The Allergy And Asthma Cure Pdf
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- Allergy and Asthma
- 5 Herbs for Severe Asthma: Are They Effective?
- Welcome to Allergy & Asthma Proceedings
Asthma is a common disease affecting the lungs. There is no cure for asthma, but it can be controlled.
If you have asthma, you may be curious about whether certain foods and diet choices could help you manage your condition. At the same time, eating fresh, nutritious foods may improve your overall health as well as your asthma symptoms. According to research in some research , a shift from eating fresh foods, such as fruits and vegetables, to processed foods may be linked to an increase in asthma cases in recent decades. Instead, people with asthma may benefit from eating a well-rounded diet high in fresh fruits and vegetables.
Allergy and Asthma
Metrics details. Asthma is the most common respiratory disorder in Canada. Despite significant improvement in the diagnosis and management of this disorder, the majority of Canadians with asthma remain poorly controlled. In most patients, however, control can be achieved through the use of avoidance measures and appropriate pharmacological interventions. Inhaled corticosteroids ICS represent the standard of care for the majority of patients. Biologic therapies targeting immunoglobulin E or interleukin-5 are recent additions to the asthma treatment armamentarium and may be useful in select cases of difficult to control asthma.
Allergen-specific immunotherapy represents a potentially disease-modifying therapy for many patients with asthma, but should only be prescribed by physicians with appropriate training in allergy. In addition to avoidance measures and pharmacotherapy, essential components of asthma management include: regular monitoring of asthma control using objective testing measures such as spirometry, whenever feasible; creation of written asthma action plans; assessing barriers to treatment and adherence to therapy; and reviewing inhaler device technique.
This article provides a review of current literature and guidelines for the appropriate diagnosis and management of asthma in adults and children. It is also the most common chronic disease of childhood [ 2 ]. Although asthma is often believed to be a disorder localized to the lungs, current evidence indicates that it may represent a component of systemic airway disease involving the entire respiratory tract, and this is supported by the fact that asthma frequently coexists with other atopic disorders, particularly allergic rhinitis [ 3 ].
Despite significant improvements in the diagnosis and management of asthma over the past decade, as well as the availability of comprehensive and widely-accepted national and international clinical practice guidelines for the disease, asthma control in Canada remains suboptimal.
Poor asthma control contributes to unnecessary morbidity, limitations to daily activities and impairments in overall quality of life [ 1 ]. This article provides an overview of diagnostic and therapeutic guideline recommendations from the Global Initiative for Asthma GINA and the Canadian Thoracic Society and as well as a review of current literature related to the pathophysiology, diagnosis, and appropriate treatment of asthma.
Asthma is defined as a chronic inflammatory disease of the airways. Symptom episodes are generally associated with widespread, but variable, airflow obstruction within the lungs that is usually reversible either spontaneously or with appropriate asthma treatment such as a fast-acting bronchodilator [ 5 ]. The Canadian Community Health Survey found that 8. Between and , close to 80, Canadians were admitted to hospital for asthma, and hospitalization rates were highest among young children and seniors.
However, the survey also found that mortality due to asthma has fallen sharply since In , a total of deaths were attributed to asthma. More recent epidemiological evidence suggests that that the prevalence of asthma in Canada is rising, particularly in the young population.
A population-based cohort study conducted in Ontario found that the age- and sex-standardized asthma prevalence increased from 8. The age-standardized increase in prevalence was greatest in adolescents and young adults compared with other age groups, and the gender-standardized increase in prevalence was greater in males compared with females.
The results of these studies suggest that effective clinical and public health strategies are needed to prevent and manage asthma in the Canadian population. Asthma is associated with T helper cell type-2 Th2 immune responses, which are typical of other atopic conditions. Asthma triggers may include allergic e. IgE production, in turn, triggers the release of inflammatory mediators, such as histamine and cysteinyl leukotrienes, that cause bronchospasm contraction of the smooth muscle in the airways , edema, and increased mucous secretion, which lead to the characteristic symptoms of asthma [ 5 , 9 ].
The mediators and cytokines released during the early phase of an immune response to an inciting trigger further propagate the inflammatory response late-phase asthmatic response that leads to progressive airway inflammation and bronchial hyperreactivity [ 9 ].
Over time, the airway remodeling that occurs with frequent asthma exacerbations leads to greater lung function decline and more severe airway obstruction [ 10 ]. This highlights the importance of frequent assessment of asthma control and the prevention of exacerbations. Evidence suggests that there may be a genetic predisposition for the development of asthma. Several chromosomal regions associated with asthma susceptibility have been identified, such as those related to the production of IgE antibodies, expression of airway hyperresponsiveness, and the production of inflammatory mediators.
However, further study is required to determine specific genes involved in asthma as well as the gene-environment interactions that may lead to expression of the disease [ 5 , 9 ]. An extensive literature review undertaken as part of the development of the Canadian Healthy Infant Longitudinal Development CHILD study an ongoing multicentre national observational study examined risk factors for the development of allergy and asthma in early childhood [ 11 ].
Prenatal risk factors linked to early asthma development include: maternal smoking, use of antibiotics and delivery by caesarean section.
With respect to prenatal diet and nutrition, a higher intake of fish or fish oil during pregnancy, and higher prenatal vitamin E and zinc levels have been associated with a lower risk of development of wheeze in young children.
Later in childhood, risk factors for asthma development include: allergic sensitization particularly house dust mite, cat and cockroach allergens , exposure to environmental tobacco smoke, breastfeeding which may initially protect and then increase the risk of sensitization , decreased lung function in infancy, antibiotic use and infections, and gender.
Although asthma has long been considered a single disease, recent studies have increasingly focused on its heterogeneity [ 12 ]. Using a hierarchical cluster analysis of subjects from the Severe Asthma Research Program SARP , Moore and colleagues [ 13 ] have identified five distinct clinical phenotypes of asthma which differ in lung function, age of asthma onset and duration, atopy and sex. In children with asthma, three wheeze phenotypes have been identified: 1 transient early wheezing; 2 non-atopic wheezing; and 3 IgE-mediated atopic wheezing [ 14 ].
Risk factors for this phenotype include decreased lung function that is diagnosed before any respiratory illness has occurred, maternal smoking during pregnancy, and exposure to other siblings or children at daycare centres. The non-atopic wheezing phenotype represents a group of children who experience episodes of wheezing up to adolescence that are not associated with atopy or allergic sensitization.
Children with this phenotype tend to have milder asthma than the atopic phenotype. Classifying asthma according to phenotypes provides a foundation for improved understanding of disease causality and the development of more targeted and personalized approaches to management that can lead to improved asthma control [ 13 ].
Research on the classification of asthma phenotypes and the appropriate treatment of these phenotypes is ongoing. Bronchoprovocation challenge testing and assessing for markers of airway inflammation may also be helpful for diagnosing the disease, particularly when objective measurements of lung function are normal despite the presence of asthma symptoms [ 5 , 15 , 16 ].
The importance of labeling asthma properly in children and preschoolers cannot be overemphasized since recurrent preschool wheezing has been associated with significant morbidity that can impact long-term health [ 17 ].
Symptoms that are variable, occur upon exposure to triggers such as allergens or irritants, that often worsen at night and that respond to appropriate asthma therapy are strongly suggestive of asthma [ 5 , 16 ]. During the history, it is also important to enquire for possible triggers of asthma symptoms, such as cockroaches, animal dander, moulds, pollens, exercise, and exposure to tobacco smoke or cold air. When possible, objective testing for these triggers should be performed.
Exposure to agents encountered in the work environment can also cause asthma. If work-related asthma is suspected, details of work exposures and improvements in asthma symptoms during holidays should be explored. It is also important to assess for comorbidities that can aggravate asthma symptoms, such as allergic rhinitis, sinusitis, obstructive sleep apnea and gastroesophageal reflux disease [ 16 ]. The diagnosis of asthma in children is often more difficult since episodic wheezing and cough are commonly associated with viral infections, and children can be asymptomatic with normal physical examinations between exacerbations.
Marked clinical improvement during the treatment period, as reflected by a reduction in daytime or nocturnal symptoms of asthma, a reduction in the use of rescue bronchodilator medication, absence of acute care visits e. In a young child who is symptomatic with cough, wheeze, or increased difficulty breathing, a physical examination both before and after administration of a bronchodilator is of extreme value and can be used as a diagnostic tool.
A positive mAPI in the preschool years has been found to be highly predictive of future school-age asthma [ 20 ]. Given the variability of asthma symptoms, the physical examination of patients with suspected asthma can often be unremarkable. Physical findings may only be evident if the patient is symptomatic. Therefore, the absence of physical findings does not exclude a diagnosis of asthma.
The most common abnormal physical findings are a prolonged expiratory phase and wheezing on auscultation, which confirm the presence of airflow limitation [ 5 ]. Auscultating the chest before and after bronchodilator treatment can be informative as well, with improved breath sounds noted once the small airways undergo bronchodilation.
Among children with asthma, persistent cough is also a positive finding on physical examination since not all children with asthma wheeze. Physicians should also examine the upper respiratory tract nose, pharynx and skin for signs of concurrent atopic conditions such as allergic rhinitis, dermatitis, and nasal polyps also seen in cystic fibrosis [ 16 ].
The greater the variations in lung function, or the more times excess variation is seen, the more likely the diagnosis is to be asthma. Spirometry is the preferred objective measure to assess for airflow limitation and excessive variability in lung function.
Lung volumes are not measured with spirometry, and instead require full pulmonary function testing. Any values less than these suggest airflow limitation and support a diagnosis of asthma [ 5 , 23 ]. Because of the variability of asthma symptoms, patients will not exhibit reversible airway obstruction at every visit and a negative spirometry result does not rule out a diagnosis of asthma. This is particularly true for children who experience symptoms predominantly with viral infections, or who are well controlled on asthma medications.
Therefore, to increase sensitivity, spirometry should be repeated, particularly when patients are symptomatic [ 15 , 16 ]. Once airflow obstruction has been confirmed, obtaining evidence of excessive variability in expiratory lung function is an essential component of the diagnosis of asthma. Spirometry must be performed according to standardized protocols such as those proposed by the American Thoracic Society by trained personnel.
It is commonly performed in pulmonary function laboratories, but can also be performed in the outpatient clinical setting. Calibration of the spirometer should be performed daily. However, PEF is not recommended for diagnosing asthma in children. PEF is usually measured in the morning and in the evening. Although simpler to perform than spirometry, PEF is more effort-dependent and much less reliable. Therefore, as mentioned earlier, spirometry is the preferred method of documenting variable expiratory airflow limitation and confirming the diagnosis of asthma.
The importance of objective measures for confirming the diagnosis of asthma cannot be overemphasized. Compared to subjects whose current asthma diagnosis was confirmed, those in whom the diagnosis was ruled out were less likely to have undergone testing for airflow limitation in the community at the time of the initial diagnosis.
These findings suggest that re-evaluation of an asthma diagnosis may be warranted. When spirometry is normal, but symptoms and the clinical history are suggestive of asthma, measurement of airway responsiveness using direct airway challenges to inhaled bronchoconstrictor stimuli e.
Tests of bronchial hyperreactivity should be conducted in accordance with standardized protocols in a pulmonary function laboratory or other facility equipped to manage acute bronchospasm. An inhaled rapid-acting bronchodilator is then provided to reverse the obstruction. However, positive challenge tests are not specific to asthma and may occur with other conditions such as allergic rhinitis and chronic obstructive pulmonary disease COPD.
Therefore, tests of bronchial hyperreactivity may be most useful for ruling out asthma among individuals who are symptomatic. A negative test result in a symptomatic patient not receiving anti-inflammatory therapy is highly sensitive [ 16 ].
The measurement of inflammatory markers such as sputum eosinophilia proportion of eosinophils in the cell analysis of sputum or levels of exhaled nitric oxide a gaseous molecule produced by some cells during an inflammatory response can also be useful for diagnosing asthma. Evidence suggests that exhaled nitric oxide levels can be supportive of the diagnosis of asthma, and may also be useful for monitoring patient response to asthma therapy [ 16 ].
It is still not accepted as a standard test for the diagnosis of asthma. Although these tests have been studied in the diagnosis and monitoring of asthma, they are not yet widely available in Canada. Allergy skin prick epicutaneous testing is recommended to identify possible environmental allergic triggers of asthma, and is helpful in identifying the asthma phenotype of the patient.
There is no minimum age at which skin prick testing can be performed. Conditions that should be considered in the differential diagnosis of adults with suspected asthma may include: COPD, bronchitis, gastrointestinal reflux disease, recurrent respiratory infections, heart disease, and vocal cord dysfunction.
Distinguishing asthma from COPD can be particularly difficult as some patients have features of both disorders. A recent population-based cohort study conducted in Ontario suggests that the prevalence of concurrent asthma and COPD is increasing, particularly in women and young adults [ 26 ].
The differential diagnosis of asthma is unique for infants and young children and includes anatomic defects laryngo- or tracheomalacia, congenital heart defects , physiological defects primary ciliary dyskinesia and genetic conditions such cystic fibrosis and primary immunodeficiency, to name just a few conditions.
A chest X-ray may be considered in the work-up of a child with suspected asthma, particularly if the diagnosis is unclear or if the child is not responding as expected to treatment.
5 Herbs for Severe Asthma: Are They Effective?
Can diet help your asthma? Research suggests eating an overall healthy, balanced diet can help. These foods are part of that diet. In general, a healthy, varied diet plan is beneficial with asthma, says Holly Prehn, RD, a certified nutrition support clinician at the University of Colorado Hospital in Denver. The Mediterranean diet , one based on eating plenty of healthy fats like olive oil , fish, whole grains, and fruit, fits the bill, she says.
Northwest Asthma and Allergy Center. Seattle, Washington. The Allergy and Asthma Cure: A Com- plete 8-Step Nutritional Program. Fred. Pescatore MD MPH.
Welcome to Allergy & Asthma Proceedings
Asthma is a chronic disease that affects your airways. Your airways are tubes that carry air in and out of your lungs. If you have asthma, the inside walls of your airways become sore and swollen. That makes them very sensitive, and they may react strongly to things that you are allergic to or find irritating. When your airways react, they get narrower and your lungs get less air.
Follow this three-step approach to keep asthma symptoms under control and prevent asthma attacks. Effective asthma treatment requires routinely tracking symptoms and measuring how well your lungs are working. Taking an active role in managing your asthma treatment will help you maintain better long-term asthma control, prevent asthma attacks and avoid long-term problems. Create a written asthma action plan with your doctor.
Asthma is a chronic condition that affects the airways. It causes wheezing and can make it hard to breathe. Some triggers include exposure to an allergen or irritant, viruses, exercise, emotional stress, and other factors.
It seems that you're in Germany. We have a dedicated site for Germany. This highly practical, easy-to-read, fully updated and expanded resource offers a wide range of targeted guidelines and insights in allergy medicine. Written by a leading allergy clinician -- along with a renowned group of nationally recognized expert contributors in allergy and immunology, pulmonary, and infectious diseases -- this title is a proven resource for front-line general practitioners, especially primary care physicians. The most clinically relevant information is provided on the pathophysiology, diagnosis, treatment, and prevention of all major allergic disorders.
A few small studies have shown that herbal supplements can ease asthma symptoms. These herbs range from those found in your pantry to common traditional Chinese medicine herbs. Combining herbs with your traditional asthma medications is known as complementary therapy. Using only herbal treatments without traditional medicines is alternative therapy.
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