What is skin allergy in hindi

It’s a excellent thought to hold an eye on the predicted pollen counts, particularly if you plan to be outdoors for a endless period of time. (If you are planning to be exterior working around plants or cutting grass, a dust mask can help.)

But even if you see a high pollen count predicted in the newspaper, on a smartphone app or on TV, it doesn’t necessarily mean that you will be affected. There are numerous types of pollen — from diverse kinds of trees, from grass and from a variety of weeds. As a result, a high overall pollen count doesn’t always indicate a strong concentration of the specific pollen to which you’re allergic.

The opposite can be true, too: The pollen count might be low, but you might discover yourself around one of the pollens that triggers your allergies.

Through testing, an allergist can pinpoint which pollens bring on your symptoms.

An allergist can also assist you discover relief by determining which medications will work best for your set of triggers.

This sheet was reviewed for accuracy 4/23/

Allergic Asthma: Symptoms and Treatment

Updated: July
Originally Posted: May

Updated by:

Nataliya M Kushnir, MD FAAAAI
Medical Director, Allergy and Immunology Clinic of East Bay
Berkeley, California
Distinguished Volunteer Teacher, Oakland Children’s Hospital Residency Program

Michael A.

Kaliner, MD FAAAAI
Medical Director, Institute for Asthma and Allergy
Chevy Chase and Wheaton, Maryland
Professor of Medicine, George Washington University School of Medicine
Washington DC

Original authors:

H. Henry Li, MD, PhD
FAAAAI, FACAAI
Institute for Asthma and Allergy
Wheaton and Chevy Chase Maryland

Michael A. Kaliner, MD FAAAAI
Medical Director, Institute for Asthma and Allergy
Chevy Chase and Wheaton, Maryland
Professor of Medicine, George Washington University School of Medicine
Washington DC

Definition and demographics

Asthma is truly a syndrome encompassing several disease entities/endotypes.

The expression asthma derives from the Greek expression for panting, or breathlessness, and thus describes the primary symptom of this disease. Asthma is recognized as a complicated condition with differences in severity, natural history, comorbidities, and treatment response. It has been defined as "a chronic inflammatory disorder associated with variable airflow obstruction and bronchial hyperresponsiveness. It presents with recurrent episodes of wheeze, cough, shortness of breath, chest tightness."

While the critical role of inflammation has been further substantiated, there is an evidence for considerable variability in the pattern of inflammation indicating phenotypic differences that may influence treatment responses.

Gene-by-environmental interactions are significant to the development and expression of asthma. Of the environmental factors, allergic reactions and pollution are of critical importance with expanding role for viral respiratory infections in these processes. The onset of asthma for most patients begins early in life with the pattern of disease persistence sure by early, recognizable risk factors including atopic disease, recurrent wheezing, and a parental history of asthma. Current asthma treatment with anti-inflammatory does not appear to prevent progression of the underlying disease severity.

The most recent comprehensive analyses of the Global Burden of Disease Study (GBD) undertaken in estimates the number of people with asthma in the world as high as million.

A lower figure of million used in the Global Asthma Report came from the most up-to-date GBD information available at that time based on analyses from Prevalence of childhood asthma varies widely between countries, and between centers within countries, and estimated at 14%. Prevalence of recent wheeze in adolescents varied widely. The highest prevalence (>20%) was generally observed in Latin America and in English-speaking countries of Australasia, Europe and North America as well as South Africa. The lowest prevalence (<5%) was observed in the Indian subcontinent, Asia-Pacific, Eastern Mediterranean, and Northern and Eastern Europe.

In Africa, % prevalence was mostly observed. Overall, % of respondents to the World Health Survey aged in reported a doctor’s diagnosis of asthma, % had reported either a doctor’s diagnosis or that they were taking treatment for asthma, and % reported that they had experienced attacks of wheezing or whistling breath (symptoms of asthma) in the preceding 12 months.

Much less is known about the prevalence of asthma in middle-aged and older adults. This reflects both a paucity of survey data and the greater difficulty of distinguishing asthma from other respiratory conditions, such as chronic obstructive pulmonary disease (COPD) in older age groups.

No standardized data on asthma prevalence in the elderly is currently available.

Causes of Asthma

The allergic asthma phenotype dominates in early life. The paradigm for allergen induction of asthma is from allergen exposure → allergic sensitization → asthma development. While a variety of ambient and indoor allergic exposures own been implicated in the development and exacerbation of childhood asthma, the indoor environment has greatest influence on asthma development. Children sensitized to aeroallergens at a young age are likely to own persistent asthma symptoms into tardy childhood and adulthood and show poorer lung function than those not sensitized.

Home dust mite (HDM), furred pets, cockroach, rodent and mold, with regional variation, account for the large proportion of aeroallergens associated with sensitization and asthma. In numerous cases, exposure and sensitivity follow a. Evidence supporting dose-response relationship is particularly strong for dust mite and cat.

The steady increase in population trends towards urban centers also shares the trajectory of increasing air pollution. Indoor and ambient air pollution own been associated with a variety of adverse cardiopulmonary health effects including asthma symptoms, exacerbations and decline in lung function.

The pollutants best studied are the gases nitrogen dioxide (NO2), ozone (O3), volatile organic compounds (VOCs), and particulate matter (PM) that comprises soot.

Recent evidence has demonstrated elevated pollution exposure in utero and in the first year of life may influence the development of asthma in young children. Exposure to indoor pollution of PM and VOCs is directly correlated with asthma inflammatory markers in schoolchildren with and without asthma, indicating potential induction of allergic airway inflammation with these exposures.

Environmental tobacco smoke (ETS) is an independent determinant of the development of asthma.

Tobacco smoke contains numerous VOCs and NO2, which are likely to serve as the conduits to poor respiratory outcomes. In vivo studies also propose that exposure to ETS is associated with IL and greater serum IgE in children with asthma compared to non-exposed asthmatic children and controls, suggesting an augmentation of the Th2 immunophenotype with exposure.

Since the early s the inverse relationship between farming, particularly traditional dairy farming lifestyle, and the development of asthma has been demonstrated early in life and appears to hold true well into adulthood. Children living on farms also had reduced rates of sensitization and other atopic conditions.

Farm studies own implicated the wealthy diversity of microbial exposure both in the animal and home environments are strongly and inversely associated with asthma, implying that the early and persistent microbial environment influences the development of the immune system away from allergic and asthmatic predisposition.

The intestinal microbiome likely influences the immune system in a manner similar to that related to farm exposure.

Because limiting exposure to allergens and allergy immunotherapy are both specifically helpful in treating allergic asthmatic subjects, a careful search for possible allergies is indicated in almost every asthmatics, certainly every persistent asthmatics.
In addition to allergen-induced asthma, numerous other factors and conditions such as exercise, infection, occupational chemical exposures, side effects to medications such as beta adrenergic blocking agents, bronchitis, and Churg-Strauss allergic granulomatosis can also cause asthma.

Sinusitis, GERD, hyperthyroidism, pregnancy and infections may complicate asthma.

Pathogenesis and genetics

Over the final decade research has confirmed the significant role of inflammation in asthma, unfortunately specific processes related to the transmission of airway inflammation to specific pathophysiologic consequences of airway dysfunction and the clinical manifestations of asthma own yet to be fully understood. Similarly, much has been learned about the host –environment factors that determine airways’ susceptibility to these processes, but the relative contributions of either and the precise interactions between them that leads to the initiation or persistence of disease is hard to establish.

The concepts underlying asthma pathogenesis own evolved dramatically in the past 25 years and are still undergoing evaluation as various phenotypes of this disease are defined and greater insight links clinical features of asthma with genetic patterns.

Because asthma involves an integrated response in the conducting airways of the lung to known or unknown triggers, it is a multicellular disease, involving abnormal responses of numerous diverse cell types in the lung.

Environmental triggers concurrently act on airway afferent nerves (which both release their own peptide mediators and stimulate reflex release of the bronchoconstrictor acetylcholine) and airway epithelial cells to initiate responses in multiple cell types that contribute to the mucous metaplasia and airway smooth muscle bronchoconstriction that characterize asthma.

Epithelial cells release TSLP and IL, which act on airway dendritic cells, and IL, which together with IL acts on mast cells, basophils, and innate type 2 lymphocytes.

These secreted products stimulate dendritic cell maturation that facilitates the generation of effector T cells and triggers the release of both direct bronchoconstrictors and Th2 cytokines from innate immune cells, which feed back on both the epithelium and airway smooth muscle and further facilitate amplification of airway inflammation through subsequent adaptive T cell responses.

Asthma is genetically heterogeneous.

A few common alleles are associated with disease risk at every ages. Implicated genes propose a role for communication of epithelial damage to the adaptive immune system and activation of airway inflammation. Asthma runs strongly in families, and its heritability has been estimated as 60%. Genetic studies offer a structured means of understanding the causes of asthma as well as identifying targets that can be used to treat the syndrome. Recent genome-wide association studies begun to shed light on both common and distinct pathways that contribute to asthma and allergic diseases.

Associations with variation in genes encoding the epithelial cell-derived cytokines, interleukin (IL) and thymic stromal lymphopoietin (TSLP), and the IL1RL1 gene encoding the IL receptor, ST2, highlight the central roles for innate immune response pathways that promote the activation and differentiation of T-helper 2 (Th2) cells in the pathogenesis of both asthma and allergic diseases. These and other genetic findings expanding our understanding of the common and unique biological pathways that are dysregulated in these related conditions and eventually will be helpful in design of new therapies and prevention modalities.

Signs and Symptoms of Asthma

To establish a diagnosis of asthma, the clinician should determine that:

  1. Airflow obstruction is at least partially reversible.
  2. Episodic symptoms of airflow obstruction or airway hyperresponsiveness are present.
  3. Alternative diagnoses are excluded.

Recommended methods to establish the diagnosis are:

  1. Physical exam focusing on the upper respiratory tract, chest, and skin.
  2. Detailed medical history.
  3. Spirometry to protest obstruction and assess reversibility, including in children 5 years of age or older.

    Reversibility is sure either by an increase in FEV1 of ≥12 percent from baseline or by an increase ≥10 percent of predicted FEV1 after inhalation of a short-acting bronchodilator.

Additional studies are not routinely necessary but may be useful when considering alternative diagnoses:

  1. Appropriate facility and is not generally recommended if the FEV1 is <65 percent predicted. A positive methacholine bronchoprovocation test is diagnostic for the presence of airway hyperresponsiveness, a characteristic feature of asthma that also can be present in other conditions (e.g., allergic rhinitis, cystic fibrosis, COPD, among others).

    Thus, although a positive test is consistent with asthma, a negative bronchoprovocation may be more helpful to law out asthma.

  2. Bronchoprovocation with methacholine, histamine, freezing air, or exercise challenge may be useful when asthma is suspected and spirometry is normal or near normal. For safety
  3. Biomarkers of inflammation. The usefulness of measurements of biomarkers of inflammation (e.g., entire and differential cell count and mediator assays) in sputum, blood, urine, and exhaled air as aids to the diagnosis and assessment of asthma
  4. Allergy testing
  5. Additional pulmonary function studies (e.g., measurement of lung volumes and evaluation of inspiratory loops) may be indicated, especially if there are questions about possible coexisting COPD, a restrictive defect, VCD, or possible central airway obstruction.

    A diffusing capacity test is helpful in differentiating between asthma and emphysema in patients, such as smokers and older patients, who are at risk for both illnesses.

  6. Chest x ray may be needed to exclude other diagnoses.
  7. reasons, bronchoprovocation testing should be carried out by a trained individual in an
  8. Wheezing—high-pitched whistling sounds when breathing out—especially in children. (Lack of wheezing and a normal chest examination do not exclude asthma.)

It is significant to consider a diagnosis of asthma if certain elements of the clinical history are present – they are not diagnostic by themselves but increase the probability of a diagnosis of asthma:

  • Mold
  • Symptoms happen or worsen in the presence of:
    1. Smoke (tobacco, wood)
    2. Increased nasal secretion, mucosal swelling, and/or nasal polyps.
    3. Gastro-esophageal reflux or laryngopharyngeal reflux, and
    4. Recurrent difficulty in breathing
    5. Exercise
    6. Changes in weather
    7. Viral infection
    8. Symptoms happen or worsen at night, awakening the patient.

      Spirometry is needed to establish a diagnosis of asthma.

      Physical examination should be focused on upper respiratory tract, chest, and skin. Certain findings present on physical exam increase the probability of asthma, while their absence does not law it out, because the disease is by definition variable, and signs of airflow obstruction are often absent between attacks:

      1. Sounds of wheezing during normal breathing, or a prolonged phase of forced exhalation (typical of airflow obstruction).

        Wheezing may only be heard during forced exhalation, but it is not a dependable indicator of airflow limitation.

      2. Hyperexpansion of the thorax, especially in children; use of accessory muscles; appearance of hunched shoulders; and chest deformity.
      3. Menstrual cycles
      4. Recurrent chest tightness
      5. History of any of the following:
        1. Recurrent wheeze
        2. Cough, worse particularly at night
        3. Pollen
        4. Animals with fur or hair
        5. Rhinosinusitis,
        6. Airborne chemicals or dusts
        7. House-dust mites (in mattresses, pillows, upholstered furniture, carpets)
        8. Strong emotional expression (laughing or crying hard)
        9. Atopic dermatitis/eczema or any other manifestation of an allergic skin condition.
        10. Wheezing—high-pitched whistling sounds when breathing out—especially in children.

          (Lack of wheezing and a normal chest examination do not exclude asthma.)

        11. Bronchitis or smoking.

Early in the disease, symptoms may include a vague, heavy feeling of tightness in the chest and in the allergic patient, there may be associated rhinitis and conjunctivitis symptoms. Typical symptoms which patients experience include coughing, wheezing, chest tightness and dyspnea. Cough in asthma is generally non-productive, but it may progress to expectoration of viscous, mucoid sputum which is hard to clear. If the sputum turns purulent or discolored, an infection may be present, as the sputum in asthma is generally clear to light yellow in color.

There is a subgroup of asthmatics whose asthma is characterized solely by cough, without overt wheezing, the "cough variant of asthma".

Monitoring of PEF or methacholine inhalation challenge, to clarify whether there is bronchial hyperresponsiveness consistent with asthma, may be helpful in diagnosis. The diagnosis of cough variant asthma is confirmed by a positive response to asthma medication.

In the completely asymptomatic patient, results of chest examination will be normal, although head, eye, ear, nose, and throat examination may reveal concomitant serous otitis media, allergic conjunctivitis, allergic rhinitis, nasal polyps, paranasal sinus tenderness, signs of postnasal drip, or pharyngeal mucosal lymphoid hyperplasia.

Clubbing of the fingers is extremely rare in uncomplicated asthma, and this finding should direct the physician's attention toward diseases such as bronchiectasis, cystic fibrosis, pulmonary neoplasm, or cardiac disease. Numerous symptomatic asthmatics can be diagnosed by careful auscultation of the chest which reveals the presence of expiratory wheezing and a somewhat prolonged expiratory phase.

Exacerbations of asthma are acute or subacute episodes of progressively worsening shortness of breath, cough, wheezing, and chest tightness—or some combination of these symptoms.

Exacerbations are characterized by decreases in expiratory airflow that can be documented and quantified by simple measurement of lung function (spirometry or PEF), can vary widely among individuals and within individuals from rare to frequent. It is significant to understand that the severity of disease does not necessarily correlate with the intensity of exacerbations, which can vary from mild to extremely severe and life-threatening.

Patients at any level of severity, even intermittent asthma, can own severe exacerbations.

For example, a person who has intermittent asthma can own a severe exacerbation during a viral illness or when exposed to allergens to which he or she is sensitized or to noxious fumes and irritants. In fact the final classification “mild intermittent asthma” was changed to “intermittent asthma”, emphasizing that patients at any level of severity — including intermittent — can own severe exacerbations. The frequency of exacerbations requiring intervention with oral systemic corticosteroids now changed to classification of persistent, rather than intermittent asthma.

The duration of exacerbations may vary from a few hours to a few days. These unpredictable variations in exacerbations can present treatment dilemmas in clinical practice.

Assessment of severity requires assessing the following components of current impairment:

Early in the disease, symptoms may include a vague, heavy feeling of tightness in the chest and in the allergic patient, there may be associated rhinitis and conjunctivitis symptoms.

Typical symptoms which patients experience include coughing, wheezing, chest tightness and dyspnea. Cough in asthma is generally non-productive, but it may progress to expectoration of viscous, mucoid sputum which is hard to clear. If the sputum turns purulent or discolored, an infection may be present, as the sputum in asthma is generally clear to light yellow in color.

There is a subgroup of asthmatics whose asthma is characterized solely by cough, without overt wheezing, the "cough variant of asthma".

Monitoring of PEF or methacholine inhalation challenge, to clarify whether there is bronchial hyperresponsiveness consistent with asthma, may be helpful in diagnosis. The diagnosis of cough variant asthma is confirmed by a positive response to asthma medication.

In the completely asymptomatic patient, results of chest examination will be normal, although head, eye, ear, nose, and throat examination may reveal concomitant serous otitis media, allergic conjunctivitis, allergic rhinitis, nasal polyps, paranasal sinus tenderness, signs of postnasal drip, or pharyngeal mucosal lymphoid hyperplasia.

Clubbing of the fingers is extremely rare in uncomplicated asthma, and this finding should direct the physician's attention toward diseases such as bronchiectasis, cystic fibrosis, pulmonary neoplasm, or cardiac disease. Numerous symptomatic asthmatics can be diagnosed by careful auscultation of the chest which reveals the presence of expiratory wheezing and a somewhat prolonged expiratory phase.

Exacerbations of asthma are acute or subacute episodes of progressively worsening shortness of breath, cough, wheezing, and chest tightness—or some combination of these symptoms.

Exacerbations are characterized by decreases in expiratory airflow that can be documented and quantified by simple measurement of lung function (spirometry or PEF), can vary widely among individuals and within individuals from rare to frequent. It is significant to understand that the severity of disease does not necessarily correlate with the intensity of exacerbations, which can vary from mild to extremely severe and life-threatening.

Patients at any level of severity, even intermittent asthma, can own severe exacerbations.

For example, a person who has intermittent asthma can own a severe exacerbation during a viral illness or when exposed to allergens to which he or she is sensitized or to noxious fumes and irritants. In fact the final classification “mild intermittent asthma” was changed to “intermittent asthma”, emphasizing that patients at any level of severity — including intermittent — can own severe exacerbations.

The frequency of exacerbations requiring intervention with oral systemic corticosteroids now changed to classification of persistent, rather than intermittent asthma. The duration of exacerbations may vary from a few hours to a few days. These unpredictable variations in exacerbations can present treatment dilemmas in clinical practice.

Assessment of severity requires assessing the following components of current impairment:

  • Psychosocial factors: depression, increased stress, socioeconomic factors
  • Ability to engage in normal daily activities or in desired activities
  • Attitudes and beliefs about taking medications
  • Certain demographic or patient characteristics: female, nonwhite, nonuse of ICS therapy, and current smoking
  • Quality-of-life assessments
  • Environment control

    Most convincing evidence for early life environmental exposures influencing the development of asthma would be from randomized controlled interventions to specifically addressing the offending agent and protest lower incidence of asthma development.

    Allergen remediation strategies directed at cat, dog, mold, mouse and cockroach protest substantially decrease exposure levels in homes. Interventions to reduce HDM alone own been effective and seem to improve early outcomes.

    Recent meta-analyses own shown multifaceted allergen remediation programs to be protective against the development of asthma with % reduction in odds. The most protective effect was seen in children with greater than 5 years of follow-up, indicating a true decrease in risk to those prone to develop atopic asthma.

    The best preventative effect of allergen avoidance was the Canadian Childhood Asthma Primary Prevention Study in a high risk birth cohort.

    In this study, the intervention was avoidance of home dust mite, pets, and environmental tobacco smoke starting prenatally, and encouragement of breastfeeding with delayed introduction of solids. HDM interventions included encasing parents’ and infants’ mattresses and box springs, weekly boiling water wash of every bedding and application of benzyl benzoate to carpets and upholstery before birth and at 4 and 8 months of age. Children receiving the intervention had significantly less physician diagnoses of asthma, wheeze in the past 12 months and wheeze apart from colds when evaluated at age 7 years.

    Another birth cohort study also observed significantly fewer asthma symptoms at age 8 years ancient in a high risk birth cohort intervention focused on HDM and food allergen avoidance in early life, and a significant decrease in atopy at the 8 year time point.

    Large studies assessing increased exposure to indoor fungi before the development of asthma symptoms suggests that Penicillium, Aspergillus, and Cladosporium species pose a respiratory health risk in susceptible populations.

    Increased exacerbation of current asthma symptoms in children and adults were associated with increased levels of Penicillium, Aspergillus, Cladosporium, and Alternaria species, although further work should consider the role of fungal diversity and increased exposure to other fungal species.

  • Persistent severe airflow obstruction. Two or more ED visits or hospitalizations for asthma in the past year; any history of intubation or ICU admission, especially if in the past 5 years
  • Lung function, measured by spirometry: FEV1, FVC (or FEV6), FEV1/FVC (or FEV6 in adults). Spirometry is the preferred method for measuring lung function to classify severity.

    Peak flow has not been found to be a dependable variable for classifying severity.

  • Severe airflow obstruction, as detected by spirometry
  • Patients report that they feel in harm or frightened by their asthma
  • Probiotics and vitamins

    Early studies on the effect of probiotics to affect asthma development by influencing the perinatal microbiome own been mixed. A recent study found significant decrease in the risk of atopic sensitization associated with pre and post-natal istration of probiotics, however there was no effect on asthma or wheeze.
    Vitamins are essential constituents of our diet that own endless been known to influence the immune system.

    Vitamins A and D own received specific attention in recent years as these vitamins own been shown to own an unexpected and crucial effect on the immune response.

  • Nighttime awakenings
  • Symptoms
    1. Work/school days missed
    2. Need for SABA for quick relief of symptoms
    3. Lung function, measured by spirometry: FEV1, FVC (or FEV6), FEV1/FVC (or FEV6 in adults). Spirometry is the preferred method for measuring lung function to classify severity. Peak flow has not been found to be a dependable variable for classifying severity.
    4. Experimental preventive therapies

      In preterm infants without bronchopulmonary dysplasia, Palivizumab, a monoclonal antibody against RSV, reduces respiratory morbidity up to 78%.

      Recent findings in tardy preterm children without BPD suggests that prophylaxis through infancy may decrease recurrent wheeze in the first year of life by 10% and by up to 50% at three years of age. While encouraging, further longitudinal studies are necessary to assess the effect of palivizumab prophylaxis to decrease the incidence of asthma in childhood.
      Recent evidence suggests that anti-allergen immunotherapy to cross-link the FcέR1 receptor may decrease viral induced asthma symptoms. While alterations of the physical environment own been studied, little attention has been given to the approach of altering the immune constitution of high risk individuals.

      In this honor, immunomodulators, such as Omalizumab may be of future interest.

Assessment of Risk

Assessment of the risk of future adverse events requires careful medical history, observation, and clinician judgment. Documentation of warning signs and adverse events will be necessary when a patient is felt to be at increased risk. Patients who are deemed at increased risk of adverse outcomes need shut monitoring and frequent assessment by their clinicians.

Predictors that own been reported to be associated with increased risk of exacerbations or death include:

  1. Psychosocial factors: depression, increased stress, socioeconomic factors
  2. Persistent severe airflow obstruction.

    Two or more ED visits or hospitalizations for asthma in the past year; any history of intubation or ICU admission, especially if in the past 5 years

  3. Environment control

    Most convincing evidence for early life environmental exposures influencing the development of asthma would be from randomized controlled interventions to specifically addressing the offending agent and protest lower incidence of asthma development. Allergen remediation strategies directed at cat, dog, mold, mouse and cockroach protest substantially decrease exposure levels in homes.

    Interventions to reduce HDM alone own been effective and seem to improve early outcomes.

    Recent meta-analyses own shown multifaceted allergen remediation programs to be protective against the development of asthma with % reduction in odds.

    What is skin allergy in hindi

    The most protective effect was seen in children with greater than 5 years of follow-up, indicating a true decrease in risk to those prone to develop atopic asthma.

    The best preventative effect of allergen avoidance was the Canadian Childhood Asthma Primary Prevention Study in a high risk birth cohort. In this study, the intervention was avoidance of home dust mite, pets, and environmental tobacco smoke starting prenatally, and encouragement of breastfeeding with delayed introduction of solids. HDM interventions included encasing parents’ and infants’ mattresses and box springs, weekly boiling water wash of every bedding and application of benzyl benzoate to carpets and upholstery before birth and at 4 and 8 months of age.

    Children receiving the intervention had significantly less physician diagnoses of asthma, wheeze in the past 12 months and wheeze apart from colds when evaluated at age 7 years. Another birth cohort study also observed significantly fewer asthma symptoms at age 8 years ancient in a high risk birth cohort intervention focused on HDM and food allergen avoidance in early life, and a significant decrease in atopy at the 8 year time point.

    Large studies assessing increased exposure to indoor fungi before the development of asthma symptoms suggests that Penicillium, Aspergillus, and Cladosporium species pose a respiratory health risk in susceptible populations.

    Increased exacerbation of current asthma symptoms in children and adults were associated with increased levels of Penicillium, Aspergillus, Cladosporium, and Alternaria species, although further work should consider the role of fungal diversity and increased exposure to other fungal species.

  4. Probiotics and vitamins

    Early studies on the effect of probiotics to affect asthma development by influencing the perinatal microbiome own been mixed. A recent study found significant decrease in the risk of atopic sensitization associated with pre and post-natal istration of probiotics, however there was no effect on asthma or wheeze.
    Vitamins are essential constituents of our diet that own endless been known to influence the immune system.

    Vitamins A and D own received specific attention in recent years as these vitamins own been shown to own an unexpected and crucial effect on the immune response.

  5. Severe airflow obstruction, as detected by spirometry
  6. Attitudes and beliefs about taking medications
  7. Certain demographic or patient characteristics: female, nonwhite, nonuse of ICS therapy, and current smoking
  8. Patients report that they feel in harm or frightened by their asthma
  9. Experimental preventive therapies

    In preterm infants without bronchopulmonary dysplasia, Palivizumab, a monoclonal antibody against RSV, reduces respiratory morbidity up to 78%.

    Recent findings in tardy preterm children without BPD suggests that prophylaxis through infancy may decrease recurrent wheeze in the first year of life by 10% and by up to 50% at three years of age. While encouraging, further longitudinal studies are necessary to assess the effect of palivizumab prophylaxis to decrease the incidence of asthma in childhood.
    Recent evidence suggests that anti-allergen immunotherapy to cross-link the FcέR1 receptor may decrease viral induced asthma symptoms. While alterations of the physical environment own been studied, little attention has been given to the approach of altering the immune constitution of high risk individuals.

    In this honor, immunomodulators, such as Omalizumab may be of future interest.

Asthma in elderly
Asthma affecting individuals across the lifespan. Current evidence consistently suggests that asthma is common among elderly subjects. Because of increased longevity, the proportion of individuals aged 65years and older is increasing worldwide. By , elderly subjects will comprise ~20% and ~36% of the populations of the United States (U.S.) and China, respectively.

Determining the exact prevalence of asthma in elderly is made hard by under-diagnosis due to decreased perception or under-reporting of symptoms by patients, suboptimal utilization of spirometry, misclassification of asthma as chronic obstructive pulmonary disease (COPD), and failure to recognize asthma in subjects with co-morbidities such as congestive heart failure or COPD. In two nationwide surveys in the U.S.

estimates of the prevalence of current asthma in the elderly were % for the period – In elderly subjects, asthma is more common in women than in men. Compared to children or younger adults, older adults and/or elderly subjects own greater morbidity and healthcare costs from asthma, thus it is significant to recognize and treat asthma in older population.

Prevention

Multifactorial disease requires multiple approaches in order to minimize development or progression of the clinical symptoms.

Assessment of Risk

Assessment of the risk of future adverse events requires careful medical history, observation, and clinician judgment.

Documentation of warning signs and adverse events will be necessary when a patient is felt to be at increased risk. Patients who are deemed at increased risk of adverse outcomes need shut monitoring and frequent assessment by their clinicians.

Predictors that own been reported to be associated with increased risk of exacerbations or death include:

  1. Psychosocial factors: depression, increased stress, socioeconomic factors
  2. Persistent severe airflow obstruction.

    Two or more ED visits or hospitalizations for asthma in the past year; any history of intubation or ICU admission, especially if in the past 5 years

  3. Environment control

    Most convincing evidence for early life environmental exposures influencing the development of asthma would be from randomized controlled interventions to specifically addressing the offending agent and protest lower incidence of asthma development. Allergen remediation strategies directed at cat, dog, mold, mouse and cockroach protest substantially decrease exposure levels in homes. Interventions to reduce HDM alone own been effective and seem to improve early outcomes.

    Recent meta-analyses own shown multifaceted allergen remediation programs to be protective against the development of asthma with % reduction in odds.

    The most protective effect was seen in children with greater than 5 years of follow-up, indicating a true decrease in risk to those prone to develop atopic asthma.

    The best preventative effect of allergen avoidance was the Canadian Childhood Asthma Primary Prevention Study in a high risk birth cohort. In this study, the intervention was avoidance of home dust mite, pets, and environmental tobacco smoke starting prenatally, and encouragement of breastfeeding with delayed introduction of solids. HDM interventions included encasing parents’ and infants’ mattresses and box springs, weekly boiling water wash of every bedding and application of benzyl benzoate to carpets and upholstery before birth and at 4 and 8 months of age.

    Children receiving the intervention had significantly less physician diagnoses of asthma, wheeze in the past 12 months and wheeze apart from colds when evaluated at age 7 years. Another birth cohort study also observed significantly fewer asthma symptoms at age 8 years ancient in a high risk birth cohort intervention focused on HDM and food allergen avoidance in early life, and a significant decrease in atopy at the 8 year time point.

    Large studies assessing increased exposure to indoor fungi before the development of asthma symptoms suggests that Penicillium, Aspergillus, and Cladosporium species pose a respiratory health risk in susceptible populations. Increased exacerbation of current asthma symptoms in children and adults were associated with increased levels of Penicillium, Aspergillus, Cladosporium, and Alternaria species, although further work should consider the role of fungal diversity and increased exposure to other fungal species.

  4. Probiotics and vitamins

    Early studies on the effect of probiotics to affect asthma development by influencing the perinatal microbiome own been mixed.

    A recent study found significant decrease in the risk of atopic sensitization associated with pre and post-natal istration of probiotics, however there was no effect on asthma or wheeze.
    Vitamins are essential constituents of our diet that own endless been known to influence the immune system. Vitamins A and D own received specific attention in recent years as these vitamins own been shown to own an unexpected and crucial effect on the immune response.

  5. Severe airflow obstruction, as detected by spirometry
  6. Attitudes and beliefs about taking medications
  7. Certain demographic or patient characteristics: female, nonwhite, nonuse of ICS therapy, and current smoking
  8. Patients report that they feel in harm or frightened by their asthma
  9. Experimental preventive therapies

    In preterm infants without bronchopulmonary dysplasia, Palivizumab, a monoclonal antibody against RSV, reduces respiratory morbidity up to 78%.

    Recent findings in tardy preterm children without BPD suggests that prophylaxis through infancy may decrease recurrent wheeze in the first year of life by 10% and by up to 50% at three years of age. While encouraging, further longitudinal studies are necessary to assess the effect of palivizumab prophylaxis to decrease the incidence of asthma in childhood.
    Recent evidence suggests that anti-allergen immunotherapy to cross-link the FcέR1 receptor may decrease viral induced asthma symptoms. While alterations of the physical environment own been studied, little attention has been given to the approach of altering the immune constitution of high risk individuals.

    In this honor, immunomodulators, such as Omalizumab may be of future interest.

Asthma in elderly
Asthma affecting individuals across the lifespan. Current evidence consistently suggests that asthma is common among elderly subjects. Because of increased longevity, the proportion of individuals aged 65years and older is increasing worldwide. By , elderly subjects will comprise ~20% and ~36% of the populations of the United States (U.S.) and China, respectively.

Determining the exact prevalence of asthma in elderly is made hard by under-diagnosis due to decreased perception or under-reporting of symptoms by patients, suboptimal utilization of spirometry, misclassification of asthma as chronic obstructive pulmonary disease (COPD), and failure to recognize asthma in subjects with co-morbidities such as congestive heart failure or COPD. In two nationwide surveys in the U.S. estimates of the prevalence of current asthma in the elderly were % for the period – In elderly subjects, asthma is more common in women than in men. Compared to children or younger adults, older adults and/or elderly subjects own greater morbidity and healthcare costs from asthma, thus it is significant to recognize and treat asthma in older population.

Prevention

Multifactorial disease requires multiple approaches in order to minimize development or progression of the clinical symptoms.

  • Prevent recurrent exacerbations of asthma and minimize the need for ED visits or hospitalizations
  • Asthma Quality of Life for Children (Juniper et al.

    )

  • Of the adjunctive therapies available, LABA is the preferred therapy to combine with ICS in youths ≥12 years of age and adults
  • The beneficial effects of LABA in combination therapy for the grand majority of patients who require more therapy than low-dose ICS alone to control asthma (i.e., require step 3 care or higher) should be weighed against the increased risk of severe exacerbations, although unusual, associated with the daily use of LABAs (see discussion in text).
  • Mini Asthma Quality of Life Questionnaire (Juniper et al.

    a)

  • Provide optimal pharmacotherapy with minimal or no adverse effects
  • Maintain (near) “normal” pulmonary function
  • Maintain normal activity levels (including exercise and other physical activity and attendance at work or school)
  • LABAs are used in combination with ICSs for long-term control and prevention of symptoms in moderate or severe persistent asthma (step 3 care or higher in children ≥5 years of age and adults)
  • The Genetics of Asthma and Allergic Disease: A 21st Century Perspective
    Carole Ober, Tsung-Chieh Yao.

    Immunol Rev. Author manuscript; available in PMC July 1. Published in final edited form as: Immunol Rev. July; (1): doi:/jXx PMCID: PMC

  • Global strategy for asthma management and prevention: GINA executive n ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M et al. Eur Respir J 31(1) DOI/ PMID:
  • ITG Asthma Short Form (Bayliss et al. )
  • Asthma Quality of Life Questionnaire (Katz et al. ; Marks et al. )
  • Experimental preventive therapies

    In preterm infants without bronchopulmonary dysplasia, Palivizumab, a monoclonal antibody against RSV, reduces respiratory morbidity up to 78%.

    Recent findings in tardy preterm children without BPD suggests that prophylaxis through infancy may decrease recurrent wheeze in the first year of life by 10% and by up to 50% at three years of age. While encouraging, further longitudinal studies are necessary to assess the effect of palivizumab prophylaxis to decrease the incidence of asthma in childhood.
    Recent evidence suggests that anti-allergen immunotherapy to cross-link the FcέR1 receptor may decrease viral induced asthma symptoms.

    While alterations of the physical environment own been studied, little attention has been given to the approach of altering the immune constitution of high risk individuals. In this honor, immunomodulators, such as Omalizumab may be of future interest.

  • Prevent chronic and troublesome symptoms (e.g., coughing or breathlessness in the daytime, in the night, or after exertion)
  • SF (Ware et al. )
  • Asthma in the elderly: what we know and what we own yet to know. Anahí Yáñez, Sang-Hoen Cho, Joan B Soriano, Lanny J Rosenwasser, Gustavo J Rodrigo, Klaus F Rabe, Stephen Peters, Akio Niimi, Dennis K Ledford, Rohit Katial, Leonardo M Fabbri, Juan C Celedón, Giorgio Walter Canonica, Paula Busse, Louis-Phillippe Boulet, Carlos E Baena-Cagnani, Qutayba Hamid, Claus Bachert, Ruby Pawankar, Stephen T Holgate.

    World Allergy Organ J. ; 7(1): 8. Published online May doi:/
    Perinatal and Early Childhood Environmental Factors Influencing Allergic Asthma Immunopathogenesis. Jonathan M. Gaffin, Watcharoot Kanchongkittiphon, Wanda Phipatanakul. Int Immunopharmacol. September; 22(1): 21– Published online June doi: / PMCID: PMC

  • Control of environmental factors and comorbid conditions that affect asthma
  • Prevent progressive loss of lung function; for children, prevent reduced lung growth
  • Require infrequent use (≤2 days a week) of inhaled SABA for quick relief of symptoms
  • National Heart, Lung, and Blood Institute National Asthma Education and Prevention ProgramExpert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma, Full report
  • Probiotics and vitamins

    Early studies on the effect of probiotics to affect asthma development by influencing the perinatal microbiome own been mixed.

    A recent study found significant decrease in the risk of atopic sensitization associated with pre and post-natal istration of probiotics, however there was no effect on asthma or wheeze.
    Vitamins are essential constituents of our diet that own endless been known to influence the immune system. Vitamins A and D own received specific attention in recent years as these vitamins own been shown to own an unexpected and crucial effect on the immune response.

  • SF (Bousquet et al. )
  • Environment control

    Most convincing evidence for early life environmental exposures influencing the development of asthma would be from randomized controlled interventions to specifically addressing the offending agent and protest lower incidence of asthma development.

    Allergen remediation strategies directed at cat, dog, mold, mouse and cockroach protest substantially decrease exposure levels in homes. Interventions to reduce HDM alone own been effective and seem to improve early outcomes.

    Recent meta-analyses own shown multifaceted allergen remediation programs to be protective against the development of asthma with % reduction in odds. The most protective effect was seen in children with greater than 5 years of follow-up, indicating a true decrease in risk to those prone to develop atopic asthma.

    The best preventative effect of allergen avoidance was the Canadian Childhood Asthma Primary Prevention Study in a high risk birth cohort.

    In this study, the intervention was avoidance of home dust mite, pets, and environmental tobacco smoke starting prenatally, and encouragement of breastfeeding with delayed introduction of solids. HDM interventions included encasing parents’ and infants’ mattresses and box springs, weekly boiling water wash of every bedding and application of benzyl benzoate to carpets and upholstery before birth and at 4 and 8 months of age. Children receiving the intervention had significantly less physician diagnoses of asthma, wheeze in the past 12 months and wheeze apart from colds when evaluated at age 7 years.

    Another birth cohort study also observed significantly fewer asthma symptoms at age 8 years ancient in a high risk birth cohort intervention focused on HDM and food allergen avoidance in early life, and a significant decrease in atopy at the 8 year time point.

    Large studies assessing increased exposure to indoor fungi before the development of asthma symptoms suggests that Penicillium, Aspergillus, and Cladosporium species pose a respiratory health risk in susceptible populations. Increased exacerbation of current asthma symptoms in children and adults were associated with increased levels of Penicillium, Aspergillus, Cladosporium, and Alternaria species, although further work should consider the role of fungal diversity and increased exposure to other fungal species.

  • Meet patients’ and families’ expectations of and satisfaction with asthma care
  • LABAs are not to be used as monotherapy for long-term control of asthma
  • Education for a partnership in asthma care
  • Asthma endotypes: a new approach to classification of disease entities within the asthma syndrome.Lötvall J1, Akdis CA, Bacharier LB, Bjermer L, Casale TB, Custovic A, Lemanske RF Jr, Wardlaw AJ, Wenzel SE, Greenberger PA.

    J Allergy Clin Immunol. Feb;(2) doi: /

  • International Consensus On (ICON) Pediatric Asthma
    N. G. Papadopoulos, H. Arakawa, K.-H. Carlsen, A. Custovic, J. Gern, R. Lemanske, P. Le Souef, M. Makela, G. Roberts, G. Wong, H. Zar, C. A. Akdis, L. B. Bacharier, E. Baraldi, H. P. van Bever, J. de Blic, A. Boner, W. Burks, T. B. Casale, J. A. Castro-Rodriguez, Y. Z. Chen, Y. M. El-Gamal, M. L. Everard, T. Frischer, M. Geller, J. Gereda, D. Y. Goh, T. W. Guilbert, G. Hedlin, P. W. Heymann, S. J. Hong, E. M. Hossny, J.

    L. Huang, D. J. Jackson, J. C. de Jongste, O. Kalayci, N. Khaled, S. Kling, P. Kuna, S. Lau, D. K. Ledford, S. I. Lee, A. H. Liu, R. F. Lockey, K. Lodrup-Carlsen, J. Lotvall, A. Morikawa, A. Nieto, H. Paramesh, R. Pawankar, P. Pohunek, J. Pongracic, D. Price, C. Robertson, N. Rosario, L. J. Rossenwasser, P. D. Sly, R. Stein, S. Stick, S. Szefler, L. M. Taussig, E. Valovirta, P. Vichyanond, D. Wallace, E. Weinberg, G. Wennergren, J. Wildhaber, R.

    S. Zeiger. Allergy. Author manuscript; available in PMC May Published in final edited form as: Allergy. August; 67(8): – Published online June doi:/jx PMCID: PMC

Treatment

Treatment with anti-inflammatory drugs can, to a large extent, reverse some of these processes; however, the successful response to therapy often requires weeks to achieve and, in some situations, may be incomplete.

The goals of asthma treatment include improving quality of life for people who own asthma in addition to controlling symptoms, reducing the risk of exacerbations, and preventing asthma-related death.

A recent large international trial demonstrated that significant reductions in the rate of severe exacerbations and improvements in quality of life were achieved by aiming at achieving guideline-defined asthma control and by adjusting therapy to achieve it.

It is significant, therefore, to examine how the disease expression and control are affecting the patient’s quality of life. Specific clinical assessment questionnaires were generated to help practicing physicians in asthma patient evaluation:

Asthma-Specific Quality of Life

  1. Asthma Quality of Life Questionnaire (Katz et al. ; Marks et al. )
  2. Mini Asthma Quality of Life Questionnaire (Juniper et al. a)
  3. ITG Asthma Short Form (Bayliss et al. )
  4. Asthma Quality of Life for Children (Juniper et al.

    )

Generic Quality of Life

  1. SF (Bousquet et al. )
  2. SF (Ware et al. )

The change in emphasis from previous practice guidelines is in periodic assessment of asthma control. For initiating treatment, asthma severity should be classified, and the initial treatment should correspond to the appropriate category of severity. Once treatment is established, the emphasis is on assessing asthma control to determine if the goals for therapy own been met and if adjustments in therapy (step up or step down) would be appropriate.

Components considered essential to effective asthma management:
Measures of assessment and monitoring, obtained by objective tests, physical examination, patient history and patient report, to diagnose and assess the characteristics and severity of asthma and to monitor whether asthma control is achieved and maintained

  1. Education for a partnership in asthma care
  2. Control of environmental factors and comorbid conditions that affect asthma

Pharmacologic therapy
The goals of therapy are to achieve asthma control by reducing impairment and risk:

  1. Maintain normal activity levels (including exercise and other physical activity and attendance at work or school)
  2. Require infrequent use (≤2 days a week) of inhaled SABA for quick relief of symptoms
  3. Prevent progressive loss of lung function; for children, prevent reduced lung growth
  4. Prevent recurrent exacerbations of asthma and minimize the need for ED visits or hospitalizations
  5. Prevent chronic and troublesome symptoms (e.g., coughing or breathlessness in the daytime, in the night, or after exertion)
  6. Meet patients’ and families’ expectations of and satisfaction with asthma care
  7. Maintain (near) “normal” pulmonary function
  8. Provide optimal pharmacotherapy with minimal or no adverse effects

Patients’ detailed recall of symptoms decreases over time; therefore, the clinician may select to assess over a 2-week, 3-week, or 4-week recall period.

Symptom assessment for periods longer than 4 weeks should reflect more global symptom assessment, such as inquiring whether the patient’s asthma has been better or worse since the final visit and inquiring whether the patient has encountered any specific difficulties during specific seasons or events.

Low FEV1 is associated with increased risk of severe asthma exacerbations. Regular monitoring of pulmonary function is particularly significant for asthma patients who do not perceive their symptoms until airflow obstruction is severe.

There is no readily available method of detecting the “poor perceivers.” The literature reports that patients who had a near-fatal asthma exacerbation, as well as older patients, are more likely to own poor perception of airflow obstruction.

Long-term control medications
Corticosteroids:Block late-phase reaction to allergen, reduce airway hyperresponsiveness, and inhibit inflammatory cell migration and activation. They are the most potent and effective anti-inflammatory medication currently available.

ICSs are used in the long-term control of asthma. Short courses of oral systemic corticosteroids are often used to acquire immediate control of the disease when initiating long-term therapy; long-term oral systemic corticosteroid is used for severe persistent asthma.

Cromolyn sodium and nedocromil:Stabilize mast cells and interfere with chloride channel function. They are used as alternative, but not preferred, medication for the treatment of mild persistent asthma.

They can also be used as preventive treatment prior to exercise or unavoidable exposure to known allergens.

Immunomodulators:Omalizumab (anti-IgE) is a monoclonal antibody that prevents binding of IgE to the high-affinity receptors on basophils and mast cells. Omalizumab is used as adjunctive therapy for patients ≥12 years of age who own allergies and severe persistent asthma. Clinicians who ister omalizumab should be prepared and equipped to identify and treat anaphylaxis that may occur.

Leukotriene modifiers:Include two LTRAs are available—montelukast (for patients >1 year of age) and zafirlukast (for patients ≥7 years of age).

The 5-lipoxygenase pathway inhibitor zileuton is available for patients ≥12 years of age; liver function monitoring is essential. LTRAs are alternative, but not preferred, therapy for the treatment of mild persistent asthma (Step 2 care). LTRAs can also be used as adjunctive therapy with ICSs, but for youths ≥12 years of age and adults. Zileuton can be used as alternative but not preferred adjunctive therapy in adults.

LABAs:Salmeterol and formoterol after a single dose istration own at least 12 hours duration of bronchodilation.

The use of LABA for the treatment of acute symptoms or exacerbations is not currently recommended.

  1. National Heart, Lung, and Blood Institute National Asthma Education and Prevention ProgramExpert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma, Full report
  2. LABAs are used in combination with ICSs for long-term control and prevention of symptoms in moderate or severe persistent asthma (step 3 care or higher in children ≥5 years of age and adults)
  3. Global strategy for asthma management and prevention: GINA executive n ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M et al.

    Eur Respir J 31(1) DOI/ PMID:

  4. The Genetics of Asthma and Allergic Disease: A 21st Century Perspective
    Carole Ober, Tsung-Chieh Yao. Immunol Rev. Author manuscript; available in PMC July 1. Published in final edited form as: Immunol Rev. July; (1): doi:/jXx PMCID: PMC
  5. Of the adjunctive therapies available, LABA is the preferred therapy to combine with ICS in youths ≥12 years of age and adults
  6. Asthma endotypes: a new approach to classification of disease entities within the asthma syndrome.Lötvall J1, Akdis CA, Bacharier LB, Bjermer L, Casale TB, Custovic A, Lemanske RF Jr, Wardlaw AJ, Wenzel SE, Greenberger PA.

    J Allergy Clin Immunol. Feb;(2) doi: /

  7. The beneficial effects of LABA in combination therapy for the grand majority of patients who require more therapy than low-dose ICS alone to control asthma (i.e., require step 3 care or higher) should be weighed against the increased risk of severe exacerbations, although unusual, associated with the daily use of LABAs (see discussion in text).
  8. LABAs are not to be used as monotherapy for long-term control of asthma
  9. Asthma in the elderly: what we know and what we own yet to know.

    Anahí Yáñez, Sang-Hoen Cho, Joan B Soriano, Lanny J Rosenwasser, Gustavo J Rodrigo, Klaus F Rabe, Stephen Peters, Akio Niimi, Dennis K Ledford, Rohit Katial, Leonardo M Fabbri, Juan C Celedón, Giorgio Walter Canonica, Paula Busse, Louis-Phillippe Boulet, Carlos E Baena-Cagnani, Qutayba Hamid, Claus Bachert, Ruby Pawankar, Stephen T Holgate. World Allergy Organ J. ; 7(1): 8. Published online May doi:/
    Perinatal and Early Childhood Environmental Factors Influencing Allergic Asthma Immunopathogenesis. Jonathan M. Gaffin, Watcharoot Kanchongkittiphon, Wanda Phipatanakul. Int Immunopharmacol. September; 22(1): 21– Published online June doi: / PMCID: PMC

  10. International Consensus On (ICON) Pediatric Asthma
    N.

    G. Papadopoulos, H. Arakawa, K.-H. Carlsen, A. Custovic, J. Gern, R. Lemanske, P. Le Souef, M. Makela, G. Roberts, G. Wong, H. Zar, C. A. Akdis, L. B. Bacharier, E. Baraldi, H. P. van Bever, J. de Blic, A. Boner, W. Burks, T. B. Casale, J. A. Castro-Rodriguez, Y. Z. Chen, Y. M. El-Gamal, M. L. Everard, T. Frischer, M. Geller, J. Gereda, D. Y. Goh, T. W. Guilbert, G. Hedlin, P. W. Heymann, S. J. Hong, E. M. Hossny, J. L. Huang, D. J. Jackson, J. C. de Jongste, O. Kalayci, N. Khaled, S. Kling, P. Kuna, S.

    Lau, D. K. Ledford, S. I. Lee, A. H. Liu, R. F. Lockey, K. Lodrup-Carlsen, J. Lotvall, A. Morikawa, A. Nieto, H. Paramesh, R. Pawankar, P. Pohunek, J. Pongracic, D. Price, C. Robertson, N. Rosario, L. J. Rossenwasser, P. D. Sly, R. Stein, S. Stick, S. Szefler, L. M. Taussig, E. Valovirta, P. Vichyanond, D. Wallace, E. Weinberg, G. Wennergren, J. Wildhaber, R. S. Zeiger. Allergy. Author manuscript; available in PMC May Published in final edited form as: Allergy.

    August; 67(8): – Published online June doi:/jx PMCID: PMC

For patients ≥5 years of age who own moderate persistent asthma or asthma inadequately controlled on low-dose ICS, the option to increase the ICS dose should be given equal weight to the option of adding LABA. For patients ≥5 years of age who own severe persistent asthma or asthma inadequately controlled on step 3 care, the combination of LABA and ICS is the preferred therapy.

LABA may be used before exercise, but duration of action does not exceed 5 hours with chronic regular use.

Frequent and chronic use of LABA for EIB is discouraged, because this use may disguise poorly controlled persistent asthma.

Methylxanthines: Sustained-release theophylline is a mild to moderate bronchodilator used as alternative, not preferred, adjunctive therapy with ICS (Evidence A). Theophylline may own mild anti-inflammatory effects. Monitoring of serum theophylline concentration is essential.

Quick-relief medications
Anticholinergics:Inhibit muscarinic cholinergic receptors and reduce intrinsic vagal tone ofthe airway.

Ipratropium bromide provides additive benefit to SABA in moderate-to-severeasthma exacerbations. May be used as an alternative bronchodilator for patients who donot tolerate SABA (Evidence D).

SABAs:Albuterol, levalbuterol, and pirbuterol are bronchodilators that relax smooth muscle. Therapy of choice for relief of acute symptoms and prevention of EIB.

Systemic corticosteroids:Although not short acting, oral systemic corticosteroids are used for moderate and severe exacerbations as adjunct to SABAs to speed recovery and prevent recurrence of exacerbations.

Other treatments
Allergen Immunotherapy
Allergen injection immunotherapy is effective in allergic asthma as well as in allergic rhinoconjunctivitis and has been shown to lead to highly significant improvements in symptoms, reduction in save medication, and improvements in both allergen specific and non-specific bronchial hyperresponsiveness.

Immunotherapy is particularly effective in seasonal asthma, although less effective in perennial asthma. Bronchial asthma is a risk-factor for systemic reactions to immunotherapy and should not be considered in poorly-controlled asthmatics. Allergy management is superimposed upon other treatment modalities for long-term control at every levels of asthma. Concurrent upper airway disease, eg, allergic rhinitis, sinusitis, should be treated, and the entire dose of inhaled corticosteroids must be monitored.

Biological treatment: Omalizumab(monoclonal anti-IgE antibody) may be considered as adjunctive therapy in step 5 or 6 care for patients who own allergies and severe persistent asthma that is inadequately controlled with the combination of high-dose ICS and LABA.

Omalizumab is effective in reducing asthma exacerbations and hospitalizations in patients with increased levels of entire IgE. It is recommended for use in moderate to severe asthma patients as an adjunctive therapy to inhaled steroids and during steroid tapering, in patients with steroid-resistant asthma, and in patients who need to reduce or withdraw their inhaled steroids.

Bronchial thermoplasty (BT) is a novel therapy for patients with severe asthma. Using radio frequency thermal energy, it aims to reduce the airway smooth muscle mass. Several clinical trials own demonstrated improvements in asthma-related quality of life and a reduction in the number of exacerbations following treatment with BT.

In addition, recent data has demonstrated the long-term safety of the procedure as well as sustained improvements in rates of asthma exacerbations, reduction in health care utilization, and improved quality of life.

In the past 10 years, there own been substantial advances in the understanding of asthma genetics, airway biology, and immune cell signaling. These advances own led to the development of little molecule therapeutics and biologic agents that may improve asthma care in the future. Several new classes of asthma drugs—including ultra endless acting β agonists and modulators of the interleukin 4 (IL-4), IL-5, IL, and IL pathways—have been evaluated in randomized controlled trials.

What is skin allergy in hindi

Other new drug classes—including dissociated corticosteroids, CXC chemokine receptor 2 antagonists, toll-like receptor 9 agonists, and tyrosine kinase inhibitors—remain in earlier phases of development.

Other co-morbid conditions treatment
In every patients, symptomatic therapies are also given, to be used on an as needed basis. The goal in every of these patients is to tailor the medicines and their doses to control the level of the disease, always trying for optimal control with the lowest effective dose of medications.
At least half of US adults with asthma own at least 1 other chronic condition.

Having asthma and other chronic conditions are associated with poorer asthma outcomes. Several studies considered the relationship between asthma and other specific chronic conditions; results of these studies indicated that having depression or anxiety and/or panic disorder is associated with an increased risk of developing a new asthma diagnosis and with poorer asthma outcomes. In addition, results of these studies indicated that having asthma is associated with an increased risk of developing a new depression or anxiety and/or panic disorder diagnosis.

Clinical Classification

It is increasingly clear that asthma syndrome is divided into distinct disease entities with specific mechanisms.

The attempt for a new classification is made were "endotype" is proposed to be a subtype of a condition defined by a distinct pathophysiological mechanism. Criteria for defining asthma endotypes on the basis of their phenotypes and putative pathophysiology are suggested.

Currently asthma is classified into atopic and non-atopic types based on the onset of symptoms. Atopic refers to early-onset whereas non-atopic refers to late-onset. Despite the differentiation, a significant degree of overlap exists between the two types. The severity of symptoms is further classified based on the GINA severity grades into mild intermittent, mild persistent, moderate persistent and severe persistent asthma.

Furthermore asthma severity classification is diverse for various ages.

Bibliography

Treatment

Treatment with anti-inflammatory drugs can, to a large extent, reverse some of these processes; however, the successful response to therapy often requires weeks to achieve and, in some situations, may be incomplete.

The goals of asthma treatment include improving quality of life for people who own asthma in addition to controlling symptoms, reducing the risk of exacerbations, and preventing asthma-related death.

A recent large international trial demonstrated that significant reductions in the rate of severe exacerbations and improvements in quality of life were achieved by aiming at achieving guideline-defined asthma control and by adjusting therapy to achieve it.

It is significant, therefore, to examine how the disease expression and control are affecting the patient’s quality of life. Specific clinical assessment questionnaires were generated to help practicing physicians in asthma patient evaluation:

Asthma-Specific Quality of Life

  1. Asthma Quality of Life Questionnaire (Katz et al. ; Marks et al. )
  2. Mini Asthma Quality of Life Questionnaire (Juniper et al. a)
  3. ITG Asthma Short Form (Bayliss et al.

    )

  4. Asthma Quality of Life for Children (Juniper et al.

    What is skin allergy in hindi

    )

Generic Quality of Life

  1. SF (Bousquet et al. )
  2. SF (Ware et al. )

The change in emphasis from previous practice guidelines is in periodic assessment of asthma control. For initiating treatment, asthma severity should be classified, and the initial treatment should correspond to the appropriate category of severity. Once treatment is established, the emphasis is on assessing asthma control to determine if the goals for therapy own been met and if adjustments in therapy (step up or step down) would be appropriate.

Components considered essential to effective asthma management:
Measures of assessment and monitoring, obtained by objective tests, physical examination, patient history and patient report, to diagnose and assess the characteristics and severity of asthma and to monitor whether asthma control is achieved and maintained

  1. Education for a partnership in asthma care
  2. Control of environmental factors and comorbid conditions that affect asthma

Pharmacologic therapy
The goals of therapy are to achieve asthma control by reducing impairment and risk:

  1. Maintain normal activity levels (including exercise and other physical activity and attendance at work or school)
  2. Require infrequent use (≤2 days a week) of inhaled SABA for quick relief of symptoms
  3. Prevent progressive loss of lung function; for children, prevent reduced lung growth
  4. Prevent recurrent exacerbations of asthma and minimize the need for ED visits or hospitalizations
  5. Prevent chronic and troublesome symptoms (e.g., coughing or breathlessness in the daytime, in the night, or after exertion)
  6. Meet patients’ and families’ expectations of and satisfaction with asthma care
  7. Maintain (near) “normal” pulmonary function
  8. Provide optimal pharmacotherapy with minimal or no adverse effects

Patients’ detailed recall of symptoms decreases over time; therefore, the clinician may select to assess over a 2-week, 3-week, or 4-week recall period.

Symptom assessment for periods longer than 4 weeks should reflect more global symptom assessment, such as inquiring whether the patient’s asthma has been better or worse since the final visit and inquiring whether the patient has encountered any specific difficulties during specific seasons or events.

Low FEV1 is associated with increased risk of severe asthma exacerbations. Regular monitoring of pulmonary function is particularly significant for asthma patients who do not perceive their symptoms until airflow obstruction is severe. There is no readily available method of detecting the “poor perceivers.” The literature reports that patients who had a near-fatal asthma exacerbation, as well as older patients, are more likely to own poor perception of airflow obstruction.

Long-term control medications
Corticosteroids:Block late-phase reaction to allergen, reduce airway hyperresponsiveness, and inhibit inflammatory cell migration and activation.

They are the most potent and effective anti-inflammatory medication currently available. ICSs are used in the long-term control of asthma. Short courses of oral systemic corticosteroids are often used to acquire immediate control of the disease when initiating long-term therapy; long-term oral systemic corticosteroid is used for severe persistent asthma.

Cromolyn sodium and nedocromil:Stabilize mast cells and interfere with chloride channel function. They are used as alternative, but not preferred, medication for the treatment of mild persistent asthma. They can also be used as preventive treatment prior to exercise or unavoidable exposure to known allergens.

Immunomodulators:Omalizumab (anti-IgE) is a monoclonal antibody that prevents binding of IgE to the high-affinity receptors on basophils and mast cells.

Omalizumab is used as adjunctive therapy for patients ≥12 years of age who own allergies and severe persistent asthma. Clinicians who ister omalizumab should be prepared and equipped to identify and treat anaphylaxis that may occur.

Leukotriene modifiers:Include two LTRAs are available—montelukast (for patients >1 year of age) and zafirlukast (for patients ≥7 years of age). The 5-lipoxygenase pathway inhibitor zileuton is available for patients ≥12 years of age; liver function monitoring is essential.

LTRAs are alternative, but not preferred, therapy for the treatment of mild persistent asthma (Step 2 care). LTRAs can also be used as adjunctive therapy with ICSs, but for youths ≥12 years of age and adults. Zileuton can be used as alternative but not preferred adjunctive therapy in adults.

LABAs:Salmeterol and formoterol after a single dose istration own at least 12 hours duration of bronchodilation. The use of LABA for the treatment of acute symptoms or exacerbations is not currently recommended.

  1. National Heart, Lung, and Blood Institute National Asthma Education and Prevention ProgramExpert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma, Full report
  2. LABAs are used in combination with ICSs for long-term control and prevention of symptoms in moderate or severe persistent asthma (step 3 care or higher in children ≥5 years of age and adults)
  3. Global strategy for asthma management and prevention: GINA executive n ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M et al.

    Eur Respir J 31(1) DOI/ PMID:

  4. The Genetics of Asthma and Allergic Disease: A 21st Century Perspective
    Carole Ober, Tsung-Chieh Yao. Immunol Rev. Author manuscript; available in PMC July 1. Published in final edited form as: Immunol Rev. July; (1): doi:/jXx PMCID: PMC
  5. Of the adjunctive therapies available, LABA is the preferred therapy to combine with ICS in youths ≥12 years of age and adults
  6. Asthma endotypes: a new approach to classification of disease entities within the asthma syndrome.Lötvall J1, Akdis CA, Bacharier LB, Bjermer L, Casale TB, Custovic A, Lemanske RF Jr, Wardlaw AJ, Wenzel SE, Greenberger PA.

    J Allergy Clin Immunol. Feb;(2) doi: /

  7. The beneficial effects of LABA in combination therapy for the grand majority of patients who require more therapy than low-dose ICS alone to control asthma (i.e., require step 3 care or higher) should be weighed against the increased risk of severe exacerbations, although unusual, associated with the daily use of LABAs (see discussion in text).
  8. LABAs are not to be used as monotherapy for long-term control of asthma
  9. Asthma in the elderly: what we know and what we own yet to know. Anahí Yáñez, Sang-Hoen Cho, Joan B Soriano, Lanny J Rosenwasser, Gustavo J Rodrigo, Klaus F Rabe, Stephen Peters, Akio Niimi, Dennis K Ledford, Rohit Katial, Leonardo M Fabbri, Juan C Celedón, Giorgio Walter Canonica, Paula Busse, Louis-Phillippe Boulet, Carlos E Baena-Cagnani, Qutayba Hamid, Claus Bachert, Ruby Pawankar, Stephen T Holgate.

    World Allergy Organ J. ; 7(1): 8. Published online May doi:/
    Perinatal and Early Childhood Environmental Factors Influencing Allergic Asthma Immunopathogenesis. Jonathan M. Gaffin, Watcharoot Kanchongkittiphon, Wanda Phipatanakul. Int Immunopharmacol. September; 22(1): 21– Published online June doi: / PMCID: PMC

  10. International Consensus On (ICON) Pediatric Asthma
    N. G. Papadopoulos, H. Arakawa, K.-H. Carlsen, A. Custovic, J. Gern, R. Lemanske, P. Le Souef, M. Makela, G. Roberts, G. Wong, H. Zar, C. A. Akdis, L. B. Bacharier, E. Baraldi, H. P. van Bever, J. de Blic, A. Boner, W. Burks, T. B. Casale, J. A. Castro-Rodriguez, Y. Z. Chen, Y. M.

    El-Gamal, M. L. Everard, T. Frischer, M. Geller, J. Gereda, D. Y. Goh, T. W. Guilbert, G. Hedlin, P. W. Heymann, S. J. Hong, E. M. Hossny, J. L. Huang, D. J. Jackson, J. C. de Jongste, O. Kalayci, N. Khaled, S. Kling, P. Kuna, S. Lau, D. K. Ledford, S. I. Lee, A. H. Liu, R. F. Lockey, K. Lodrup-Carlsen, J. Lotvall, A. Morikawa, A. Nieto, H. Paramesh, R. Pawankar, P. Pohunek, J. Pongracic, D. Price, C. Robertson, N. Rosario, L. J. Rossenwasser, P. D. Sly, R. Stein, S. Stick, S. Szefler, L. M. Taussig, E. Valovirta, P. Vichyanond, D. Wallace, E. Weinberg, G. Wennergren, J. Wildhaber, R. S. Zeiger. Allergy. Author manuscript; available in PMC May Published in final edited form as: Allergy.

    August; 67(8): – Published online June doi:/jx PMCID: PMC

For patients ≥5 years of age who own moderate persistent asthma or asthma inadequately controlled on low-dose ICS, the option to increase the ICS dose should be given equal weight to the option of adding LABA. For patients ≥5 years of age who own severe persistent asthma or asthma inadequately controlled on step 3 care, the combination of LABA and ICS is the preferred therapy.

LABA may be used before exercise, but duration of action does not exceed 5 hours with chronic regular use. Frequent and chronic use of LABA for EIB is discouraged, because this use may disguise poorly controlled persistent asthma.

Methylxanthines: Sustained-release theophylline is a mild to moderate bronchodilator used as alternative, not preferred, adjunctive therapy with ICS (Evidence A).

Theophylline may own mild anti-inflammatory effects. Monitoring of serum theophylline concentration is essential.

Quick-relief medications
Anticholinergics:Inhibit muscarinic cholinergic receptors and reduce intrinsic vagal tone ofthe airway. Ipratropium bromide provides additive benefit to SABA in moderate-to-severeasthma exacerbations. May be used as an alternative bronchodilator for patients who donot tolerate SABA (Evidence D).

SABAs:Albuterol, levalbuterol, and pirbuterol are bronchodilators that relax smooth muscle. Therapy of choice for relief of acute symptoms and prevention of EIB.

Systemic corticosteroids:Although not short acting, oral systemic corticosteroids are used for moderate and severe exacerbations as adjunct to SABAs to speed recovery and prevent recurrence of exacerbations.

Other treatments
Allergen Immunotherapy
Allergen injection immunotherapy is effective in allergic asthma as well as in allergic rhinoconjunctivitis and has been shown to lead to highly significant improvements in symptoms, reduction in save medication, and improvements in both allergen specific and non-specific bronchial hyperresponsiveness.

Immunotherapy is particularly effective in seasonal asthma, although less effective in perennial asthma. Bronchial asthma is a risk-factor for systemic reactions to immunotherapy and should not be considered in poorly-controlled asthmatics. Allergy management is superimposed upon other treatment modalities for long-term control at every levels of asthma. Concurrent upper airway disease, eg, allergic rhinitis, sinusitis, should be treated, and the entire dose of inhaled corticosteroids must be monitored.

Biological treatment: Omalizumab(monoclonal anti-IgE antibody) may be considered as adjunctive therapy in step 5 or 6 care for patients who own allergies and severe persistent asthma that is inadequately controlled with the combination of high-dose ICS and LABA.

Omalizumab is effective in reducing asthma exacerbations and hospitalizations in patients with increased levels of entire IgE. It is recommended for use in moderate to severe asthma patients as an adjunctive therapy to inhaled steroids and during steroid tapering, in patients with steroid-resistant asthma, and in patients who need to reduce or withdraw their inhaled steroids.

Bronchial thermoplasty (BT) is a novel therapy for patients with severe asthma. Using radio frequency thermal energy, it aims to reduce the airway smooth muscle mass.

What is skin allergy in hindi

Several clinical trials own demonstrated improvements in asthma-related quality of life and a reduction in the number of exacerbations following treatment with BT. In addition, recent data has demonstrated the long-term safety of the procedure as well as sustained improvements in rates of asthma exacerbations, reduction in health care utilization, and improved quality of life.

In the past 10 years, there own been substantial advances in the understanding of asthma genetics, airway biology, and immune cell signaling. These advances own led to the development of little molecule therapeutics and biologic agents that may improve asthma care in the future.

Several new classes of asthma drugs—including ultra endless acting β agonists and modulators of the interleukin 4 (IL-4), IL-5, IL, and IL pathways—have been evaluated in randomized controlled trials. Other new drug classes—including dissociated corticosteroids, CXC chemokine receptor 2 antagonists, toll-like receptor 9 agonists, and tyrosine kinase inhibitors—remain in earlier phases of development.

Other co-morbid conditions treatment
In every patients, symptomatic therapies are also given, to be used on an as needed basis.

The goal in every of these patients is to tailor the medicines and their doses to control the level of the disease, always trying for optimal control with the lowest effective dose of medications.
At least half of US adults with asthma own at least 1 other chronic condition. Having asthma and other chronic conditions are associated with poorer asthma outcomes. Several studies considered the relationship between asthma and other specific chronic conditions; results of these studies indicated that having depression or anxiety and/or panic disorder is associated with an increased risk of developing a new asthma diagnosis and with poorer asthma outcomes. In addition, results of these studies indicated that having asthma is associated with an increased risk of developing a new depression or anxiety and/or panic disorder diagnosis.

Clinical Classification

It is increasingly clear that asthma syndrome is divided into distinct disease entities with specific mechanisms.

The attempt for a new classification is made were "endotype" is proposed to be a subtype of a condition defined by a distinct pathophysiological mechanism. Criteria for defining asthma endotypes on the basis of their phenotypes and putative pathophysiology are suggested.

Currently asthma is classified into atopic and non-atopic types based on the onset of symptoms. Atopic refers to early-onset whereas non-atopic refers to late-onset. Despite the differentiation, a significant degree of overlap exists between the two types.

The severity of symptoms is further classified based on the GINA severity grades into mild intermittent, mild persistent, moderate persistent and severe persistent asthma. Furthermore asthma severity classification is diverse for various ages.

Bibliography

  • Asthma in the elderly: what we know and what we own yet to know. Anahí Yáñez, Sang-Hoen Cho, Joan B Soriano, Lanny J Rosenwasser, Gustavo J Rodrigo, Klaus F Rabe, Stephen Peters, Akio Niimi, Dennis K Ledford, Rohit Katial, Leonardo M Fabbri, Juan C Celedón, Giorgio Walter Canonica, Paula Busse, Louis-Phillippe Boulet, Carlos E Baena-Cagnani, Qutayba Hamid, Claus Bachert, Ruby Pawankar, Stephen T Holgate.

    World Allergy Organ J. ; 7(1): 8. Published online May doi:/
    Perinatal and Early Childhood Environmental Factors Influencing Allergic Asthma Immunopathogenesis. Jonathan M. Gaffin, Watcharoot Kanchongkittiphon, Wanda Phipatanakul. Int Immunopharmacol. September; 22(1): 21– Published online June doi: / PMCID: PMC

  • National Heart, Lung, and Blood Institute National Asthma Education and Prevention ProgramExpert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma, Full report
  • The Genetics of Asthma and Allergic Disease: A 21st Century Perspective
    Carole Ober, Tsung-Chieh Yao.

    Immunol Rev. Author manuscript; available in PMC July 1. Published in final edited form as: Immunol Rev. July; (1): doi:/jXx PMCID: PMC

  • Global strategy for asthma management and prevention: GINA executive n ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M et al. Eur Respir J 31(1) DOI/ PMID:
  • Asthma endotypes: a new approach to classification of disease entities within the asthma syndrome.Lötvall J1, Akdis CA, Bacharier LB, Bjermer L, Casale TB, Custovic A, Lemanske RF Jr, Wardlaw AJ, Wenzel SE, Greenberger PA.

    J Allergy Clin Immunol. Feb;(2) doi: /

  • International Consensus On (ICON) Pediatric Asthma
    N. G. Papadopoulos, H. Arakawa, K.-H. Carlsen, A. Custovic, J. Gern, R. Lemanske, P. Le Souef, M. Makela, G. Roberts, G. Wong, H. Zar, C. A. Akdis, L. B. Bacharier, E. Baraldi, H. P. van Bever, J. de Blic, A. Boner, W. Burks, T. B. Casale, J. A. Castro-Rodriguez, Y. Z. Chen, Y. M. El-Gamal, M. L. Everard, T. Frischer, M. Geller, J. Gereda, D. Y. Goh, T. W. Guilbert, G. Hedlin, P. W. Heymann, S. J. Hong, E. M. Hossny, J. L. Huang, D. J. Jackson, J. C. de Jongste, O. Kalayci, N. Khaled, S. Kling, P. Kuna, S. Lau, D. K.

    What is skin allergy in hindi

    Ledford, S. I. Lee, A. H. Liu, R. F. Lockey, K. Lodrup-Carlsen, J. Lotvall, A. Morikawa, A. Nieto, H. Paramesh, R. Pawankar, P. Pohunek, J. Pongracic, D. Price, C. Robertson, N. Rosario, L. J. Rossenwasser, P. D. Sly, R. Stein, S. Stick, S. Szefler, L. M. Taussig, E. Valovirta, P. Vichyanond, D. Wallace, E. Weinberg, G. Wennergren, J. Wildhaber, R. S. Zeiger. Allergy. Author manuscript; available in PMC May Published in final edited form as: Allergy. August; 67(8): – Published online June doi:/jx PMCID: PMC

Arshad Jamal, 48, has been battling a skin disease for four years in addition to asthma.

Doctors own advised him to remain indoors, drink clean water and avoid dust pollution to avoid aggravation of his health issues . There is, however, little he can do to heed the advice for Jharkhand’s Jharia, Jamal’s home for 35 years, continues to be among the country’s most polluted cities. According to Greenpeace India’s Airpocalypse-IV annual report released final week, Jharia was India’s most polluted city in

“I sell clothes on a footpath to feed my five-member family.

If I do not work, what would my family eat?” asked Jamal. He added the doctors own blamed pollution in Jharia for his woes. “Life is no less then hell for us here,” said Jamal, who visits a doctor almost weekly

Jamal is not alone. Numerous love him in the city of half-a-million known worldwide for its underground coal fires suffer from pollution-induced diseases. Shatia Bhuniya, 50, a local resident who suffers from regular chest pain, said she can feel coal dust and ash inside her body.

Babita Devi, a housewife, said they cannot even dry their clothes in the open because of layers of dust that stick to them

In neighbouring Dhanbad that was second on the list of most-polluted cities in as per the report, Patliputra Medical College and Hospital (PMCH)’s Dr Bibhuti Nath Mittal said most patients from Jharia they treat suffer from pollution-related diseases. “ [They] complain of skin allergies, burning sensation in eyes and allergic bronchitis. Pollution plays a significant role in aggravating such diseases,” said Mittal.

Mittal said Jharia’s air has high levels of nitrogen oxide and sulphur oxide, which can further aggravate breathing ailments, emitted by diesel trucks that move around the city daily carrying coal.

Jharia is the hub of coal mining in Jharkhand and has 40 opencast mines, which are mostly affected by underground fires, according to government officials. Over 2, trucks ferry coal out of the region daily.

Kolkata-based organisation Science for Human Being’s March survey found 17% of Jharia residents face hair loss, 17% suffer from skin diseases and 13% from respiratory issues due to pollution.

Another study by South Korean Future Science Research Institute in October found a link between high particulate matter (PM) and baldness. It said the PM and dust reduce protein levels in the scalp and lead to hair loss.

To be certain, experts tell there can be other reasons for hair loss in addition to air pollution.

Coal is the biggest contributor to high air pollution in Jharia, which according to the Greenpeace study, was 50% more than the average annual pollution levels in Delhi in The Greenpeace report said Jharia recorded highest PM10 at micrograms per cubic meter (ug/m3) in the country in It was more than five times the normal limit of the 60 ug/m3.

A study by Dhanbad’s Central Institute of Mining and Fuel Research (CIMFR) in found opencast mining, underground coal fires and unscientific coal transportation were the major contributors to Jharia’s toxic air.

It said the city’s air quality can improve by 50% if the mining is restricted. The study added high PM and emission of toxic gases love nitrogen oxide, sulfur dioxide, and carbon dioxide were directly linked to the coal burning.

The CIMFR study’s main author, Raj Sekhar Singh, said PM can reach deep into lungs and lead to diseases love asthma and tuberculosis. He added the diseases were badly impacting human health in Jharia.

Jha said nitrogen oxide, sulfur dioxide and carbon dioxide were adding to more woos.

Rashtriya Colliery Mazdoor Sangh general secretary A K Jha said 60, to 1 lakh tonne coal is extracted daily from Jharia coalfields. He said there are 58 little and large opencast mines operating in the area and almost every opencast mines are fire affected.

Bharat Coking Coal Limited (BCCL), the biggest mines’ operator in the region, officials insist they own taken various measures to check pollution in Jharia.

Sumit Jha, a BCCL official, said most of the mines affected by fires are extremely ancient.

“The underground fires can be checked only through opencast mining. If fire-affected coal blocks are not extracted at the earliest, they will also damage the entire city,” Jha said.

He said they own made it mandatory for trucks to cover the coal being transported out of the region. “We are also constructing concrete little ponds at exit points of mines so that tyres of the coal loading vehicles could be washed. Water is also sprinkled on roads in morning and afternoon to check dust pollution,” he said. Sumit Jha added greenery was also being promoted.

Activist Pinaki Roy of Save Jharia campaign said the steps being taken were inadequate.

“Opening cast mining has reached the city’s boundaries. The height of the coal dumps is much higher than permitted. Even slight wind brings ashes and dust from the mining areas to the city,” he said.

Mohammed Shabir, a local resident, said environmental safeguards were not excellent enough. “Heavy vehicles enter the city without proper coverings and are laden with coal dust,” he said.

Congress leader Poornima Singh, who is a lawmaker from the region, blamed the previous Bharatiya Janata Party government and BCCL for making Jharia a non-livable place.

“The BCCL has outsourced opencast mines to private companies, which do not follow rules and regulations.

A little example is of the coal dumps. Rules tell the height of a dump should be between metres. However, the minimum height of such dumps in Jharia is 90 metres and a maximum metres, which adds to the pollution problem,” she said. Singh promised more funds to tackle the pollution.

Overview

A maculopapular rash is made of both flat and raised skin lesions. The name is a mix of the words “macule,” which are flat discolored skin lesions, and “papule,” which are little raised bumps.

These skin lesions are generally red and can merge together. Macules that are bigger than 1 centimeter are considered patches, while papules that are merged together are considered plaques.

A maculopapular rash is a marker for numerous diseases, allergic reactions, and infections. Most of the time, the cause is a viral infection. See a doctor if you own a maculopapular rash. The rash could indicate a serious disease.

Arshad Jamal, 48, has been battling a skin disease for four years in addition to asthma.

Doctors own advised him to remain indoors, drink clean water and avoid dust pollution to avoid aggravation of his health issues . There is, however, little he can do to heed the advice for Jharkhand’s Jharia, Jamal’s home for 35 years, continues to be among the country’s most polluted cities. According to Greenpeace India’s Airpocalypse-IV annual report released final week, Jharia was India’s most polluted city in

“I sell clothes on a footpath to feed my five-member family. If I do not work, what would my family eat?” asked Jamal. He added the doctors own blamed pollution in Jharia for his woes. “Life is no less then hell for us here,” said Jamal, who visits a doctor almost weekly

Jamal is not alone.

Numerous love him in the city of half-a-million known worldwide for its underground coal fires suffer from pollution-induced diseases. Shatia Bhuniya, 50, a local resident who suffers from regular chest pain, said she can feel coal dust and ash inside her body. Babita Devi, a housewife, said they cannot even dry their clothes in the open because of layers of dust that stick to them

In neighbouring Dhanbad that was second on the list of most-polluted cities in as per the report, Patliputra Medical College and Hospital (PMCH)’s Dr Bibhuti Nath Mittal said most patients from Jharia they treat suffer from pollution-related diseases.

“ [They] complain of skin allergies, burning sensation in eyes and allergic bronchitis. Pollution plays a significant role in aggravating such diseases,” said Mittal.

Mittal said Jharia’s air has high levels of nitrogen oxide and sulphur oxide, which can further aggravate breathing ailments, emitted by diesel trucks that move around the city daily carrying coal.

Jharia is the hub of coal mining in Jharkhand and has 40 opencast mines, which are mostly affected by underground fires, according to government officials. Over 2, trucks ferry coal out of the region daily.

Kolkata-based organisation Science for Human Being’s March survey found 17% of Jharia residents face hair loss, 17% suffer from skin diseases and 13% from respiratory issues due to pollution.

Another study by South Korean Future Science Research Institute in October found a link between high particulate matter (PM) and baldness.

It said the PM and dust reduce protein levels in the scalp and lead to hair loss. To be certain, experts tell there can be other reasons for hair loss in addition to air pollution.

Coal is the biggest contributor to high air pollution in Jharia, which according to the Greenpeace study, was 50% more than the average annual pollution levels in Delhi in The Greenpeace report said Jharia recorded highest PM10 at micrograms per cubic meter (ug/m3) in the country in It was more than five times the normal limit of the 60 ug/m3.

A study by Dhanbad’s Central Institute of Mining and Fuel Research (CIMFR) in found opencast mining, underground coal fires and unscientific coal transportation were the major contributors to Jharia’s toxic air.

It said the city’s air quality can improve by 50% if the mining is restricted. The study added high PM and emission of toxic gases love nitrogen oxide, sulfur dioxide, and carbon dioxide were directly linked to the coal burning.

The CIMFR study’s main author, Raj Sekhar Singh, said PM can reach deep into lungs and lead to diseases love asthma and tuberculosis. He added the diseases were badly impacting human health in Jharia. Jha said nitrogen oxide, sulfur dioxide and carbon dioxide were adding to more woos.

Rashtriya Colliery Mazdoor Sangh general secretary A K Jha said 60, to 1 lakh tonne coal is extracted daily from Jharia coalfields. He said there are 58 little and large opencast mines operating in the area and almost every opencast mines are fire affected.

Bharat Coking Coal Limited (BCCL), the biggest mines’ operator in the region, officials insist they own taken various measures to check pollution in Jharia.

Sumit Jha, a BCCL official, said most of the mines affected by fires are extremely ancient. “The underground fires can be checked only through opencast mining. If fire-affected coal blocks are not extracted at the earliest, they will also damage the entire city,” Jha said.

He said they own made it mandatory for trucks to cover the coal being transported out of the region.

“We are also constructing concrete little ponds at exit points of mines so that tyres of the coal loading vehicles could be washed. Water is also sprinkled on roads in morning and afternoon to check dust pollution,” he said. Sumit Jha added greenery was also being promoted.

Activist Pinaki Roy of Save Jharia campaign said the steps being taken were inadequate. “Opening cast mining has reached the city’s boundaries. The height of the coal dumps is much higher than permitted. Even slight wind brings ashes and dust from the mining areas to the city,” he said.

Mohammed Shabir, a local resident, said environmental safeguards were not excellent enough.

“Heavy vehicles enter the city without proper coverings and are laden with coal dust,” he said.

Congress leader Poornima Singh, who is a lawmaker from the region, blamed the previous Bharatiya Janata Party government and BCCL for making Jharia a non-livable place.

“The BCCL has outsourced opencast mines to private companies, which do not follow rules and regulations. A little example is of the coal dumps. Rules tell the height of a dump should be between metres.

However, the minimum height of such dumps in Jharia is 90 metres and a maximum metres, which adds to the pollution problem,” she said. Singh promised more funds to tackle the pollution.

Overview

A maculopapular rash is made of both flat and raised skin lesions. The name is a mix of the words “macule,” which are flat discolored skin lesions, and “papule,” which are little raised bumps. These skin lesions are generally red and can merge together. Macules that are bigger than 1 centimeter are considered patches, while papules that are merged together are considered plaques.

A maculopapular rash is a marker for numerous diseases, allergic reactions, and infections. Most of the time, the cause is a viral infection. See a doctor if you own a maculopapular rash. The rash could indicate a serious disease.


How will a doctor assess your rash and discover the cause?

It’s best to see a doctor if you break out in a maculopapular rash. Diagnosis can be hard because there are so numerous possible causes for the rash.

Your doctor will enquire about your medical history and whether you’ve traveled, and they will conduct a physical exam.

They’ll glance at where it started and how the rash has spread. They’ll also enquire questions to determine the cause of the rash.

The doctor will likely ask:

  1. Have you had allergic reactions in the past to drugs, or foods, or insect bites?
  2. Do you own other symptoms, such as fever, sore throat, fatigue, diarrhea, or conjunctivitis?
  3. What medications and over-the-counter drugs are you taking?
  4. Do you own any other diseases, such as a heart condition or diabetes?
  5. When did your rash appear?
  6. Have you traveled recently to an area where mosquito-borne diseases such as Zika or chikungunya are present?

  7. Have you been in contact with people or animals that may own a contagious disease?

Depending on the course of your rash and your history, the doctor may order a blood or urine test. The doctor may also do a skin biopsy and refer you to a skin disease specialist.


How can you identify a maculopapular rash?

A maculopapular rash looks love red bumps on a flat, red patch of skin. The reddish background area may not show up if your skin is dark. The rash is sometimes itchy, and it can final from two days to three weeks depending on the cause.

How quickly the rash appears and where it appears on your body will differ depending on the cause of the rash.

What is skin allergy in hindi

It can spread anywhere on the body, from the face below to the limbs. In some cases, your doctor may enquire where the rash started on the body. This can assist the doctor narrow below potential causes.

Since maculopapular rashes are most common in infections and body immune responses, more than one symptom may also appear. These include:

  1. breathing troubles
  2. headache
  3. vomiting
  4. muscle pain
  5. fever
  6. dry skin

This may be a sign of an infection, which may be potentially contagious. Only a doctor can provide an exact diagnosis. Make an appointment with your doctor if you own a maculopapular rash and other symptoms.


What are possible causes of a maculopapular rash?

Maculopapular rashes may be present in numerous diverse conditions.

Some may be due to:

  1. allergies
  2. drug reactions
  3. bacterial or viral infections
  4. our body’s own systemic inflammation

Infection

If a viral or bacterial infection is the cause of your rash, you will also experience other symptoms such as a fever, headache, muscle pain, and breathing troubles. Possible viral causes include:

Drug reactions

Allergic reactions to a drug may be the cause if the maculopapular rash develops four to 12 days after taking a medication.

Reactions to medications can take up to seven or eight days to show symptoms. You may experience a low-grade fever and muscle pain. The rash generally fades after one to two weeks.

Read more: Identifying and caring for an amoxicillin rash »

Allergic reaction

A rash that breaks out immediately may also be due to allergies. This generally happens within minutes to hours of exposure to the allergen.

Sometimes a maculopapular rash may break out before hives do. A person may also experience increased heart rate and breathing problems.

Body’s systemic inflammation

The body’s own systemic inflammation can cause maculopapular rashes. Inflammation is how your body responds to an injury or infection. A drug reaction, infection, an autoimmune response, or allergic reaction can cause your body’s immune system to reply and develop maculopapular rashes.


What are possible complications?

You may feel pain and itchiness due to the rash, but complications are unlikely to arise from the rash itself.

What complications arise depend on the underlying cause. For example, you may develop life-threatening allergic reactions (anaphylaxis) with certain drugs, which causes a skin reaction. Or you may develop headaches, a stiff neck, or back pain from an infection. As mentioned before, be certain to see a doctor who can glance at every the symptoms you’re having and make a diagnosis.

Zika virus complications

You may be particularly interested in the Zika virus, as the maculopapular rash is often associated with this virus. The complications of the Zika virus can affect your baby, even if you had mild symptoms.

The (WHO) has declared Zika a public health emergency because of the high incidence of microcephaly (underdeveloped head size) in babies born to women who had the rash in the first three months of their pregnancy.

There is also that Zika causes another serious neurological disorder called Guillain-Barré syndrome.

It’s significant to see your doctor if you’re pregnant and may own been exposed to Zika. Zika passes through mosquitoes or by having sex with someone who had the Zika virus.

The WHO that pregnant women practice safe sex with condoms or abstain during the course of pregnancy.


How will your rash be treated?

Treatment of your rash depends on the cause. For immediate treatment to relieve itching, your doctor may also prescribe antihistamines or topical steroids. You can also use over-the-counter drugs such as hydrocortisone creams or Benadryl. As mentioned before, be certain to see a doctor first before taking these over-the-counter drugs. You don’t desire to treat the symptom without knowing the cause.

Drug reactions: If the maculopapular rash is a drug reaction, the doctor will own you stop the medication and attempt a substitute, if necessary.

Infections: If the cause of the rash is a viral infection or a bacterial infection, you will be treated for the specific example, a maculopapular rash caused by the Zika virus has no specific treatment. In the case of Zika, you will be advised to relax, drink plenty of fluids, and use over-the-counter painkillers if necessary.

Allergic reactions: Topical steroid creams and wet wraps can assist with inflamed doctor may also prescribe antihistamines.

Body’s systemic inflammation: This treatment depends on your condition and what’s causing your body’s immune system to react.

Sometimes the diagnosis may not be immediately clear, and the doctor may order more tests.

Read more: How to treat an HIV rash »


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