• Luisa Ricciardi added an answer:
    In a metacholine challenge test - I have observed that some patients overcome the challenge test, while some don't - why is it so?

    What is the ratio of negative positive patients passing the induced asthma test even though asthma is duly induced during the test and reversed if proven detrimental?

    Luisa Ricciardi · Università degli Studi di Messina

    The gold standard for the diagnosis of asthma is spirometry as it shows FEV1 reductions which must be reversible of at least 12% after beta-2 short acting  inhalation. Even if FEV1 values are normal asthmatic patients present airway inflammation which causes  the reduction of the small airways parameters. For allergic asthma  Nitric Oxide determination could be useful for monitoring treatment efficacy. 

  • Imran AHMED Khan added an answer:
    How could we generate an asthma warning system through monitoring environmental factors?

    Asthma is a serious issue. Early warnings for asthmatic are very important. In many countries pollen count or its covering area, pollutants, dust are monitored, but there is a need for combined efforts to minimize the triggers.

    Imran AHMED Khan · Govt Degree Sc/Com College Landhi Korangi 6/ ,University of Karachi

    Dear Amy,

    Thank you very much for answer this in such detail. This will help me a lot, I am doing asthma related modeling. Thanks again.

    Regards

    Imran

  • George Christoff added an answer:
    Who knows about ongoing studies of vitamin D as a possible adjunct to standard therapy in paediatric asthma?

    I have published recently about the association between asthma exacerbation and hours of sunlight exposure in UK children. I am interested in undertaking a large study of vitamin D versus placebo to see whether this reduces asthma admissions. Obviously I am aware of the Majak study but does anyone know what active research is going on?

    George Christoff · Medical University of Sofia

    This could be of some help as well: http://www.waojournal.org/content/7/1/27

  • George Christoff added an answer:
    How useful are asthma action plans for pediatric asthma patients?

    I am looking into the compliance rate of asthma action plans in the pediatric patient population. How useful are they. Are there results from focus groups regarding asthma action plans?

    George Christoff · Medical University of Sofia

    Asthma action plans are the corner stone of modern asthma management. So their usefulness is beyond question. On the other hand it depends to a great extend on patients' compliance. A prerequisite for a high compliance with an asthma action plan is it being tailored to the specific characteristics of the patient group. If you need further information on asthma action plans in different focus groups I suggest you try a search in the medical databases available.

  • Emanuele Cauda added an answer:
    Who should I contact if I wanted a "bronchodilator inhaler" charged with solid spherical microparticles?

    I need to find a company/facility that is interested in loading a drug inhaler cartridge (something generally used for asthmatic people) with monodisperse microsize particles. These are solid spheres in the range of 1-10 um. I want a cheap and quick way to create an aerosol using this inhaler for the testing of samplers. Any suggestion and contacts are very welcome.

    Emanuele Cauda · Centers for Disease Control and Prevention

    Claudio,

    Thanks for the suggestion. I searched hard-shell capsules and they might be good for my application. I need to discover though if each capsule can be used only once. If so, this could be problematic considering the cost of the microsphere and the fact I would need few micrograms in the each capsule.

    Rana,

    I am very familiar with cascade impactors and I don't think is what I need for this idea.Thanks

  • Bruce Compton added an answer:
    Any guidelines on dosing with a MDI(metered dose inhaler)in a BE study?

    Any ideas on minimizing inconsistency of dose delivery with MDI's in bio studies. Eg contamination, statics and ?inspirational flow rate? Is this at all necessary?

    Bruce Compton · University of Massachusetts Lowell

    This is tough, when I worked in this are we had to develop much of our equipment and used a half dozen methods.  I think you need to find a CRO that has a focus on this type of dosage form.  The systems we did use were base on what you'd expect - automating the dispensing and capturing/weighing what was released. Some things are not easy.

  • John Blakey added an answer:
    What is the best humanized monoclonal antibody used to treat lung inflammation in asthma disease?

    Monoclonal antibody therapy for asthma disease.

    John Blakey · Liverpool School of Tropical Medicine

    Because asthma is a syndrome rather than a specific disease, there are no "best" treatments. As we've previously seen with medications such as LABAs, ICS, and montelukast what is "best" depends on the processes underlying the asthma and the outcome measured. From the landmark FACET study to recent papers (e.g. Flood-Page then Haldar) investigating Mepolizumab, the effectiveness of a medication depends on patient selection and endpoints measured (airflow measures vs exacerbations). As more antibodies are brought to market, what's best will also be influenced by ease of administration and shelf-life, and by cost.

    Sorry not to answer your question definitively, but I'd be surprised if anyone did. In a few years time we should have a better handle on who should have mepo, who lebrikizumab, etc

  • Jeffrey P Kahn added an answer:
    Can anyone recommend literature for Asthma and mental health?

    My background is in mental health, however I am new to the study of asthma. What are the key conversations regarding the interaction of these two elements should I get myself up to speed on?

  • Daniel Laskowski added an answer:
    What is the best method for induction of bronchial asthma in mice?

    There are many different methods for induction of bronchial asthma using mice as animal model particularly by OVA albumin. Can you suggest other ways to get good results?

    Daniel Laskowski · Cleveland Clinic

    methacholine

  • Joanna Szram added an answer:
    What has a higher potential to cause asthma - glycol ethers or organic quaternary ammonium compounds?

    Both glycol ethers and organic quaternary ammonium compounds are increasingly associated with causing asthma among workers handling chemicals which contain either or both of the compounds.

    However, little information other than their intrinsic characteristics of being airway irritants is available.

    How comparable can these two groups of compounds be?

    Joanna Szram · Imperial College London

    Organic quaternary ammonium compounds are a known, reported low molecular mass asthmagen. There is a wealth of information available on this topic  in the published literature; also the University of Manchester have worked with chemists to create an Asthma Hazard Program; headed up by Professor Raymond Agius.

    glycol ether is to my understanding a VOC and so is irritant/exacerbatory of pre-existing airway hyper-reactivity. the potential for irritant induced asthma , aside from an acute, normall one off, high dose exposure is still debated. again, lots of literature out there.

  • Michael E Wechsler added an answer:
    Can anyone suggest whether increasing ICS dose or adding LABA to ICS works best for Asthmatic patients?

    In asthmatic children whose symptoms are uncontrolled on standard doses of inhaled corticosteroids (ICS), guidelines recommend to either increase the ICS dose or to add further controller medication, e.g. a long acting beta-agonist (LABA)

    Is it important to follow the stepwise approach in treating Adults and children with asthma which almost all international guidelines recommend, or is it ok to change it around if you see that it works best!

    In addition, In Bahrain, in the primary health care setting precisly, physicians tend to 'skip' starting with mono therapy (ICS) and start directly with combination Tx like seretide Diskus, patients find it easier to use and they get better on so many levels,, so is that ok?

    Michael E Wechsler · National Jewish Health

    There is no perfect answer to this question for all subjects.

    Different studies have shown that addition of either of these agents, or even an anticholinergic therapy such as tiotropium, can be effective as add-on therapy. 

    One strategy is to try to identify predictive biomarkers, such as exhaled NO, or blood or sputum eosinophils. For many of these patients who have increased levels of these,, increasing the dose of inhaled corticosteroids is often beneficial.

    In the acute setting, when a patient is poorly controlled, I try to get them under better control and i often do both, increase the dose of the inhaled corticosteroid AND add a long acting beta agonist. Once well controlled, I will step them down sequentially. 

  • Eskandar Ahdab added an answer:
    I want to ask about pattern of asthma prevalence in children age groups whether there is any pathophysiology of disease describing different prevalence?
    ISAAC studies have commonly used age groups of 6-7 years and 13-14 years for describing the burden, why were other age groups not taken into account ? Is there any scientific justification for that? Some studies have also used age groups of 3-7 years, 8-14 years and 15-17 years to find out the difference in prevalence using ISAAC questionnaire as study tool. Are they justified in that by choosing these age groups and if yes, what could be the possible explanation of that in we look at course of disease whether there is increasing trend as the age increases (3-7 years) and there is the dip in between years (8-14 years) and then again rise in the trend (15-17 years)?
    Eskandar Ahdab · University of Illinois at Chicago
    thank you Kathy and Benjamin
  • Javad Ghaffari added an answer:
    Does a person whose Total IgE test is positive i.e., concentration of IgE is above the normal level, go for a repeat test in the same year?

    Also, do we have separate kits for reagents, conjugate and calibrators for Allergen Specific IgE or the complete thing comes in one kit? 

    Javad Ghaffari · Mazandaran University of Medical Sciences

    we ask the patient for relation between positive skin or RAST test with clinical manifestations.

  • Ayodeji Osunkentan added an answer:
    What is the current best evidence in the treatment of asthma in adults older than 60 years?
    If possible, provide a recent systematic review in pdf
    Ayodeji Osunkentan · University of the West of England, Bristol

    Thanks, John

  • Prasad D.K. Dhulipala added an answer:
    Does anyone know a protocol for isolation and culture of airway smooth muscle cells from the trachea of mice?
    I have prepared a mouse model of asthma. I need ASM cells to do some in-vitro experiments. Can somebody tell me a nice user friendly protocol please?
    Prasad D.K. Dhulipala · Baker Hughes Incorporated, Tomball, TX

    Please contact Yangxio Wang at Albany medical college or Dr. Micheal Kotlikoff at Cornell Univ.

  • Khaled Saad added an answer:
    When do you use Theophylline in pediatric patients?

    Theophylline in pediatric patients

    Khaled Saad · Assiut University

    Thanks Jaiswal

  • Israel Amirav added an answer:
    Are there articles about Zileuton as inhalable formulation?

    Did anybody read or know any reference/ research work about Zileuton as DPI or MDI formulation !?

    Israel Amirav · University of Alberta

    In addition to my previous answer- Invion company work with 3M Drug Delivery Systems to develop inhaled formulations of  zafirlukast to be delivered using 3M’s MDI technology.

    Best regards

  • Khaled Saad added an answer:
    What are the new data in GINA guidelines in pediatric asthma?
    GINA guidelines in pediatric asthma.
    Khaled Saad · Assiut University

    Thanks José Angelo Rizzo

  • Amin Zakeri added an answer:
    Does anybody know a reliable protocol concerning the asthma induction in mice by OVA?

    I am studying the immunopathology of asthma. I tried some protocols that have been mentioned in papers but after several experiments I have not seen any eosinophil in BAL. I used the OVA SIGMA grade III, and I really don't know where the major problem is. Could someone please share any practical protocol that describes asthma induction step by step? By the way, is it essential to remove LPS from OVA that is provided by SIGMA?

    Thanks.

    Amin Zakeri · Ferdowsi University Of Mashhad

    Yes, that's right. unfortunately Research Gate has not any symbol for micron !

    thanks

  • Krishnan Umachandran added an answer:
    What is best herbal plant used to alleviate asthma?

    There are many herbal plants used to treat many different diseases like asthma. Which is the best one used in this case?

    Krishnan Umachandran · Professor

    This is one of the good sites to go through for herbal uses...

  • JN Li added an answer:
    What concentration of histamine in the body can produce positive effects?

    And if I use histamine-inhalation test for asthma, what is the relationship between the histamine concentration inhaled by subjects and the concentration finally reached at cell surface. For example, inhalation concentration is 8mg/ml, and what is the final concentration when histamine touch the sensory nerve endings of airway. Thank you very much.

    JN Li · Harbin Medical University

    Thank you very much for your helpful answer!

  • Guergana Petrova added an answer:
    Does usage of inhaled steroids in bronchial asthma for long periods of time make the airway dependant on steroids?
    I have observed patients with bronchial asthma, be initially treated with budesonide which after a period of use becomes ineffective. They are then switched over to formoterol for a while and eventually to salmeterol. What will they be treated with after salmeterol?
    Guergana Petrova · Alexandrovska University Hospital

    I perfectly agree with dr Picardo,

    I don't think long term ICS induces total CS resistance. Also the danger of switching ICS with LABA.

    I will never switch a patient to LABA only, if he needs LABA - go for combination with ICS, but not LABA alone.

  • César Picado added an answer:
    What's your opinion on assay sensitivity (i.e. placebo arm) in asthma trials?
    Could placebo be accepted from an ethical point of view for short term studies (e.g. 8 weeks)? Which alternatives are there? E.g. low fixed dose of inhaled corticosteroid.
    César Picado · Hospital Clínic. Universtity of Barcelona. IDIBAPS
    Clinical and epidemiological studies have shown that asthma exacerbations can occur in a short period of time (rapid-onset exacerbations) or come on slowly for days of progressive deterioration (slow-onset). Rapid-onset exacerbations represent around 15% of all severe exacerbations and can be precipitated by an NSAID (8%), the remaining severe exacerbations are cause by exposure to potent allergens (in young patients alternaria alternata) or by undetected precipitants. Slow onset usually occur in asthma patients with not well controlled asthma (inadecuate assessment, insufficient therapy, poor compliance).
    In patients with well controlled asthma discontinuation of therapy will not result in a sudden dererioration, the way these patients deteriorate clinically and functionally is progressive over various days. A close control of patients will allow to detect the initial symptoms of clinical deterioration and PF and FeNO recording will show the initial steps of a potential asthma excerbation. If treatment is restablished asthma will be quickly controlled.
  • Would you use inhaled budesonide (Pulmicort [R] respules) to treat acute asthma?
    Inhaled budesonide is typically used as a controller for persistent asthma, I disagreed with a fellow allergist who insisted that it has given good results when used to treat acute asthma. The medication insert does not indicate its use for acute exacerbations. What are your personal experiences?
    Mohammed Abdel Fattah Abdel Motey · Cairo University
    Edmonds ML, Milan SJ, Camargo Jr CA, Pollack CV, Rowe BH. Early use of inhaled corticosteroids in the emergency department treatment of acute asthma. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD002308. DOI: 10.1002/14651858.CD002308.pub2
    "Authors' conclusions: ICS therapy reduces hospital admissions in patients with acute asthma who are not treated with oral or intravenous corticosteroids. They may also reduce admissions when they are used in addition to systemic corticosteroids; however, the most recent evidence is conflicting. There is insufficient evidence that ICS therapy results in clinically important changes in pulmonary function or clinical scores when used in acute asthma in addition to systemic corticosteroids. Also, there is insufficient evidence that ICS therapy can be used in place of systemic corticosteroid therapy when treating acute asthma. Further research is needed to clarify the most appropriate drug dosage and delivery device, and to define which patients are most likely to benefit from ICS therapy. Use of similar measures and reporting methods of lung function, and a common, validated, clinical score would be helpful in future versions of this meta-analysis".
  • Alexander Tauras added an answer:
    Could pit latrines be the answer to domestic air pollution in developing countries?

    During the recently concluded CAHRD Meeting held in Liverpool (UK), one of the issues discussed was the prospect of reducing domestic air pollution (from burning biomass) and its negative health consequences, which particularly affects women and children.

    I frequently come across papers reporting the success of domestic and public pit latrines designed to double up as bio digesters to produce bio gas for cooking and lighting purposes.

    My questions are: Could this be the way forward for developing countries? How feasible is it to be scaled up?

    Alexander Tauras · Presbyterian Intercommunity Hospital, Whittier, CA, United States
    I had some acquaintances in Washington DC working on developing a low-cost biodigester for this purpose, with partners in Madagascar. More info including photos here: http://www.hatch-international.org/bio-d/

    I don't know the current status of their project. I believe their model is meant for use by a single extended family.

    I'm sure there are many other models out there as well being tested.
  • Kurt Rasche added an answer:
    Does performing whole body plethysmography have clinical value?
    ATS/ERS statement 2005 recommends performing body plethysmography after spirometry and before DLCO/TLCO. I wonder whether performing body plethysmography adds relevant information required for clinical decision making. Any thoughts?
    Kurt Rasche · HELIOS Kliniken
    Many aspects are already mentioned above. For me, the most important value of the "body" is to measure hyperinflation in terms of lung emphysema. Another aspect is that even severe ill patients are able to do the maneuver.
  • Ismail Abdul Manan added an answer:
    How to get rid of non-specific signals in the staining of immunofluorescent microscopy?
    We are trying to stain mouse lungs in an allergic asthma model for immunofluorescent microscopy. We are blocking the tissue with unlabeled mouse and goat IgGs, 2% BSA, avidin, and biotin. Nevertheless, we still get a strong non-specific signal mainly from the branchial epithelium filled with mucus. I would appreciate any suggestions on how we could get rid of these non-specific signals.
    Ismail Abdul Manan · University of Science Malaysia
    You can treat the non-specific antibody with cold acetone.
  • Jefferson Buendia added an answer:
    What is your opinion about using antihistamines in asthma?
    Drugs such as Loratadine or Zaditen.
  • Stanley Szefler added an answer:
    What is the most appropriate step-down strategy in patients with mild asthma?
    Inhaled corticosteroids are the key controllers in Asthma but the long term use is linked to some important side-effects.
    Stanley Szefler · University of Colorado
    In stepping down from low-dose ICS, a strategy to consider is using ICS each time a SABA is needed. This lessens the risk of an asthma exacerbation and assesses stability. In addition, eNO could be measures to assess increase in airway inflammation. It would be nice if eventually there was a combination SABA/ICS product for use in the USA since earn ICS/LABA is currently not approved.

About Asthma

A form of bronchial disorder with three distinct components: airway hyper-responsiveness (RESPIRATORY HYPERSENSITIVITY), airway INFLAMMATION, and intermittent AIRWAY OBSTRUCTION. It is characterized by spasmodic contraction of airway smooth muscle, WHEEZING, and dyspnea (DYSPNEA, PAROXYSMAL).

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