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The article reviews management of mild to moderate asthma in adults in Great Britain, where the prevalence of asthma is one of the highest in the world. The article presents pharmacological and non-pharmacological treatments for asthma which include, avoiding underuse of inhaled corticosteroids (ICS) and overreliance on short acting beta agonists; importance of weight loss for obese asthma patients and education on self-management.

The airborne particulate pollutants originating in the deserts of Mongolia and China which becomes contaminated with industrial effluents and traffic emissions while moving with the wind currents towards East Asia has recently become a serious environmental and health issue in the region. They cause asthma, collateral lung tissue damage, oxidative stress, allergic reactions, and inflammation. The current study was undertaken to evaluate the protective effects of alginate extracted from the invasive alga Sargassum horneri (SHA) against fine dust collected from Beijing, China (Chinese fine dust; CFD). It was found that CFD induces inflammation in HaCaT keratinocytes and inhibits macrophage activation. All of the particulate matter (PM) comprising CFD was < PM13 majority being < PM2.5 which is defined for mineral elements and polycyclic aromatic hydrocarbons. SHA attenuated PGE 2 levels in CFD-induced HaCaT keratinocytes. The IC 50 for SHA was 36.63 ± 4.11 µg mL -l . SHA also reduced the levels of COX-2, IL-6, and TNF-α, and inhibited certain key molecular mediators of the NF-κB and MAPK pathways in keratinocytes. SHA substantially reduced the levels of CFD-derived metal ions like Pb 2+ and Ca 2+ in keratinocytes attributable to its metal ion chelating properties. CFD-induced HaCaT keratinocyte culture media increased inflammatory responses in RAW 264.7 macrophages. These cells presented with increased levels of NO, iNOS, COX-2, PGE 2 , and pro-inflammatory cytokines. It was found that the aforementioned effects could be reversed in RAW 264.7 macrophages when keratinocytes were treated with SHA. Therefore, SHA could be used against fine dust-induced inflammation in keratinocytes. [ABSTRACT FROM AUTHOR]

Background: The prevalence of asthma and allergic diseases has risen in recent decades. The etiology of asthma and allergic diseases has not been entirely elucidated. Objective: In this study, we investigated the possibility that programmed vaccination in China may have a potential role in asthma and allergic diseases. Methods: In this animal model, newborn BALB/c mice were randomly divided into three groups: vaccine plus ovalbumin (OVA), OVA, and control. The mice of vaccine plus OVA only group were inoculated with vaccines by following the National Vaccines Inoculation Program in China. Mice of vaccine plus OVA and OVA only groups were sensitized and challenged with OVA. Airway hyperresponsiveness was assessed by lung function and serum interleukin (IL) 4 and interferon (IFN) γ were measured. Results: The results of lung function showed that mice of the vaccine plus OVA group exhibited an increase in enhanced pause (Penh) compared with that in the OVA group at methacholine concentrations of 6.25 and 12.5 mg/mL (p < 0.05). Serum IL-4 in the vaccine plus OVA group was higher than that in the OVA group (p < 0.01). The serum IFN-γ level in the OVA group was lower than that in the control group (p < 0.01), and also lower than that in the vaccine plus OVA group (p < 0.05). The ratio of IFN-γ to IL-4 both in the OVA and vaccine plus OVA group was lower than that in the control group (p < 0.01). Conclusions: Results of our study indicated that programmed vaccination in China may have a potential role in the prevalence of asthma and allergic diseases by inducing T-helper 2 cytokine expression and may be responsible for the increasing prevalence of asthma and allergic diseases in China. [ABSTRACT FROM AUTHOR]

Asthma in the inner city contributes to high morbidity and mortality, and, in school children, reduced school attendance and alteration in academic performance. There is a need to improve asthma care in the inner city by reducing asthma exacerbations. Methods are currently available to predict and prevent seasonal exacerbations of asthma. In addition, new medications are being developed that will be effective in improving pulmonary function and reducing asthma exacerbations. School-centered asthma programs can also be helpful to assist children and clinicians in applying asthma treatment plans and assuring optimal adherence to these plans. [ABSTRACT FROM AUTHOR]

The article focuses on the management of acute asthma among children in primary care. Topics discussed include an overview of asthma in children, the diagnosis of the disease, its causes and symptoms, the assessment of the affected children, the consideration of its features, and the approaches for its treatment.

Airway narrowing by smooth muscle constriction is a hallmark of asthma attacks that may cause severe difficulties of breathing. However, the causes of asthma and the underlying mechanisms are not fully understood. Bronchoconstriction within a bronchial tree involves complex interactions among the airways that lead to the emergence of regions of poor ventilation (ventilation defects, VDefs) in the lungs. The emphasis of this review is on mathematical modeling of the mechanisms involved in bronchoconstriction and the emergence of the complex airway behavior that leads to VDefs. Additionally, the review discusses characteristic model behaviors and experimental data to demonstrate advances and limitations of different models. [ABSTRACT FROM AUTHOR]

Abstract: Background: The Saudi national asthma protocol (SNAP) for asthma management was released in 1995 in an attempt to streamline asthma management practices in Saudi Arabia and improve the quality of care for asthma. Up to our knowledge, few studies assessed the adherence of Saudi physicians to the national asthma guidelines. Objectives: The objective of this present study was to assess the level of adherence of pediatricians and primary care physicians (PCPs) to the current SNAP recommendations and identify barriers to physician adherence. Methodology: This is a cross-sectional study involving pediatricians and PCPs selected randomly from five major governmental hospitals in Riyadh, Saudi Arabia. Subjects were administered a self-administered questionnaire comprising 24 questions assessing their awareness of SNAP and their level of adherence to the recommendations. Results: The response rate was 38% (80/206). Out of most of the physicians who responded, 70% (56) were aware of SNAP, and only 78.2% (n =43) of them had modified their management of asthmatic patients according to the SNAP recommendations. The level of knowledge of the pharmacotherapy and diagnostic parts of the guidelines ranged between 41.5% and 90.7% in the pharmacotherapy part, and 53.7–59.6% in the diagnostic part. The most common barriers to adherence to SNAP were lack of awareness (25.2%), patient non- compliance (18.9%) and lack of resources (13.5%). There was no significant difference in awareness between pediatricians and PCPs (69.2%, 70.7% respectively). Conclusion: This study reveals a substantial gap between the actual care provided by pediatricians and PCPs to asthmatic patients and the recommendations formulated in the Saudi National Asthma Protocol (SNAP). Lack of awareness remains the most common barrier for adherence to the guidelines followed by patient non-compliance. To improve SNAP guideline adherence, tailored interventions that address barriers to adherence need to be implemented. [Copyright &y& Elsevier]

Background: Allergic asthma is characterized by reversible airway obstruction and bronchial hyperresponsiveness associated with TH2 cell–mediated inflammation. Cysteinyl leukotrienes (CysLTs) are potent lipid mediators involved in bronchoconstriction, mucus secretion, and cell trafficking in asthmatic patients. Recent data have implicated CysLTs in the establishment and amplification of TH2 responses in murine models, although the precise mechanisms are unresolved. Objectives: Preliminary microarray studies suggested that human TH2 cells might selectively express cysteinyl leukotriene receptor 1 (CYSLTR1) mRNA. We sought to establish whether human TH2 cells are indeed a CysLT target cell type. Methods: We examined the expression of CYSLTR1 using real-time PCR in human TH1 and TH2 cells. We functionally assessed cysteinyl leukotriene receptor 1 protein (CysLT1) expression using calcium flux, cyclic AMP, and chemotaxis assays. Results: We show that human TH2 cells selectively express CYSLTR1 mRNA at high levels compared with TH1 cells after in vitro differentiation from naive precursors. Human TH2 cells are selectively responsive to CysLTs in a calcium flux assay when compared with TH1 cells with a rank order of potency similar to that described for CysLT1 (leukotriene [LT] D4 > LTC4 > LTE4). We also show that LTD4-induced signaling in TH2 cells is mediated through CysLT1 coupled to Gαq and Gαi proteins, and both pathways can be completely inhibited by selective CysLT1 antagonists. LTD4 is also found to possess potent chemotactic activity for TH2 cells at low nanomolar concentrations. Conclusions: These findings suggest a novel mechanism of action for CysLTs in the pathogenesis of asthma and provide a potential explanation for the anti-inflammatory effects of CysLT1 antagonists. [ABSTRACT FROM AUTHOR]

Background: Asthma morbidity and mortality rates are high among young inner-city children. Lack of routine primary care provider visits, poor access to care, and poor patient-physician communication might be contributing factors. Objective: This study evaluated the effects of providing Breathmobile services only, a Facilitated Asthma Communication Intervention (FACI) only, or both Breathmobile plus FACI on asthma outcomes relative to standard care. Methods: Children with asthma (n = 322; mean age, 4 years; 53% male; 97% African American) were recruited from Head Start programs in Baltimore City and randomized into 4 groups. Outcome measures included symptom-free days (SFDs), urgent care use (emergency department visits and hospitalizations), and medication use (courses of oral steroids and proportion taking an asthma controller medication), as reported by caregivers at baseline, 6-month, and 12-month assessments. Generalized estimating equations models were conducted to examine the differential treatment effects of the Breathmobile and FACI compared with standard care. Results: Children in the combined treatment group (Breathmobile plus FACI) had an increase of 1.7 (6.6%) SFDs that was not maintained at 12 months. In intent-to-treat analyses the FACI-only group had an increase in the number of emergency department visits at 6 months, which was not present at 12 months or in the post hoc as-treated analyses. No significant differences were found between the intervention groups compared with those receiving standard care on all other outcome measures. Conclusions: Other than a slight improvement in SFDs at 6 months in the Breathmobile plus FACI group, the intervention components did not result in any significant improvements in asthma management or asthma morbidity. [ABSTRACT FROM AUTHOR]

2010 found a number of significant advances in environmental and occupational respiratory disease. The role of sensitization and the subsequent production of allergic disease have been explored. New allergens and their T- and B-cell epitopes have been characterized. Novel approaches to the diagnosis and evaluation of food allergy have been described. The role of pollutants as they affect respiratory disease and the effects of age extremes on sensitization and asthma have been addressed. Significant advances in the understanding of inflammatory changes in both the upper and lower respiratory systems occurred. Novel therapeutic approaches have been explored, including the development of hypoallergens from improved molecular biology techniques. New effective approaches to asthma therapy have been identified. Exposure reduction through air filtration and novel immunotherapy approaches, such as sublingual therapy, have made significant advances. [ABSTRACT FROM AUTHOR]

Background: Epidemiologic findings support a positive association between asthma and obesity. Objective: Determine whether obesity or increasing level of body mass index (BMI) are associated with worse asthma control in an ethnically diverse urban population. Methods: Cross-sectional assessment of asthma control was performed in patients with asthma recruited from primary care offices by using 4 different validated asthma control questionnaires: the Asthma Control and Communication Instrument (ACCI), the Asthma Control Test (ACT), the Asthma Control Questionnaire (ACQ), and the Asthma Therapy Assessment Questionnaire (ATAQ). Multiple linear regression analysis was performed to evaluate the association between obesity and increasing BMI level and asthma control. Results: Of 292 subjects with a mean age of 47 years, the majority were women (82%) and African American (67%). There was a high prevalence of obesity with 63%, with only 15% normal weight. The mean score from all 4 questionnaires showed an average suboptimal asthma control (mean score/maximum possible score): ACCI (8.3/19), ACT (15.4/ 25), ACQ (2.1/ 6), and ATAQ (1.3/ 4). Regression analysis showed no association between obesity or increasing BMI level and asthma control using all 4 questionnaires. This finding persisted even after adjusting for FEV1, smoking status, race, sex, selected comorbid illnesses, and long-term asthma controller use. Conclusion: Using 4 validated asthma control questionnaires, we failed to find an association between obesity and asthma control in an urban population with asthma. Weight loss may not be an appropriate strategy to improve asthma control in this population. [Copyright &y& Elsevier]

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Background: Asthma-associated morbidity is rising, especially in inner city children. Objective: We evaluated the allergen sensitivities, allergen exposures, and associated morbidity for participants in the Inner City Asthma Study. We also determined geographic variations of indoor allergen levels. Methods: Nine hundred thirty-seven inner city children 5 to 11 years old with moderate to severe asthma underwent allergen skin testing. Bedroom dust samples were evaluated for Der p 1, Der f 1, Bla g 1, Fel d 1, and Can f 1. Results: Skin test sensitivities to cockroach (69%), dust mites (62%), and molds (50%) predominated, with marked study site–specific differences. Cockroach sensitivity was highest in the Bronx, New York, and Dallas (81.2%, 78.7%, and 78.5%, respectively), and dust mite sensitivity was highest in Dallas and Seattle (83.7% and 78.0%, respectively). A majority of homes in Chicago, New York, and the Bronx had cockroach allergen levels greater than 2 U/g, and a majority of those in Dallas and Seattle had dust mite allergen levels greater than 2 μg/g. Levels of both of these allergens were influenced by housing type. Cockroach allergen levels were highest in high-rise apartments, whereas dust mite allergen levels were highest in detached homes. Children who were both sensitive and exposed to cockroach allergen had significantly more asthma symptom days, more caretaker interrupted sleep, and more school days missed than children who were not sensitive or exposed. Conclusion: Geographic differences in allergen exposure and sensitivity exist among inner city children. Cockroach exposure and sensitivity predominate in the Northeast, whereas dust mite exposure and sensitivity are highest in the South and Northwest. Cockroach allergen appears to have a greater effect on asthma morbidity than dust mite or pet allergen in these children. [ABSTRACT FROM AUTHOR]

The article presents the key points related to the management of acute asthma among children in primary care. Topics discussed include the number of children under asthma treatment in Great Britain, its features that parents need to consider, and the requirement for asthma patients to have a personalised asthma action plan.

The article discusses the report "Examining Causes of the Inner City Asthma Epidemic" by Stanley J. Szefler showing the high asthma prevalence in populations living in poor areas in large cities. Topics discussed include asthma risk factors in large cities, contribution of medical health system in solving asthma problem in those places, and impact of social inequities on the asthma treatment process.

The article presents a study suggesting substandard housing to be linked to health impairments such as asthma. Topics discusssed include record of asthma attacks in children exposed to environmental triggers such as pest infestation and mould, assessment of children who had asthma-related emergency department visits to hospital at the Cincinnati Children's Hospital Medical Center in Cincinnati, Ohio and increase in children previously admitted for asthma being re-admitted to hospital.

Background: The specific cause or causes of asthma development must be identified to prevent this disease. Objective: Our hypothesis was that specific mold exposures are associated with childhood asthma development. Methods: Infants were identified from birth certificates. Dust samples were collected from 289 homes when the infants were 8 months of age. Samples were analyzed for concentrations of 36 molds that comprise the Environmental Relative Moldiness Index (ERMI) and endotoxin, house dust mite, cat, dog, and cockroach allergens. Children were evaluated at age 7 years for asthma based on reported symptoms and objective measures of lung function. Host, environmental exposure, and home characteristics evaluated included a history of parental asthma, race, sex, upper and lower respiratory tract symptoms, season of birth, family income, cigarette smoke exposure, air conditioning, use of a dehumidifier, presence of carpeting, age of home, and visible mold at age 1 year and child''s positive skin prick test response to aeroallergens and molds at age 7 years. Results: Asthma was diagnosed in 24% of the children at age 7 years. A statistically significant increase in asthma risk at age 7 years was associated with high ERMI values in the child''s home in infancy (adjusted relative risk for a 10-unit increase in ERMI value, 1.8; 95% CI, 1.5-2.2). The summation of levels of 3 mold species, Aspergillus ochraceus, Aspergillus unguis, and Penicillium variabile, was significantly associated with asthma (adjusted relative risk, 2.2; 95% CI, 1.8-2.7). Conclusion: In this birth cohort study exposure during infancy to 3 mold species common to water-damaged buildings was associated with childhood asthma at age 7 years. [Copyright &y& Elsevier]

Background: Asthma typically originates in early-life, and the impact of infection during immunologic maturation is a critical factor in disease pathogenesis. The progression of aberrant TH2 cell responses and disease development has been attributed to a lack of infections. However, exposure to specific pathogens such as Chlamydia may alter immunologic programming and predispose to asthma. Objective: To investigate the effects of chlamydial infection at different ages on allergic airways disease in later life. Methods: Neonatal, infant, or adult BALB/c mice were infected and 6 weeks later were sensitized and subsequently challenged with ovalbumin. Hallmark features of allergic airways disease were compared with uninfected allergic and nonallergic controls. Results: Early-life (neonatal and infant) but not adult chlamydial infection enhanced the development of hallmark features of asthma in ovalbumin-induced allergic airways disease. Notably early-life infection increased mucus-secreting cell numbers, IL-13 expression, and airway hyperresponsiveness. Neonatal infection attenuated eosinophil influx and ovalbumin-specific TH2 cytokine release and numbers of activated myeloid dendritic cells (DCs) in lymph nodes. By contrast, infant infection augmented features of allergic inflammation with increased airway eosinophils, TH2 cytokine, and DC responses. Both neonatal and infant infection increased systemic DC-induced IL-13 release from CD4+ T cells. The timing of infection had significant effects on lung structure because neonatal but not infant or adult infection induced increases in alveolar diameter. Conclusion: Early-life respiratory chlamydial infections modulate immune responses, alter lung function and structure, and enhance the severity of allergic airways disease in later life. [Copyright &y& Elsevier]