Asthma and pregnancy

Pregnancy is accompanied by physiological hyperventilation that may be perceived as shortness of breath; causes are a reduced residual capacity and a reduced expiratory reserve volume due to the swelling uterus, and a larger tidal volume due to increase of the progesterone concentration and of the chemosensitivity to CO2 and O2. Fatigue, lowered exercise tolerance and orthopnoea also may occur, as do basal crepitations at auscultation. In pregnant asthma patients the symptoms may either improve greatly or become aggravated. During an asthma attack the foetus is exposed to hypoxaemia, which may be worsened by a decreased uteroplacental blood circulation in case of maternal alkalosis. Poorly controlled asthma has a stronger adverse effect on the unborn child than the judicious use of anti-asthma drugs. Safe drugs against asthma during pregnancy, around parturition and during breast feeding, are cromoglycic acid and ipratropium; relatively safe drugs are short-acting beta-sympathicomimetics, inhalation corticosteroids and systemic corticosteroids, as well as theophylline from the second trimester; use of long-acting beta-sympathicomimetics is advised against.     

Asthma and panic attacks

Panic disorder (PD) and asthma share many common characteristics and have been found in epidemiological studies to be significantly comorbid. To investigate possible reasons for this overlapping, the authors evaluated 51 patients with asthma, assessing the prevalence of PD and sporadic panic attacks, the temporal relationship between these two disorders, and the familial risk for PD in the families of asthmatics. The results showed significantly higher prevalences of PD, sporadic panic attacks, and social phobia in asthmatics than those reported for the general population. In 9 (90%) of the asthmatics with PD, asthma appeared first. Finally, the morbidity risk for PD in families of asthmatics with PD (13.5%) was significantly higher than in families of asthmatics without evidence of panic (2%). Our results suggest that the high prevalence of PD in asthmatics might be related to a facilitating effect of asthma on the development of PD in subjects with familial predisposition to PD.     

Asthma and reproductive medicine

Asthma is a common disease affecting approximately 5 percent of the population and is a major cause of disability. Research interest in the condition is high because of frequent reports that the incidence, prevalence, severity, and mortality rates have been rising in recent years. Although the etiology remains elusive, knowledge about its pathophysiology is extensive and detailed, which in turn has spawned an impressive array of effective and safe drugs to prevent and treat acute exacerbations. Pharmacotherapy is enhanced by appropriate environmental control measures and immunotherapy for the significant number of asthmatics with an allergic component to their disease. The pregnant asthmatic may pose special requirements for the small minority with severe corticosteroid-dependent disease or those subject to frequent attacks. However, the great majority of asthmatic women need not face much risk of adverse effects on the course of the pregnancy or significant fetal or perinatal abnormalities, as long as appropriate preventive measures and monitoring are taken.     

Asthma.

Problems that arise in the asthma assessment process are illustrated by describing 3 areas of concern to medicine and psychology: diagnosis, characteristics, and classification. Psychological and behavioral approaches to treatment are also described. It is concluded that behavioral scientists have a role in the assessment and treatment of the asthmatic patient, particularly with respect to the management of asthma-related behaviors. Further research is necessary to become more familiar with the course of the disorder and how to medically investigate and control asthma. (57 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Asthma physiopathology

Bronchial asthma is a very common disease but often the diagnosis and treatment is not done correctly. The physiopathology is very complex in which are involved neuroimmune mechanism with imbalance between sympatic-parasympatic system, and the other pathways including non adrenergic non colinergic and neuropeptide factors. The immunologic participation with a high level of IgE and the activation of the interleukins, all these together with very active participation of the adhesives, are the responsible for the activations and action of the chemical substances who are the origin of the bronchospasm and inflammation.     

Asthma and domestic air quality

HeLa x skin fibroblast human hybrid cells have been developed into a model of radiation-induced neoplastic transformation. The authors' studies indicate that the loss of putative tumour suppressor loci on fibroblast chromosomes 11 and 14 is evident after radiation-induced neoplastic transformation. How these fibroblast chromosomes/putative tumour suppressor loci are lost after radiation exposure is currently being investigated. It has been shown that the appearance of transformed foci correlates with the onset of the delayed reduction in plating efficiency or delayed death. This delayed death appears to be the result of the onset of a novel delayed apoptosis in the irradiated progeny beginning around day 8 post-irradiation. It was proposed that the reduction in plating efficiency and subsequent neoplastic transformation are all the result of a radiation-induced genomic instability. The instability process has two relevant outcomes: (1) cell death due to the induction of a delayed apoptosis in cells; and (2) neoplastic transformation of a small subset of survivors that have lost fibroblast chromosomes 11 and 14 (tumour suppressor loci) but either have not acquired enough genetic damage to induce the apoptotic response or have undergone molecular changes allowing them to bypass apoptosis. Data from the genomic instability and delayed death literature will be reviewed in terms of relevance to radiation-induced neoplastic transformation. New data are presented which demonstrate that use of growth media supplemented with a specific lot of calf serum was found to increase the number of cells undergoing radiation-induced neoplastic transformation, compared with standard serum after a fixed dose of radiation. This correlates with an increase in delayed death in the irradiated progeny which the authors propose is the result of increased genomic instability post-irradiation of cells grown in this serum. Preliminary data are presented indicating that a delayed apoptosis is also seen after high-energy He- particle exposure in this system.     

Chronic rhinosinusitis in cystic fibrosis (mucoviscidosis)

The authors present two clinical studies performed in the ENT departments of two Belgian Universities. A total of 248 patients with mucoviscidosis (cystic fibrosis, CF) were assessed by means of nasal endoscopy. One hundred eighteen underwent computed tomography of the paranasal sinuses (CT) and 55 were endoscopically operated. This allowed the observation of different clinical patterns of rhinosinusitis: mucopyosinusitis (pseudomucocele) of the maxillary antrum with bulging of the lateral nasal wall (LNW), nasal polyposis with erosion of the LNW, and chronic purulent rhinosinusitis with an isolated prominent uncinate process. The treatment of those patients could be tailored to the individual clinical pattern. Medical therapy consisted of systemic antibiotics and topical drugs delivered by sprays or by lavages with a nose can. Surgery was mainly aimed at removing the massive polyposis when it interfered with the daily life activities. The use of the endoscope enabled to perform safely more extensive procedures resulting in a lower recurrence rate. In patients with chronic rhinosinusitis without polyposis, yet presenting ostiomeatal obstruction, a limited and more functional endoscopic surgery was indicated in order to restore some drainage and to improve the penetration of topical drugs into the affected sinus. A short addendum presents two studies: one about genetics and the other about prevalence of middle ear disease in CF. The first concluded that no clear correlation was found between DF508 (the most common CF mutation) and nasal polyposis. The second revealed that in contrast with the extremely high prevalence of sinus problems, there was no clear evidence of an increased prevalence of middle ear disease in CF.     

Chronic rhinosinusitis in children: evolution of concepts

The concept of chronic rhinosinusitis in children has been recently individualized. The diagnosis is based upon the clinical history. It may be part of a diffuse inflammatory disease of the respiratory tract. Allergic and environmental polluting factors are possibly involved and must be looked for. Drainage of the rhinopharynx and local steroids are usually the first line treatment. In case of failure, a CT-scan of the sinuses should be performed looking for an obstructive anomaly of the sinuses requiring functional endoscopic sinus surgery.     

Asthma induced by exercise

A report is given of the results of histopathologic examinations of subsequent biopsies carried out on 54 patients with prostate carcinomas and of the clinical development of the prostate carcinomas of 89 patients. All these patients were treated only by therapeutic radiology. Then follows a discussion whether the radiation or the hormone therapy has the preponderant values. The possible complications of the two therapy methods are compared.     

Asthma. The states'' challenge

A brief overview of the theory of corrosion and the formation of galvanic couples is presented, followed by a discussion of the metals and alloys used in the fabrication of orthodontic appliances and devices. Attention is paid to the factors that contribute to establishment of corrosion cells in the mouth. Although oral corrosion generally does not cause significant destruction of metal, it can elicit in patients adverse physiological responses such as local irritation and metal hypersensitivity. There are indications that orthodontic treatment may lower the incidence of nickel hypersensitivity. Destructive attack on orthodontic appliances does occur, however, when certain types of denture cleanser are used to clean appliances that contain soldered joints.