. ...

During very severe attacks, an asthma sufferer can turn blue from lack of oxygen, and can experience chest pain or even loss of consciousness. Just before loss of consciousness, there is a chance that the patient will feel numbness in the limbs and palms may start to sweat. The person's feet may become icy cold. Severe asthma attacks, which may not be responsive to standard treatments (status asthmaticus), are life-threatening and may lead to respiratory arrest and death. Despite the severity of symptoms during an asthmatic episode, between attacks an asthmatic may show few or even no signs of the disease.^[7] Cyanosis refers to the bluish coloration of the skin due to the presence of deoxygenated hemoglobin in blood vessels near the skin surface. ... In medicine, chest pain is a symptom of a number of conditions and is generally considered a medical emergency, unless the patient is a known angina pectoris sufferer and the symptoms are familiar (appearing at exertion and resolving at rest, known as stable angina). When the chest pain is not... Consciousness is a quality of the mind generally regarded to comprise qualities such as subjectivity, self-awareness, sentience, sapience, and the ability to perceive the relationship between oneself and ones environment. ...

Aetiology

Asthma is caused by a complex interaction of genetic and environmental factors that researchers do not fully understand yet.^[8] These factors can also influence how severe a person’s asthma is and how well they respond to medication.^[9] As with other complex diseases, many genetic and environmental factors have been suggested as causes of asthma, but not all of them have been replicated. In addition, as researchers detangle the complex causes of asthma, it is becoming more evident that certain environmental and genetic factors may only affect asthma when combined.

The hygiene hypothesis is a theory about the cause of asthma and other allergic disease, and is supported by epidemiologic data for asthma. For example, asthma prevalence has been increasing in developed countries along with increased use of antibiotics, c-sections, and cleaning products.^[10][11][12] All of these things may negatively affect exposure to beneficial bacteria and other immune system modulators that are important during development, and thus may cause increased risk for asthma and allergy. In medicine, the hygiene hypothesis says that an excessively hygienic environment in early childhood may predispose some people towards asthma, allergies, and other autoimmune diseases. ...

Environmental

Many environmental risk factors have been associated with asthma, but a few stand out as well-replicated or that have a meta-analysis of several studies to support their direct association. A risk factor is a variable associated with an increased risk of disease or infection but risk factors are not necessarily causal. ... A meta-analysis is a statistical practice of combining the results of a number of studies. ...

• Poor air quality, from traffic pollution or high ozone levels, has been repeatedly associated with increased asthma morbidity and has a suggested association with asthma development that needs further research^[13][14]
• Environmental tobacco smoke, especially maternal cigarette smoking, is associated with high risk of asthma prevalence and asthma morbidity, wheeze, and respiratory infections^[13]
• Viral respiratory infections at an early age, along with siblings and day care exposure, may be protective against asthma, although there have been controversial results, and this protection may depend on genetic context^[13][15][16]
• Antibiotic use early in life has been linked to development of asthma in several examples; it is thought that antibiotics make one susceptible to development of asthma because they modify gut flora, and thus the immune system (as described by the hygiene hypothesis)^[10]
• Caesarean sections have been associated with asthma when compared with vaginal birth; a meta-analysis found a 20% increase in asthma prevalence in children delivered by Caesarean section compared to those who were not. It was proposed that this is due to modified bacterial exposure during Caesarean section compared with vaginal birth, which modifies the immune system (as described by the hygiene hypothesis).^[11]
• Psychological stress on the part of a child's caregiver has been associated with asthma, and is an area of active research. Stress can modify behaviors that affect asthma, like smoking, but research suggests that stress has other effects as well. There is growing evidence that stress may influence asthma and other diseases by influencing the immune system.^[13]

The Air Quality Index (AQI) is a standardized index of the air quality in a given location, given in parts per billion. ... For other uses, see Ozone (disambiguation). ... In medicine, epidemiology and actuarial science, the term morbidity can refer to the state of being diseased (from Latin morbidus: sick, unhealthy), the degree or severity of a disease, the prevalence of a disease: the total number of cases in a particular population at a particular point in time, the... Staphylococcus aureus - Antibiotics test plate. ... Escherichia coli, one of the many species of bacteria present in the human gut. ... A caesarean section (AE cesarean section), or c-section, is a form of childbirth in which a surgical incision is made through a mothers abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies. ... Stress has different meanings in different fields: Look up stress in Wiktionary, the free dictionary. ...

Genetic

Over 100 genes have been associated with asthma in at least one genetic association study.^[17] However, as with all association studies, replication is important before genetic variation (such as a single nucleotide polymorphism, or SNP) in a certain gene is thought to influence asthma. Through the end of 2005, 25 genes had been associated with asthma in six or more separate populations:^[17] This stylistic schematic diagram shows a gene in relation to the double helix structure of DNA and to a chromosome (right). ... This article may be too technical for most readers to understand. ... DNA strand 1 differs from DNA strand 2 at a single base-pair location (a C/T polymorphism). ...

Many of these genes are related to the immune system or to modulating inflammation. However, even among this list of highly replicated genes associated with asthma, the results have not been consistent among all of the populations that have been tested.^[17] This indicates that these genes are not associated with asthma under every condition, and that researchers need to do further investigation to figure out the complex interactions that cause asthma. Interleukin-10 (IL-10 or IL10), also known as human cytokine synthesis inhibitory factor (CSIF), is an anti-inflammatory cytokine, capable of inhibiting synthesis of pro-inflammatory cytokines like IFN-gamma, IL-2, IL-3, TNFα and GM-CSF by cells such as macrophages and Th1 cells. ... CTLA4 (Cytotoxic T-Lymphocyte Antigen 4) is a CD28-family receptor expressed on mainly CD4+ T cells. ... STAT6 is a STAT protein. ... Interleukin-4, abbreviated IL-4, is a Cytokine that stimulates the proliferation of activated B-cells, T-cells, and differentiation of CD4+T-cells into Th2 cells, among other effects. ... CD14 is a membrane-associated glycosylphosphatidylinositol-linked protein expressed at the surface of cells, especially macrophages. ... Expression pattern Orthologs Human Mouse Entrez Ensembl Uniprot Refseq Location Pubmed search Adrenergic, beta-2-, receptor, surface, also known as ADRB2, is a human gene and receptor. ... HLA-DR antigens are a group of antigens in the Class II/HLA-D family which can be used as indicators of several different diseases (per MeSH): HLA-DR1 Antigen - unknown HLA-DR2 Antigen - Goodpasture syndrome, multiple sclerosis, and narcolepsy HLA-DR3 Antigen - celiac disease, Graves disease, dermatitis herpetiformis... In medicine, tumor necrosis factor alpha (TNFα, cachexin or cachectin) is an important cytokine involved in systemic inflammation and the acute phase response. ...

Gene-Environment Interactions

Research is now finding that some genetic variants may only cause asthma when they are combined with specific environmental exposures, and otherwise may not be risk factors for asthma.^[8]

The CD14 SNP C-159T and endotoxin exposure are a well-replicated example of a gene-environment interaction that is associated with asthma. Endotoxin exposure varies from person to person and can come from several environmental sources, including environmental tobacco smoke, dogs, and farms. Researchers have found that risk for asthma changes based on a person’s genotype at CD14 C-159T and level of endotoxin exposure.^[18] Endotoxins are potentially toxic, natural compounds found inside pathogens such as bacteria. ... This article does not cite any references or sources. ...

Pathophysiology

Inflamed airways and bronchoconstriction in asthma. Airways narrowed as a result of the inflammatory response cause wheezing.

Image File history File links During an asthma episode, inflamed airways react to environmental triggers such as smoke, dust, or pollen. ... Image File history File links During an asthma episode, inflamed airways react to environmental triggers such as smoke, dust, or pollen. ...

Bronchoconstriction

During an asthma episode, inflamed airways react to environmental triggers such as smoke, dust, or pollen. The airways narrow and produce excess mucus, making it difficult to breathe. In essence, asthma is the result of an immune response in the bronchial airways.^[19] The bronchioles are the first airway branches that no longer contain cartilage. ... Mucus cells. ... A request has been made on Wikipedia for this article to be deleted in accordance with the deletion policy. ... The bronchioles are the first airway branches that no longer contain cartilage. ...

The airways of asthmatics are "hypersensitive" to certain triggers, also known as stimuli (see below). In response to exposure to these triggers, the bronchi (large airways) contract into spasm (an "asthma attack"). Inflammation soon follows, leading to a further narrowing of the airways and excessive mucus production, which leads to coughing and other breathing difficulties. Hypersensitivity refers to undesirable (damaging, discomfort-producing and sometimes fatal) reactions produced by the normal immune system. ... A bronchus (plural bronchi, adjective bronchial) is a caliber of airways in the the respiratory tract that conducts air into the lungs. ... A spasm is a sudden, involuntary contraction of a muscle, a group of muscles, or a hollow organ, or a similarly sudden contraction of an orifice. ... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... Mucus cells. ...

Stimuli

• Imbalance in the Autonomic Nervous System Present-day knowledge about the pathogenesis of asthma has clearly pointed out that the problem lies in hyper-responsiveness of the bronchus. (1) The cause of this hyper-responsiveness is an imbalance in the autonomic nervous system. We know that stimulation of the parasympathetic nervous system brings about bronchial constriction and that stimulation of the sympathetic causes bronchodilation.

The normal calibre of the bronchus is maintained by a balanced functioning of these systems, which both operate reflexively. The parasympathetic reflex loop consists of afferent nerve endings which terminate under the inner lining of the bronchus. Whenever these afferent nerve endings are stimulated (for example, by dust, cold air or fumes) impulses travel to the brain-stem vagal centre, then down the vagal afferent pathway to again reach the bronchus. Acetylcholine is released from the afferent nerve endings. This acetylcholine results in the excessive formation of cyclic Guanine Mono phosphate (GMP). This initiates bronchoconstriction.

• Allergens from nature, typically inhaled, which include waste from common household pests, such as the house dust mite and cockroach, grass pollen, mould spores, and pet epithelial cells;^{[citation needed]}
• Indoor air pollution from volatile organic compounds, including perfumes and perfumed products. Examples include soap, dishwashing liquid, laundry detergent, fabric softener, paper tissues, paper towels, toilet paper, shampoo, hairspray, hair gel, cosmetics, facial cream, sun cream, deodorant, cologne, shaving cream, aftershave lotion, air freshener and candles, and products such as oil-based paint.^{[citation needed]}
• Medications, including aspirin,^[20] β-adrenergic antagonists (beta blockers), and penicillin.^{[citation needed]}
• Food allergies such as milk, peanuts, and eggs. However, asthma is rarely the only symptom, and not all people with food or other allergies have asthma.^{[citation needed]}
• Use of fossil fuel related allergenic air pollution, such as ozone, smog, summer smog, nitrogen dioxide, and sulfur dioxide, which is thought to be one of the major reasons for the high prevalence of asthma in urban areas.^{[citation needed]}
• Various industrial compounds and other chemicals, notably sulfites; chlorinated swimming pools generate chloramines—monochloramine (NH₂Cl), dichloramine (NHCl₂) and trichloramine (NCl₃)—in the air around them, which are known to induce asthma.^[21]
• Early childhood infections, especially viral respiratory infections. However, persons of any age can have asthma triggered by colds and other respiratory infections even though their normal stimuli might be from another category (e.g. pollen) and absent at the time of infection. In many cases, significant asthma may not even occur until the respiratory infection is in its waning stage, and the person is seemingly improving. Eighty percent of asthma attacks in adults and 60% in children are caused by respiratory viruses.^{[citation needed]}
• Exercise, the effects of which differ somewhat from those of the other triggers.^{[citation needed]}
• Hormonal changes in adolescent girls and adult women associated with their menstrual cycle can lead to a worsening of asthma. Some women also experience a worsening of their asthma during pregnancy whereas others find no significant changes, and in other women their asthma improves during their pregnancy.^{[citation needed]}
• Emotional stress which is poorly understood as a trigger.^{[citation needed]} Emotional stress can affect breathing temporarily, however unlike something such as heart problems, it is unclear if it has any long-term effect.
• Cold weather can make it harder for asthmatics to breathe.^[22] Whether high altitude helps or worsens asthma is debatable and may vary from person to person.^[23]

An allergen is any substance (antigen), most often eaten or inhaled, that is recognized by the immune system and causes an allergic reaction. ... Binomial name Trouessart, 1897 The house dust mite (sometimes abbreviated by allergists to HDM), is a cosmopolitan guest in human habitation. ... For other uses, see Cockroaches. ... SEM image of pollen grains from a variety of common plants: sunflower (Helianthus annuus), morning glory (Ipomoea purpurea), prairie hollyhock (Sidalcea malviflora), oriental lily (Lilium auratum), evening primrose (Oenothera fruticosa), and castor bean (Ricinus communis). ... Moldy cream cheese Molds (British English: moulds) are various fungi that cover surfaces as fluffy mycelium and usually produce masses of asexual, sometimes sexual spores. ... This article is about the epithelium as it relates to animal anatomy. ... Air pollution Pollution is the introduction of pollutants (whether chemical substances, or energy such as noise, heat, or light) into the environment to such a point that its effects become harmful to human health, other living organisms, or the environment. ... This article describes a highly specialized aspect of its subject in the Terminology and legal definitions section. ... This article does not cite any references or sources. ... This article is about the drug. ... Beta blockers or beta-adrenergic blocking agents are a class of drugs used to treat a variety of cardiovascular conditions and some other diseases. ... Penicillin core structure Penicillin (abbreviated PCN) is a group of β-lactam antibiotics used in the treatment of bacterial infections caused by susceptible, usually Gram-positive, organisms. ... A food allergy is an immunologic response to a food protein. ... A glass of cows milk. ... This article is about the legume. ... Chicken egg (left) and quail eggs (right), the types of egg commonly used as food An egg is a body consisting of an ovum surrounded by layers of membranes and an outer casing of some type, which acts to nourish and protect a developing embryo. ... Fossil fuels or mineral fuels are fossil source fuels, that is, hydrocarbons found within the top layer of the earth’s crust. ... An allergen is any substance (antigen), most often eaten or inhaled, that is recognized by the immune system and causes an allergic reaction. ... Air pollution Pollution is the introduction of pollutants (whether chemical substances, or energy such as noise, heat, or light) into the environment to such a point that its effects become harmful to human health, other living organisms, or the environment. ... For other uses, see Ozone (disambiguation). ... For other uses, see Smog (disambiguation). ... Summer smog, which is common in major cities such as New York and Los Angeles, is pollutants, mainly ozone, which collect in large cities, especially during the summer. ... [1] R-phrases , S-phrases , , , , , Supplementary data page Structure and properties n, εr, etc. ... Sulfur dioxide (or Sulphur dioxide) has the chemical formula SO2. ... Cities with at least a million inhabitants in 2006 An urban area is an area with an increased density of human-created structures in comparison to the areas surrounding it. ... Sulfites are sulfur-based compounds often used as preservatives in wines (to prevent spoilage and oxidation,) dried fruits, and dried potato products. ... General Name, symbol, number chlorine, Cl, 17 Chemical series nonmetals Group, period, block 17, 3, p Appearance yellowish green Standard atomic weight 35. ... Chloramine (monochloramine) is chemical compound with the formula NH2Cl. ... An infection is the detrimental colonization of a host organism by a foreign species. ... This article is about biological infectious particles. ... Upper respiratory tract infection, also popularly known as either the acronym URTI or URI, is the disease characterised by an acute infection which involves the upper respiratory tract: nose, sinuses, pharynx, or larynx. ... For the Codename: Kids Next Door character with this name, see Common Cold. ... The term Exercise can refer to: Physical exercise such as running or strength training Exercise (options), the financial term for enacting and terminating a contract Category: ... For other uses, see Hormone (disambiguation). ... A separate article is about the punk band called The Adolescents. ... Menstrual cycle In the female reproductive system, the menstrual cycle is a recurring cycle of physiologic changes that occurs in reproductive age females of several mammals, including human beings and other apes. ... This article is about human pregnancy in biological females. ... In medical terms, stress is the disruption of homeostasis through physical or psychological stimuli. ...

Bronchial inflammation

The mechanisms behind allergic asthma—i.e., asthma resulting from an immune response to inhaled allergens—are the best understood of the causal factors. In both asthmatics and non-asthmatics, inhaled allergens that find their way to the inner airways are ingested by a type of cell known as antigen presenting cells, or APCs. APCs then "present" pieces of the allergen to other immune system cells. In most people, these other immune cells (T_H0 cells) "check" and usually ignore the allergen molecules. In asthmatics, however, these cells transform into a different type of cell (T_H2), for reasons that are not well understood. The resultant T_H2 cells activate an important arm of the immune system, known as the humoral immune system. The humoral immune system produces antibodies against the inhaled allergen. Later, when an asthmatic inhales the same allergen, these antibodies "recognize" it and activate a humoral response. Inflammation results: chemicals are produced that cause the airways to constrict and release more mucus, and the cell-mediated arm of the immune system is activated. The inflammatory response is responsible for the clinical manifestations of an asthma attack. The following section describes this complex series of events in more detail. A request has been made on Wikipedia for this article to be deleted in accordance with the deletion policy. ... An allergen is any substance (antigen), most often eaten or inhaled, that is recognized by the immune system and causes an allergic reaction. ... The bronchioles are the first airway branches that no longer contain cartilage. ... Steps of a macrophage ingesting a pathogen: a. ... An antigen presenting cell (APC) is a cell that displays foreign antigen complexed with MHC on its surface. ... A scanning electron microscope image of a single neutrophil (yellow), engulfing anthrax bacteria (orange). ... Antigen presentation stimulates T cells to become either cytotoxic CD8+ cells or helper CD4+ cells. ... Differentiation can mean the following: In biology: cellular differentiation; evolutionary differentiation; In mathematics: see: derivative In cosmogony: planetary differentiation Differentiation (geology); Differentiation (logic); Differentiation (marketing). ... Humoral immunity is the aspect of immunity that is mediated by secreted antibodies, produced in the cells of the B lymphocyte lineage (B cell). ... Each antibody binds to a specific antigen; an interaction similar to a lock and key. ... Humoral immunity is mediated by secreted antibodies, produced in cells of the B lymphocyte lineage (B cell). ... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ...

Pathogenesis

The fundamental problem in asthma appears to be immunological: young children in the early stages of asthma show signs of excessive inflammation in their airways. Epidemiological findings give clues as to the pathogenesis: the incidence of asthma seems to be increasing worldwide, and asthma is now very much more common in affluent countries. Immunology is a broad branch of biomedical science that covers the study of all aspects of the immune system in all organisms. ... Epidemiology is the study of factors affecting the health and illness of populations, and serves as the foundation and logic of interventions made in the interest of public health and preventive medicine. ... Pathogenesis is the mechanism by which a certain etiological factor causes disease (pathos = disease, genesis = development). ...

In 1968 Andor Szentivanyi first described The Beta Adrenergic Theory of Asthma; in which blockage of the Beta-2 receptors of pulmonary smooth muscle cells causes asthma.^[24] Szentivanyi's Beta Adrenergic Theory is a citation classic^[25] and has been cited more times than any other article in the history of the Journal of Allergy.

In 1995 Szentivanyi and colleagues demonstrated that IgE blocks beta-2 receptors.^[26] Since overproduction of IgE is central to all atopic diseases, this was a watershed moment in the world of allergy.^[27]

The Beta-Adrenergic Theory has been cited in the scholarship of such noted investigators as Richard F. Lockey (former President of the American Academy of Allergy, Asthma, and Immunology),^[28] Charles Reed (Chief of Allergy at Mayo Medical School),^[29] and Craig Venter (Human Genome Project).^[30]

In 2006, Researchers at Harvard Medical School found evidence that asthma is caused by over-proliferation of a special type of natural "killer" cell.^[31]

Asthma and sleep apnea

Main article: sleep apnea

It is recognized with increasing frequency, that patients who have both obstructive sleep apnea (OSA) and bronchial asthma, often improve tremendously when the sleep apnea is diagnosed and treated.^[32] CPAP is not effective in patients with nocturnal asthma only.^[33] Sleep apnea, sleep apnoea or sleep apnœa is a sleep disorder characterized by pauses in breathing during sleep. ... Continuous positive airway pressure (CPAP) is a method of respiratory ventilation used primarily in the treatment of sleep apnea and various lung diseases. ...

Asthma and gastro-esophageal reflux disease

Main article: gastro-esophageal reflux disease

If gastro-esophageal reflux disease is present, the patient may have repetitive episodes of acid aspiration, which results in airway inflammation and "irritant-induced" asthma.^{[citation needed]} GERD may be common in difficult-to-control asthma, but according to one study, treating it does not seem to affect the asthma.^[34] Gastroesophageal Reflux Disease (GERD, or GORD when -oesophageal, the BE form, is substituted) is injury to the esophagus that develops from chronic exposure of the esophagus to acid coming up from the stomach (reflux). ...

Diagnosis

Asthma is defined simply as reversible airway obstruction. Reversibility occurs either spontaneously or with treatment. The basic measurement is peak flow rates and the following diagnostic criteria are used by the British Thoracic Society:^[35] A peak flow meter is a small, hand-held device used to manage asthma by monitoring airflow through the bronchi and thus the degree of restriction in the airways. ... The British Thoracic Society (BTS) is a specialist medical society in the United Kingdom in the field of respiratory medicine. ...

• ≥20% difference on at least three days in a week for at least two weeks;
• ≥20% improvement of peak flow following treatment, for example:
  • 10 minutes of inhaled β-agonist (e.g., salbutamol);
  • six week of inhaled corticosteroid (e.g., beclometasone);
  • 14 days of 30mg prednisolone.
• ≥20% decrease in peak flow following exposure to a trigger (e.g., exercise).

In many cases, a physician can diagnose asthma on the basis of typical findings in a patient's clinical history and examination. Asthma is strongly suspected if a patient suffers from eczema or other allergic conditions—suggesting a general atopic constitution—or has a family history of asthma. While measurement of airway function is possible for adults, most new cases are diagnosed in children who are unable to perform such tests. Diagnosis in children is based on a careful compilation and analysis of the patient's medical history and subsequent improvement with an inhaled bronchodilator medication. In adults, diagnosis can be made with a peak flow meter (which tests airway restriction), looking at both the diurnal variation and any reversibility following inhaled bronchodilator medication. Salbutamol (INN) or albuterol (USAN) is a short-acting β2-adrenergic receptor agonist used for the relief of bronchospasm in conditions such as asthma and COPD. Salbutamol sulphate is usually given by the inhaled route for direct effect on bronchial smooth muscle. ... In physiology, corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. ... Beclometasone is an inhaled corticosteroid drug for the use of prophylaxis of asthma. ... Prednisolone is the active metabolite of prednisone. ... In general, diagnosis (plural diagnoses) has two distinct dictionary definitions. ... For the beetle, see Exema. ... Allergy is an abnormal reaction to a substance foreign to the body that is acquired, predictable and rapid. ... Eczema-a typical atopic manifestation Atopy (Greek ατοπία - placelessness) or atopic syndrome is an allergic hypersensitivity affecting parts of the body not in direct contact with the allergen. ... In medicine, a family history consists of information about disorders that a patients direct blood relatives have suffered from. ... The medical history of a patient (sometimes called anamnesis [1][2] ) is information gained by a physician by asking specific questions, either of the patient or of other people who know the person and can give suitable information (in this case, it is sometimes called heteroanamnesis). ... A bronchodilator is a medication intended to improve bronchial airflow. ... A peak flow meter is a small, hand-held device used to manage asthma by monitoring airflow through the bronchi and thus the degree of restriction in the airways. ... A circadian rhythm is a roughly-24-hour cycle in the physiological processes of living beings, including plants, animals, fungi and cyanobacteria. ... A bronchodilator is a medication intended to improve bronchial airflow. ... For other uses, see Asthma (disambiguation). ...

Testing peak flow at rest (or baseline) and after exercise can be helpful, especially in young asthmatics who may experience only exercise-induced asthma. If the diagnosis is in doubt, a more formal lung function test may be conducted. Once a diagnosis of asthma is made, a patient can use peak flow meter testing to monitor the severity of the disease. Exercise-induced anaphylaxis is a syndrome in which the symptoms of anaphylaxis occur related to exercise. ... Flow-Volume loop showing successful FVC maneuver. ... A peak flow meter is a small, hand-held device used to manage asthma by monitoring airflow through the bronchi and thus the degree of restriction in the airways. ...

Monitoring asthma with a peak flow meter on an ongoing basis assists with self monitoring of asthma. Peak flow readings can be charted on graph paper charts together with a record of symptoms or use peak flow charting software.^[36] This allows patients to track their peak flow readings and pass information back to their doctor or nurse.^[37] Graph paper or quad-ruled paper is writing paper that is printed with fine lines making up a regular grid. ...

In the Emergency Department doctors may use a capnography which measures the amount of exhaled carbon dioxide,^[38] along with pulse oximetry which shows the amount of oxygen dissolved in the blood, to determine the severity of an asthma attack as well as the response to treatment. Capnography is the indirect monitoring of carbon dioxide (CO2) concentrations in a patients blood. ... Carbon dioxide (chemical formula: ) is a chemical compound composed of two oxygen atoms covalently bonded to a single carbon atom. ... Pulse oximetry is a non-invasive method allowing the monitoring of the oxygenation of a patients blood. ...

Differential diagnosis

Before diagnosing someone as asthmatic, alternative possibilities should be considered. A clinician taking a history should check whether the patient is using any known bronchoconstrictors (substances that cause narrowing of the airways, e.g., certain anti-inflammatory agents or beta-blockers). This article does not cite any references or sources. ... Anti-inflammatory refers to the property of a substance or treatment that reduces inflammation. ... Beta blockers or beta-adrenergic blocking agents are a class of drugs used to treat a variety of cardiovascular conditions and some other diseases. ...

Chronic obstructive pulmonary disease, which closely resembles asthma, is correlated with more exposure to cigarette smoke, an older patient, less symptom reversibility after bronchodilator administration (as measured by spirometry), and decreased likelihood of family history of atopy. For COPD occuring in horses, see recurrent airway obstruction. ... Flow-Volume loop showing successful FVC maneuver. ... Eczema-a typical atopic manifestation Atopy (Greek ατοπία - placelessness) or atopic syndrome is an allergic hypersensitivity affecting parts of the body not in direct contact with the allergen. ...

Pulmonary aspiration, whether direct due to dysphagia (swallowing disorder) or indirect (due to acid reflux), can show similar symptoms to asthma. However, with aspiration, fevers might also indicate aspiration pneumonia. Direct aspiration (dysphagia) can be diagnosed by performing a Modified Barium Swallow test and treated with feeding therapy by a qualified speech therapist. If the aspiration is indirect (from acid reflux) then treatment directed at this is indicated. In medicine, aspiration is the entry of secretions or foreign material into the trachea and lungs. ... Dysphagia () is a medical term defined as difficulty swallowing. ... Aspiration pneumonia is a specific form of lung infection (pneumonia) that develops when oral or gastric contents (including food, saliva, or nasal secretions) enter the bronchial tree. ... Speech therapy is the corrective or rehabilitative treatment of physical and/or cognitive deficits/disorders resulting in difficulty with verbal communication. ...

A majority of children who are asthma sufferers have an identifiable allergy trigger. Specifically, in a 2004 study, 71% had positive test results for more than 1 allergen, and 42% had positive test results for more than 3 allergens.^[39] Allergy is an abnormal reaction to a substance foreign to the body that is acquired, predictable and rapid. ...

The majority of these triggers can often be identified from the history; for instance, asthmatics with hay fever or pollen allergy will have seasonal symptoms, those with allergies to pets may experience an abatement of symptoms when away from home, and those with occupational asthma may improve during leave from work. Allergy tests can help identify avoidable symptom triggers. For the play, see Hay Fever. ... SEM image of pollen grains from a variety of common plants: sunflower (Helianthus annuus), morning glory (Ipomoea purpurea), prairie hollyhock (Sidalcea malviflora), oriental lily (Lilium auratum), evening primrose (Oenothera fruticosa), and castor bean (Ricinus communis). ... This article is about animals kept for companionship. ... Occupational Asthma is defined as “a disease characterized by variable airflow limitation and/or airway hyper-responsiveness due to causes and conditions attributable to a particular occupational environment and not stimuli encountered outside the workplace”.1 // Asthma is defined as a respiratory disease caused by narrowing of the air passages. ... Allergy is an abnormal reaction to a substance foreign to the body that is acquired, predictable and rapid. ...

After a pulmonary function test has been carried out, radiological tests, such as a chest X-ray or CT scan, may be required to exclude the possibility of other lung diseases. In some people, asthma may be triggered by gastroesophageal reflux disease, which can be treated with suitable antacids. Very occasionally, specialized tests after inhalation of methacholine — or, even less commonly, histamine — may be performed. Spirometry, also known as Pulmonary Function Testing (PFT), is the measurement of lung function, specifically by measuring the volume and speed of air that can be inhaled and exhaled. ... Frontal chest X-ray. ... negron305 Cat scan redirects here. ... Gastroesophageal Reflux Disease (GERD or GORD using the British Å“sophageal) is defined as chronic symptoms or mucosal damage produced by the abnormal reflux in the esophagus[1]. This is commonly due to transient or permanent changes in the barrier between the esophagus and the stomach. ... Look up antacid in Wiktionary, the free dictionary. ... The methacholine challenge test is a technique use in the testing of asthma. ... This article or section does not cite any references or sources. ...

Asthma is categorized by the United States National Heart, Lung and Blood Institute as falling into one of four categories: intermittent, mild persistent, moderate persistent and severe persistent. The diagnosis of "severe persistent asthma" occurs when symptoms are continual with frequent exacerbations and frequent night-time symptoms, result in limited physical activity and when lung function as measured by PEV or FEV₁ tests is less than 60% predicted with PEF variability greater than 30%. The National Heart, Lung and Blood Institute is part of the US federal government, a division of the NIH, which is tasked with allocating about 2. ...

Prevention

Current treatment protocols recommend prevention medications such as an inhaled corticosteroid, which helps to suppress inflammation and reduces the swelling of the lining of the airways, in anyone who has frequent (greater than twice a week) need of relievers or who has severe symptoms. If symptoms persist, additional preventive drugs are added until the asthma is controlled. With the proper use of prevention drugs, asthmatics can avoid the complications that result from overuse of relief medications. In physiology, corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. ... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ...

Asthmatics sometimes stop taking their preventive medication when they feel fine and have no problems breathing. This often results in further attacks, and no long-term improvement.

Preventive agents include the following.

• Inhaled glucocorticoids are the most widely used of the prevention medications and normally come as inhaler devices (ciclesonide, beclomethasone, budesonide, flunisolide, fluticasone, mometasone, and triamcinolone).
  Long-term use of corticosteroids can have many side effects including a redistribution of fat, increased appetite, blood glucose problems and weight gain. In particular high doses of steroids may cause osteoporosis. For this reasons inhaled steroids are generally used for prevention, as their smaller doses are targeted to the lungs unlike the higher doses of oral preparations. Nevertheless, patients on high doses of inhaled steroids may still require prophylactic treatment to prevent osteoporosis.
  Deposition of steroids in the mouth may cause a hoarse voice or oral thrush (due to decreased immunity). This may be minimised by rinsing the mouth with water after inhaler use, as well as by using a spacer which increases the amount of drug that reaches the lungs.
• Leukotriene modifiers (montelukast, zafirlukast, pranlukast, and zileuton).
• Mast cell stabilizers (cromoglicate (cromolyn), and nedocromil).
• Antimuscarinics/anticholinergics (ipratropium, oxitropium, and tiotropium), which have a mixed reliever and preventer effect. (These are rarely used in preventive treatment of asthma, except in patients who do not tolerate beta-2-agonists.)
• Methylxanthines (theophylline and aminophylline), which are sometimes considered if sufficient control cannot be achieved with inhaled glucocorticoids and long-acting β-agonists alone.
• Antihistamines, often used to treat allergic symptoms that may underlie the chronic inflammation. In more severe cases, hyposensitization ("allergy shots") may be recommended.
• Omalizumab, an IgE blocker; this can help patients with severe allergic asthma that does not respond to other drugs. However, it is expensive and must be injected.
• Methotrexate is occasionally used in some difficult-to-treat patients.
• If chronic acid indigestion (GERD) contributes to a patient's asthma, it should also be treated, because it may prolong the respiratory problem.

Glucocorticoids are a class of steroid hormones characterised by an ability to bind with the cortisol receptor and trigger similar effects. ... Ciclesonide is a glucocorticoid used to treat obstructive airway diseases. ... Beclometasone dipropionate is a corticosteroid drug. ... Budesonide is a glucocorticoid steroid for the treatment of asthma, non-infectious rhinitis (including hay fever and other allergies), and for treatment and prevention of nasal polyposis. ... Flunisolide is a corticosteroid often prescribed as treatment for allergic rhinitis. ... Fluticasone proprionate is a glucocorticoid often prescribed as treatment for asthma and allergic rhinitis. ... Mometasone furoate (also referred to as Mometasone) is a moderately potent glucocorticoid steroid used in the treatment of inflammatory skin disorders (such as eczema and psoriasis), allergic rhinitis (such as hay fever), and asthma for patients unresponsive to less potent corticosteroids. ... Triamcinolone (trade names Kenalog, Aristocort, Nasacort, Tri-Nasal, Triderm, Azmacort, Trilone, Volon A, Tristoject, Fougera;) is a synthetic corticosteroid given orally, by injection, inhalation, or as a topical ointment or cream. ... The appetite is the desire to eat food, felt as hunger. ... Glucose (Glc), a monosaccharide (or simple sugar), is an important carbohydrate in biology. ... Osteoporosis is a disease of bone - leading to an increased risk of fracture. ... Lisp may mean: Lisp programming language Lisp (speech) This is a disambiguation page — a list of pages that otherwise might share the same title. ... Oral thrush is an infection of yeast fungus, Candida albicans, in the mucous membranes of the mouth. ... Young asthmatic girl using an inhaler attached to a spacer. ... Leukotrienes are autocrine and paracrine eicosanoid lipid mediators derived from arachidonic acid by 5-lipoxygenase. ... Montelukast is a leukotriene receptor antagonist (LTRA) used for the maintenance treatment of asthma and to relieve symptoms of seasonal allergies. ... Zafirlukast is an oral leukotriene receptor antagonist (LTRA) for the maintenance treatment of asthma. ... Pranlukast is a cysteinyl leukotriene receptor-1 antagonist. ... Zileuton is an asthma drug. ... Mast cells A mast cell (or mastocyte) is a resident cell of areolar connective tissue (loose connective tissue) that contains many granules rich in histamine and heparin. ... Cromoglicate (INN) (also referred to as cromolyn (USAN) or cromoglycate (former BAN)) is traditionally described as a mast cell stabilizer, and is commonly marketed as the sodium salt sodium cromoglicate. ... The introduction to this article provides insufficient context for those unfamiliar with the subject matter. ... Ipratropium (as ipratropium bromide, trade name Atrovent) is an anticholinergic drug administered by inhalation for the treatment of obstructive lung diseases. ... Tiotropium (IPA: ) is a long-acting anticholinergic bronchodilator used in the management of chronic obstructive pulmonary disease (COPD). ... Theophylline is a methylxanthine drug used in therapy for respiratory diseases such as COPD or asthma under a variety of brand names. ... Aminophylline is a drug combination that contains theophylline and ethylenediamine in 2:1 ratio. ... An H1 antihistamine is a histamine antagonist which serves to reduce or eliminate effects mediated by histamine, an endogenous chemical mediator released during allergic reactions, through action at the H1 receptor. ... Hyposensitization (or allergy desensitization) is a form of immunotherapy where the patient is gradually vaccinated against progressively larger doses of the allergen in question. ... Omalizumab (marketed under the name Xolair®) is a monoclonal antibody made by Genentech / Novartis and used mainly in allergy-related asthma therapy, with the purpose of reducing allergic hypersensitivity. ... Immunoglobulin E (IgE) is an antibody subclass (known as isotypes), found only in mammals. ... Amethopterin redirects here. ... Gastroesophageal Reflux Disease (GERD or GORD using the British œsophageal) is defined as chronic symptoms or mucosal damage produced by the abnormal reflux in the esophagus[1]. This is commonly due to transient or permanent changes in the barrier between the esophagus and the stomach. ...

Trigger avoidance

As is common with respiratory disease, smoking is believed to adversely affect asthmatics in several ways, including an increased severity of symptoms, a more rapid decline of lung function, and decreased response to preventive medications.^[40] Automobile emissions are considered an even more significant cause and aggravating factor. [1] Asthmatics who smoke or who live near traffic [2] typically require additional medications to help control their disease. Furthermore, exposure of both non-smokers and smokers to wood smoke, gas stove fumes and second-hand smoke is detrimental, resulting in more severe asthma, more emergency room visits, and more asthma-related hospital admissions.^[41] Smoking cessation and avoidance of second-hand smoke is strongly encouraged in asthmatics.^[42] The cigarette is the most common method of smoking tobacco. ... Vehicle emissions inspection station Automobile emissions control covers all the technologies that are employed to reduce the air pollution-causing emissions produced by automobiles. ... This article needs additional references or sources for verification. ... For the article on tobacco smoking, see here; For the main health effects of tobacco smoking, see here: Second-hand Smoke redirects here, for the Sublime album, see Second-hand Smoke (album) Passive smoking (also known as environmental tobacco smoke (ETS), involuntary smoking or secondhand smoke) occurs when the exhaled... The emergency room is the American English term for a room, or group of rooms, within a hospital that is designed for the treatment of urgent and medical emergencies. ...

For those in whom exercise can trigger an asthma attack (exercise-induced asthma), higher levels of ventilation and cold, dry air tend to exacerbate attacks. For this reason, activities in which a patient breathes large amounts of cold air, such as skiing and running, tend to be worse for asthmatics, whereas swimming in an indoor, heated pool, with warm, humid air, is less likely to provoke a response.^[6] Exercise-induced anaphylaxis is a syndrome in which the symptoms of anaphylaxis occur related to exercise. ...

Treatment

The most effective treatment for asthma is identifying triggers, such as pets or aspirin, and limiting or eliminating exposure to them. If trigger avoidance is insufficient, medical treatment is available. Desensitization is currently the only known "cure" to the disease.^[43] Other forms of treatment include relief medication, prevention medication, long-acting β2-agonists, and emergency treatment. For medical purposes, desensitization is a method to reduce or eliminate an organisms negative reaction to a substance or stimulus. ...

Medical

The specific medical treatment recommended to patients with asthma depends on the severity of their illness and the frequency of their symptoms. Specific treatments for asthma are broadly classified as relievers, preventers and emergency treatment. The Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma (EPR-2)^[42] of the U.S. National Asthma Education and Prevention Program, and the British Guideline on the Management of Asthma^[44] are broadly used and supported by many doctors. On August 29, 2007 the final Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma was officially released. Bronchodilators are recommended for short-term relief in all patients. For those who experience occasional attacks, no other medication is needed. For those with mild persistent disease (more than two attacks a week), low-dose inhaled glucocorticoids or alternatively, an oral leukotriene modifier, a mast-cell stabilizer, or theophylline may be administered. For those who suffer daily attacks, a higher dose of glucocorticoid in conjunction with a long-acting inhaled β-2 agonist may be prescribed; alternatively, a leukotriene modifier or theophylline may substitute for the β-2 agonist. In severe asthmatics, oral glucocorticoids may be added to these treatments during severe attacks.

The discovery in 2006 by researchers at Harvard Medical School that asthma may be caused by over-proliferation of a special type of natural "killer" cell may ultimately lead to the development of better and more targeted drugs. Natural killer T cells seem to be resistant to the corticosteroids, one of the mainstays of current treatment.^[31]

Pharmaceutical

Symptomatic control of episodes of wheezing and shortness of breath is generally achieved with fast-acting bronchodilators. These are typically provided in pocket-sized, metered-dose inhalers (MDIs). In young sufferers, who may have difficulty with the coordination necessary to use inhalers, or those with a poor ability to hold their breath for 10 seconds after inhaler use (generally the elderly), an asthma spacer (see top image) is used. The spacer is a plastic cylinder that mixes the medication with air in a simple tube, making it easier for patients to receive a full dose of the drug and allows for the active agent to be dispersed into smaller, more fully inhaled bits. A bronchodilator is a medication intended to improve bronchial airflow. ... An inhaler is a medical device used for delivering medication into the body via the lungs. ... Young asthmatic girl using an inhaler attached to a spacer. ...

A nebulizer which provides a larger, continuous dose can also be used. Nebulizers work by vaporizing a dose of medication in a saline solution into a steady stream of foggy vapour, which the patient inhales continuously until the full dosage is administered. There is no clear evidence, however, that they are more effective than inhalers used with a spacer. Nebulizers may be helpful to some patients experiencing a severe attack. Such patients may not be able to inhale deeply, so regular inhalers may not deliver medication deeply into the lungs, even on repeated attempts. Since a nebulizer delivers the medication continuously, it is thought that the first few inhalations may relax the airways enough to allow the following inhalations to draw in more medication. A nebulizer with an attached inhaling apparatus In medicine, a nebulizer is a device used to administer medication to people in forms of a liquid mist to the airways. ...

Relievers include:

• Short-acting, selective beta₂-adrenoceptor agonists, such as salbutamol (albuterol USAN), levalbuterol, terbutaline and bitolterol.
  Tremors, the major side effect, have been greatly reduced by inhaled delivery, which allows the drug to target the lungs specifically; oral and injected medications are delivered throughout the body. There may also be cardiac side effects at higher doses (due to Beta-1 agonist activity), such as elevated heart rate or blood pressure; with the advent of selective agents, these side effects have become less common. Patients must be cautioned against using these medicines too frequently, as with such use their efficacy may decline, producing desensitization resulting in an exacerbation of symptoms which may lead to refractory asthma and death.
• Older, less selective adrenergic agonists, such as inhaled epinephrine and ephedrine tablets, have also been used. Cardiac side effects occur with these agents at either similar or lesser rates to albuterol.^{[45] [46]} When used solely as a relief medication, inhaled epinephrine has been shown to be an effective agent to terminate an acute asthmatic exacerbation.^[45] In emergencies, these drugs were sometimes administered by injection. Their use via injection has declined due to related adverse effects.
• Anticholinergic medications, such as ipratropium bromide may be used instead. They have no cardiac side effects and thus can be used in patients with heart disease; however, they take up to an hour to achieve their full effect and are not as powerful as the β₂-adrenoreceptor agonists.
• Inhaled glucocorticoids are usually considered preventive medications; however, a randomized controlled trial has demonstrated the benefit of 250 microg beclomethasone when taken as an as-needed combination inhaler with 100 microg of albuterol.^[47]

Beta2-adrenergic receptor agonists are a class of drugs used to treat asthma and other pulmonary disease states. ... Salbutamol (INN) or albuterol (USAN) is a short-acting β2-adrenergic receptor agonist used for the relief of bronchospasm in conditions such as asthma and COPD. Salbutamol sulphate is usually given by the inhaled route for direct effect on bronchial smooth muscle. ... United States Adopted Names are unique nonproprietary names assigned to pharmaceuticals marketed in the United States. ... Levalbuterol (Xopenex®) is the R-enantiomer of the short-acting β2-adrenergic receptor agonist albuterol. ... The drug Terbutaline (trade names Brethine, Bricanyl, or Brethaire) is a β2-adrenergic receptor agonist, used as a fast-acting bronchodilator and off-label to delay premature labour as a tocolytic. ... Bitolterol mesylate (Tornalate®) is a β2-adrenergic receptor agonist used for the relief of bronchospasm in conditions such as asthma and COPD. Bitolterol has a rapid onset of action (2-5 minutes) and may last up to 6-8 hours. ... For the film see Tremors (film). ... This page is about the muscular organ, the Heart. ... Desensitization is a method to reduce or eliminate an organisms negative reaction to a substance or stimulus. ... Epinephrine Norepinephrine The adrenergic receptors (or adrenoceptors) are a class of G protein-coupled receptors that are targets of the catecholamines. ... Adrenaline redirects here. ... Ephedrine (EPH) is a sympathomimetic amine similar in structure to the synthetic derivatives amphetamine and methamphetamine. ... An anticholinergic agent is a member of a class of pharmaceutical compounds which serve to reduce the effects mediated by acetylcholine in the central nervous system and peripheral nervous system. ... Ipratropium is an anticholinergic drug (trade name: Atrovent®) administered by inhalation for the treatment of obstructive lung diseases. ... The name glucocorticoid derives from early observations that these hormones were involved in glucose metabolism. ... A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicines or medical procedures. ... Beclometasone dipropionate is a corticosteroid drug. ... Salbutamol (INN) or albuterol (USAN) is a short-acting β2-adrenergic receptor agonist used for the relief of bronchospasm in conditions such as asthma and COPD. It is marketed by the Allen & Hanburys respiratory division of GlaxoSmithKline under the trade name Ventolin. ...

Long-acting β₂-agonists

A typical inhaler, of Serevent (salmeterol), a long-acting bronchodilator.

Long-acting bronchodilators (LABD) are similar in structure to short-acting selective beta₂-adrenoceptor agonists, but have much longer side chains resulting in a 12-hour effect, and are used to give a smoothed symptomatic relief (used morning and night). While patients report improved symptom control, these drugs do not replace the need for routine preventers, and their slow onset means the short-acting dilators may still be required. In November of 2005, the American FDA released a health advisory alerting the public to findings that show the use of long-acting β₂-agonists could lead to a worsening of symptoms, and in some cases death.^[48] ImageMetadata File history File links Download high resolution version (870x1024, 79 KB) Summary from commons, file of same name, PD, by User:Mendel Uploading to en for use on Main Page. ... ImageMetadata File history File links Download high resolution version (870x1024, 79 KB) Summary from commons, file of same name, PD, by User:Mendel Uploading to en for use on Main Page. ... An inhaler is a medical device used for delivering medication into the body via the lungs. ... Salmeterol is a long-acting beta2-adrenergic receptor agonist drug that is currently prescribed for the treatment of asthma and chronic obstructive pulmonary disease COPD. It is currently available in both dry-powder inhalers (DPIs) and pressurised metered dose inhalers (pMDIs). ... “FDA” redirects here. ...

Currently available long-acting beta₂-adrenoceptor agonists include salmeterol, formoterol, bambuterol, and sustained-release oral albuterol. Combinations of inhaled steroids and long-acting bronchodilators are becoming more widespread; the most common combination currently in use is fluticasone/salmeterol (Advair in the United States, and Seretide in the United Kingdom). Another combination is budesonide/formoterol which is commercially known as Symbicort. Long acting beta-adrenoceptor agonists include formoterol, salmeterol and are usually prescribed for moderate to severe persistent asthma patients or patients with COPD. They are designed to replace the shorter acting B2-agonists such as salbutamol, as they have a duration of action of approximately 12 hours in comparison with... Salmeterol is a long-acting beta2-adrenergic receptor agonist drug that is currently prescribed for the treatment of asthma and chronic obstructive pulmonary disease COPD. It is currently available in both dry-powder inhalers (DPIs) and pressurised metered dose inhalers (pMDIs). ... Formoterol belongs to the family of prescription-only medicines known as beta 2-agonists. ... Bambuterol (INN, marketed by AstraZeneca under the trade names Bambec® and Oxeol®) is a long acting beta-adrenoceptor agonist used in the treatment of asthma. ... Salbutamol (INN) or albuterol (USAN) is a short-acting β2-adrenergic receptor agonist used for the relief of bronchospasm in conditions such as asthma and COPD. It is marketed by the Allen & Hanburys respiratory division of GlaxoSmithKline under the trade name Ventolin. ... Fluticasone Propionate The Diskus device Advair® (known in the United Kingdom as Seretide®) is a medicine prescribed for individuals suffering from asthma and COPD. Rather than being a single drug, Advair is actually a combination of two drugs. ... Fluticasone Propionate The Diskus device Advair® (known in the United Kingdom as Seretide®) is a medicine prescribed for individuals suffering from asthma and COPD. Rather than being a single drug, Advair is actually a combination of two drugs. ... Budesonide is a glucocorticoid steroid for the treatment of asthma, non-infectious rhinitis (including hay fever and other allergies), and for treatment and prevention of nasal polyposis. ... Formoterol belongs to the family of prescription-only medicines known as beta 2-agonists. ... Symbicort is an inhaled treatment for asthma and COPD, marketed by AstraZeneca. ...

A recent meta-analysis of the roles of long-acting beta-agonists may indicate a danger to asthma patients. The study, published in the Annals of Internal Medicine in 2006, found that long-acting beta-agonists increased the risk for asthma hospitalizations and asthma deaths 2- to 4-fold, compared with placebo.^[49] "These agents can improve symptoms through bronchodilation at the same time as increasing underlying inflammation and bronchial hyper-responsiveness, thus worsening asthma control without any warning of increased symptoms," said Shelley Salpeter in a press release after the publication of the study. The release goes on to say that "Three common asthma inhalers containing the drugs salmeterol or formoterol may be causing four out of five US asthma-related deaths per year and should be taken off the market".^[50] This assertion has drawn criticism from many asthma specialists for being inaccurate. As Dr. Hal Nelson points out in a recent letter to the Annals of Internal Medicine,

"Salpeter and colleagues also assert that salmeterol may be responsible for 4000 of the 5000 asthma-related deaths that occur in the United States annually. However, when salmeterol was introduced in 1994, more than 5000 asthma-related deaths occurred per year. Since the peak of asthma deaths in 1996, salmeterol sales have increased about 5-fold, while overall asthma mortality rates have decreased by about 25%, despite a continued increase in asthma diagnoses. In fact, according to the most recent data from the National Center for Health Statistics, U.S. asthma mortality rates peaked in 1996 (with 5667 deaths) and have decreased steadily since. The last available data, from 2004, indicate that 3780 deaths occurred. Thus, the suggestion that a vast majority of asthma deaths could be attributable to LABA use is inconsistent with the facts."

Dr. Shelley Salpeter, in a letter to the Annals of Internal Medicine, responds to the comments of Dr. Nelson,

"It is true that the asthma death rate increased after salmeterol was introduced, then peaked and is now starting to decline despite continued use of the long-acting beta-agonists. This trend in death rates can best be explained by examining the ratio of beta-agonist use to inhaled corticosteroids... In the recent past, inhaled corticosteroid use has increased steadily while long-acting beta-agonist use has begun to stabilize and short-acting beta-agonist use has declined... Using this estimate, we can imagine that if long-acting beta-agonists were withdrawn from the market while maintaining high inhaled corticosteroid use, the death rate in the United States could be reduced significantly..."

Emergency

When an asthma attack is unresponsive to a patient's usual medication, other treatments are available to the physician or hospital:^[51]

• Oxygen to alleviate the hypoxia (but not the asthma per se) that results from extreme asthma attacks.
• Nebulized salbutamol or terbutaline (short-acting beta-2-agonists), often combined with ipratropium (an anticholinergic).
• Systemic steroids, oral or intravenous (prednisone, prednisolone, methylprednisolone, dexamethasone, or hydrocortisone). Some research has looked into an alternative inhaled route.^[52]
• Other bronchodilators that are occasionally effective when the usual drugs fail:
  • Intravenous salbutamol
  • Nonspecific beta-agonists, injected or inhaled (epinephrine, isoetharine, isoproterenol, metaproterenol)
  • Anticholinergics, IV or nebulized, with systemic effects (glycopyrrolate, atropine, ipratropium)
  • Methylxanthines (theophylline, aminophylline)
  • Inhalation anesthetics that have a bronchodilatory effect (isoflurane, halothane, enflurane)
  • The dissociative anaesthetic ketamine, often used in endotracheal tube induction
  • Magnesium sulfate, intravenous
• Intubation and mechanical ventilation, for patients in or approaching respiratory arrest.
• Heliox, a mixture of helium and oxygen, may be used in a hospital setting. It has a more laminar flow than ambient air and moves more easily through constricted airways.

This article is about the chemical element and its most stable form, or dioxygen. ... Salbutamol (INN) or albuterol (USAN) is a short-acting β2-adrenergic receptor agonist used for the relief of bronchospasm in conditions such as asthma and COPD. Salbutamol sulphate is usually given by the inhaled route for direct effect on bronchial smooth muscle. ... The drug Terbutaline (trade names Brethine, Bricanyl, or Brethaire) is a β2-adrenergic receptor agonist, used as a fast-acting bronchodilator and off-label to delay premature labour as a tocolytic. ... Prednisone is a synthetic corticosteroid drug which is usually taken orally but can be delivered by intramuscular injection and can be used for a great number of different conditions. ... Prednisolone is the active metabolite of prednisone. ... Methylprednisolone (molecular weight 374. ... Dexamethasone is a potent synthetic member of the glucocorticoid class of steroid hormones. ... Hydrocortisone is a synthetic corticosteroid drug which may be given by injection or by topical application. ... Adrenaline redirects here. ... Isoetarine is a selective beta2-adrenergic receptor agonist. ... Isoproterenol hydrochloride (Medihaler-Iso®) is a beta adrenergic receptor agonist medication, used as an inhaled aerosol to treat asthma. ... Metaproterenol is used as a bronchodialator in the treatment of asthma. ... Glycopyrrolate is a medication of the muscarinic anticholinergic group. ... Atropine is a tropane alkaloid extracted from the deadly nightshade (Atropa belladonna) and other plants of the family Solanaceae. ... Ipratropium (as ipratropium bromide, trade name Atrovent) is an anticholinergic drug administered by inhalation for the treatment of obstructive lung diseases. ... Theophylline is a methylxanthine drug used in therapy for respiratory diseases such as COPD or asthma under a variety of brand names. ... Aminophylline is a drug combination that contains theophylline and ethylenediamine in 2:1 ratio. ... Structural formula of isoflurane Isoflurane (1-chloro-2,2,2-trifluoroethyl difluoromethyl ether) is a halogenated ether used for inhalation anesthesia. ... Halothane vapour is an inhalational general anaesthetic. ... Structural formula of enflurane Enflurane (2-chloro-1,1,2,-trifluoroethyl-difluomethyl ether) is a halogenated ether that was commonly used for inhalational anesthesia during the 1970s and 1980s. ... Ketamine is a dissociative anesthetic for use in human and veterinary medicine developed by Parke-Davis (1962). ... Diagram of an endotracheal tube (10) that has been inserted into the airway of a patient. ... Magnesium sulfate (or sulphate) is a chemical compound containing magnesium and sulfate, with the formula MgSO4. ...

Non-medical treatments

Many asthmatics, like those who suffer from other chronic disorders, use alternative treatments; surveys show that roughly 50% of asthma patients use some form of unconventional therapy.^[53][54] There is little data to support the effectiveness of most of these therapies. A Cochrane systematic review of acupuncture for asthma found no evidence of efficacy.^[55] A similar review of air ionisers found no evidence that they improve asthma symptoms or benefit lung function; this applied equally to positive and negative ion generators.^[56] A study of "manual therapies" for asthma, including osteopathic, chiropractic, physiotherapeutic and respiratory therapeutic manoeuvres, found there is insufficient evidence to support or refute their use in treating asthma;^[57] these manoeuvers include various osteopathic and chiropractic techniques to "increase movement in the rib cage and the spine to try and improve the working of the lungs and circulation"; chest tapping, shaking, vibration, and the use of "postures to help shift and cough up phlegm." One meta-analysis finds that homeopathy may have a potentially mild benefit in reducing the intensity of symptoms.^[58] However, the number of patients involved in the analysis was small, and subsequent studies have not supported this finding.^[59] Several small trials have suggested some benefit from various yoga practices, ranging from integrated yoga programs,^[60] yogasanas, Pranayama, meditation, and kriyas, to sahaja yoga,^[61] a form of 'new religious' meditation. Alternative medicine has been described as any of various systems of healing or treating disease (as chiropractic, homeopathy, or faith healing) not included in the traditional medical curricula taught in the United States and Britain.[1] Alternative medicine practices are often based in belief systems not derived from modern science. ... The Cochrane Collaboration developed in response to Archie Cochranes call for systematic, up-to-date reviews (currently known as systematic reviews) of all relevant randomized clinical trials of health care. ... Evidence-based medicine (EBM) or scientific medicine is an attempt to apply more uniformly the standards of evidence gained from the scientific method to certain aspects of medical practice. ... An air ioniser is a device which uses high voltage to ionise, or electrically charge, molecules of air. ... Chiropractic (from Greek chiros and praktikos meaning done by hand) is a health care profession whose purpose is to diagnose and treat mechanical disorders of the spine and musculoskeletal system with the intention of affecting the nervous system and improving health. ... Physical therapy can help restore lost functionality in many people. ... Respiratory therapy is categorized as an allied health profession in the United States and Canada. ... A meta-analysis is a statistical practice of combining the results of a number of studies. ... Homeopathic remedy Rhus toxicodendron, derived from poison ivy. ... For other uses such as Yoga postures, see Yoga (disambiguation) Statue of Shiva performing Yogic meditation Yoga (Sanskrit: योग Yoga, IPA: ) is a group of ancient spiritual practices originating in India. ... For other senses of this word, see Meditation (disambiguation). ...

Treatment controversies

In November 2007 The New York Times reported a review of more than 500 studies finding that independently backed studies on inhaled corticosteroids are up to four times more likely to find adverse effects than studies paid for by drug companies.^[62][63] The New York Times is a daily newspaper published in New York City and distributed internationally. ...

Prognosis

The prognosis for asthmatics is good; especially for children with mild disease. For asthmatics diagnosed during childhood, 54% will no longer carry the diagnosis after a decade. The extent of permanent lung damage in asthmatics is unclear. Airway remodelling is observed, but it is unknown whether these represent harmful or beneficial changes.^[19] Although conclusions from studies are mixed, most studies show that early treatment with glucocorticoids prevents or ameliorates decline in lung function as measured by several parameters.^[64] For those who continue to suffer from mild symptoms, corticosteroids can help most to live their lives with few disabilities. The mortality rate for asthma is low, with around 6000 deaths per year in a population of some 10 million patients in the United States.^[6] Better control of the condition may help prevent some of these deaths. Disabilities are limitations in activity and/or functioning that are attributable to permanent medical conditions in physical, mental, emotional, and/or sensory domains and, significantly, are also due to societal responses to those limitations. ...

The prevalence of childhood asthma has increased since 1980, especially in younger children.

Image File history File links Download high resolution version (1024x567, 58 KB)Asthma prevalence in children has increased since 1980, especially in younger children. ... Image File history File links Download high resolution version (1024x567, 58 KB)Asthma prevalence in children has increased since 1980, especially in younger children. ... In epidemiology, the prevalence of a disease in a statistical population is defined as the total number of cases of the disease in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population. ...

Epidemiology

More than 6% of children in the United States have been diagnosed with asthma, a 75% increase in recent decades. The rate soars to 40% among some populations of urban children.^{[citation needed]}

Asthma is usually diagnosed in childhood. The risk factors for asthma include:^{[citations needed]}

• A personal or family history of asthma or atopy
• Triggers (see Pathophysiology above)
• Premature birth or low birth weight
• Viral respiratory infection in early childhood
• Maternal smoking
• Being male, for asthma in prepubertal children
• Being female, for persistence of asthma into adulthood

Current research suggests that the prevalence of childhood asthma has been increasing. According to the Centers for Disease Control and Prevention's National Health Interview Surveys, some 9% of US children below 18 years of age had asthma in 2001, compared with just 3.6% in 1980 (see figure). The World Health Organization (WHO) reports that some 8% of the Swiss population suffers from asthma today, compared with just 2% some 25–30 years ago.^[65] Although asthma is more common in affluent countries, it is by no means a problem restricted to the affluent; the WHO estimate that there are between 15 and 20 million asthmatics in India. In the U.S., urban residents, Hispanics, and African Americans are affected more than the population as a whole. Globally, asthma is responsible for around 180,000 deaths annually.^[65] This article is about the study of the past in human terms. ... Eczema-a typical atopic manifestation Atopy (Greek ατοπία - placelessness) or atopic syndrome is an allergic hypersensitivity affecting parts of the body not in direct contact with the allergen. ... For other uses, see Asthma (disambiguation). ... Upper respiratory tract infection, also popularly known as either the acronym URTI or URI, is the disease characterised by an acute infection which involves the upper respiratory tract: nose, sinuses, pharynx, or larynx. ... In epidemiology, the prevalence of a disease in a statistical population is defined as the total number of cases of the disease in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population. ... The Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, is recognized as the leading United States agency for protecting the public health and safety of people. ... WHO redirects here. ...

Population Disparities

Asthma prevalence, morbidity, mortality, and drug response vary greatly across populations. There is an almost 30-fold difference in asthma prevalence between some of the countries included in the International Study of Asthma and Allergy in Childhood[3], with a trend toward more developed and westernized countries having higher asthma prevalence. Westernization can’t explain the entire difference in asthma prevalence between countries, however, and the disparities may also be affected by differences in genetic, social and environmental risk factors.^[13] There are also worldwide disparities in asthma mortality, which is most common in low to middle income countries.^[66] World map indicating Human Development Index (as of 2004). ... For alternative meanings for The West in the United States, see the U.S. West and American West. ...

Asthma prevalence in the US is higher than in most other countries in the world, but varies drastically between diverse US populations.^[13] In the US, asthma prevalence is highest in Puerto Ricans, African Americans, Filipinos and Native Hawaiians, and lowest in Mexicans and Koreans.^[67][68][69] Mortality rates follow similar trends, and response to albuterol is lower in Puerto Ricans than in African Americans or Mexicans.^[70][71] As with worldwide asthma disparities, differences in asthma prevalence, mortality, and drug response in the US may be explained by differences in genetic, social and environmental risk factors. Salbutamol (INN) or albuterol (USAN) is a short-acting β2-adrenergic receptor agonist used for the relief of bronchospasm in conditions such as asthma and COPD. It is marketed by the Allen & Hanburys respiratory division of GlaxoSmithKline under the trade name Ventolin. ...

Asthma prevalence also differs between populations of the same ethnicity who are born and live in different places.^[72] US-born Mexican populations, for example, have higher asthma rates than non-US born Mexican populations that are living in the US.^[73]This probably reflects differences in social and environmental risk factors associated with acculturation to the US. Look up acculturation in Wiktionary, the free dictionary. ...

Asthma prevalence and asthma deaths also differ by gender. Males are more likely to be diagnosed with asthma as children, but asthma is more likely to persist into adulthood in females. Sixty five percent more adult women than men will die from asthma. This difference may be attributable to hormonal differences, among other things. In support of this, girls who reach puberty before age 12 were found to have a later diagnosis of asthma more than twice as much as girls who reach puberty after age 12. Hormone is also the NATO reporting name for the Soviet/Russian Kamov Ka-25 military helicopter. ...

Socioeconomic factors

The incidence of asthma is highest among low-income populations (asthma deaths are most common in low to middle income countries [4]), which in the western world are disproportionately ethnic minorities^[74] and are more likely to live near industrial areas. Additionally, asthma has been strongly associated with the presence of cockroaches in living quarters, which is more likely in such neighborhoods. For other uses, see Cockroaches. ...

Asthma incidence and quality of treatment varies among different racial groups, though this may be due to correlations with income (and thus affordability of health care) and geography. For example, Black Americans are less likely to receive outpatient treatment for asthma despite having a higher prevalence of the disease. They are much more likely to have emergency room visits or hospitalization for asthma, and are three times as likely to die from an asthma attack compared to whites. The prevalence of "severe persistent" asthma is also greater in low-income communities compared with communities with better access to treatment.^[75][76]

Asthma and athletics

Asthma appears to be more prevalent in athletes than in the general population. One survey of participants in the 1996 Summer Olympic Games, in Atlanta, Georgia, U.S., showed that 15% had been diagnosed with asthma, and that 10% were on asthma medication.^[77] These statistics have been questioned on at least two bases. Athletes with mild asthma may be more likely to be diagnosed with the condition than non-athletes, because even subtle symptoms may interfere with their performance and lead to pursuit of a diagnosis. It has also been suggested that some professional athletes who do not suffer from asthma claim to do so in order to obtain special permits to use certain performance-enhancing drugs. Poster for the 1920 Summer Olympics in Antwerp. ... Atlanta redirects here. ...

There appears to be a relatively high incidence of asthma in sports such as cycling, mountain biking, and long-distance running, and a relatively lower incidence in weightlifting and diving. It is unclear how much of these disparities are from the effects of training in the sport, and from self-selection of sports that may appear to minimize the triggering of asthma.^[77][78] Police officer on a bicycle Cycling is a means of transport, a form of recreation and a sport. ... For other uses, see Running (disambiguation). ...

In addition, there exists a variant of asthma called exercise-induced asthma that shares many features with allergic asthma. It may occur either independently, or concurrent with the latter. Exercise studies may be helpful in diagnosing and assessing this condition. Exercise-induced anaphylaxis is a syndrome in which the symptoms of anaphylaxis occur related to exercise. ...

History

Asthma was long considered a psychosomatic disease, and

... during the 1930s–50s, was even known as one of the 'holy seven' psychosomatic illnesses. At that time, psychoanalytic theories described the aetiology of asthma as psychological, with treatment often primarily involving psychoanalysis and other 'talking cures'. As the asthmatic wheeze was interpreted as the child's suppressed cry for his or her mother, psychoanalysts viewed the treatment of depression as especially important for individuals with asthma.^[79]

Etiology (alternately aetiology, aitiology) is the study of Greek words aitia = cause and logos = word/speech) is used in philosophy, physics and biology in reference to the causes of various phenomena. ...

See also

Wikimedia Commons has media related to:

Asthma

• Reactive airway disease
• Atopy
• Hopkins syndrome
• Hygiene hypothesis
• Immune response
• Asthma and Allergy Foundation of America
• Occupational asthma

Image File history File links Commons-logo. ... Reactive Airway Disease [RADS] is a term proposed by RM Brooks and colleagues in 1985 to describe an asthma-like syndrome developing after a single exposure to high levels of an irritating vapor, fume, or smoke. ... Eczema-a typical atopic manifestation Atopy (Greek ατοπία - placelessness) or atopic syndrome is an allergic hypersensitivity affecting parts of the body not in direct contact with the allergen. ... Hopkins syndrome, sometimes called acute post-asthmatic amyotrophy, is an acute attack of muscle weakness that arises in a small number of patients with asthma, usually after a severe asthma episode. ... In medicine, the hygiene hypothesis says that an excessively hygienic environment in early childhood may predispose some people towards asthma, allergies, and other autoimmune diseases. ... A request has been made on Wikipedia for this article to be deleted in accordance with the deletion policy. ... The Asthma and Allergy Foundation of America (AAFA) is a non-profit organization dedicated to finding a cure for and controlling asthma, food allergies, nasal allergies and other allergic diseases. ... Occupational Asthma is defined as “a disease characterized by variable airflow limitation and/or airway hyper-responsiveness due to causes and conditions attributable to a particular occupational environment and not stimuli encountered outside the workplace”.1 // Asthma is defined as a respiratory disease caused by narrowing of the air passages. ...

References

2008 (MMVIII) is the current year, a leap year that started on Tuesday of the Anno Domini (or common era), in accordance to the Gregorian calendar. ... is the 3rd day of the year in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 118th day of the year (119th in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 75th day of the year (76th in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 266th day of the year (267th in leap years) in the Gregorian calendar. ... For information on Wikipedia press releases, see Wikipedia:Press releases. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 266th day of the year (267th in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 206th day of the year (207th in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 323rd day of the year (324th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 62nd day of the year (63rd in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 160th day of the year (161st in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 266th day of the year (267th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... The New York Times is a daily newspaper published in New York City and distributed internationally. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 336th day of the year (337th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... WHO redirects here. ... Year 2005 (MMV) was a common year starting on Saturday (link displays full calendar) of the Gregorian calendar. ... {| style=float:right; |- | |- | |} is the 235th day of the year (236th in leap years) in the Gregorian calendar. ... WHO redirects here. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 363rd day of the year (364th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 122nd day of the year (123rd in leap years) in the Gregorian calendar. ... 2004 : January - February - March - April - May - June - July - August - September - October - November - December Deaths in May • 28 Gerald Anthony • 27 Umberto Agnelli • 22 Richard Biggs • 20 Len Murray • 17 Tony Randall • 17 Ezzedine Salim • 9 Alan King • 9 Akhmad Kadyrov • 8(?) Nick Berg • 7 Waldemar Milewicz Other recent deaths Ongoing... April 2006 : ← - January - February - March - April - May - June - July - August - September - October - November - December- → Marcos Pontes, Brazils first astronaut, reaches the International Space Station. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ...

External links

• VIDEO Identifying Risk Factors for Childhood Asthma Presentation by James E. Gern, M.D., at the UW-Madison Health Sciences Learning Center.
• World Health Organization site on asthma
• National Heart, Lung, and Blood Institute — Asthma – U.S. NHLBI Information for Patients and the Public page.
• MedLinePlus: Asthma – a U.S. National Library of Medicine page
• Neurogenic factors in mechanisms of bronchial asthma
• Asthma Helpline