Vocal Cord Dysfunction: A Functional Respiratory Tract Disorder

Vocal Cord Dysfunction
Vocal cord dysfunction (VCD) is a functional respiratory tract disorder resulting from paradoxical adduction of the vocal cords, complicates the diagnosis and management of common respiratory tract problems, including asthma. The recognition of VCD in a patient with atypical or difficult-to-control asthma is critical in minimizing symptoms and potential side-effects associated with treatment of severe asthma. The symptoms of VCD are not unique to the disorder and include cough, wheeze, stridor, dyspnea, hoarseness, and choking. (more…)

Asthma Progression of Disease with Abnormality in Pulmonary Function

asthma progression
More severe asthma can persist from childhood into adulthood without remission. Another important tendency in the natural history is for symptoms to remit in adolescence only to return again in adulthood. In general, the amount of wheezing in early adolescence seems to be a guide for severity in early adult years, with 73% of those with few symptoms at age 14 years continuing to have little or no asthma progression at age 28 years. Similarly 68% of those with frequent wheezing at 14 years still suffered from recurrent asthma at age 28 years. Most subjects with frequent wheezing at 21 years continued to have comparable asthma at 28 years. In addition to the importance of symptoms in childhood, childhood degree of bronchial responsiveness in combination with a low FEV-1 were also related to the outcome of asthma in adulthood. (more…)

Airway Fibroblasts Exhibit A Synthetic Phenotype in Severe Asthma

Airway Fibroblasts
Airway remodelling is considered to be of major importance in the pathology of asthma, with subepithelial basement membrane thickening in particular being indicative of early development of the disease and characteristic of its progression. Airway fibroblasts are central cells in the processes of remodelling: increased deposition of fibroblast-derived connective tissue proteins and differentiation of fibroblasts into contractile myofibroblasts are consistent observations in morphological studies of moderate to severe asthmatic airways. The secretory function of fibroblasts is under the control of locally produced growth factors such as vascular endothelial cell growth factor (VEGF, see below) and platelet-derived growth factor (PDGF). (more…)

Antileukotrienes in Acute Asthma: Zafirlukast, Montelukast, Leukotriene Receptor Antagonists

Leukotriene Receptor Antagonists
Leukotrienes can be found in the airway and urine following both spontaneous exacerbations of asthma and acute exposure to bronchoconstrictor stimuli in the laboratory. This in turn indicates that they may have a role in the pathogenesis of acute episodes of bronchoconstriction. Although antileukotrienes are not currently advocated in the management of acute asthma, there are data to suggest that they might be of some potential benefit. Prior treatment with montelukast asthma has been shown in several studies to significantly shorten the time taken to recover (in terms of FEV 1 ) following exposure to a bronchoconstrictor stimulus. (more…)

Asthma Morbidity and Mortality

asthma morbidity
In 2004, there were 2.4 million children aged 5 to 14 years, or 5.9% of this population group, with a self-reported asthma attack, with no decrease in prevalence since 1997 1 in spite of the much improved therapies available. In this interval, the number of physician office visits for asthma doubled, from 1.7 to 3.3 million which many leads to asthma morbidity and asthma mortality. (more…)

Asthma and Stress: How are They Related?

asthma stress
Negative family characteristics such as family conflict and family dysfunction discriminated children who died of asthma from children with equally severe asthma who did not die. Parenting difficulties have been associated with a higher risk for the development of asthma early in life. In addition, children with the highest risk of developing early-onset asthma were those in families with both parenting problems and high stress. Evidence for a asthma and stress link has been demonstrated through temporal studies, as experiencing an acute negative life event increased children’s risk for an asthma attack 4 to 6 weeks after the occurrence of the event. (more…)

Budesonide Inhalation Dose versus Maintenance Treatment in Asthma Exacerbations

budesonide inhalation
This study was similar to the study of Harrison and colleagues, which looked at doubling the dose of inhaled corticosteroid during an asthma exacerbation. This study investigated whether doubling the dose of budesonide inhalation in patients on regular inhaled budesonide would be beneficial during an asthma exacerbation. (more…)

Budesonide Formoterol Inhaler Therapy Safety in Moderate To Severe Asthma

Budesonide Formoterol
This study evaluated budesonide formoterol efficacy and safety of a novel asthma management strategy for both maintenance and symptom relief (Symbicort Single Inhaler Therapy) – compared with a higher maintenance dose of budesonide in patients with moderate to severe asthma. (more…)

Leukotriene B4 in Exhaled Breath Condensate And Sputum

Leukotriene B4
Some features seem to be common to severe asthma and Chronic Obstructive Pulmonary Disease with reversibility of airflow limitation. The neutrophil chemoattractant leukotriene B 4 (LTB 4) may play a role in Chronic Obstructive Pulmonary Disease and in some forms of asthma. In this study, 55 smokers with no disease, Chronic Obstructive Pulmonary Disease (with or without bronchodilator reversibility of airflow limitation) or asthma underwent measurement of LTB 4 in sputum supernatants and exhaled breath condensate asthma (EBC). Both Chronic Obstructive Pulmonary Disease and asthma patients had higher levels of LTB 4 than control subjects; patients with asthma or reversible Chronic Obstructive Pulmonary Disease exhibited significantly higher levels of LTB 4 than those with irreversible Chronic Obstructive Pulmonary Disease. (more…)

Tumour Necrosis Factor Alpha in Symptomatic Corticosteroid-Dependent Asthma

Tumour Necrosis Factor Alpha
Tumour necrosis factor alpha (TNF-a) is a major therapeutic target in a range of chronic inflammatory disorders involving neutrophils and its excess production is characterized by a Th1-type immune response. Asthma is regarded as a Th2-type disorder when associated with atopy, (more…)

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