Asthma: 2015 and Beyond

Pediatric Diagnostics and Respiratory Care, Rainbow Babies and Children's Hospital, Cleveland, Ohio 44106, USA.
Respiratory care (Impact Factor: 1.84). 09/2011; 56(9):1389-407; discussion 1407-10. DOI: 10.4187/respcare.01334
Source: PubMed


Asthma is a multifactorial, chronic inflammatory disease of the airways. The knowledge that asthma is an inflammatory disorder has become a core fundamental in the definition of asthma. Asthma's chief features include a variable degree of air-flow obstruction and bronchial hyper-responsiveness, in addition to the underlying chronic airways inflammation. This underlying chronic airway inflammation substantially contributes to airway hyper-responsiveness, air-flow limitation, respiratory symptoms, and disease chronicity. However, this underlying chronic airway inflammation has implications for the diagnosis, management, and potential prevention of the disease. This review for the respiratory therapy community summarizes these developments as well as providing an update on asthma epidemiology, natural history, cause, and pathogenesis. This paper also provides an overview on appropriate diagnostic and monitoring strategies for asthma, pharmacology, and newer therapies for the future as well as relevant management of acute and ambulatory asthma, and a brief review of educational approaches.

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    • "This finding suggests that the constant cell production process would eventually eliminate cells programmed by PNMS, replacing them with new, non-exposed leukocytes except in the case when this programming is induced early in pluripotent stem cells. A similar pattern can be observed in human diseases, where some immune-related disorders, such as rheumatic fever and asthma, are more prevalent during childhood (Carapetis et al., 2005; Myers & Tomasio, 2011). This argues for the presence of a developmental component in the etiology of some immune-related disorders. "
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    ABSTRACT: Abstract The intra-uterine environment provides the first regulatory connection for the developing fetus and shapes its physiological responses in preparation for postnatal life. Psychological stress acts as a programming determinant by setting functional parameters to abnormal levels, thus inducing postnatal maladaptation. The effects of prenatal maternal stress (PNMS) on the developing immune system have been documented mostly through animal studies, but inconsistent results and methodological differences have hampered the complete understanding of these findings. As the immune system follows a similar ontogenic pattern in all mammals, a translational framework based on the developmental windows of vulnerability proposed by immunotoxicology studies was created to integrate these findings. The objective of this review is to examine the available literature on PNMS and immune function in the offspring through the above framework and gain a better understanding of these results by elucidating the moderating influence of the stressor type, timing and duration, and the offspring species, sex and age at assessment. The evaluation of the literature through this framework showed that the effects of PNMS are parameter specific: the moderating effects of timing in gestation were relevant for lymphocyte population numbers, Natural Killer cell function, and mitogen-induced proliferation. The presence of an important and directional sexual dimorphism was evident and the influence of the type or duration of PNMS paralleled that of stress in non-pregnant animals. In conclusion, PNMS is a relevant factor in the programming of immune function. Its consequences may be related to disorders with an important immune component such as allergies.
    Stress (Amsterdam, Netherlands) 01/2014; 17(2). DOI:10.3109/10253890.2013.876404 · 2.72 Impact Factor
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    • "The highest levels of sTREM-1 molecules have been found in patients with sepsis [14] and other inflammatory diseases caused mainly by extracellular microorganisms—bacteria and fungi [15] [16] [17] [18], as well as inflammatory states of noninfectious origin, for example, rheumatoid arthritis [19] [20]. Knowledge that asthma is an inflammatory disorder [21] has prompted us to investigate the plasma levels of sTREM-1 in patients suffering from allergic asthma bronchiale. "
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    ABSTRACT: The knowledge that asthma is an inflammatory disorder has prompted us to investigate the plasma levels of a new inflammatory marker sTREM-1 that is released from the surfaces of activated neutrophils and monocytes. The plasma levels of sTREM-1 were analysed by a sandwich ELISA test in the cohort of 76 patients with allergic asthma bronchiale and 39 healthy controls. Our results revealed more than 3.5 times higher levels of sTREM-1 in AB patients (92.3 pg/mL ± 125.6) compared with healthy subjects (25.7 pg/mL ± 9.2; P = 0.0001). Higher levels of sTREM-1 were found also in patients with exacerbated AB (170.5 pg/mL ± 78.2) compared with nonexacerbated AB patients (59.1 ± 78.2; P < 0.0001), patients with respiratory tract obstruction (176.4 pg/mL ± 177.8), than those without obstruction (51.99 pg/mL ± 64.0; P < 0.0001) and patients with anti-IgE therapy (P < 0.0001). Levels of sTREM-1 correlated with number of leucocytes (P = 0.002), and absolute number of neutrophils (P = 0.001). Elevated plasma levels of sTREM-1 reflect the severity, state of exacerbation, presence of respiratory tract obstruction in AB patients and together with increased number of neutrophils point to the role of neutrophils in inflammation accompanying AB.
    Mediators of Inflammation 07/2012; 2012(10):628754. DOI:10.1155/2012/628754 · 3.24 Impact Factor
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    ABSTRACT: Neonatal and pediatric respiratory care continues to move forward at a truly impressive pace. Recent technologic advances and an increasing number of randomized clinical trials are leading to improved outcomes for neonates, infants, children, and adolescents with respiratory illness. The goals of this 47th Respiratory Care Journal Conference were to review pertinent recent advances in neonatal and pediatric respiratory care and, more importantly, to offer thoughts and perspectives for the future of our field. It is important to note that of the prior 46 Journal Conferences, only 2 have been dedicated to neonatal and/or pediatric respiratory care topics. It is our hope that the publication of these proceedings will provide respiratory therapists, physicians, and other members of the clinical care team a foundation on which to ponder the future of neonatal and pediatric respiratory care.
    Respiratory care 09/2011; 56(9):1466-80. DOI:10.4187/respcare.01505 · 1.84 Impact Factor
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