Asthma: Difference between revisions
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==Treatment== | ==Treatment== | ||
A [[systematic review]] by the [[Cochrane Collaboration]] found that monitoring sputum eosinophils can guide treatment<ref name="pmid17443604">{{cite journal |author=Petsky H, Kynaston J, Turner C, ''et al'' |title=Tailored interventions based on sputum eosinophils versus clinical symptoms for asthma in children and adults |journal=Cochrane database of systematic reviews (Online) |volume= |issue=2 |pages=CD005603 |year=2007 |pmid=17443604 | id= PMID 17443604 |doi=10.1002/14651858.CD005603.pub2}}</ref> The review identified three [[randomized controlled | ===Treatment of acute exacerbations=== | ||
The U.S. National Asthma Education and Prevention Program defines exacerbations as:<ref name="NAEP">National Asthma Education and Prevention Program: Expert Panel Report III: Guidelines for the diagnosis and management of asthma. Bethesda, MD. National Heart, Lung, and Blood Institute, 2007. (NIH publication no. 08-4051). Available from www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm. (Accessed September 1, 2008).</ref> | |||
* '''Mild'''. "Dyspnea only with activity (assess tachypnea in young children)"; [[peak expiratory flow rate]] ≥70 percent predicted or personal best | |||
* '''Moderate'''. "Dyspnea interferes with or limits usual activity"; [[peak expiratory flow rate]] 40−69 percent predicted or personal best | |||
* '''Severe'''. "Dyspnea at rest; interferes with conversation"; [[peak expiratory flow rate]] <40 percent predicted or personal best | |||
** '''Life threatening'''. "Too dyspneic to speak; perspiring"; [[peak expiratory flow rate]] <25 percent predicted or personal best | |||
===Chronic treatment=== | |||
====Monitoring==== | |||
A [[systematic review]] by the [[Cochrane Collaboration]] found that monitoring sputum eosinophils can guide treatment<ref name="pmid17443604">{{cite journal |author=Petsky H, Kynaston J, Turner C, ''et al'' |title=Tailored interventions based on sputum eosinophils versus clinical symptoms for asthma in children and adults |journal=Cochrane database of systematic reviews (Online) |volume= |issue=2 |pages=CD005603 |year=2007 |pmid=17443604 | id= PMID 17443604 |doi=10.1002/14651858.CD005603.pub2}}</ref> The review identified three [[randomized controlled trial]]s that found that benefit from adjusting anti-inflammatory medications to maintain less than 2 to 8% eosinophils in sputum. | |||
Regarding [[peak expiratory flow rate]] monitoring, according to a [[meta-analysis]] of [[randomized controlled trial]]s by the [[Cochrane Collaboration]], peak flow monitoring is equivalent to symptom monitoring.<ref name="pmid12535511">{{cite journal |author=Powell H, Gibson PG |title=Options for self-management education for adults with asthma |journal=Cochrane Database Syst Rev |volume= |issue=1 |pages=CD004107 |year=2003 |pmid=12535511 |doi=}}</ref> The U.S. National Asthma Education and Prevention Program recommends [[peak expiratory flow rate]] monitoring for selected patients.<ref name="NAEP">National Asthma Education and Prevention Program: Expert Panel Report III: Guidelines for the diagnosis and management of asthma. Bethesda, MD. National Heart, Lung, and Blood Institute, 2007. (NIH publication no. 08-4051). Available from www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm. (Accessed September 1, 2008).</ref> | |||
==References== | ==References== | ||
<references/> | <references/> | ||
Revision as of 03:31, 24 January 2008
Definition
Epidemiology
Etiology
Pathophysiology
Diagnosis
Prognosis
Treatment
Treatment of acute exacerbations
The U.S. National Asthma Education and Prevention Program defines exacerbations as:[1]
- Mild. "Dyspnea only with activity (assess tachypnea in young children)"; peak expiratory flow rate ≥70 percent predicted or personal best
- Moderate. "Dyspnea interferes with or limits usual activity"; peak expiratory flow rate 40−69 percent predicted or personal best
- Severe. "Dyspnea at rest; interferes with conversation"; peak expiratory flow rate <40 percent predicted or personal best
- Life threatening. "Too dyspneic to speak; perspiring"; peak expiratory flow rate <25 percent predicted or personal best
Chronic treatment
Monitoring
A systematic review by the Cochrane Collaboration found that monitoring sputum eosinophils can guide treatment[2] The review identified three randomized controlled trials that found that benefit from adjusting anti-inflammatory medications to maintain less than 2 to 8% eosinophils in sputum.
Regarding peak expiratory flow rate monitoring, according to a meta-analysis of randomized controlled trials by the Cochrane Collaboration, peak flow monitoring is equivalent to symptom monitoring.[3] The U.S. National Asthma Education and Prevention Program recommends peak expiratory flow rate monitoring for selected patients.[1]
References
- ↑ 1.0 1.1 National Asthma Education and Prevention Program: Expert Panel Report III: Guidelines for the diagnosis and management of asthma. Bethesda, MD. National Heart, Lung, and Blood Institute, 2007. (NIH publication no. 08-4051). Available from www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm. (Accessed September 1, 2008).
- ↑ Petsky H, Kynaston J, Turner C, et al (2007). "Tailored interventions based on sputum eosinophils versus clinical symptoms for asthma in children and adults". Cochrane database of systematic reviews (Online) (2): CD005603. DOI:10.1002/14651858.CD005603.pub2. PMID 17443604. PMID 17443604. Research Blogging.
- ↑ Powell H, Gibson PG (2003). "Options for self-management education for adults with asthma". Cochrane Database Syst Rev (1): CD004107. PMID 12535511. [e]