ASTHMA. Epidemiology Pathophysiology Diagnosis Management Safe Bets. o AERD o ABPA o VCD o Pregnancy
|
|
- Emil Spencer
- 5 years ago
- Views:
Transcription
1 ASTHMA David M. Lang, MD Head, Allergy/Immunology Section Respiratory Institute Cleveland Clinic Foundation Member, Rock and Roll Hall of Fame (Roller Level)
2 Disclosure Consultant/Advisory Board: Hycor, Quest Speaker: Genentech, Novartis, GlaxoSmithKline, Merck Honorarium: Genentech, Novartis, GlaxoSmithKline, Merck Research Grant: Genentech, Novartis, Merck
3 Learning Objectives Upon completion of this session, participants should be able to: Describe recent asthma trends in the USA, and risk factors for asthma mortality. Relate the paradigm of asthma management proposed in EPR3 guidelines, specifically in terms of the assessment of asthma severity and asthma control. Describe key facts concerning conditions such as AERD, ABPA, VCD, and management of asthma during pregnancy
4 ASTHMA Epidemiology Pathophysiology Diagnosis Management Safe Bets o AERD o ABPA o VCD o Pregnancy
5 EPIDEMIOLOGY
6 The US Asthma Burden 2010: An estimated 25.7 million (8%) with current asthma, compared with 20 million (7%) in 2001 African Americans = 10.2% Whites = 7.6% Asthma cost the USA about $3,300 per person with asthma each year from 2002 to 2007 in medical expenses. 2007: $56 billion in annual costs including medical costs, lost school/work, and early deaths deaths (2010) o accessed January 11, 2014 o Mooreman et al. Surveillance for asthma United States, MMWR. 2007;56:1. o Akinbami L, Moorman J. National Health Statistics Reports, Number 32, January 12, 2011
7 2.5 2 Asthma Mortality per 100, Asthma M ortal ity per 100,000 Trends in US Asthma Mortality: Source:
8 Asthma Mortality Patterns in Philadelphia Asthma Mortality per 100, Poisson Regression Poverty African Americans Hispanic Americans p <.001 p =.032 p =.013 Lang DM, Polansky M. N Engl J Med 1994; 331: Low Mid High
9 Asthma Mortality - Risk Factors Past history of sudden, severe exacerbations Prior intubation and ICU management 2 hospitalizations for asthma in past year 3 ED visits for asthma in past year Hospitalization or ED visit for asthma in past month Use of 2 canisters of rescue inhaler per month Current use of or recent withdrawal from oral steroid Poor perception of dyspnea Psychologic co-morbidity Low socioeconomic status Inner city residence African-American race or Hispanic-American ethnicity Illicit drug use IgE-mediated potential to Alternaria Modified from: Restrepo R, Peters J. Curr Opinion Pulm Med 2008; 14:13-23.
10 Common Sources of Allergens in Inner-City Homes
11 Cockroach Dominant Allergen Associated with Asthma Morbidity p = p = 0.88 p = 0.81 Rosenstreich D, et al. N Engl J Med 1997; 336:
12 PATHOPHYSIOLOGY
13 Asthma is Heterogeneous Not a single disease entity It s a syndrome characterized by multiple phenotypes Age Gender Race/ethnicity Disease pattern Remission/relapse Persistence.
14 Airway Remodeling Changes to the formed elements of the airway contribute to pathophysiology Airway epithelium Mucus/sputum Airway smooth muscle Inflammation Angiogenesis Pascual RM, Peters SP. Airway remodeling contributes to progressive loss of lung function in asthma. J Allergy Clin Immunol. 2005;116:
15 Airway Remodeling Changes to the formed elements of the airway contribute to pathophysiology Airway epithelium Mucus/sputum Airway smooth muscle Inflammation Angiogenesis Pascual RM, Peters SP. Airway remodeling contributes to progressive loss of lung function in asthma. J Allergy Clin Immunol. 2005;116:
16 Pathology of Asthma Normal Lungs Asthma Source: What You and Your Family Can Do About Asthma by the Global Initiative For Asthma Created and funded by NIH/NHLBI
17 DIAGNOSIS
18 Airways of Asthmatics are Hyperresponsive Colasurdo G, Larson G. Airway hyperresponsiveness. In Busse, et al. Asthma and Rhinitis, 2nd Edition Blackwell Science,
19 Bronchoprovocation NON-SELECTIVE Direct (e.g., methacholine, histamine) Indirect (e.g., exercise, mannitol) SELECTIVE Immunologic (e.g., allergen) Non-Immunologic (e.g., aspirin)
20 Estimates of Sensitivity and Specificity Test Sensitivity Specificity Methacholine High Medium Mannitol Medium High FE NO High Medium Sputum EOS High Medium
21 What s New and What s Hot? Genetics Biomarkers Phenotypes/Endotypes Personalized management
22 Genetics What s Hot? Epigenetics: It s not genes, it s gene activation. Biomarkers eno Sputum EOS LTE 4 Periostin Personalized management profile severity and prognosis
23 Accessed January 11, 2014 at:
24 Fraction of Exhaled Nitric Oxide (FE NO )
25 FE NO : Diagnostic Properties Yes Asthma (n = 17) No Nonasthma (n = 30) Yes No Sensitivity (%) Specificity (%) Positive Predictive Value (%) Negative Predictive Value (%) Bronchodilator reversibility >12% Bronchial hyperresponsiveness <20 ml Peak flow variation >20% * NA 70 Peak flow improvement with steroid >15% * FEV 1 <80% predicted FEV 1 <90% predicted FEV 1 /FVC ratio <70% FEV 1 /FVC ratio <80% FEV 1 improvement with steroid >15% * Sputum eosinophils >3% 12 2* 3 23* FE NO >20 ppb Asthma diagnosed by bronchodilator reversibility and/or bronchial hyperresponsiveness (shown above purple line) Comparison of FE NO with other diagnostic tests is shown at bottom ppb = parts per billion. *Patient unable or unwilling to complete procedure. Technical difficulties prevented completion of FE NO measurements at 50 ml/second. Smith AD et al. Amer J Respir Crit Care Med. 2004;169:
26 FE NO : Possible Detection of Noncompliance With ICS FE NO (ppb) On ICS Off ICS Weeks Silkoff P et al. J Asthma. 1998;35:
27 Which of the following will increase the measurement of exhaled nitric oxide in a patient with asthma? A. Drinking 16 ounces of beer B. Eating a hot dog C. Running 3 miles D. Smoking a cigarette
28 Factors Affecting FE NO Levels Increase Viral URI Allergic Rhinitis Nitrate-rich diet Decrease Cystic Fibrosis Smoking Pulmonary Hypertension Alcohol consumption Spirometric maneuvers
29 Anti-IL13 and Periostin TH2 cells secrete IL-4 and IL-13, which induce B cells to produce IgE. IL-13 can mediate several features of asthma: Airways hyperresponsiveness Mucous metaplasia Eosinophilic inflammation Activation and proliferation of airway fibroblasts. High TH2 phenotype ( IL-13 signature surrogate ) recently described, associated with increased circulating levels of periostin, a matricellular protein induced by IL-13. Kraft M. N Engl J Med 2011; 365:
30 Kraft M. N Engl J Med 2011; 365:
31 Corren J. N Engl J Med 2011; 365:
32 14.0% 5.8% p=.03 * FEV 1 5.1% 3.5% p=.61 Corren J. N Engl J Med 2011; 365:
33 Which is the Best Biomarker For Detecting Eosinophilic Airway Inflammation? Presence of eosinophilic airway inflammation defines pathophysiologically and clinically distinct subgroups of asthma, and predicts salutary response to steroids and emerging therapies (e.g., anti-il5). Invasive sampling via bronchoscopy or sputum induction not feasible. Non-invasive biomarkers will have utility for identifying asthma subgroups responsive to Th2 targeted therapies. Woodruff PG, et al. AJRCCM 2009; 180: Nair P, et al. N Engl J Med 2009; 360:
34 What is the Best Biomarker For Detecting Eosinophilic Airway Inflammation? Jia G, et al. J Allergy Clin Immunol 2012; 130:
35 What is the Best Biomarker For Detecting Eosinophilic Airway Inflammation? Serum periostin: PPV = 93% Jia G, et al. J Allergy Clin Immunol 2012; 130:
36 Personalized Care Heterogeneity of asthma leads to differential responses to treatment. Several studies imply that genetic factors and biomarkers -- perhaps in combination, can direct asthma pharmacotherapy.
37 Lotvall J, et al. J Allergy Clin Immunol 2011; 127:
38 Lotvall J, et al. J Allergy Clin Immunol 2011; 127:
39 Meta analysis Prospective Epidemiologic Studies Compared with normal weight, elevated BMI confers increased odds of incident asthma. Beuther DA, Sutherland ER. Am J Resp Crit Care Med 2007; 175:
40 Meta analysis Prospective Epidemiologic Studies Dose response effect of overweight and obesity on incident asthma Beuther DA, Sutherland ER. Am J Resp Crit Care Med 2007; 175:
41 Weight Loss Interventions Medical Low calorie diets Exercise Behavioral Medications Surgical: Gastric bypass
42 Weight Loss Interventions for Asthma RCTs of interventions for overweight or obese asthmatics, compared with no intervention or alternative weight loss intervention 4 studies, N=197 Brazil, Mexico, Australia, Finland variety of medical interventions Serious methodologic issues Imprecision Selection bias Detection bias Conclusion: The benefit of weight loss as an intervention for asthma control remains uncertain, as such, clinicians should be prepared to help patients to make a decision that is consistent with their own values. Adeniyi FB, Young T. Cochrane Database accessed 1/2/14:
43 Mary is a 25 year-old woman with episodes of wheezing 3 days each week. She awakens out of sleep once every other week with wheezing and cough. Her only medication is albuterol inhaler prn, which she requires at least 3 days per week. She had a hospitalization at age 18 for asthma requiring ICU management. Her physical exam is normal, and spirometry shows no ventilatory impairment: FEV1 = 88% predicted, FVC = 94% predicted. How would you categorize the severity of Mary s asthma? A. Intermittent B. Mild persistent C. Moderate persistent D. Severe persistent
44 accessed January14, 2012
45 MANAGEMENT
46 Based on evidence from randomized, placebo-controlled, double blind studies, which of the following controller options is preferred for Mary? A. Low dose inhaled steroid monotherapy B. Medium dose inhaled steroid monotherapy C. Combination low dose inhaled steroid and long acting beta agonist D. Leukotriene modifier monotherapy
47 mild Asthma Control, Management, and Severity optimal good control Asthma Management A poor Severity severe B poor control modified from: Osborne M, et al. Chest 1999; 115:
48 Definitions Severity the intrinsic intensity of the disease process Measured most easily and directly in a patient not receiving long term control therapy Control The degree to which manifestations of asthma (symptoms, functional impairments, and risks of untoward events) are minimized and the goals of therapy are met. accessed January
49 Asthma Severity and Control: Impairment Domain Impairment = Frequency and Intensity of Symptoms and Functional Limitations Symptoms Nighttime awakenings Need for SA β 2 -agonists (SABAs) for quick relief Work/school days missed Ability to engage in normal and desired daily activities Quality-of-life assessments Lung Function Spirometry Peak flow Adapted from NHLBI Expert Panel Guidelines (EPR-3).
50 Assessing Asthma Control in Children 12 Years of Age and Adults: NAEPP Guidelines Impairment Components of Control Symptoms Nighttime awakenings Interference with normal activity SABA use for symptoms (not prevention of EIB) FEV 1 or peak flow Validated Questionnaires ATAQ ACQ ACT Well Controlled 2 days/week 2/month None 2 days/week >80% predicted/personal best Not Well Controlled >2 days/week 1-3/month Some limitation >2 days/week 60%-80% predicted/personal best Poorly Controlled Throughout the day 4/week Extremely limited Several times per day <60% predicted/personal best 3-4 N/A 15 Risk Exacerbations Progressive loss of lung function Treatment-related adverse effects 0-1 per year 2-3 per year >3 per year Evaluation requires long-term follow-up care Medication side effects can vary in intensity from none to very troublesome and worrisome. The level of intensity does not correlate to specific levels of control but should be considered in the overall assessment of risk. ACQ = Asthma Control Questionnaire; ACT = Asthma Control Test; ATAQ = Asthma Therapy Assessment Questionnaire; EIB = exercise-induced bronchospasm; FEV 1 = forced expiratory volume in 1 second; N/A = not applicable. accessed January 14, 2012
51 Validated Tools to Assess Asthma Control Asthma Control Questionnaire (ACQ) 1 Asthma Control Test (ACT) 2 Asthma Therapy Assessment Questionnaire (ATAQ) 3 1. Juniper EF, et al. Eur Respir J. 1999;14: Nathan RA, et al. J Allergy Clin Immunol. 2004;113: Vollmer WM, et al. Am J Respir Crit Care Med. 1999;160:
52 Patients on a controller are classified as having not well controlled asthma if they have any ONE of the following * : Albuterol use >2 days/week Asthma symptoms >2 days/week Nighttime awakenings 1-3x/week Some limitation of normal activity FEV 1 between 60%-80% of predicted ACT score < 20 ACT = Asthma Control Test. Asthma Control Test is a trademark of QualityMetric Incorporated. *Based on NIH asthma guidelines for adjusting therapy in patients 12 years. accessed January 14, 2010
53 Algorithm for Attaining Optimal Asthma Control Presentation with Asthma Classify Asthma Severity Assess Asthma Control Frequency of symptoms Frequency of rescue bronchodilator Frequency of night/morning symptoms Activity, work, school limitations Patient assessment Pulmonary Function Tests Periodic Assessment of Asthma Assess psychosocial status Assess adherence/compliance Assess medication s side effects Assess asthma triggers Review action plan Confirm/reconfirm diagnosis of asthma Asthma Well-controlled No Detailed asthma assessment Step-up therapy Yes Maintain or step-down therapy Attaining optimal asthma control: A practice parameter. J Allergy Clin Immunol. 2005;116:S3-11.
54 Intermittent Mild Persistent Moderate Persistent Severe Persistent Step 1 Preferred: SABA prn Step 2 Preferred: Low-Dose ICS (A) Alternative: Cromolyn (B), Nedocromil (B), LTRA (B), or Theophylline (B) Step 3 Preferred: Medium-Dose ICS (A) or Low-Dose ICS + LABA (A) Alternative: Low-Dose ICS and either LTRA (A), Theophylline (B), or Zileuton (D) Step 4 Preferred: Medium-Dose ICS + LABA (B) Alternative: Medium-Dose ICS and either LTRA (B), Theophylline (B), or Zileuton (D) Step 5 Preferred: High-Dose ICS + LABA (B) and Consider Omalizumab for Patients Who Have Allergies (B) Step 6 Preferred: High-Dose ICS + LABA + Oral Corticosteroid and Consider Omalizumab for Patients Who Have Allergies accessed January 14, 2010
55 Intermittent Mild Persistent Moderate Persistent Severe Persistent Step 6 Step 1 Preferred: SABA prn Step 2 Preferred: Low-Dose ICS (A) Alternative: LTRA (B), Cromolyn (B), Nedocromil (B), or Theophylline (B) Step 3 Preferred: Medium- Dose ICS (B) or Low-Dose ICS and either LABA (B), LTRA (B), or Theophylline (B) Step 4 Preferred: Medium-Dose ICS + LABA (B) Alternative: Medium-Dose ICS and either LTRA (B) or Theophylline (B) Step 5 Preferred: High-Dose ICS + LABA (B) Alternative: High-Dose ICS and either LTRA (B) or Theophylline (B) and Omalizumab May Be Considered for Patients Who Have Allergies Preferred: High-Dose ICS + LABA + Oral Corticosteroid (D) Alternative: High-Dose ICS and either LTRA or Theophylline and Oral Corticosteroid (D) and Omalizumab May Be Considered for Patients Who Have Allergies LTRA = leukotriene receptor antagonist. accessed January 14, 2010
56 Intermittent Mild Persistent Moderate to Severe Persistent Step 1 Preferred: SABA prn Step 2 Preferred: Low-Dose ICS (A) Alternative: Montelukast (A) or Cromolyn (B) Step 3 Preferred: Medium- Dose ICS (D) Step 4 Preferred: Medium-Dose ICS and either Montelukast or LABA (D) Step 5 Preferred: High-Dose ICS and either Montelukast or LABA (D) Step 6 Preferred: High-Dose ICS and either Montelukast or LABA and Oral Corticosteroids (D) accessed January 14, 2010
57 ASTHMA MEDICATIONS Inhaled short acting beta agonists Inhaled long acting beta agonists Oral anti-leukotrienes Oral Theophylline Inhaled anti-cholinergics Inhaled corticosteroids Oral corticosteroids Anti-IgE
58 Inhaled Steroid Is the Most Effective Controller for Asthma Sin DD, et al. JAMA. 2004;292:367-76
59 accessed January 14, 2010
60 SMART Salmeterol Multicenter Asthma Research Trial A Comparison of Usual Pharmacotherapy for Asthma or Usual Pharmacotherapy plus Salmeterol Nelson HS et al. Chest. 2006;129:15-26.
61 Long-acting ß2-agonists Salmeterol, Formoterol SMART Implications Avoid LABA as monotherapy No use of LABA as reliever Arg/Arg at codon 16 of ADRB2 Worsening of lung function observed in association with regular use of albuterol No convincing evidence for this in association with LABA.
62 zileuton zafirlukast montelukast
63 Theophylline: Drug Interactions Increase Levels Decrease Levels - alcohol - aminoglutethamide - cimetidine - carbamazepine - ciprofloxacin - isoproterenol - clarithromycin - phenobarbital - erythromycin - phenytoin - oral contraceptives - rifampin - verapamil - sulfinpyrazone - zileuton - others
64 Paradoxical Vocal Cord Motion (Vocal Cord Dysfunction) Functional airway obstruction results from inappropriate motion of the vocal cords, usually during inspiration. Patients may present with dyspnea, throat tightness, choking, dysphonia, and/or cough. Occurs most commonly in women between the ages of Symptom onset may be spontaneous or provoked by exercise or irritant exposures. Gimenez L, Zafra H. Ann Allergy Asthma Immunol 2011;106:
65 Paradoxical Vocal Cord Motion (Vocal Cord Dysfunction) Gimenez L, Zafra H. Ann Allergy Asthma Immunol 2011;106:
66 PARADOXICAL VOCAL CORD MOTION Gimenez L, Zafra H. Ann Allergy Asthma Immunol 2011;106:
67
68
69 Allergic Bronchopulmonary Aspergillosis Major criteria Asthma Roentgenographic infiltrates Proximal bronchiectasis Eosinophilia > 1000/mm3 Serum IgE markedly elevated Positive immediate skin test reaction to A. fumigatus IgG precipitins against Aspergillus antigens. Minor criteria Aspergillus in sputum History of expectorated brown plugs Delayed (Arthus) skin test reaction to Aspergillus antigen Greenberger P, Patterson R. Ann Allergy 1986;56:444-52
70 Wheal/Flare Reaction
71
72
73 Asthma and Pregnancy Most common chronic condition in pregnancy, affecting 3.4% %. Physiologic changes Minute ventilation increases Normal: compensated respiratory alkalosis Related to increased circulating levels of progesterone Lung volume changes TV increases RV decreases FRC decreases Diagnosis of asthma can be confirmed in pregnancy -- similar to non-pregnancy -- with 12% increase in FEV1 after bronchodilator; methacholine challenge not recommended. Dombrowski MP. Asthma and pregnancy. Obstet Gynecol 2006; 108: Rey E, Boulet LP. Asthma in pregnancy. BMJ 2007; 334:
74 Asthma and Pregnancy Course of asthma Worse: 35% Same: 33% Improved: 28% More likely to worsen in women with severe (52-65%) compared with mild (8-13%) asthma Reverts to pre-pregnancy level within 3 months post-partum. Exacerbations most likely between weeks Most common: respiratory or urinary tract infection (69%) 2nd most common: non-adherence to ICS (29%) Rey E, Boulet LP. BMJ 2007; 334: Schatz M, et al. J Allergy Clin Immunol 1988; 81:
75 FDA Pregnancy Categories Category A B C D X Interpretation Controlled studies show no risk No evidence of risk in humans Risk cannot be ruled out Positive evidence of risk Contraindicated in pregnancy Gluck PA, Gluck JC. Curr Med Res Opin 2005; 21:
76 FDA Pregnancy Categories Drug Category Inhaled short acting beta agonists C Inhaled long acting beta agonists C Theophylline C Cromones B Leukotriene Modifiers B * Inhaled Corticosteroids C # Oral Corticosteroids C Anti-IgE B * Zileuton = C # Budesonide = B Yawn B, Knudtson M. J Am Board Fam Med 2007; 20:
77 The Future Will Be Better Tomorrow Dan Quayle
Optimal Assessment of Asthma Control in Clinical Practice: Is there a role for biomarkers?
Disclosures: Optimal Assessment of Asthma Control in Clinical Practice: Is there a role for biomarkers? Stanley Fineman, MD Past-President, American College of Allergy, Asthma & Immunology Adjunct Associate
More informationImproving the Management of Asthma to Improve Patient Adherence and Outcomes
Improving the Management of Asthma to Improve Patient Adherence and Outcomes Robert Sussman, MD Atlantic Health System Overlook Medical Center Asthma Remains a Serious Health Risk in the US Every day in
More informationLearning the Asthma Guidelines by Case Studies
Learning the Asthma Guidelines by Case Studies Timothy Craig, DO Professor of Medicine and Pediatrics Distinguished Educator Penn State University Hershey Medical Center Objectives 1. Learn the Asthma
More informationCurrent Asthma Management: Opportunities for a Nutrition-Based Intervention
Current Asthma Management: Opportunities for a Nutrition-Based Intervention Stanley J. Szefler, MD Approximately 22 million Americans, including 6 million children, have asthma. It is one of the most prevalent
More information#1 cause of school absenteeism in children 13 million missed days annually
Asthma Update 2013 Jennifer W. McCallister, MD, FACP, FCCP Associate Professor Pulmonary & Critical Care Medicine The Ohio State University Wexner Medical Center Disclosures None 2 Objectives Review burden
More informationControversial Issues in the Management of Childhood Asthma: Insights from NIH Asthma Network Studies
Controversial Issues in the Management of Childhood Asthma: Insights from NIH Asthma Network Studies Stanley J. Szefler, MD Helen Wohlberg and Herman Lambert Chair in Pharmacokinetics, Head, Pediatric
More informationAsthma Management for the Athlete
Asthma Management for the Athlete Khanh Lai, MD Assistant Professor Division of Pediatric Pulmonary and Sleep Medicine University of Utah School of Medicine 2 nd Annual Sports Medicine Symposium: The Pediatric
More information12/18/2017. Disclosures. Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing
Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing Diana M. Sobieraj, PharmD, BCPS Assistant Professor University of Connecticut School
More informationDecember 7, 2010 Future Use of Biologics in Allergy and Asthma
December 7, 2010 Future Use of Biologics in Allergy and Asthma Lanny J. Rosenwasser, M.D. Dee Lyons/Missouri Endowed Chair in Immunology Research Professor of Pediatrics Allergy-Immunology Division Childrens
More informationPrimary Care Medicine: Concepts and Controversies Wed., February 17, 2010 Fiesta Americana Puerto Vallarta, Mexico Update on Asthma and COPD
Primary Care Medicine: Concepts and Controversies Wed., February 17, 2010 Fiesta Americana Puerto Vallarta, Mexico Update on Asthma and COPD Talmadge E. King, Jr., M.D. Krevins Distinguished Professor
More informationAsthma Update A/Prof. John Abisheganaden. Senior Consultant, Dept Of Respiratory & Crit Care Medicine Tan Tock Seng Hospital
Asthma Update - 2013 A/Prof. John Abisheganaden Senior Consultant, Dept Of Respiratory & Crit Care Medicine Tan Tock Seng Hospital Asthma A complex syndrome Multifaceted disease Heterogeneous Genetic and
More informationImproving Outcomes in the Management & Treatment of Asthma. April 21, Spring Managed Care Forum
Improving Outcomes in the Management & Treatment of Asthma April 21, 2016 2016 Spring Managed Care Forum David M. Mannino, M.D. Professor Department of Preventive Medicine and Environmental Health University
More informationClinical Implications of Asthma Phenotypes. Michael Schatz, MD, MS Department of Allergy
Clinical Implications of Asthma Phenotypes Michael Schatz, MD, MS Department of Allergy Definition of Phenotype The observable properties of an organism that are produced by the interaction of the genotype
More informationAsthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing
Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing Diana M. Sobieraj, PharmD, BCPS Assistant Professor University of Connecticut School
More informationAsthma for Primary Care: Assessment, Control, and Long-Term Management
Asthma for Primary Care: Assessment, Control, and Long-Term Management Learning Objectives After participating in this educational activity, participants should be better able to: 1. Choose the optimal
More informationMeeting the Challenges of Asthma
Presenter Disclosure Information 11:05 11:45am Meeting the Challenge of Asthma SPEAKER Christopher Fanta, MD The following relationships exist related to this presentation: Christopher Fanta, MD: No financial
More informationAsthma 2015: Establishing and Maintaining Control
Asthma 2015: Establishing and Maintaining Control Webinar for Michigan Center for Clinical Systems Improvement (Mi-CCSI) Karen Meyerson, MSN, APRN, NP-C, AE-C June 16, 2015 Asthma Prevalence Approx. 26
More informationDiagnosis, Assessment, Monitoring and Pharmacological Treatment of Asthma
Diagnosis, Assessment, Monitoring and Pharmacological Treatment of Asthma Magnitude of Asthma - India Delhi Childhood asthma: 10.9% Adults: 8% Other Cities 3 to 18% Chhabra SK et al Ann Allergy Asthma
More informationQ: Should patients with mild asthma
1-MINUTE CONSULT CME CREDIT EDUCATIONAL OBJECTIVE: Readers will consider prescribing inhaled corticosteroids to their patients who have mild persistent asthma brief answers to specific clinical questions
More informationAsthma Upate 2018: What s New Since the 2007 Asthma Guidelines of NAEPP?
10:50-11:50am Asthma Update 2018: What s New Since the 2007 National Asthma Guidelines? SPEAKER Christopher H. Fanta, MD Disclosures The following relationships exist related to this presentation: Christopher
More informationStep up if needed (first, check adherence, environmental control and comorbid conditions) Patients ASSESS CONTROL. Step down if possible
12/9/212 Pharmacogenomics Treating the Individual Asthma Patient Elliot Israel, M.D. Professor of Medicine Harvard Medical School Brigham & Women s Hospital Partners Asthma Center Too much of a good thing?
More informationDifficult Asthma Assessment: A systematic approach
Difficult Asthma Assessment: A systematic approach Dr Naghmeh Radhakrishna Respiratory, Sleep & Allergy Physician Allergy, Asthma & Clinical Immunology Service The Alfred Hospital Melbourne, Australia
More informationAsthma ASTHMA. Current Strategies for Asthma and COPD
Current Strategies for Asthma and COPD Talmadge E. King, Jr., M.D. Krevins Distinguished Professor of Medicine Chair, Department of Medicine University of California San Francisco (UCSF) San Francisco,
More informationAsthma and Its Many Unmet Needs: Directions for Novel Therapeutic Approaches
Asthma and Its Many Unmet Needs: Directions for Novel Therapeutic Approaches William W. Busse,, M.D. University of Wisconsin School of Medicine and Public Health Madison, WI, USA Disclosure Slide Employment
More informationClinical Benefits of FeNO Monitoring in Asthma RYAN BURTON, MS, RPFT
Clinical Benefits of FeNO Monitoring in Asthma RYAN BURTON, MS, RPFT Disclosures I am an employee of Circassia Pharmaceuticals. Objectives Nitric Oxide Inflammation in Asthma Phenotyping Personalized Medicine
More informationThe methodology behind GINA and EPR-3 medication recommendations: Stepwise treatment in asthma
The methodology behind GINA and EPR-3 medication recommendations: Stepwise treatment in asthma Maureen George PhD RN AE-C FAAN Columbia University mg3656@cumc.columbia.edu Faculty Disclosures Maureen George
More informationAsthma and COPD. Health Net Provider Educational Webinar
Asthma and COPD Health Net Provider Educational Webinar AstraZeneca 2015 Disclosures Presenters today are employed by Astra Zeneca and have nothing to disclose. This presentation is free from bias. 2 Objectives
More informationAmanda Hess, MMS, PA-C President-Elect, AAPA-AAI Arizona Asthma and Allergy Institute Scottsdale, AZ
Amanda Hess, MMS, PA-C President-Elect, AAPA-AAI Arizona Asthma and Allergy Institute Scottsdale, AZ Financial Disclosures Advanced Practiced Advisory Board for Circassia Learning Objectives 1. Briefly
More informationExpert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma Full Report 2007
Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma Full Report 2007 TARGET POPULATION Eligibility Inclusion Criterion Exclusion Criterion RECOMMENDATIONS Selecting Initial Therapy
More informationEmily DiMango, MD Asthma II
Emily DiMango, MD Asthma II Director John Edsall/John Wood Asthma Center Columbia University Medical Center HP 2000 Goal: 2.25/1,000 Comparison of Asthma Hospitalization Rates in Children Aged 0-14 in
More informationClinical Practice Guideline: Asthma
Clinical Practice Guideline: Asthma INTRODUCTION A critical aspect of the diagnosis and management of asthma is the precise and periodic measurement of lung function both before and after bronchodilator
More informationAsthma. Rachel Miller, MD, FAAAAI Director Allergy and Immunology New York Presbyterian Hospital. Figure 1 Asthma Prevalence,
Asthma Rachel Miller, MD, FAAAAI Director Allergy and Immunology New York Presbyterian Hospital Figure 1 Asthma Prevalence, 1980-2000 * Gap between 1995-1996 and 1997 indicates a break in trend due to
More informationXolair (Omalizumab) Drug Prior Authorization Protocol (Medical Benefit & Part B Benefit)
Line of Business: All Lines of Business Effective Date: August 16, 2017 Xolair (Omalizumab) Drug Prior Authorization Protocol (Medical Benefit & Part B Benefit) This policy has been developed through review
More informationAsthma in Pediatric Patients. DanThuy Dao, D.O., FAAP. Disclosures. None
Asthma in Pediatric Patients DanThuy Dao, D.O., FAAP Disclosures None Objectives 1. Discuss the evaluation and management of asthma in a pediatric patient 2. Accurately assess asthma severity and level
More informationAsthma in Pregnancy. Asthma. Chronic Airway Inflammation. Objective Measures of Airflow. Peak exp. flow rate (PEFR)
Chronic Airway Inflammation Asthma in Pregnancy Robin Field, MD Maternal Fetal Medicine Kaiser Permanente San Francisco Asthma Chronic airway inflammation increased airway responsiveness to a variety of
More informationExhaled Nitric Oxide Today s Asthma Biomarker. Richard F. Lavi, MD FAAAAI FAAP
Exhaled Nitric Oxide Today s Asthma Biomarker Richard F. Lavi, MD FAAAAI FAAP Objectives Describe exhaled nitric oxide physiology and pathophysiology Review the current literature regarding exhaled nitric
More informationSearching for Targets to Control Asthma
Searching for Targets to Control Asthma Timothy Craig Distinguished Educator Professor Medicine and Pediatrics Penn State University Hershey, PA, USA Inflammation and Remodeling in Asthma The most important
More informationCOPD COPD. Update on COPD and Asthma
Update on COPD and Asthma Talmadge E. King, Jr., M.D. Krevins Distinguished Professor of Medicine Chair, Department of Medicine University of California San Francisco (UCSF) San Francisco, CA COPD COPD
More informationAsthma - Chronic. Presentations of asthma Cough Wheeze Breathlessness Chest tightness
Asthma - Chronic Definition of asthma Chronic inflammatory disease of the airways 3 components: o Reversible and variable airflow obstruction o Airway hyper-responsiveness to stimuli o Inflammation of
More informationOne Year in the USA with Asthma. Asthma. The Burden of Asthma in the U.S. Asthma. Definition of Asthma. prevalence increasing at 5% per year
In the past year, Dr. Israel has been a Consultant or has performed Clinical Research for the following companies: Elliot Israel, M.D. Professor of Medicine Harvard Medical School Brigham & Women s Hospital
More informationImproving asthma outcomes though education
Improving asthma outcomes though education Segment 1 Clinical Aspects of Asthma and Long term Plan Primary Care and Asthma Most common chronic disease of childhood. Primary care providers are expected
More informationAsthma and Vocal Cord Dysfunction
Asthma and Vocal Cord Dysfunction Amy L. Marks DO, FACOP Pediatric Allergy and Immunology Assistant Professor of Pediatrics Oakland University William Beaumont School of Medicine Objectives: Understanding
More informationCOPD and Asthma Update. April 29 th, 2017 Rachel M Taliercio, DO Staff, Respiratory Institute
COPD and Asthma Update April 29 th, 2017 Rachel M Taliercio, DO Staff, Respiratory Institute What we ll be talking about COPD: diagnosis, management of stable COPD, COPD exacerbations Asthma: diagnosis,
More informationAllergy and Immunology Review Corner: Chapter 75 of Middleton s Allergy Principles and Practice, 7 th Edition, edited by N. Franklin Adkinson, et al.
Allergy and Immunology Review Corner: Chapter 75 of Middleton s Allergy Principles and Practice, 7 th Edition, edited by N. Franklin Adkinson, et al. Chapter 75: Approach to Infants and Children with Asthma
More informationBiologic Agents in the treatment of Severe Asthma
Biologic Agents in the treatment of Severe Asthma Daniel L Maxwell, D.O., FACOI, FAASM Clinical Assistant Professor of Medicine Michigan State University College of Osteopathic Medicine College of Human
More informationDR REBECCA THOMAS CONSULTANT RESPIRATORY PHYSICIAN YORK DISTRICT HOSPITAL
DR REBECCA THOMAS CONSULTANT RESPIRATORY PHYSICIAN YORK DISTRICT HOSPITAL Definition Guidelines contact complicated definitions Central to this is Presence of symptoms Variable airflow obstruction Diagnosis
More informationCurrent Asthma Therapy: Little Need to Phenotype. Phenotypes of Severe Asthma. Cellular Phenotypes 12/7/2012
Subbasement Membrane Thickness(µm) 12/7/212 Current Asthma Therapy: Little Need to Phenotype Phenotypes of Severe Asthma Most mild and to some degree moderate asthmatics respond well to currently available
More informationNational Institutes of Health (NIH) NAEPP 2007 Asthma Guideline UPDATE. Susan K. Ross RN, AE-C MDH Asthma Program.
National Institutes of Health (NIH) NAEPP 2007 Asthma Guideline UPDATE Susan K. Ross RN, AE-C MDH Asthma Program 651-201 201-5629 Susan.Ross@health.state.mn.us 1 National Institutes of Health National
More informationExercise-Induced Bronchospasm. Michael A Lucia, MD, FCCP Asst Clinical Professor, UNR School of Medicine Sierra Pulmonary & Sleep Institute
Exercise-Induced Bronchospasm Michael A Lucia, MD, FCCP Asst Clinical Professor, UNR School of Medicine Sierra Pulmonary & Sleep Institute EIB Episodic bronchoconstriction with exercise May be an exacerbation
More informationOutline FEF Reduced FEF25-75 in asthma. What does it mean and what are the clinical implications?
Reduced FEF25-75 in asthma. What does it mean and what are the clinical implications? Fernando Holguin MD MPH Director, Asthma Clinical & Research Program Center for lungs and Breathing University of Colorado
More informationNational Institutes of Health (NIH) NAEPP 2007 Asthma Guideline Expert Panel Report (EPR) 3
National Institutes of Health (NIH) NAEPP 2007 Asthma Guideline Expert Panel Report (EPR) 3 Susan K. Ross RN, AE C MDH Asthma Program 651 201 201 5629 Susan.Ross@state.mn.us 1 National Institutes of Health
More informationInhaler Confusion. Today s Speaker Dr. Randall Brown. Director of Asthma Programs 6/7/2016. Dr. Randall Brown March 31, 2016
+ Inhaler Confusion Dr. Randall Brown March 31, 2016 + Today s Speaker Dr. Randall Brown Director of Asthma Programs Center for Managing Chronic Disease University of Michigan 1 ASTHMA ESSENTIALS IN PRIMARY
More informationAdult Asthma Clinical Practice Guideline Summary
Adult Asthma Clinical Practice Guideline Summary The following evidence-based guideline was developed to assist Primary Care physicians and other clinicians in the management of asthma in adults. It was
More informationAir Flow Limitation. In most serious respiratory disease, a key feature causing morbidity and functional disruption is air flow imitation.
Asthma Air Flow Limitation In most serious respiratory disease, a key feature causing morbidity and functional disruption is air flow imitation. True whether reversible, asthma and exercise-induced bronchospasm,
More informationUsing Patient Characteristics to Individualize and Improve Asthma Care
Using Patient Characteristics to Individualize and Improve Asthma Care Leonard B. Bacharier, M.D. Associate Professor of Pediatrics Clinical Director, Division of Allergy, Immunology, & Pulmonary Medicine
More informationDisclosures. Learning Objective. Biological therapies. Biologics with action against 11/30/2011. Biologic Asthma Therapies and Individualized Medicine
Biologic Asthma Therapies and Individualized Medicine Mark S. Dykewicz, MD Director, Allergy & Immunology Fellowship Program Director Wake Forest University School of Medicine Winston-Salem, North Carolina
More informationASTHMA-COPD OVERLAP SYNDROME 2018: What s All the Fuss?
ASTHMA-COPD OVERLAP SYNDROME 2018: What s All the Fuss? Randall W. Brown, MD MPH AE-C Association of Asthma Educators Annual Conference July 20, 2018 Phoenix, Arizona FACULTY/DISCLOSURES Randall Brown,
More informationPresented by the California Academy of Family Physicians 2013/California Academy of Family Physicians
Family Medicine and Patient-Centered Asthma Care Presented by the California Academy of Family Physicians Faculty: Hobart Lee, MD Disclosures: Jeffrey Luther, MD, Program Director, Memorial Family Medicine
More informationThe Asthma Guidelines: Diagnosis and Assessment of Asthma
The Asthma Guidelines: Diagnosis and Assessment of Asthma Christopher H. Fanta, M.D. Partners Asthma Center Brigham and Women s Hospital Harvard Medical School Objectives Know how the diagnosis of asthma
More informationClinical efficacy of montelukast in anti-inflammatory treatment of asthma and allergic rhinitis
Clinical efficacy of montelukast in anti-inflammatory treatment of asthma and allergic rhinitis Kim Hyun Hee, MD, PhD. Dept. of Pediatrics The Catholic University of Korea College of Medicine Achieving
More informationTARGET POPULATION Eligibility Inclusion Criterion Exclusion Criterion RECOMMENDATIONS
TARGET POPULATION Eligibility Inclusion Criterion Exclusion Criterion RECOMMENDATIONS Recommendation PULMONARY FUNCTION TESTING (SPIROMETRY) Conditional: The Expert Panel that spirometry measurements FEV1,
More informationAsthma Pathophysiology and Treatment. John R. Holcomb, M.D.
Asthma Pathophysiology and Treatment John R. Holcomb, M.D. Objectives Definition of Asthma Epidemiology and risk factors of Asthma Pathophysiology of Asthma Diagnostics test of Asthma Management of Asthma
More informationThe ability of peak flow measurement
Lessons Learned From the Asthma Clinical Research Network By Brian Piazza, MS 2 and Timothy J. Craig, DO In 1993, the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health
More informationPediatric and Adult. Disclosure. Asthma. Learning Objectives. EPR-3: What s Changed? Asthma: Pediatric and Adult
Asthma: Pediatric and Adult Americo D. Fraboni, MD, FAAFP Assistant Clinical Professor Department of Family Practice & Community Health University of Minnesota Medical School Minneapolis, Minnesota Disclosure
More informationCase-Compare Impact Report
Case-Compare Impact Report October 8, 20 For CME Activity: Developed through an independent educational grant from Genentech: Moderate to Severe Persistent Asthma: A Case-Based Panel Discussion (March
More information(Asthma) Diagnosis, monitoring and chronic asthma management
Dubai Standards of Care 2018 (Asthma) Diagnosis, monitoring and chronic asthma management Preface Asthma is one of the most common problem dealt with in daily practice. In Dubai, the management of chronic
More informationDiagnosis, Treatment and Management of Asthma
Diagnosis, Treatment and Management of Asthma Asthma is a complex disorder characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresponsiveness, and an underlying inflammation.
More informationCynthia S. Kelly, M.D. Professor of Pediatrics Eastern Virginia Medical School Division Director Allergy Children s Hospital of The King s Daughters
Cynthia S. Kelly, M.D. Professor of Pediatrics Eastern Virginia Medical School Division Director Allergy Children s Hospital of The King s Daughters Disclosures Speakers bureau of Novartis and Genentech
More informationAsthma Therapy 2017 JOSHUA S. JACOBS, M.D.
Asthma Therapy 2017 JOSHUA S. JACOBS, M.D. BACKGROUND-PREVALENCE Asthma is one of the most common chronic diseases worldwide with an estimated 300 million affected individuals Prevalence is increasing
More informationAsthma Management in Pregnancy HEATHER HOWE, MD UNIVERSITY OF UTAH PULMONARY DIVISION
Asthma Management in Pregnancy HEATHER HOWE, MD UNIVERSITY OF UTAH PULMONARY DIVISION Asthma Management in Pregnancy Effects of asthma on pregnancy outcomes Effects of pregnancy on asthma control Management
More informationNG80. Asthma: diagnosis, monitoring and chronic asthma management (NG80)
Asthma: diagnosis, monitoring and chronic asthma management (NG80) NG80 NICE has checked the use of its content in this product and the sponsor has had no influence on the content of this booklet. NICE
More informationAdult asthma management: focus on control
Adult asthma management: focus on control Jennifer W. McCallister, MD Associate Professor Pulmonary, Allergy, Critical Care & Sleep Medicine The Ohio State University Wexner Medical Center Objectives Apply
More informationAsthma Description. Asthma is a disease that affects the lungs defined as a chronic inflammatory disorder of the airways.
Asthma Asthma Description Asthma is a disease that affects the lungs defined as a chronic inflammatory disorder of the airways. Symptoms of asthma In susceptible individuals, this inflammation causes recurrent
More informationRobert Kruklitis, MD, PhD Chief, Pulmonary Medicine Lehigh Valley Health Network
Robert Kruklitis, MD, PhD Chief, Pulmonary Medicine Lehigh Valley Health Network Robert.kruklitis@lvh.com Correlation of a Asthma pathophyisology with basic science Asthma (Physiology) Bronchodilators
More informationEndobronchial Thermoplasty
Endobronchial Thermoplasty Asthma Education Day Thursday, October 30, 2014 Cynthia Ray, MD, FCCP Senior Staff Physician Interventional Pulmonology Pulmonary and Critical Care Medicine Henry Ford Hospital
More informationASTHMA. Epidemiology. Pathophysiology. Diagnosis. IAP UG Teaching slides
BRONCHIAL ASTHMA ASTHMA Epidemiology Pathophysiology Diagnosis 2 CHILDHOOD ASTHMA Childhood bronchial asthma is characterized by Airway obstruction which is reversible Airway inflammation Airway hyper
More informationImpact of Asthma in the U.S. per Year. Asthma Epidemiology and Pathophysiology. Risk Factors for Asthma. Childhood Asthma Costs of Asthma
American Association for Respiratory Care Asthma Educator Certification Prep Course Asthma Epidemiology and Pathophysiology Robert C. Cohn, MD, FAARC MetroHealth Medical Center Cleveland, OH Impact of
More informationEffective Date: 4/27/2016 Version: 1.0 Approval By: CCC Clinical Delivery Steering Planned Review Date: 4/27/2017
Protocol Title: Adult Asthma Protocol Effective Date: 4/27/2016 Version: 1.0 Approval By: CCC Clinical Delivery Steering Planned Review Date: 4/27/2017 1 Purpose & Objective This protocol provides evidence-based
More informationDiagnosis and Management of Fungal Allergy Monday, 9-139
Diagnosis and Management of Fungal Allergy Monday, 9-139 13-2010 Alan P. Knutsen,, MD Director, Pediatric Allergy & Immunology Director, Jeffrey Modell Diagnostic Center for Primary Immunodeficiencies
More informationAsthma training. Mike Levin Division of Asthma and Allergy Red Cross Hospital
Asthma training Mike Levin Division of Asthma and Allergy Red Cross Hospital Introduction Physiology Diagnosis Severity Treatment Control Stage 3 of guidelines Acute asthma Drug delivery Conclusion Overview
More informationAsthma in Pregnancy. Michael Schatz, MD, MS Department of Allergy Kaiser Permanente Medical Center San Diego, CA. Introduction
Asthma in Pregnancy Michael Schatz, MD, MS Department of Allergy Kaiser Permanente Medical Center San Diego, CA Introduction Asthma is the most common potentially serious medical problem to complicate
More informationDo We Need Biologics in Pediatric Asthma Management?
Do We Need Biologics in Pediatric Asthma Management? Ting Fan LEUNG, MBChB, MD, FRCPCH, FAAAAI Professor and Chairman Department of Paediatrics The Chinese University of Hong Kong Asthma and Allergy by
More informationI have no perceived conflicts of interest or commercial relationships to disclose.
ASTHMA BASICS Michelle Dickens RN FNP-C AE-C Nurse Practitioner/Certified Asthma Educator Ferrell Duncan Allergy/Asthma/Immunology Coordinator, CoxHealth Asthma Center DISCLOSURES I have no perceived conflicts
More informationLONG-ACTING BETA AGONISTS
LONG-ACTING BETA AGONISTS AND ICS/LABA COMBINATIONS DISCLOSURE Dr. Francisco has no financial interest in any commercial entity discussed in this presentation Dr. Francisco will not discuss experimental
More informationAsthma Population Management: Identifying Persistent Asthma, Defining High Risk Asthma, and Measuring Quality of Asthma Care
Asthma Population Management: Identifying Persistent Asthma, Defining High Risk Asthma, and Measuring Quality of Asthma Care Michael Schatz, MD, MS Allergy Department Kaiser Permanente, San Diego, CA Constructs
More informationDual-Controller Asthma Therapy: Rationale and Clinical Benefits
B/1 Dual-Controller Asthma Therapy: Rationale and Clinical Benefits MODULE B The 1997 National Heart, Lung, and Blood Institute (NHLBI) Expert Panel guidelines on asthma management recommend a 4-step approach
More informationAsthma. UVM. University of Vermont. Alicia Jacobs MD Fletcher Allen Health Care and the University of Vermont
University of Vermont ScholarWorks @ UVM Family Medicine Scholarly Works 6-14-2013 Asthma Alicia Jacobs MD Fletcher Allen Health Care and the University of Vermont Follow this and additional works at:
More informationEndobronchial Thermoplasty
Endobronchial Thermoplasty Michigan Society for Respiratory Care Monday, October 5, 2015 Cynthia Ray, MD, FCCP Senior Staff Physician Interventional Pulmonology Pulmonary and Critical Care Medicine Henry
More informationThe Acute & Maintenance Treatment of Asthma via Aerosolized Medications
The Acute & Maintenance Treatment of Asthma via Aerosolized Medications Douglas S. Gardenhire, EdD, RRT-NPS, FAARC Associate Professor and Chairman Department of Respiratory Therapy Objectives Define Asthma.
More informationPredicting, Preventing and Managing Asthma Exacerbations. Heather Zar Department of Paediatrics & Child Health University of Cape Town South Africa
Predicting, Preventing and Managing Asthma Exacerbations Heather Zar Department of Paediatrics & Child Health University of Cape Town South Africa Asthma exacerbations Predicting exacerbation recognising
More informationObjectives. Asthma in Primary Care. Definition. Epidemiology. Pathophysiology
Objectives Asthma in Primary Care Jed Grant, PA-C Program Director, SJVC PA Program Staff PA, AMCH Emergency Department Apply the NAEPP guideline measures of severity and control including current impairment
More informationII: Moderate Worsening airflow limitations Dyspnea on exertion, cough, and sputum production; patient usually seeks medical
Table 3.1. Classification of COPD Severity Stage Pulmonary Function Test Findings Symptoms I: Mild Mild airflow limitations +/ Chronic cough and sputum production; patient unaware of abnormal FEV 1 80%
More informationExhaled Nitric Oxide: An Adjunctive Tool in the Diagnosis and Management of Asthma
Exhaled Nitric Oxide: An Adjunctive Tool in the Diagnosis and Management of Asthma Jason Debley, MD, MPH Assistant Professor, Pediatrics Division of Pulmonary Medicine University of Washington School of
More informationDistinction and Overlap. Allergy Dpt, 2 nd Pediatric Clinic, University of Athens
Asthma Phenotypes: Distinction and Overlap Nikos Papadopoulos Allergy Dpt, 2 nd Pediatric Clinic, University of Athens Asthma as a syndrome From the Iliad to ADAM 33 and back again Bronchoconstriction,
More informationPediatric Asthma Management
Pediatric Asthma Management APRN Conference February 2016 Cheryl Kerrigan, MSN, CPNP Aimee Tiller RN, AE-C The Plan Definition Pathophysiology review Triggers & Risk Factors Incidence and Prevalence Making
More informationAsthma: Classification, Management, Prevention and New Treatments
Asthma: Classification, Management, Prevention and New Treatments Cori Daines, MD, Professor Pediatric Pulmonary Medicine University of Arizona April 28, 2018 I have no relevant financial relationships
More informationSpeaker Disclosure. Identification and Diagnosis of Asthma. Definition of Asthma. Objectives 11/9/2017
Speaker Disclosure Identification and Diagnosis of Asthma Isabel L. Virella Lowell, MD, Associate Professor, Pulmonology and Sleep Medicine, University of Alabama at Birmingham Isabel Virella-Lowell, MD
More informationSymptoms are worse at night and in the morning and includes cough, whz, chest tightness.
Asthma Review ETIOLOGY Airflow limitation is caused by the following: - bronchoconstriction - mucous pluggin - airway inflammation Sudden death - heavy mucous plugging is common - typically occurs between
More informationASTHMA BEST PRACTICES FOR SCHOOL NURSES. School Nurses November 2015
ASTHMA BEST PRACTICES FOR SCHOOL NURSES School Nurses November 2015 1 BACKGROUND AND CURRENT STATS General definitions and explanations 2 Incidence of Asthma Centers for Disease Control (CDC) - 1 in 12
More informationBronchial Thermoplasty For Severe Persistent Asthma
Bronchial Thermoplasty For Severe Persistent Asthma Faisal Khan MD Center For Respiratory and Sleep Medicine Indiana Internal Medicine Consultants Franciscan Saint Francis hospital Agenda Burden of Severe
More information