New Home Remedy to Cure Asthma

Asthma Free Forever

With Asthma Free Forever, asthma sufferers worldwide will learn how they can cure asthma easily, naturally, and permanently in Asthma Free Forever. This guide was written by Jerry Ericson, an alternative medical practitioner and former asthma sufferer. Inside this guide, users will discover the methods that helped the author cure his asthma without useless and harmful medications. A well organized and precisely explained all natural asthma recovery methods keeps you out from having on the counter drugs pr from so highly priced medicines prescribed by the doctors, even you need to revolve around the doctor for good results to be shown, there is all consists inside the content of this online health guide and by following it properly and timely you will get treated soon. With the help of Asthma Free Forever, anyone can solve its asthma problem for good in just a few days right in the comfort of their own home. This treatment is based on proven medical research, so users can be sure that it's safe and guaranteed to work. Read more...

Asthma Free Forever Summary


4.7 stars out of 13 votes

Contents: EBook
Author: Jerry Ericson
Official Website:
Price: $37.00

Access Now

My Asthma Free Forever Review

Highly Recommended

This ebook comes with the great features it has and offers you a totally simple steps explaining everything in detail with a very understandable language for all those who are interested.

This ebook served its purpose to the maximum level. I am glad that I purchased it. If you are interested in this field, this is a must have.

Asthma Introduction

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

Pediatric Asthma Case Study

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

Could Clarithromycin Prevent Asthma

Asthma is the most disabling of all chronic diseases in childhood, and one of the commonest. About 30 of individuals who are subsequently diagnosed, in middle childhood or later, as having asthma began with symptoms of recurrent wheezing, cough, and bronchospasm in the first year of life, A longitudinal study of infants who wheezed in the first year has revealed that only a portion, about 25 , who have had more severe symptoms and abnormal pulmonary function develop asthma in later life (1). Most severe childhood asthmatics become asthmatic adults. Prior studies have concentrated on family history and demographic factors such as low birth weight and prematurity, social risk, and lower maternal age. Infection with respiratory syncytial virus (RSV) and chlamydia pneumoniae also have been implicated in some studies of asthma, possibly through hostmediated IgE responses (2-4). of age. No prior study has been carried out to determine if U. urealyticum plays a pathogenic role in children...

Care for Asthma via Mobile Phone CAMP

The primary goal of the Care for Asthma via Mobile Phone (CAMP) service is to provide an effective method by which Taiwan's asthma patients can easily monitor their asthma symptoms using a common mobile phone. With the CAMP service, the patient uses his own cellular phone to submit his daily peak expiratory flow rate (PEFR) and answer a simple questionnaire regarding to daily activities. The CAMP service participant then receives an asthma symptom assessment and care suggestion message immediately after imputing his information. This assessment, which is in accordance with the World Health Organization's (WHO) Global Initiative for Asthma (GINA) standard, includes weather conditions that might adversely affect the asthma patient (e.g. temperature, pollen count, etc.). This information is, in turn, used to advise the asthma patient how to avoid a severe asthmatic attack. Keywords. Long-distance care, long-term care, asthma care, chronic disease care, wireless-care system,...

Theophylline Table

The first clinical report of theophylline-erythromycin interaction appeared in 1977. In this report, the blood levels of theophylline increased 37 and 46 after the addition of 4.5-5.0 mg kg q6h of erythromycin A in two children. In healthy volunteers, after a 10-day course of erythromycin stearate (250 mg tid orally), the half-life of serum theophylline increased from 4.79 to 7.53 h, whereas drug clearance decreased from 91.6 to 54.8 ml h kg. Theophylline metabolites 3-methylxanthine and 1.3 dimethyl uric acid also decreased (7). Other investigators demonstrated prolongation of theophylline T j2 in asthmatics but not in patients with bronchitis and most investigators failed to demonstrate changes in theophylline clearance. Other investigators failed to demonstrate changes in theophylline pharmacokinetics and metabolism both in volunteers and in patients with a variety of respiratory conditions (bronchitis, asthma, chronic bronchoecta-sis, etc.). Some of these controversies may be due...


Was treated by a spoonful of NETTLE-juice mixt with clarified Honey, every night and morning (Wesley). Domestic medicine agrees on nettle's efficacy in chest complaints, from coughs to tuberculosis, but COMFREY root tea, taken for a variety of ailments, is not so well known (Painter). An infusion of ELECAMPANE roots has been used for asthma (Forey), as well as for coughs and whooping cough. Cockayne quotes a Saxon leechdom ad pectoris dolorem in which elecampane played its part along with many other herbs. Mulled ELDER berry wine is good for asthma (Hatfield). Another recipe is to make a conserve of HONEYSUCKLE flowers, beaten up with three times their weight of honey a tablespoonful dose is to be taken night and morning, to relieve the condition (A W Hatfield). An Irish remedy was to use GORSE flowers. They would be packed tightly in a crock, and brown sugar put on top. The crock would be covered, and put in a saucepan to stew slowly (Lucas). Also from an Irish source, sufferers were...

Perioperative Cardiac Complications

Of myocardial infarction by 56 (p 0.04), and the surrogate risk of cardiac death and nonfatal myocardial infarction by 67 (p 0.002). Administration of beta-blockers should be commenced prior to surgery, a dose-titration has to be carried out up to the induction of anesthesia, and a lifelong continuation of beta-blocker therapy is recommended in high-risk patients. The optimum time interval to start treatment with beta-blockers before surgery has not yet been defined by studies. The choice of the beta-blocker is of minor importance, since no specific beta-blocker demonstrated a superior effect in the perioperative setting. The side effects of perioperative administration of beta-blockers are a 4.3-fold increased risk of bradycardia (p 0.006), but hypotension, atrioventricular block, pulmonary edema, and bronchospasm are not significantly associated with perioperative beta-blocker therapy. The following contraindications should be kept in mind prior to commencement of beta-blocker...

Causes of False Positive and False Negative Tests for Marked Inspiratory Fall in Blood Pressure

Why do some asthmatic patients seem to have a marked inspiratory fall in blood pressure ANS Bronchospasm may raise the intrathoracic pressure very high (similar to a Valsalva maneuver), and inspiration will, by contrast, seem to lower the systolic pressure excessively. Actually, it is an expiratory rise in blood pressure, not an inspiratory fall.

Discharge And Home Healthcare Guidelines

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

Gender Ethnicracial And Life Span Considerations

Although the incidence of asthma is estimated at 1 to 5 in the general population, children have a higher incidence of 12 . Children make up more than a third of the people with asthma. Asthma is diagnosed more frequently in males under 14 years and over 45 years of age and in females between the ages of 15 and 45. Inner-city children of color have higher morbidity and mortality rates than white chldren. Approximately 80 to 85 of childhood asthma episodes are associated with a prior exposure to a virus.

The Future Of Macrolides

The macrolides, after more than 40 years of use as antibiotics, are now on the verge of a new age. New macrolides with improved activity against the resistant Streptococcus pneumoniae will continue the antibiotic uses of this class of drugs. Macrolides have become widely used as immunomodulators in the treatment of rejection during organ transplantation. Their usefulness in the treatment of inflammation associated with diseases such as asthma and Crohn's disease are just being defined and the possibilities of treating some forms of cancer with combination therapy including macrolides has been reported. The prokinetic macrolides are extending the nonantibiotics uses of the macrolides this suggests that the potential may be unlimited for these extremely versatile molecules.

Primary Nursing Diagnosis

General Comments Treatment generally focuses on symptoms such as controlling coughs with preparations such as dextromethorphan and controlling discomfort with analgesics and antipyretics. Routine antimicrobial use is not recommended unless influenza or pertussis is confirmed. Xanthines may also be used to assist with respiratory muscle strength by increasing the contractility of the diaphragm. Steroids are used more often with asthma but may occasionally be used in patients with bronchitis. Bronchodilators Varies with drug Ultrasonic or nebulized treatments Relax smooth Other Drugs Xanthines such as aminophylline and theophylline are administered to reduce mucosal edema and smooth-muscle spasms rimantadine (Flumadine) may be used to inhibit viral replication of influenza A virus subtypes.

Macromolecular Composition

Infection is transmitted via respiratory secretions. After a variable incubation period of up to 4 weeks the disease begins with growing hoarseness and aching throat, mild cough, and fever and does later develop into an atypical pneumonia. 12,13 In rare cases infection may also present as sinusitis or otitis media or lead to the aggravation of asthma. 14 In immunocompetent individuals the infection is usually self-limiting, but may be complicated by superinfections. In immunocompromised persons infection may take a more severe course. Reinfections do occur but are generally milder than primary infections. 13

NOC Family Coping

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

Medicinal Polygalaceae

The family Polygalaceae consists of 10 families and 750 species of herbs, shrubs, or woody climbers that have attracted a great deal of interest on account of their ability to produce a series of neuroactive oleanane saponins known as polygalasaponins. In addition, Polygalaceae, like the Malpighiaceae, are member of the Polygalales and elaborate also a series of indole alkaloids that are of neuropharmacological interest. In Asia and the Pacific, about 10 species of plants classified within the family Polygalaceae are of medicinal value. Note that these plants are often used to counteract putrefaction, to treat cough, asthma, and bronchitis, to promote fertility, and to treat cerebral dysfunctions.

The twoprocess model of sleep regulation

An early study showed that subcutaneous injection of adenosine in the guinea pig resulted in sleep-like behavior, although it is unlikely that this was a reaction to adenosine receptor activation in the brain 147 . More recent pharmacological studies have described the sleep-inducing effects of adenosine, when exogenous adenosine or adenosine agonists were systemically or intracerebrally administered 144,145 . Conversely, antagonism of the adenosine receptor, by substances such as coffee (caffeine) and tea (theophylline), increases alertness.

What is the role of qualitative studies

Randomized clinical trials and observational studies rarely consider individual patients' perceptions or preferences. Qualitative studies fill this void. One must not forget that patients may regard risks and benefits very differently, and patients with the same medical condition may have very different symptoms, as well as completely different thresholds of tolerance for these symptoms. Some patients with asthma may suffer primarily from exertion dyspnea, while others have difficulty coping with dry cough or insomnia due to nocturnal attacks. Any trial evaluating asthma interventions for symptomatic relief ought to focus especially on what is most important to individual patients. Patient perspectives and expectations should be taken into account when designing trials to evaluate interventions.

Nase I in NonCF Respiratory Diseases

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

Which symptoms are most relevant

A similar situation exists for trials of anti-asthmatic treatments. In an asthma attack, exertional dyspnea and nocturnal orthopnea are the most troublesome symptoms for the patient clinical trials of acute treatment should focus on those symptoms. In contrast, trials evaluating the effectiveness of long-term maintenance therapy need to assess the prevention of acute exacerbations and disease progression, so it is appropriate to measure complication rates, changes in pulmonary function and, in more advanced disease stages, survival.

Host Cell Reactions upon Rhinoviral Infections The Molecular Origin of Symptoms

HRV, as well as other respiratory pathogens, have been shown to induce production of many cytokines and che-mokines, among them IL-4, IL-6, IL-8, and granulocyte macrophage colony stimulating factor (GMCSF), to name the most frequently published. The induction of chemo-kines triggers the inflammatory response, which is considered to enhance exacerbations like asthma and chronic obstructive pulmonary disease (COPD). A common feature of asthma and COPD exacerbations is a high level of IL-8 and an increased number of neutrophils in the sputum and nasal secretions of patients suffering an HRV infection. shown to be increased in monocytes and macrophages. Surprisingly, HRV16 induces the same signal transduc-tion pathways in lymphocytes as in epithelial cells. Again, the p38-K is activated and engages the nuclear factor ATF-2 involving NF-kB. The signal transduction could be attenuated by preincubation of the lymphocytes with ICAM-1, suggesting that HRV can bind to and enter lymphocytes....

Patients And Methods

Polymorphonuclear leukocytes (PNLs) and gram-positive diplococci on microscopic examination of sputum. Patients with evidence of tuberculosis or malignancy, chronic liver or renal impairment, or receiving theophylline theophylline analogs, as well as pregnant or lactating women were excluded. Patients with severe or complicated lower respiratory tract infections necessitating parenteral antibiotic treatment were not eligible.

The Influence of Inactive Components on Antimicrobial Activity

The activity of antimicrobial peptides could be adversely affected regardless of which of these two models applies in vivo. While increased salt concentrations would interfere with the function of many antimicrobial polypeptides, diminished mucociliary clearance would prolong the exposure time of inhaled microbes to antimicrobial substances and could permit microbial adaptation or the emergence of resistant variants. Specific questions that remain to be answered about CF airway fluid include (1) whether antimicrobial polypeptides are produced in normal or sufficient quantities (2) which, if any, of the polypeptides are defective (3) whether the increased production of inhibitory substances (e.g., polyanionic macromolecules) interferes with effective antimicrobial polypeptide activity and (4) whether the increased production of antimicrobial polypeptides contributes to destructive airway inflammation. Investigations of the antimicrobial activity of natural airway fluid are an...

Radiocontrastinduced Nephrotoxicity

Radiocontrast-induced nephropathy is a leading cause of hospital-acquired acute renal failure (ARF) with an incidence ranging from 2 to 10 depending on the population's risk factors. Risk factors include preexistent volume depletion, age, underlying chronic renal insufficiency, diabetes mellitus, proteinuria, and the amount of the radiocontrast dye used. The pathogenesis of ARF in this setting is probably related to decreased renal blood flow and medullary ischemia resulting from an imbalance of vasodilative and vasoconstrictive factors 14 . Radiocontrast agents may also be directly toxic to the renal tubule epithelium. This form of ARF is somewhat unique because preexisting risk factors can be identified and the timing and dose of dye can be controlled. Measures which have been proposed to prevent or reduce the severity of contrast-induced nephrotoxicity include volume expansion and the administration of furose-mide, mannitol, calcium channel blockers, dopamine, atrial natriuretic...

Pathology and Histopathology

Physical examination of patients with a rhinovirus infection usually reveals nasal obstruction and discharge, the nasal mucosa being pale and edematous. Elevated levels of bradykinin found locally, possibly contribute to this edema. Neutrophil infiltration is observed in the common cold and this may be caused by rhinoviruses inducing the expression of interleukin 8 (IL-8), a neutrophil chemoattractant. IL-8 may also be involved in asthma exacerbation, which is characterized by rhinovirus-induced enhancement of allergic inflammation and responsiveness to histamine.

Future Perspectives

The past few years have seen major advances in the study of rhinoviruses, particularly the determination of three-dimensional structures and the identification of receptors. Several nucleotide sequences have been determined, revealing conserved regions which have been exploited by PCR-based systems for rapid detection. These are an improvement on virus isolation procedures for detection and are giving a more complete picture of the role of rhinoviruses in human disease, for instance the recognition of their importance in asthma exacerbation. Rhinovirus serotype diversity means that broadly reactive prophylactic or therapeutic approaches must be devised. The economic and social significance of the common cold continues to stimulate research and our knowledge of the structure of the virus particle, the determinants of antigenicity and cellular receptors, together with

Preanalytical Variables Anticoagulant

Accurate assessment of in vivo or in vitro cellular expression of molecules requires optimal preanalytical conditions to prevent in vitro artifactual activation. The choice of anticoagulant is one of the critical preanalytical conditions because anticoagulants exert different effects on the activation of cells ex vivo. Historically, sodium citrate has been the favored anticoagulant for use in the studies of platelet activation and function, including aggregation and adherence. However, recent studies have shown that the anticoagulant CTAD (a mixture of sodium citrate, theophylline, adenosine, and dipyridamole) is better for retaining the ex vivo status of platelets (80). But it should be noted that this anticoagulant is light-sensitive and, when exposed, stable for only up to 4 h (81). In addition, when CTAD is combined with EDTA (ethylenediaminetetraacetic acid) and the blood held at 4 C, platelet activation after venesection is inhibited for at least 6 h after venesection (82,83)....

David Rueda and Nils G Walter

Biosensors are devices that amplify signals generated from the specific interaction between a receptor and an analyte of interest. RNA structural motifs called aptamers have recently been discovered as receptor components for biosensors owing to the ease with which they can be evolved in vitro to bind a variety of ligands with high specificity and affinity. By coupling an aptamer as allosteric control element to a catalytic RNA such as the hammerhead ribozyme, ligand binding is transduced into a catalytic event. We have made use of fluorescence resonance energy transfer (FRET) to further amplify ligand induced catalysis into an easily detectable fluorescence signal. This chapter reviews in detail the methods and protocols to prepare a theophylline specific aptazyme and to label its substrate with fluorophores. We also include detailed protocols to characterize by FRET the binding affinity of the target, theophylline, as well as the external substrate to the aptazyme. The chapter...

Evaluation of Eyelid Lesions

Lesions Definition

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

Basic Protocol Searching Omim Over The Internet

NCBI's Genes and Diseases database is an extremely useful database for physicians, researchers and scientists alike. This database is part of an ongoing effort to map and characterize diseases caused by the mutation in one gene or a result of mutations in several genes such as asthma and diabetes. The Genes and Disease site linked to from the SNCA entry in OMIM (Fig. 1.2.5) is made up of two sections. The first section of note is located in the large middle panel containing an overview of the disease. The second section, on the left, contains additional links to information on SNCA and Parkinson's Disease. The most relevant source of information from a clinical standpoint is found in the Information subsection, towards the bottom of the left-hand sidebar. This section includes links to general information for clinicians, physicians and patients. It also includes the Medline Plus feature (Fig. 1.2.6) which when selected provides a link to the Clinical Trials...

Macrolides As Antiinflammatory Agents In Vivo Studies

It has also been shown that erythromycin and troleandomycin favorably affect the clinical status of patients with severe steroid-dependent asthma (31-33). An effect of macrolides on theophylline or corticosteroid clearance has been postulated to contribute to their beneficial actions. Macrolide interactions with various processess involved in the pathogenesis of asthma e.g., bronchial inflammation and bronchial hyperreactivity (34) is an area of active investigation (see below).

The respiratory system

Functional Residual Capacity

Pregnancy, even in women with asthma. The rise in tidal volume is largely driven by progesterone, which appears to decrease the threshold and increase the sensitivity of the medulla oblongata to carbon dioxide. Respiratory rate does not change, so the minute ventilation rises by a similar amount. This overbreathing also begins before conception the PC02 is lowest in early gestation. Progesterone also increases erythrocyte carbonic anhydrase , which will also lower PC02. Carbon dioxide production rises sharply during the third trimester, as fetal metabolism increases. The fall in maternal PC02 allows more efficient placental transfer of carbon dioxide from the fetus, which has a PC02 of around 55 mmHg (7.3 kPa). The fall in Pco2 results in a fall in plasma bicarbonate concentration (to 18-22 mmol l by comparison with 24-28 mmol l) which contributes to the fall in plasma osmolality the peripheral venous pH rises slightly (Table 2.2 Fig. 2.4).

Antithyroid Drug Therapy

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

Epidemiology of chronic pelvic pain

Moving from the general population to those seen in general practice, a picture of consulting patterns was obtained using a national database study of UK general practices 3 . Data relating to 284,162 women aged 12-70 who had a general practice contact in 1991 were analysed to identify subsequent contacts over the following 5 years. The monthly prevalence rate was 21.5 per 1000 and the monthly incidence rate was 1.58 per 1000. These prevalence rates are comparable to those for migraine, back pain and asthma in primary care. Older women had higher monthly prevalence rates for example, the rate was 18.2 per 1000 in the 15-20 year age group and 27.6 per 1000 in women over 60 years of age. This association was thought to be due to persistence of symptoms in older women, the median duration of symptoms being 13.7 months in 1320 year olds and 20.2 months in women over the age of 60 4 . It is clear that future population-based studies need to include older women.

Ca2 Channel Antagonists and Other Direct Vasodilators

Drugs that lead to increases in cAMP or cGMP in vascular smooth muscle cells represent another class of agents that may elicit natriuresis primarily by enhancing renal blood flow and GFR. These include methylxanthines (theophylline and aminophylline), the vasodilatory amines (dopamine), natriuretic peptides, nitric oxide donors, and vasodilatory prostaglandins. The methylxan- thines include the older nonspecific drugs that block membrane bound adenosine receptors as well as inhibit intracellular phosphodiesterase activity which also increases intracellular cAMP levels 31 . Most of these agents also have tubular effects to inhibit sodium reabsorption rate at one or more segments of the tubule. Varied renal hemodynamic responses have been reported with some reports showing substantive increases in GFR and others failing to establish significant changes in filtered load. Nevertheless, for any given level of perfusion pressure, renal blood flow is slightly augmented by these agents. While...

Drug Interactions of Macrolides and Azalides

Over the last 25 years there have been many reports indicating that the macrolides and azalides may interfere with the metabolism of other drugs. Erythromycin and triacetyloleandomycin have had the longest experience. The most studied and controversial interaction has been between erythromycin and theophylline. The background for understanding these drug interactions lies in the understanding of the interaction of the macrolide or its metabolite with the cytochrome P-450 enzyme complex. Critical evaluation of this interaction requires consideration of several factors, including (a) dose, formulation, route, serum concentration, time of dose relative to meals, and duration of therapy with the antibiotic (relative to possible saturable elimination) of the other drug (b) characteristics of the patients or study subjects (e.g., age, gender, smoking history and status, pathophysiology of the underlying condition, and environmental factors) and (c) study design (1). zymes arc inactivated by...

CTXqPreCTXq O1 Strains

The severity of sporadic cases of cholera caused by ctxAB- tcpA- strains varies from mild diarrhea to significant dehydration. The latter mainly concerns immun-odeficient humans weakened by concomitant or chronic illnesses. For example, a non-toxigenic strain was isolated in Chelyabinsk during 2000 from a cholera patient with hormone-dependent bronchial asthma and chronic gastritis. The signs of cholera were fierce including abundant watery diarrhea, vomiting, and muscle cramps. However, the agent lacked not only CTX element and VPI but also a major part of VPI-2, mshA (in the presence of mshQ), ACD-vgrG, stn sto, and slt1. From a set of tested genes the agent contained only RTX cluster (including ACD-rtxA) and hapA 7, 8 . In the infant rabbit model, the strain caused moderate enteropathogenic effect in response to 109 colony forming units (CFU) and in vitro showed proteolytic, hemolytic, and phospholipase activity. So the severe diarrhea might be completely or partly stipulated by...

Critical Parameters and Troubleshooting

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

Angioedema and Urticaria

Urticaria And Angioneurotic Edema

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

Food Intolerance and Allergy

Mast Cell Diagram

Many people eat a variety of foods and show no ill effects however, a few people exhibit adverse reactions to certain foods. Food sensitivities refer to the broad concept of individual adverse reactions to foods. Food sensitivities are reproducible, unpleasant reactions to specific food or food ingredients. There are many types of adverse reactions to foods, e.g., hives, headaches, asthma, and gastrointestinal complaints. Food sensitivities can be divided into primary and secondary sensitivities (Table 10.1). in the blood stream are called basophils. Basophils and mast cells contain granules filled with active chemicals (mediators) thatcanbereleasedduringanallergicor inflammatory response. The mechanism hypersensitivity (Type I Figure 10.1), is composed of two major events. The first event or sensitization is when an allergen(antigen)isconsumed.Otherroutes of exposure can be portals for Serum concentration of IgE is low comparedwiththatofotherimmunoglobulins, and its serum half-life...

C5L2 an Antiinflammatory Molecule or a Receptor for Acylation Stimulating Protein C3adesArg

(Bao, Gerard, Eddy, Jr., Shows, and Gerard 1992). Unlike most other G-protein coupled receptors, usually consisting of a single exon, it is made up of two exons separated by a 9 kb intron located directly behind the start codon. While most G-protein coupled receptors share a high interspecies similarity ( 85-98 ), the gene for C5aR is quite variable in different species. The overall similarity among human, mouse, rat, rabbit and bovine C5aR is only about 68 (Gerard, Bao, Orozco, Pearson, Kunz, and Gerard 1992 Perret, Raspe, Vassart, and Parmentier 1992). C5aR binds C5a with a Kd of 1 nM and, to a lesser extent, also its desarginated form. The affinity of C5aR on human monocytes for C5a-desArg is roughly 10-100 fold lower than for C5a (Marder, Chenoweth, Goldstein, and Perez 1985). However, this study did not take in account another C5a-desArg binding receptor. In recent reports, the Kd of C5a-desArg binding to C5aR was estimated at 412-660 nM (Okinaga et al. 2003). Binding of C5a to...

Clinical Note continued

Asthma is the other main obstructive pulmonary disease. Asthma causes severe bronchoconstriction leading to low Va Q regions in the lung but no shunt. A big advance in the treatment of asthma was the development of selective p2-adrenergic agents (e.g., albuterol) to stimulate bronchodilation. older, non-selective -adrenergic agents (e.g., isoproterenol) stimulated receptors on the heart also, which increased blood flow to low Va Q regions of the lung and could actually decrease Pao2. The benefits of relieving bronchoconstriction and increasing ventilation generally outweighed the negative side effects of -adrenergic agents on gas exchange, but the selective 2-adrener-gic agents completely obviate these side effects.

Advantages of breastfeeding

Enteromammary Pathway

There are a number of reports that show lower incidences of atopic illness such as eczema and asthma in breastfed babies. This effect is particularly important when there is a family history of atopic illnesses 22 . When the atopic illness is present, it is commonly associated with raised levels of immunoglobulin E, especially cow's milk protein.

The legal background labelling

This fish sauce may contain many ingredients which might include shellfish capable of causing an allergic reaction in susceptible people, yet the labelling meets the requirements of the law. Also, the stipulation for the labelling of functional additives may itself give rise to problems. A garlic puree used in garlic bread may have contained sulphur dioxide as a preservative, but because this preserving effect is no longer required in the finished product, possibly because it is frozen, there is no need to label its presence. This may present a hidden problem for asthmatics. Other exemptions may be realised through the provisions which permit the use of generic names for certain ingredients or because the ingredient is a food which itself is not required to be labelled with an ingredients list. Certain foods such as chocolate currently fall outside the requirements of food labelling law and are subject to the specific requirements of their own legislation. Typically, this may not...

Effects on Particular Organs or Organ Systems

Occupational exposure to a variety of substances is known to be capable of causing asthma. This is an allergic reaction in which exposure causes histamine to be released. Histamine stimulates the bronchi to contract, greatly increasing breathing resistance. This is known to affect bakers exposed to flour and workers exposed to wood dust, as well as butchers exposed to fumes caused by heat-sealing PVC films for wrapping meat. Some people become sensitized to toluene diisocyanate, which is used in polyurethane products. Subsequent exposures to very small amounts can cause a severe asthma attack. Immunostimulants usually cause their reaction within 15 minutes of exposure. A first exposure does not cause a reaction since the immune system must generate immunoglo-bulin antibodies. Second and later exposures cause the release of histamine, heparin, serotonin, prostaglandins, and other compounds. These result in symptoms such as asthma and rhinitis. Examples of immunostimulant toxins include...

Aptazyme Transcription and Purification

The aptazyme can be conveniently transcribed in vitro from a DNA template because it does not contain any site-specific chemical modification that would require incorporation by solid phase synthesis. The following protocols describe in detail how to transcribe and purify the theophylline specific aptazyme (Fig. 1) starting from the initial design of the DNA template. This procedure is schematically depicted in Fig. 3.

Medicinal Lauraceae

P. thunbergii (Sieb. & Zucc.) Kosterm. (Machilus thunbergii Sieb.& Zucc.), or common machilus, tabunoki (Japanese), is a tree native to Korea and Japan and is also found in Taiwan. The bark is smooth, fawn, and lenticelled. The leaves are spiral, simple, exstipulate-elliptic, glossy, and somewhat fleshy. In Japan and Korea, the plant affords a remedy for eczema, diseases of the spleen and stomach, and asthma.

Immediate and Nonimmediate Reactions to Contrast Media

Serious reactions to CM are comparable to type 1 hypersensitivity reactions (anaphylaxis), which begin within minutes after antigen exposure and are mediated by a variety of chemotactic, vasoactive, and spasmogenic compounds. Histamine seems to be the primary mediator of anaphylaxis anaphylactoid reaction and is responsible for the intense immediate manifestations. Preformed histamine is present in basophils and mast cells and is released rapidly by degranulation of these cells in a response to a variety of stimuli. There are several other biological mediators produced by mast cells and basophils, including leukotrienes, prostaglandins, enzymes, and a variety of cytokines. These substances act in an autocrine, paracrine, and endocrine fashion, triggering a cascade of inflammatory mediators. They induce vasodilatation, an increase in vascular permeability leading to edema, contraction of smooth muscle cells precipitating bronchospasm, and an increase in airway mucous secretion. The...

Predisposing factors for anaphylaxis

It is clearly established now that pre-existing asthma may exacerbate or predispose to anaphylaxis. This is clearly in keeping with the concept of the target organ of the reaction being important. Sampson's group of fatal and nonfatal reactors were clearly distinguished by the presence of a diagnosis of asthma, particularly if the asthma was poorly controlled. Our study in Southampton has supported this finding (Table 4.4).10,21

Information for industry

In 1993, the Food and Consumer Products Manufacturers of Canada (FCPMC) in association with Health Canada and the Allergy and Asthma Information Association produced an industry training programme called 'Allergy Beware'. The purpose of the programme, which includes a teaching guide, a video and a factory audit checklist, is to raise awareness about anaphylaxis in the food industry.

Sources of further information and advice

The Ministry of Agriculture, Fisheries and Food has produced information packs for the catering industries on how to anticipate the problems that might arise from allergic individuals in their restaurants. The Anaphylaxis Campaign, the British Allergy Foundation and their American counterpart, the Food Allergy Network, are excellent sources of rationally prepared and non-hysterical advice for individuals affected by food allergy and intolerance. The American Academy of Allergy, Asthma and Immunology has a website that has free patient information available, links to other sites and access to American physicians who may treat individuals. The Anaphylaxis Campaign has recently gone online. The British Allergy Foundation website is rather rudimentary at present.

Immunological Mechanism

Allergic asthma The main primary mediator, histamine, activates Hj and H2 receptors. Pruritus, rhinorrhea, tachycardia, and bronchospasm are caused by the Hj receptors, whereas both Hj and H2 receptors mediate headache, flushing, and hypotension. Gastrointestinal signs and symptoms are associated with histamine more so than with tryptase levels.

Idiopathic Scrotal Edema

Acute idiopathic scrotal edema (AISE) is a fairly common, yet underreported cause of the acute scrotum in children, accounting for as many as 30 of patients who undergo assessment (Najmaldin and Burge 1987). It is characterized by the rapid onset of nontender, frequently unilateral scrotal and penile erythema and edema. The patient is usually afebrile and is otherwise asymptomatic, apart from the distressing appearance of the genitalia. It is usually found in prepubertal children from 5 to 11 years of age. As the name implies, the cause of AISE is unknown however, some children present with a history of asthma or allergic conditions such as eczema or dermatitis (Klin et al. 2002). Laboratory investigations are usually normal, with occasional

Background Information

Sam's mother reported that asthma has weakened his vocal cords, leading to scar tissue and nodules. According to the speech pathologist, he had a speech language evaluation for voice concerns at the hospital approximately a year before kindergarten, but no services were deemed needed. Sam was evaluated by the speech pathologist at BBE in the Spring of 2000. His language skills were screened with the Clinical Evaluation of Language Fundamentals-Third Edition Screening Test. Sam did not meet criteria to pass this

Treating the immediate symptoms 551 Acute allergic reactions to foods

The severity of reaction depends on sensitivity of the patients to food allergen and the amount ingested. Patients with life-threatening symptoms such as respiratory difficulty due to laryngeal oedema or severe bronchospasm and or hypotension should be regarded as having a severe reaction or anaphylaxis.13 Troublesome, but not immediately life-threatening, reactions such as generalised urticaria angioedema and bronchospasm of moderate severity may be termed severe allergic reactions. Sometimes the reaction is mild and confined to an organ or system, for instance oral or gastrointestinal symptoms or localised urticaria.

Severe allergic reactions

Bronchospasm Mild to moderate bronchospasm commonly occurs as part of a generalised reaction but may be the most prominent symptom. This usually responds to inhaled or nebulised bronchodilator in addition to corticosteroids. Short-acting beta-2 agonists such as salbutamol or terbutalin may be given through a metered dose inhaler attached to a spacer device when outside the hospital. If the response is not adequate, the patient should be transferred to the hospital where nebulised or intravenous bronchodilator may be administered. Corticosteroids

Prevention of allergy

There is general consensus that the prevalence of asthma and other atopic diseases, including food allergies, is increasing. A history of allergic disease in the immediate family (atopic heredity) is the most important risk factor. Recent studies indicate that exposure to allergens in utero and in the first few months of life is critical in the development of allergic disease in children with an atopic heredity. In children at high risk, reduction in exposure to allergen should lead to a decline in disease prevalence. Food proteins are important allergens in early childhood. A hypoallergenic diet has therefore been suggested as a means of preventing the development of allergy.

Other symptomatic treatment

Ketotifen with antihistaminic and anti-inflammatory properties has been used in food allergic reactions such as urticaria and bronchospasm. It may be useful as an additional therapy in some patients. Beta-2 agonists such as salbutamol or terbutalin may be used when bronchospasm is a prominent feature in an allergic reaction. These drugs can be delivered by inhalation through a metered dose inhaler, in an aerosol form through a nebuliser, or by intravenous route. Food-related eczema and rhinitis should be treated along the standard line with topical steroids and antihistamine in addition to allergen avoidance.

Occupational food allergy

A number of shellfish can cause occupational asthma and rhinoconjunctivitis primarily from inhalation of particles during food processing. The reactions have been demonstrated to occur with shrimp, crab and oyster handlers. Workers affected include those involved in seafood processing, cooks and fishermen (Malo and Cartier 1993). Up to 10-40 of workers exhibit respiratory symptoms, and in studies where skin testing has been done up to 60 are found to be positive, with a close correlation between skin test reactivity and clinical reactivity (Orford and Wilson 1985, Cartier et al. 1986). Baker's asthma is due to sensitisation to cereal proteins. The majority of cases are reported to wheat, rye and barley, and it has been one of the most common occupational diseases in the UK (Block et al. 1984). One study found 7-9 of bakers to be affected (Thiel and Ulmer 1980), and there may be a long latent period of up to 10-15 years before symptoms occur. Again, atopic individuals appear to be at...

Occupation and smoking

Respiratory diseases have known associations with those working in the food and food-related industries. These include occupational asthma, occupational rhinitis and hypersensitivity pneumonitis. Skin diseases such as contact dermatitis and contact urticaria are also associated with work in these industries. These diseases are not all Type I, IgE-mediated reactions. Some cases of occupational asthma and some of contact dermatitis occur as a result of irritation.12 Hypersensitivity pneumonitis occurs as a result of a Type III or possibly a Type IV hypersensitivity reaction.13 As with non-industrial food allergy or intolerance, the pathophysiological mechanism affects the choice of diagnostic tests. at higher risk of occupational asthma. More than 50 agents have been implicated. Such diseases among workers in food industries are sometimes due to the food proteins themselves, but in other cases the specific IgE is directed against microorganisms or insects involved in food production or...

Intervention strategies aimed at preventing adverse food reactions

Most of the work in this area has been directed at preventing allergic sensitisation (primary prevention), rather than the prevention or suppression of clinical disease once sensitisation has occurred (secondary and tertiary prevention respectively). Up to now, no therapy has been shown to be of value in secondary or tertiary prevention of adverse food reactions. Furthermore, whilst some studies show that pharmacological intervention may alter the incidence and natural history of asthma, there are no comparable data regarding adverse food reactions (Bustos et al. 1995, Warner 1997). This section therefore concentrates on the dietary intervention studies set up with the aim of preventing or reducing the occurrence of adverse food reactions. Some of the studies look at children with a high risk of atopy (usually defined as those children with at least one first-degree relative with documented atopic disease), others at unselected children from the general population. Most do not focus...

Commonly reported food allergies 1031 Cows milk

In general, adverse reactions to soy are first seen in the later part of infancy although when infants are exposed to soy at a young age, reactions can occur (Bruno et al. 1997). The prevalence of self-reporting of soy allergy is very low unless a selected, atopic population is studied (Table 10.3). In atopic children presenting to allergy clinics the prevalence is 1.2-3 when diagnosed by open challenge. In unselected childhood population, the prevalence is only 0-0.3 . Most of these children have positive specific IgE to soy and react within four hours. Where soy allergic children have been followed up, all have been found to outgrow their allergy within seven years (Bock 1982). This correlates with adult studies where the prevalence of soy allergy has been estimated as zero (Table 10.3). Soy may behave as an aeroallergen in both adults and children in Barcelona, aerosolised soy from the port has been linked to epidemics of asthma (Navarro et al. 1993).

Heterologous Enzyme Production

Regular enzyme application in the dough system is carried out by exogenous addition of commercial preparations. Although substantial amounts of these compounds are obtained from recombinant organisms, mainly fungi and bacteria, all of them contain a cocktail of minor enzymatic activities that may negatively affect bread quality. Moreover, these products may act as allergens, producing a high prevalence of occupational hypersensitivity, in terms of dermal and bronchial (asthma) allergies (164-166). Alternatively, recombinant baker's yeast strains producing a technological enzyme can be employed to obtain the same benefits, avoiding airborne allergen pollution at the workplace (167).

Recognition of Microbial Components

Forward View Summary

These findings apparently reflect that a leaky surface epithelium anywhere in the body may be a predisposing condition for allergen penetration, and that food allergy could be a consequence rather than a cause of atopic eczema 12 . Therefore, the use of this disorder as a clinical read-out of intervention effects on food allergy may not be scientifically acceptable.

Cells Regulates Inhalation Tolerance

C5aR signaling in mice results in spontaneous development of a Th2-polarized immune response. Moreover, repeated pulmonary exposure to ovalbumin, resulting in inhalation tolerance, induced a strong Th2 adaptive immune response, associated with eosinophilic and lymphocytic airway inflammation and increased airway responsiveness in the absence of C5aR signaling115. These data suggest a dynamic model of inhalation tolerance in which C5aR signaling in pulmonary DCs is necessary to prevent their full activation and subsequent induction of adaptive immunity. Thus, adaptive immune responses not only develop when infectious (non-self) or noninfectious danger signals trigger TLRs, but also in the absence of complement-derived danger transmitters. As is evident from these data, the term danger transmitter does not adequately describe the effect of C5a on DCs, which is suppressive but not activating. Rather, C5a needs to be considered an endogenous, soluble self-recognition signal, the lack of...

Clinical Development Plan

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

Acidbase Disorder Common Causes

(anesthetics, opiates, barbiturates, ethanol) Decreased amount of functioning lung tissue bronchial asthma, chronic bronchitis, emphysema, pneumonia, hemothorax, pneumothorax, pulmonary edema Airway obstruction foreign body aspiration, sleep apnea, bronchospasm, laryngospasm blood) anemia hypotension high altitudes and pulmonary disease, such as pneumonia, interstitial lung disease, pulmonary vascular disease, and acute asthma Direct stimulation of the central respiratory center anxiety, pain, fever, sepsis, salicylate ingestion, head trauma, central nervous system (CNS) disease (inflammation, lesions)

Adverse Effects Interactions and Pharmacokinetics

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

Clinical Features of Infection

In humans, influenza is characterized by the sudden onset of an acute respiratory illness with headaches, chills and nonproductive cough, followed by high fever, muscle aches, generalized weakness and loss of appetite. The fever declines by the third day and is usually gone by the sixth day, but cough and weakness can persist for an additional 2 weeks. More severe illness can develop if primary influenza pneumonia or secondary bacterial pneumonia occurs. People over 65 years of age and those with health problems, such as heart conditions, emphysema, asthma or acquired immune deficiency syndrome (AIDS), and children and adults receiving cancer chemotherapy are at increased risk for complications from influenza and should receive yearly vaccination. At least 10000 excess deaths (over expected) have been documented in each of 19 different US epidemics in the period 1957-1986 in three epidemics there were 40 000 excess deaths. Approximately 80-90 of the excess deaths attributed to...

Metabolism of Chemotherapeutic Agents

While most significant associations between GST genotypes and clinical phenotype have not been replicated, a minority have been independently confirmed. For example, GSTP1 Val105 Val105 has been associated with reduced risk of airway hyperresponsiveness (odds ra-tio 0.23-0.38) in three studies in asthmatic adults and children. 20 This genotype is also protective against childhood respiratory illness. 21 The advent of high-throughput genotyping, availability of new SNP, and ease of deriving haplotypes should place an emphasis on large studies incorporating some assessment of reproducibility. Furthermore, assessment of further allelic GST sites associated with binding of peptides involved with cell signaling warrants further investigation.

Prevention and Control

An alternative approach is interferon, produced in large amounts by recombinant DNA means. High, intranasal doses, initiated several days before virus challenge, have proved to be effective in preventing illness. However, side effects limit long-term use and as symptoms are only reduced if treatment is commenced before virus infection, interferon has limited applicability. It may prove useful in the family context when it is important to prevent virus spread to specific individuals, e.g. asthmatics and bronchitics. In these cases, it may also be possible to use what we know about the properties of rhinoviruses and their mode of transmission to limit spread. Interrupting transmission by avoiding direct contact with the infected person and by frequent hand-washing is sensible. Furthermore, experiments have been performed in which paper tissues impregnated with virucidal agents (mild acid to exploit rhinovirus lability at low pH) were used for frequent...

GnRH agonists in diagnosis

Related to the endocrine cycle and which (i.e. those which persist) are not. This is also a valuable way of demonstrating whether symptoms or medical problems such as premenstrual migraine, asthma and epilepsy are truly related to the hormone cycle. If a woman was undergoing a hysterectomy for a gynaecological indication, such information may help the patient make the decision to conserve or retain her ovaries. If any PMS or other premenstrual symptom is eradicated by GnRH, it is likely (though not guaranteed) that she would also benefit from removal of ovaries if the hysterectomy is being undertaken. This information would be valuable in the final pre-operative counselling.

Respiratory disorders

Asthma Asthma is the most common respiratory disorder affecting 3 of women of childbearing age. Pregnancy has a variable effect on asthma but for the vast majority of women there is no impact whatsoever. The most common reason that their asthma symptoms deteriorate is patients reducing their treatment because of a belief that the medication may be harmful. All commonly used medications to control asthma aresafein pregnancy. All patients must be reassured that any flairs of their asthma must not be ignored and that treatment with medication such as steroids is safe both for themselves and for their fetus. With regard to the effect of asthma on fetal outcome, there is no evidence that there is any significant impact on fetal growth or outcome. Any patient whose asthma seems to be deteriorating, particularly in the third trimester, should be seen by an obstetric physician for review. It is obviously desirable that control of their asthma should be at its optimum prior to the onset of...

Dosage Form Decisions

The other key item in selecting the product profile is defining how the product will be used. A product intended for surgical anesthesia would be most amenable to an injectable dosage form that can be easily titrated to achieve the desired level of anesthesia. A product intended to treat heartburn would likely need to be self-administered as an oral dosage form. A product intended to be given predominantly to smaller children would be easier to administer as a solution or a suspension. Product use and the resulting product profile also may be dependent on the disease being treated. Diseases producing significant nausea such as cancer may need non-oral alternatives to ensure proper dosing. Asthma can be treated with inhalation products, depending on the mechanism of action, given the pulmonary site of disease and the accessibility of lung tissue to direct product administration. Diseases that harbor in specific tissues may benefit from special direct extravascular administration, such...

Measurement Of Venous Pressure

Note the higher absolute level but smaller amplitude of pulsations on expiration. With bronchospasm jugular pulsations with normal pressures may only be visible above the clavicle during expiration due to the effect of straining, which elevates intrathoracic pressure with each expiration.

Why is a priori testing important

In a New Zealand study evaluating asthma treatment,6 regular and as needed administration of fenoterol were compared using a non-standardized combination of respiratory flow, symptomatic improvement and drug use. The investigators reported that a significantly greater number of patients deteriorated over 24 weeks when given regular inhaled beta-agonist treatment compared to on-demand treatment. Unfortunately, the home-made criteria for assessing drug effectiveness had not been specified in advance. Often it is impossible for readers to know when investigators play the postmaster's game, even if the study is reported in a highly reputable journal. Without access to the trial protocol or a design paper, one cannot know for certain whether the investigators clearly stated a limited number of a priori hypotheses or whether the hypotheses

Why are clinical trials unreliable for the detection of rare adverse events

When a new compound intended for chronic or life-long use is introduced into the market, approximately a few hundred patients will have been treated for one year or longer. If the agent is an inhaled steroid for treatment of asthma, a lipid-lowering statin, or an antihypertensive drug, one can assume that the medications will be prescribed for longer than one year, maybe even for decades. Thus, one could legitimately question whether the one-year experience with the compound is adequate to predict drug safety over 5, 10, or up to 30 years. Many serious adverse events may take several years to become apparent. For example, it may take more than a decade of tobacco use to cause lung cancer. A safety profile based on limited drug exposure is inadequate and can be very misleading.

Diagnostic Tests and Risk Factors

Generally, all patients with a history of asthma or atopy (including hay fever and food allergies) have an increased risk of anaphylactic anaphylactoid reactions in the perioperative interval. Risk factors have been clearly demonstrated for two major allergens commonly found in hospital 1. Although reactions to iodinated radiographic CM are not true allergic ones, patients with a history of a previous reaction to contrast material have a three-to fourfold greater risk of subsequent reaction than the general population (Katayama et al. 1990 Mor-cos and Thomsen 2001). Other important risk factors include asthma and a history of atopy, including hay fever and food allergies, increasing the risk of anaphylaxis eight- to tenfold (Morcos and Thomsen 2001 Shehadi 1982). In addition, patients treated with -adrenergic blockers and interleukin-2 are at increased risk of acute adverse reactions to CM (Thomsen et al. 2004 Morcos 2005) (see Sect. 4.7).

Collaboration with governments

However, all this began to change in late 1993 when five deaths triggered by allergic reactions to peanuts or nuts received widespread national publicity. Almost overnight, allergy became a serious issue. The death of my teenage daughter Sarah was reported by the Mail on Sunday in December 1993 - two days before an inquest was held - and subsequently by numerous other newspapers and television news programmes just before Christmas. Sarah's death caught the imagination of the media and the public generally. She was an attractive young hairdresser who had taken a rail trip to town one afternoon on her own and had treated herself to a slice of lemon meringue pie in her favourite restaurant. She had died a few hours later of anaphylactic shock, the most severe symptoms being severe bronchospasm and a dramatic fall in blood pressure. I am sure many people were deeply moved by the image of this innocent young girl being killed by something as innocuous as the peanut. Other deaths which...

Risk Versus Benefit Assessment

A good example of an application of mechanistic modeling in quantitative risk benefit assessments comes from the literature on inhaled corticosteroids (43,44). While inhaled corticosteroids present a viable therapeutic option for asthma, there have been questions on their long-term safety. Specifically, these concerns stem from their potential to suppress development of the adrenal function. Consequently, a clear delineation of the benefit (for asthma) and risk (clinical adrenal suppression) is necessary for development of newer inhaled cor-ticosteroids. Here the benefit is a conglomeration of all favorable attributes of a molecule, including optimal PK properties, drug delivery properties, and increased residence in the lung, which may likely contribute to a more favorable systemic side-effect profile. An assessment of a quantitative risk benefit value would entail the use of cortisol levels in plasma as a biomarker of the suppression in adrenal function. PK PD modeling can then be...

Genetic Characteristics of Founder Populations

Founder populations may have increased prevalence of certain genetic traits, including genetic disease. Disease alleles that happen to be present in the founders may be passed on to offspring, and, since the population is small, there may be a higher prevalence of the disease than in other, larger populations. Isolated founder populations, with little marriage outside of the populations, are especially likely to have a higher prevalence of recessive disorders, since parents are likely to share many genes, and there is an increased chance of inheriting two copies of a particular disease gene. Examples of rare genetic diseases that are prevalent in founder populations are Tay-Sachs disease in Ashkenazic Jewish populations and asthma in the Hutterian population.

Antirhinoviral Strategies

Although the common cold is usually mild, with symptoms lasting a week or less, it is a leading cause of physician visits and of school job absence in addition to several more severe exacerbations like asthma (see above). Initial studies that employed monoclonal antibodies to define candidates of viral receptors demonstrated a surprising 'immunological resistance' of rhinoviruses. On the one hand this is due to the fact that over 100 different rhinoviral serotypes have been isolated and antibodies raised against one serotype after immunization are not necessarily protective against a different serotype. However, the identification of the so-called 'canyon' allowed an additional explanation if this 'canyon' represents the predominant site of receptor interactions, it is difficult to block with antibodies since the canyon is too narrow to enable interactions with the antigen. Both findings seem to rule out vaccination as a standard antirhinoviral treatment. Hence, the canyon structure...

Exubera Inhaled Insulin

Inhaled insulin is not a new insulin it is simply an old insulin (regular insulin) that is delivered into the body in a different way. You use an inhaler (very much like an asthma inhaler) to inhale the insulin powder, which is available in 1 mg and 3 mg blister packs. You should not use Exubera if you have lung disease such as asthma or bronchitis, or if you are a smoker. Smoking results in more of the insulin being absorbed, and you have to stop smoking for at least six months before you can start on inhaled insulin. There are higher levels of antibodies to insulin in the blood after using inhaled insulin compared to injected insulin, but this does not seem to have a negative effect. Other side effects include cough, shortness of breath, sore throat, and dry mouth. In the clinical trials of Exubera, approximately 2,500 adult patients with type 1 and type 2 diabetes were studied for an average duration of about two years. Many more people will need to take inhaled insulin for longer...

Adenosine Ai Receptor Related Ligands

Angiotensins II, III and IV (Ang II, Ang III and Ang IV) exert a crucial rote in learning and memory processes either alone or interacting with other neurotransmitters and neuromodulators. The present study examines the functional interaction between angiotensin II, III, IV and adenosine A receptor-related drugs on passive avoidance (step-through) conditioning in rats. Ang II and III facilitated while the heptapeptide decreased the retention response. Adenosine A, receptors could modulate the realization of angiotensins memory effects. Adenosine A and Ang II receptors interact in adaptation to long-term theophylline administration in step-through memory task. Taken together, the obtained data suggest that angiotensin peptides are closely implicated in the regulation of memory retention processes and mutual interaction with adenosine A receptors could play an important role in its realization. Adenosine Ai receptors play a significant role in the cognition. Thus, the selective agonists...

Salt And Diet

Philip Karrell (1806-1886), personal physician to Tsar Alexander III of Russia, was the first to advocate a simple dietary regimen (200 ml of milk four times a day) for the treatment of dropsy, which he presented to the Medical Society of St. Petersburg in 1866. He credited his observations to a Doctor Inosemtzoff, who in 1857 had published a book titled De la Cure de Lait, which is also the title Karrell gave his paper. Karrell reported not only on the improvement of dropsy with his regime but also that of asthma, neuralgias, and liver disease. He attributed the curative powers of milk to its diaphoretic, diuretic, resolvent or tonic effects. Charles Richer (1850-1931), Professor of Physiology in Paris, famous for introducing the term anaphylaxis in medicine, reported in 1881 on the diuretic action of milk as well as that of different sugars. The use of a milk diet continued for over 40 years before the mechanism of its effectiveness was elucidated 16, 35 .


Caffeine held its undisputed position as a diuretic until 1887 when W. von Schroeder investigated the diuretic properties of theobromine, the alkaloid of cocoa bean and an analog of caffeine. Theobromine exceeded caffeine in both diuretic capacity and duration of action. The clinical demonstration of its efficacy led to the introduction of a combination of theobromine and sodium salicylate as a diuretic agent, which was successfully marketed by Knoll Company under the trade name of Diuretin in 1888. The third xanthine diuretic, theophylline, was extracted from tea leaves in 1888 but not introduced into therapeutic use until 1902, when it was synthesized and marketed by Bayer Company under the trade name of Theocin. In 1908, a new synthetic agent, aminophyl-line (theophylline ethylene diamine) was introduced by G. D. Searle and Company under the trade name of Emphyllin. The quest for orally effective xanthines with fewer side-effects led to the introduction of aminouracils, of which...

The Opioid System

Historically, the nociceptive analgesic effect of naturally occurring opiates such as morphine has long been recognized by humans. Advances in research in the last several decades have revealed the existence of the so-called endogenous opioid peptides, can be divided into three classes dynorphins, enkephalins, and -endorphins. Contrary to the initial understanding, in addition to the cells of the central nervous system, those of peripheral tissues such as cardiac myocytes and heart tissues also express opioid peptides (1-3). The wide distribution of opioid peptides throughout the body underscores their involvement in a variety of cellular activities including pain regulation, respiration, immune responses, and ion channel activity (4) as well as possibly pathophysiological conditions such as asthma, alcoholism, and eating disorders (5-7).


The metabolism of azalides is quite different from other macrolides. In vitro studies have demonstrated a lack of degradation of azithromycin within the cytochrome P450 system (8). In addition, numerous drug interaction studies have shown no impact of azithromycin on the metabolism of theophylline, terfenadine, estrogen, carbamazepine, rifabutin, and zidovudine (9-11). With regard to azithromycin, most of the drug is not metabolized at all, with two-thirds being excreted unchanged in the bile. Metabolism of the remaining drug occurs via demethylation of the nitrogen groups.


Centaury earned a reputation as a tonic (Vickery. 1995). Gypsies used it as such (Vesey-Fitzgerald). The juice (in whisky ) is described on South Uist as excellent for the one in need of a nerve tonic or for weakness following an illness (Shaw). From an Irish recipe a cordial was made of one part gentian, two parts of centaury, bruised well together, and mixed with distilled water for a drink (Wilde. 1890). It is, too an Irish remedy for asthma (O Suilleabhain), and it is taken internally for muscular rheumatism (Moloney).The flower or leaf infusion makes a good wash for wounds and sores, for it is strongly antiseptic (Conway). It is also used as a wound salve in the Balkans, and is drunk in decoction to check menstruation. or when blood is found in urine or the spittle, and thus for coughs or chest pains (Kemp). And in early times it had a great reputation for healing snake-bites (see Cockayne, and Dawson. 1934). Topsell The history of four-footed beasts (1607), and The history of...

Pulmonary System

Acetazolamide has effects on pulmonary function that may be of clinical importance. Carbonic anhydrase is abundantly present in the lung, primarily located at the alveolar-capillary barrier. This location allows for the enzyme to cause the rapid dehydration of carbonic acid, thereby facilitating the excretion of pCOz. Inhibition of this enzyme with acetazolamide leads to an increase in tissue pC02. In patients with chronic obstructive pulmonary disease in whom pulmonary reserve is limited, such an increase may be of clinical consequence. In patients with asthma, inhaled acetazolamide has been shown effective in limiting the bronchoconstrictive response to cold-air hyperventilation. The mechanism of this protective effect is unknown. A large number of studies have shown that furosemide is effective in preventing bronchoconstriction induced by a variety of stimuli. This protective effect is mostly seen when asthmatic subjects are challenged with stimuli that indirectly act to induce...


In Vietnam, Cambodia, and Laos, the roots are used to cure inflamed throat, reduce fever, and remove blood from urine. In Indonesia, a tea of the leaves is drunk to treat asthma and cough. The plant is known to elaborate a series of polygalasaponins including polygalasaponins XLII-XLVI, hence mucolytic properties (26,27). The plant elaborates a series of oligosaccharide polyesters, the effects of which would be worth assessment because oligosaccharides, especially from the Caryophyllidae, displayed very encouraging pharmacological potentials as antiviral and immunomodulatory agents.


This drastically intensified the biochemical investigations on and with DNase I. In 1950, Armstrong, et al., reported that partially purified bovine pancreatic DNase I reduced the viscosity of purulent cystic fibrosis (CF) lung secretions 8 . Clinical trials with inhaled bovine DNase I followed soon after and showed clinical improvements in CF patients and patients with purulent secretions 9-11 . In 1958, bovine pancreatic DNase I (Dornavac) was approved in the United States as a mucolytic agent for human use 12 . However, in the early 1960s, severe adverse reactions like bronchospasms and asthmatic attacks led to the withdrawal of bovine pancreatic DNase I from the market 13,14 . During the following decades, clinical interest in DNase I diminished, but DNase I received much attention once again when Shak, et al. 12 cloned the human version of it in 1990. In 1993, this led to the marketing of recombinant human (rh) DNase I under the trade name Pulmozyme (Genentech Inc., San...

Elderberry Wine

Apparently once called Pop-gun in the south of England (Halliwell), it has always been popular, so much so that whole orchards of the trees were planted in Kent, and the berries have even been used for making ersatz port (Jordan). Evelyn (in Sylva, 1729) was of the opinion that it greatly assisted longevity , and Cobbett was enthusiastic too - a cup of mulled elder wine, with nutmeg and sippets of toast, just before going to bed on a cold winter's night, is a thing to be run for . Besides, it is good for sciatica, so it is claimed (Moloney), and according to another Irish belief, drinking it will cure pimples on the face (Maloney). Mulled elderberry wine is certainly good for a sore throat, and also for asthma, so it is claimed (Hatfield).


For medicine for humans, the roots have been used for a long time (and apparently still are (Le Strange) ) to make cough candies (Brownlow) they were, too, a long-standing remedy for bronchitis (Clair), and even for hay fever (Conway). The infusion of the fresh roots was used for whooping cough (Thornton), or for asthma (Forey). The existence of names like Elf-wort, or Elf-dock, suggested to Grigson that supernatural belief was mixed up with real medicinal value (Grig-son. 1952). Be that as it may, the tincture is still sometimes taken for loss of appetite (Fl ck) (Gerard too said it is good and wholesome for the stomacke ). From Apuleius as far as Gerard, elecampane was used for worms, even, apparently, by laying the preparation on the stomach. It is not very clear what Gerard wanted his patients to do with it - presumably drink the juyce boyled, for it driveth forth all kinde of wormes of the belly. .


Airway smooth muscle in asthma. Perturbed equilibria of myosin binding. Am. J. Respir. Crit. Care Med., 161, S158-60. Fredberg, J. J., K. A. Jones, et al. (1996). Friction in airway smooth muscle mechanism, latch, and implications in asthma. J. Appl. Physiol., 81, 2703-12.

Carcinoid Syndrome

The aptly named carcinoid crisis presents with flushing, profound hypotension (sometimes hypertension), and occasionally, bronchospasm or tachyarrhythmias (105). Stressors such as anesthetic induction for surgery or surgical manipulation of the tumor usually precipitate this phenomenon, which is believed to be mediated by a massive release of vasoactive amines by the tumor. The hypotension is difficult to treat because it is resistant to sympathomimetic agents. These agents may actually induce more release of vasoactive substances from the tumor (89). A recommended therapy for the hypotension of carcinoid crisis is the combination of fluid administration in conjunction with an infusion of octreotide, which often corrects the hypotensive episode in 10 min (89,106).


Most patients with metastatic carcinoid tumors live for some time after diagnosis, given the slow-growing nature of the tumor (Table 3). Physicians are often left with palliative treatment of symptoms, and should do so in these challenging cases. Conservative treatment of symptoms with agents such as loperamide for mild diarrhea, nicotinic acid to prevent pellagra, bronchodilators for bronchospasm, and controlling symptoms of heart failure when valvular problems occur, are an integral part of supporting patients with this illness.

Indian Tobacco

(Lobelia inflata) In large doses, this is a poison (Weiner), but in small ones, it is useful for asthma (one of its names in America is Asthma-weed). It was actually introduced into Britain for this purpose around 1830 (W A R Thomson. 1976). The leaves and tops of Thorn-apple are mixed with this herb to make the asthma powders commonly sold for the relief of the complaint. A little nitre is included to make it burn, and the smoke is inhaled. The mixture is often made up into cigarettes, for convenience (Hutchinson & Melville). The plant has also been used to treat falling hair. The Indiana practice is to fill a bottle with


It has been used as a medicine by both native American Indians and Caucasian immigrants, and also by African Americans, who take the root tea for kidney and liver problems (Fontenot). The Hopi used the powdered dried root (a teaspoonful in half a glass of cold water) as a contraceptive, lasting a week. Two teaspoons of a hot infusion would bring permanent sterility, so they said (Weiner). Another use of the root, pounded, is for a poultice to put on sore eyes. Small doses of the partially dried rhizome are used to treat chronic bronchitis, asthma and rheumatism, the latter also treated by the Pawnees with the powdered rhizome (Corlett).


The system suitability of Apparatus 1, 2, and 4 as described in USP 23 NF18 requires the testing of two types of USP calibrator tablets, non-disintegrating salicylic acid tablets and disintegrating prednisone tablets. The system suitability of USP Apparatus 3, the reciprocating cylinder, requires the testing of chlorpheniramine maleate extended-release tablets and theophylline extended release beads 15 . The calibrator tablets are supplied with a certificate of acceptable ranges established for the specific lot of calibrator tablet. The appropriate USP reference standard should be used when testing the calibrator tablets. Calibration should be conducted at regular intervals (usually every six months) or when the apparatus is moved or maintenance modifications are performed. For Apparatus 1 and 2, the acceptance ranges for the calibrator tablets are given at both 50 and 100 rpm. Some dissolution tests require modifications in the setup of the Apparatus 1 and 2 such as a two liter...


The inverse relationship between previous appendectomy and ulcerative colitis has been confirmed in several studies. In a study including 213 patients with UC, 110 with CD and 337 controls, a highly significant association to appendectomy was found for UC (OR 0.20), and even higher when the operation was performed before the age of 20 (OR 0.14). No association was found for CD, and no association for tonsillectomy for either disease 120 , Moreover, the study from Spain also showed that appendectomy was less frequent, not only among UC and CD patients, but also among their relatives 120 , compared to the general population. A case-control study from Iran confirmed the inverse relationship between appendectomy and UC in contrast to Crohn's disease 121 . A population-based study from New Zealand reported that not only appendectomy, but also tonsil-lectomy, infectious mononucleosis, and asthma were more common in CD patients than controls 122 , Another case-control study from Spain 123...

Dealing With Asthma Naturally

Dealing With Asthma Naturally

Do You Suffer From ASTHMA Chronic asthma is a paralyzing, suffocating and socially isolating condition that can cause anxiety that can trigger even more attacks. Before you know it you are caught in a vicious cycle Put an end to the dependence on inhalers, buying expensive prescription drugs and avoidance of allergenic situations and animals. Get control of your life again and Deal With Asthma Naturally

Get My Free Ebook