PHRM 514 - Asthma - Fall 2012 (1)

Factors influencing asthma n environmental factors

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Factors Influencing Asthma n Environmental factors ¡ Allergen exposure ¡ Socioeconomic status ¡ Urbanization ¡ Family size ¡ Decreased exposure to childhood infectious agents ¡ Occupational stimuli ¡ Active smoking and secondhand smoking ¡ Air pollution Kelly HW, Sorkness CA. Asthma. In: DiPiro JT, Talbert RL, Yee GC, et al., eds. Pharmacotherapy a pathophysiologic approach. 8th ed. New York: McGraw Hill Medical; 2011:439-448. Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma. . Updated 2011. Accessed October 10, 2012.
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Agents and Events Triggering Asthma n Respiratory infections n Allergens n Occupational stimuli n Environment n Emotions n Exercise n Drugs/preservatives Kelly HW, Sorkness CA. Asthma. In: DiPiro JT, Talbert RL, Yee GC, et al., eds. Pharmacotherapy a pathophysiologic approach. 8th ed. New York: McGraw Hill Medical; 2011:439-448.
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Which of the following is/are the most significant precipitant(s) of severe asthma exacerbations in adults? 1. Drugs 2. Exercise 3. Environmental exposures 4. Viral respiratory infections 5. Emotions
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Which of the following is/are the most significant precipitant(s) of severe asthma in children? 1. Drugs 2. Exercise 3. Environmental exposures 4. Viral respiratory infections 5. Emotions
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Viral Respiratory Infections n Particularly in children < 10 years old n Rhinovirus most common cause n Other viruses include: ¡ Respiratory syncytial virus ¡ Parainfluenza virus ¡ Coronavirus ¡ Influenza n Inflammatory response associated with BHR n Increase in asthma symptoms may last for days or weeks after resolution of virus symptoms Kelly HW, Sorkness CA. Asthma. In: DiPiro JT, Talbert RL, Yee GC, et al., eds. Pharmacotherapy a pathophysiologic approach. 8th ed. New York: McGraw Hill Medical; 2011:439-448.
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Environmental and Occupational Factors n General mechanisms unknown n Thought to be a result of epithelial damage and inflammation in the airway mucosa n Asthma may occur as a result of repeated prolonged exposure to industrial inhalants n Occupational asthma accounts for ~2% of all asthma cases Kelly HW, Sorkness CA. Asthma. In: DiPiro JT, Talbert RL, Yee GC, et al., eds. Pharmacotherapy a pathophysiologic approach. 8th ed. New York: McGraw Hill Medical; 2011:439-448.
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Psychological Factors n Association between increased stress and worsening of asthma n Bronchoconstriction associated with excess parasympathetic input n Coping skills may help patients who become distraught during an asthma attack Kelly HW, Sorkness CA. Asthma. In: DiPiro JT, Talbert RL, Yee GC, et al., eds. Pharmacotherapy a pathophysiologic approach. 8th ed. New York: McGraw Hill Medical; 2011:439-448.
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Rhinitis and Sinusitis n 40 to 50% of patients with asthma have an abnormal sinus x-ray n Mechanism by which sinusitis aggravates asthma is unknown n Transport of mucus chemotactic factors and inflammatory mediators from nasal passages to lung may exacerbate BHR n Treatment of upper airway disease may improve overall asthma control Kelly HW, Sorkness CA. Asthma. In: DiPiro JT, Talbert RL, Yee GC, et al., eds. Pharmacotherapy a pathophysiologic approach. 8th ed. New York: McGraw Hill Medical; 2011:439-448.
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