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PHRM 514 - Asthma - Fall 2012 (1)

Eds pharmacotherapy a pathophysiologic approach 8th

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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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Fibroblasts and Myofibroblasts n Produce connective tissue components (e.g., collagens) n Involved in airway remodeling Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma. http://www.ginasthma.org/. Updated 2011. Accessed October 10, 2012.
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Inflammatory Mediators n Histamine ¡ Induces smooth muscle constriction and bronchospasm; thought to play a role in mucosal edema and mucus secretion ¡ Release stimulated by physical stimuli (exercise) and allergens n Chemokines ¡ Recruit inflammatory cells in the airways n Cytokines ¡ Direct and modify inflammatory response in asthma and determine severity n Cysteinyl leukotrienes ¡ Potent bronchoconstrictors and proinflammatory mediators n Prostaglandin D2 ¡ Potent bronchoconstrictor n Nitric oxide ¡ Potent vasodilator 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. http://www.ginasthma.org/. Updated 2011. Accessed October 10, 2012. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. National Institutes of Health, National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program. http://www.nhlbi.nih.gov/guidelines/asthma/ asthgdln.pdf. Published August 28, 2007. Accessed October 16, 2011.
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Factors Influencing Asthma n Host factors ¡ Genetic predisposition n Partially heritablerequires a gene-by-environment interaction for phenotypic expression n Genetic factors account for 35-70% of the susceptibility n Genes predisposing to: ¡ Atopy ¡ Airway hyperresponsiveness ¡ Generation of inflammatory mediators ¡ Determination of TH1 and TH2 immune responses ¡ Obesity ¡ Sex 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. http://www.ginasthma.org/. Updated 2011. Accessed October 10, 2012.
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Hygiene Hypothesis n Allergic immunologic system develops (TH2 lymphocytes) instead of the immunologic system used to fight infections (TH1 lymphocytes) n First two years of life most important for the exposures to produce an alteration to the immune system response n Lower risk of asthma in children who: ¡ Exposed to higher levels of bacteria or endotoxin ¡ Live on farms ¡ Have large numbers of older siblings ¡ Enroll early in child care ¡ Are exposed to fewer antibiotics 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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Hygiene Hypothesis Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. National Institutes of Health, National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program. http://www.nhlbi.nih.gov/guidelines/asthma/ asthgdln.pdf. Published August 28, 2007. Accessed October 16, 2011.
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