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Asthma is a chronic condition affecting populations around the world. Public attention has recently focused on this condition because its prevalence and the associated mortality rate have increased over the last several decades. While familial aggregation is observed, no clear pattern of segregation can be discerned. There are multiple genetic, developmental, and environmental factors which interact to produce the overall condition.

Treatment

A specific, customized plan for proactively monitoring and managing symptoms should be created. Someone who has asthma should understand the importance of reducing exposure to allergens, testing to assess the severity of symptoms, food, vitamins and supplements, and the usage of medications. The treatment plan should be written down and adjusted according to changes in symptoms.

The most effective treatment for asthma is identifying triggers, such as smoke (tobacco and other), air pollution, non selective beta-blockers, sulfite-containing foods, pets, allergens, aspirin, and eliminating exposure to them. If trigger avoidance is insufficient, then taking sufficient amounts of Vitamins D, C and A and medical treatment is recommended. Medical treatments used depend on the severity of illness and the frequency of symptoms. Specific medications for asthma are broadly classified into fast-acting and long-acting categories, (NHLBI Guideline 2007 p.213 and Guideline on the Management of Asthma).

Lifestyle modification

Avoidance of triggers is a key component of improving control and preventing attacks. The most common triggers include allergens, smoke (tobacco and other), air pollution, non selective beta-blockers, and sulfite-containing foods.

Many studies have been done about the link between smoking and asthma, including The Influence of Smoking.., Challenges of Treating Asthma in People who Smoke, and What is the Therapeutic Response to Corticosteroid in Smokers with Asthma? A good article on asthma and air pollution is Asthma Rate and Costs from Traffic Related Air Pollution..

Vitamins and Supplements

Taking D supplements may reduce the number of asthma attacks. In the randomized trial of vitamin D supplementation, in children with a previous diagnosis of asthma, asthma attacks as a secondary outcome occurred in 2 children receiving vitamin D3 (1200 IU/d) compared with 12 children receiving placebo (RR: 0.17; 95% CI: 0.04, 0.73; P = 0.006). In other words, children taking vitamin D supplements had one sixth the the number of asthma attacks compared to those on placebo.

According to the Vitamin D Levels study, children with asthma who have higher levels of vitamin D use less inhaled steroids and less hospital visits compared to children with lower levels of vitamin D. The study found that an increase in vitamin D levels was associated with reduced odds of any hospitalization and use of antiinflammatory medications in the previous year, and increased airway responsiveness.

British researchers found that people who took vitamin C were able to reduce their intake of inhaled corticosteroids without any loss of symptom control. This is important because the side effects of corticosteroid drugs increase when higher doses are used; reducing daily intake, even by a small amount, could prevent some adverse effects.

According to the Nottingham University Asthma study, people with a low intake of vitamin C had a 12% increased risk of asthma. For vitamin A the raised risk was less clear cut, the team said, but there was still a significant association.

There is some evidence that Omega3 oils, found in fish oil, hemp oil and some other oils, will help with asthma.

Medications

Medications used to treat asthma are divided into two general classes: quick-relief medications used to treat acute symptoms; and long-term control medications used to prevent further exacerbation.

Fast acting

Long term control

  • Glucocorticoids are the most effective treatment available for long term control. Inhaled forms are usually used except in the case of severe persistent disease, in which oral steroids may be needed. Inhaled formulations may be used once or twice daily, depending on the severity of symptoms.
  • Long acting beta-adrenoceptor agonists (LABA) have at least a 12-hour effect. They are however not to be used without a steroid due to an increased risk of severe symptoms. In December 2008, members of the FDA's drug-safety office recommended withdrawing approval for these medications in children. Discussion is ongoing about their use in adults.
  • Leukotriene antagonists (such as zafirlukast) are an alternative to inhaled glucocorticoids, but are not preferred. They may also be used in addition to inhaled glucocorticoids but in this role are second line to LABA.
  • Mast cell stabilizers (such as cromolyn sodium) are another non-preferred alternative to glucocorticoids.

Delivery methods

Medications are typically provided as metered-dose inhalers (MDIs) in combination with an asthma spacer or as a dry powder inhaler. The spacer is a plastic cylinder that mixes the medication with air, making it easier to receive a full dose of the drug. A nebulizer may also be used. Nebulizers and spacers are equally effective in those with mild to moderate symptoms however insufficient evidence is available to determine whether or not a difference exists in those severe symptomatology.

Adverse effects

Long-term use of inhaled glucocorticoids at usual doses carries a low risk for adverse effects. This risk include the potential for cataracts and a slight decrease in height.

Extreme

When asthma is unresponsive to usual medications, other options are available for both emergency management and prevention of flareups. For emergency management other options include:

  • Oxygen is used to alleviate hypoxia if saturations fall below 92%.
  • Magnesium sulfate intravenous treatment has been shown to provide a bronchodilating effect when used in addition to other treatment in severe acute asthma attacks.
  • Heliox, a mixture of helium and oxygen, may also be considered in severe unresponsive cases.
  • Intravenous salbutamol is not supported by available evidence and is thus used only in extreme cases.
  • Methylxanthines (such as theophylline) were once widely used, but do not add significantly to the effects of inhaled beta-agonists.
  • The dissociative anesthetic ketamine is theoretically useful if intubation and mechanical ventilation is needed in people who are approaching respiratory arrest; however, there is no evidence from clinical trials to support this.

For those with severe persistent asthma not controlled by inhaled corticosteroids and LABAs bronchial thermoplasty can lead to clinical improvements. It involves the delivery of controlled thermal energy to the airway wall during a series of bronchoscopies and result in a prolonged reduction in airway smooth muscle mass.

Alternative Medicine

Surveys, like the Alternative Therapies.. study and the Survey of the Use of Complementary Medicines.., show that roughly 50% of asthma patients use some form of unconventional therapy.

A review of the effects of impermeable bedding encasements.., found that “bedding encasement might be an effective asthma treatment under some conditions” (when the patient is highly allergic to dust mite and the intervention reduces the dust mite exposure level from high levels to low levels). Washing laundry/rugs in hot water was also found to improve control of allergens.

The Buteyko breathing technique for controlling hyperventilation may result in a reduction in medications use however does not have any effect on lung function.

A home remedy that is used to help asthma attacks is the use of honey breathing, if an inhaler isn't available. When one is experiencing an attack he or she should hold a jar of honey under their nose and breathe slowly and deeply for several minutes. The person experiencing the attack should continue to breathe in the sweet honey smell until their attack weakens and it become easier to breathe. The amount of honey needed for this remedy is one jar or a bottle of honey that has a large opening. This method has been used by many people around the world way before inhalers were prescribed to people for their asthma problems.

There is speculation that drinking lots of slightly salty water will help with asthma.

According to the NHLBI Guideline 2007, p. 240, there is insufficient evidence to support the use of acupuncture in treating asthma. Air ionisers show no evidence that they improve asthma symptoms or benefit lung function; this applied equally to positive and negative ion generators.

A study of manual therapies for asthma, including osteopathic, chiropractic, physiotherapeutic and respiratory therapeutic manoeuvres, found there is only evidence to support the use of the Buteyko breathing technique in treating asthma.

Disclaimer

The information presented is for informational purposes only and is not intended as a substitute for advice from your physician or other health care professional. You should consult with a healthcare professional before starting any diet, exercise or supplementation program, before taking any medication, or if you have or suspect you might have a health problem.

Attribution

This is based on the Ethnomedicine by Illness Asthma section and the Wikipedia Asthma article.

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