The prevalence of aspirin-sensitive asthma is uncertain although it may exist in up to 20% of all asthmatics patients. The characteristic features include profound bronchoconstriction asthma following aspirin ingestion, rhinosinusitis, nasal polyps, and abdominal cramps. Aspirin and nonsteroidal antiinflammatory drugs selectively inhibit COX-1, which in turn shunts arachidonic acid down the 5-lipoxygenase activating protein pathway, causing overproduction of cysteinyl leukotrienes. As a consequence, elevated levels of cysteinyl leukotrienes can be found in bronchial asthma and nasal aspirates, and in urine following aspirin challenge. (more…)

A role for Leukotriene B4 in the induction of airway hyper-responsiveness was explored through the use of transgenic mice deficient in the BLT1 receptor for LTB4 . Ovalbumin challenge of sensitized wild-type mice resulted in the usual features of experimental asthma, including goblet cell hyperplasia, hyper-responsiveness to inhaled methacholine and elevated BAL fluid concentrations of the Th2 cytokine IL-13. In contrast, BLT1 –/– mice (i.e. genetically modified mice lacking the gene coding for the BLT1 receptor) exhibited significantly lower responses. BLT1 –/– mice also exhibited lower numbers of IL-13-positive T lymphocytes of both the helper (CD4 T Cells) and cytotoxic/suppressor (CD8 + ) types. (more…)

A variety of proinflammatory cells, mediators, and cytokines orchestrate the development of airway hyperresponsiveness, which results in the episodic airflow obstruction characteristic of asthma. As a consequence, modulation of the underlying disease process with antii-nflammatory agents is firmly established as being the cornerstone of successful management. Inhaled corticosteroids are the most potent antiinflammatory agents available and satisfactorily suppress underlying airway inflammation in most individuals. (more…)

The new corticosteroid ciclesonide has been evaluated in various studies to assess its efficacy and adverse effect profile in asthma. However, there are no data comparing the effects of high-dose ciclesonide with those of fluticasone propionate on airway and systemic outcomes in patients with moderate persistent asthma.

The relative effects of 4 weeks of treatment with ciclesonide and fluticasone propionate on airway hyper-reactivity, exhaled nitric oxide levels, lung function, symptoms, and quality of life were compared in 14 patients with moderately persistent asthma. Both drugs significantly improved airway outcomes in terms of methacholine bronchial hyper-responsiveness and exhaled nitric oxide levels. Fluticasone propionate 2000 µg daily but not ciclesonide 1600 µg daily significantly suppressed hypothalamic pituitary adrenal (HPA) axis outcomes, overnight 10 h urinary cortisol levels being lower after fluticasone propionate administration than after ciclesonide administration.

The efficacy of a new medication depends upon comparison with an existing medication that is used in the community for the treatment of a particular condition. Inhaled corticosteroid, namely beclomethasone, budesonide and fluticasone, have been used in the treatment of asthma. The introduction of newer inhaled corticosteroid would depend on the efficacy of the medication in comparison with existing medication. Ciclesonide has been evaluated in various studies essentially looking at the adverse effect profile and its effectiveness in asthma. There are no reports of head-to-head comparisons with the standard inhaled corticosteroid asthma. This study compared the effects of ciclesonide with those of fluticasone propionate, albeit in a small population of moderately persistent asthmatics. The absence of significant differences between the group receiving fluticasone propionate and the group receiving ciclesonide in airway parameters, including spirometry, PEF, symptoms and Mini-AQLQ (Asthma Quality of Life Questionnaire) score, suggest that ciclesonide could prove to be a useful option in the management of asthma. With regard to safety, the treatment period of 4 weeks may not be adequate to cause significant suppression of the hypothalamic–pituitary–adrenal axis and long-term trials are required to evaluate the effects of ciclesonide on the HPA axis.

The findings of these studies, coupled with the results of earlier studies on the pharmacology, pharmacokinetics and efficacy of ciclesonide, indicate great promise for this new inhaled steroid in the treatment of asthma. The higher bioavailability and improved plasma binding of this steroid provide it with greater efficacy and minimal side effects. Furthermore, ciclesonide nasal spray with its minimal effect on the hypothalamic–pituitary–adrenal axis, could be useful in the treatment of children with asthma. However, data on the long-term effects on the HPA axis with ciclesonide are necessary if they are to be considered to be safe medications with no effect on the HPA axis.

The symptoms of asthma occur together with variations in the diameter of medium- size airways such that it is increasingly difficult to exhale. Narrowing of the airways can occur because of smooth muscle contraction, edema or swelling of the wall, or increased mucus in the airways. However, it is increasingly clear that the pathologic event underlying most cases of asthma is acute inflammation of the airway walls. (more…)

Antihistamines have been shown to be effective in seasonal allergic rhinitis and chronic idiopathic urticaria. They improve quality of life scores, acute inflammatory response markers in atopic dermatitis asthma and symptom scores. Newer histamine H1-receptor antagonists may also have an antiplatelet-activating factor effect and are equally effective in seasonal allergic rhinitis. The antileukotrienes were developed in the 1980s. The first compounds of this novel class of anti-asthma drugs were registered in the second half of the 1990s. The mechanism of action of the cysteinyl leukotriene receptor antagonists (LTRAs) is based on counteracting the effects of cysteinyl leukotrienes at their receptor site (CysLT1 receptor) within the airways. (more…)

This article focuses on symptoms of exercise induced asthma. Exercise can be a trigger factor when asthma is not well controlled. People with asthma should not avoid any form of exercise. It is advisable to exercise to keep the lungs and body in good physiological state. Doing regular exercise will strengthens the respiratory muscles. It will also increase your immune system and maintain a healthy weight. Those advantages can improve body health condition in the long term. The key to asthma exercise is to have a total control of asthma symptoms before to starting a fitness program. (more…)

It is very common in asthmatic children where overprotective parents prevent a normal level of exercise to their kids. However, a controlled sport appropriate to the course of their disease is very healthy.

Asthma is an inflammatory disease of the airways characterized by variable bronchial obstruction and reversible, either spontaneously or with treatment, (more…)

Epidemiological studies of farm children are of international interest because farm children are less often atopic disorders, have less allergic disease, and often have less asthma pain than do non-farm children—findings consistent with the hygiene hypothesis. The investigators studied a cohort of rural Iowa children to determine the association between farm and other environmental risk factors with four asthma outcomes: (more…)

Drug allergy reactions may be classified, at least theoretically, according to one of four implicated immunologic mechanisms, according to the scheme of Gell and Coombs:

Type I Drug Allergy Reactions

Type I reactions are the result of an IgE antibody reaction, which induces immediate-type hypersensitivity reactions. (more…)