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Query: KEGG:D04296 (Asthma)
 25,733 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Asthma is now considered primarily an inflammatory disease in which bronchospasm occurs secondary to airway inflammation. Management strategies include the use of inhaled anti-inflammatory agents, notably inhaled corticosteroids and cromolyn. Mild intermittent asthma may be treated with inhaled bronchodilators. Moderate asthma should be treated with an inhaled anti-inflammatory agent in addition to an inhaled beta agonist. If symptoms persist, an oral bronchodilator (either a beta-adrenergic agonist or theophylline) should be added. Therapy for severe asthma includes combinations of the foregoing medications, with the possible addition of oral corticosteroids. Other aspects of management include the use of a spacer device with inhaler therapy, control of concomitant allergies and triggering factors such as chronic sinusitis, tobacco smoke and gastroesophageal reflux, and home use of a portable peak flow meter to monitor the disease.
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PMID:National guidelines for the management of asthma in adults. 135 47

Chronic sinusitis has been suggested to play a causal role in creating recalcitrant asthma. However, this hypothesis has never been confirmed in a blind placebo-controlled study. Several studies have documented an association between abnormal sinus X-rays and asthma in 30-70% of patients, depending on criteria chosen for evaluation of the radiologic changes. Asthma is associated with inflammation in the lower airways, and the same inflammation might involve the sinuses in a parallel fashion. It is now felt that early therapy of this inflammation can modify the course of asthma resulting in its amelioration. Conversely, delay in institution of this therapy might result in the inflammation entrenching airway reactivity. It must be clearly proven in a controlled fashion that antibiotic or other therapy of sinusitis will improve the course of asthma since such therapy could delay the aggressive management of inflammation.
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PMID:Role of sinusitis in asthma. 179 18

Aspirin-induced asthma (AIA) should be recognized as an important types of bronchial asthma for the following reasons. 1) The pathogenesis of AIA is specific. Inhibition of cyclooxygenase a (key enzyme for the production of prostanoids from arachidonic acid) by non-steroidal antiinflammatory drugs (NSAID) is an important trigger of asthma attacks. 2) The frequency of AIA is not low. It is estimated to be 9.8% in adults with chronic asthma. 3) Some clinical features of AIA are characteristic. Naso-sinus complications, such as rhinitis, chronic sinusitis, nasal polyposis, and anosmia, are commonly found in patients with AIA. 4) Glucocorticoids with succinate ester, which are commonly used to treat asthma attacks, induce asthma symptoms or provoke severe asthma attacks in 70% to 80% of patients with AIA. 5) Some patients with AIA are hypersensitive to some agents in addition to NSAID, e.g., tartrazine (15.1%), sodium benzoate (14.3%), and parabens (12.0%). 6) Patients with latent AIA are in danger of having fatal or near-fatal asthma attacks if they take NSAID. We should educate patients to eliminate the risk posed by NSAID and other agents that may induce asthma attacks, and should enlighten doctors and pharmacists, who are not specialists in allergy or respiratory disease, about AIA. 7) Asthma in these patients will be less severe if their condition is correctly diagnosed and they receive appropriate medical treatment.
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PMID:[Aspirin-induced asthma as an important type of bronchial asthma]. 875 93

Nasal polyps are usually found in nonallergic individuals. However, when nasal polyps and atopy occur together, a special interaction exists. Total and specific immunoglobulin E (IgE) are found in significantly greater concentration in nasal polyp tissue than in serum and tonsil tissue. Immunoglobulin A (IgA) is also more concentrated in nasal polyps than serum. Patients with nasal polyps and allergies seem to have a greater recurrence rate after surgical polypectomy. Frequently, polyp recurrence occurs during specific pollen seasons in sensitive individuals. Upper respiratory infections are also a precipitating factor for recurrence. Nasal ciliary beat frequency is inhibited in patients with chronic sinusitis, allergic nasal reactions, and nonspecific nasal eosinophilia syndromes: nonallergic rhinitis with eosinophils (NARES) and blood eosinophilic nonallergic rhinitis (BENARS). Nasal polyps are frequently associated with these conditions, which may predispose the nasal mucosa to infections and increased risk for developing nasal polyps. When nasal polyps and allergies occur together, it is important to treat the allergic condition. This takes the form of identifying the allergens, eliminating them from the environment (if possible) using antihistamines/decongestants, and nasal antiinflammatory drugs such as topical steroids. Hyposensitization may be considered in resistant cases.
Allergy Asthma Proc
PMID:Nasal polyps and immunoglobulin E (IgE). 892 46

The diagnosis and management of chronic sinusitis in children represents a difficult challenge for the clinician. Part of the problem stems from the fact that normal children have many upper respiratory infections and it is sometimes difficult to determine whether the upper respiratory symptoms a child experiences with these infections are consistent with a normal number of "routine" childhood infections or whether there is a more significant problem. The issue is complicated by the fact that sinus infections in children may not have the same clinical manifestations as similar infections in adults. This review focuses on the pathophysiology of persistent and chronic sinus infections in children. Particular emphasis is placed on the potential role for allergic and/or immunologic disorders in children with chronic sinus problems.
Allergy Asthma Proc
PMID:Immunologic considerations in the child with recurrent or persistent sinusitis. 919 39

Sinusitis affects up to 14% of Americans. Traditionally, most patients with sinusitis are evaluated and treated by either primary care physicians or otolaryngologists. In order to gain information regarding the characteristics at presentation and the outcome of treatment of sinusitis by an allergist, the records of 200 consecutive patients seen at the Institute for Asthma and Allergy at the Washington Hospital Center for chronic sinusitis were reviewed. The most common presenting symptoms were nasal congestion, postnasal drip, purulent rhinorrhea, headache, cough, facial pressure, anosmia or hyposmia, hypogeusia, and throat clearing. Initial abnormal physical exam findings included abnormal transillumination, purulent secretions, nasal mucosal swelling, nasal polyps, and nasal crusting. Treatment included 4 weeks of oral antibiotics, nasal corticosteroids, nasal lavage, and topical decongestants. All of the presenting symptoms (23-75% of the patients) and signs (50-84% of patients) improved with medical management. Patients have been followed for 1 to 27 months, with a mean of 6 months, and 6% have required surgery, with one complication of cerebrospinal fluid leak. These findings indicate that medical management of chronic sinusitis in an allergist's office is effective.
Allergy Asthma Proc
PMID:Sinusitis in an allergist's office: analysis of 200 consecutive cases. 919 44

Allergy has been reported as an important factor in the etiology of nasal polyposis. Asthma, chronic sinusitis and aspirin hypersensitivity are frequently found together with nasal polyposis. Total IgE, RAST for specific IgE and skin prick test were used to investigate the incidence of allergy in 95 patients with nasal polyposis. In addition, histopathologic appearance of polyp tissue was examined in 21 patients after polypectomy and compared in allergic and nonallergic groups. IgG subclass levels were also measured to detect if there were any changes. Mean serum IgE level was found to be higher in the patient group and the skin prick test (SPT) was positive in 66.3% of patients. On the basis of positive SPT and serum RAST results, 45.2% of all patients with nasal polyposis were defined as allergic. Both total IgE and IgG4 were detected at increased levels in the SPT-positive group. These findings suggest that an IgE-mediated mechanism may be present in a subpopulation of patients with nasal polyposis.
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PMID:Allergy as an etiologic factor in nasal polyposis. 933 Jan 87

Sinusitis is an increasingly more important disease due to its increasing prevalence, costs, and recognition. Most acute sinusitis episodes follow colds or acute allergic rhinitis. Chronic sinusitis is most commonly due to allergic and nonallergic rhinitis or anatomical defects in the nose. Several common immunologic abnormalities usually present as sinusitis and may be recognized first by the allergist-immunologist. Treatment involves a carefully selected antibiotic prescribed for an adequate period of time, nasal hygiene using nasal saline washes, topical nasal corticosteroids, and decongestants. Medical management of sinusitis tends to be effective, even in patients with long-standing sinus disease.
Allergy Asthma Proc
PMID:Treatment of sinusitis in the next millennium. 972 48

Using objective and subjective criteria, we performed a study to assess the long-term impact of functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis and asthma at an average follow-up of 6.5 years. One hundred twenty patients who underwent FESS for chronic rhinosinusitis were followed up for an average of 6.5 years (range 6.0 to 10.6 years). Seventy-two (60%) patients responded to a follow-up questionnaire, and 30 (42%) of them reported a history of asthma. Subjective levels of improvement and assessments of medication need were evaluated and statistically assessed with parametric and nonparametric methods. Of these 30 patients, 27 (90%) reported that their asthma was better than it had been before FESS, 6.5 years ago. Average reported improvement increased from 49% at 1.1 years after surgery to 65% at 6.5 years after surgery. Asthma attacks declined in 20 of 27 (74.1%). Medication use for asthma showed similar improvement, with approximately half reporting less inhaler usage and nearly two thirds reporting less oral steroid use. This study demonstrates that a combination of FESS, careful postoperative care, and appropriate medical therapy for chronic rhinosinusitis has a favorable long-term effect on asthma in patients with symptomatic chronic sinusitis. In this study asthma severity, frequency of attacks, and medication need were all improved.
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PMID:Long-term impact of functional endoscopic sinus surgery on asthma. 1038 81

With unfortunate high frequency, clinicians consider allergic rhinitis to be more of a nuisance than an illness. When in fact, allergic rhinitis is not only a very common disease process, affecting up to a cumulative frequency of 42% of the U.S. population by age 40, but can lead to significant short-term and long-term medical complications. Poorly controlled symptoms of allergic rhinitis may contribute to sleep loss, secondary daytime fatigue, learning impairment, decreased overall cognitive functioning, decreased long-term productivity and decreased quality of life. Additionally, poorly controlled allergic rhinitis may also contribute to the development of other related disease processes including acute and chronic sinusitis, recurrence of nasal polyps, otitis media/otitis media with effusion, hearing impairment, abnormal craniofacial development, sleep apnea and related complications, aggravation of underlying asthma, and increased propensity to develop asthma. Treatment of allergic rhinitis with sedating antihistamine therapy may result in negative neuropsychiatric effects that contribute to some of these complications. Sedating antihistamines may also be dangerous to use in certain other settings such as driving or operating potentially dangerous machinery. In contrast nonsedating antihistamines have been demonstrated to result in improved performance in allergic rhinitis.
Allergy Asthma Proc
PMID:Complications of allergic rhinitis. 1047 18


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