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Asthma
FromWikipedia,thefreeencyclopedia

Asthmaisacommonlongterminflammatorydiseaseoftheairwaysofthelungs.[2]Itischaracterizedby
variableandrecurringsymptoms,reversibleairflowobstruction,andbronchospasm.[3]Symptomsinclude
episodesofwheezing,coughing,chesttightness,andshortnessofbreath.[4]Theseepisodesmayoccurafew
timesadayorafewtimesperweek.Dependingonthepersontheymaybecomeworseatnightorwith
exercise.[2]

Asthma

Asthmaisthoughttobecausedbyacombinationofgeneticandenvironmentalfactors.[5]Environmental
factorsincludeexposuretoairpollutionandallergens.[2]Otherpotentialtriggersincludemedicationssuchas
aspirinandbetablockers.[2]Diagnosisisusuallybasedonthepatternofsymptoms,responsetotherapyover
time,andspirometry.[6]Asthmaisclassifiedaccordingtothefrequencyofsymptoms,forcedexpiratoryvolume
inonesecond(FEV1),andpeakexpiratoryflowrate.[7]Itmayalsobeclassifiedasatopicornonatopicwhere
atopyreferstoapredispositiontowarddevelopingatype1hypersensitivityreaction.[8][9]
Thereisnocureforasthma.[2]Symptomscanbepreventedbyavoidingtriggers,suchasallergensandirritants,
andbytheuseofinhaledcorticosteroids.[10][11]Longactingbetaagonists(LABA)orantileukotrieneagents
maybeusedinadditiontoinhaledcorticosteroidsifasthmasymptomsremainuncontrolled.[12][13]Treatmentof
rapidlyworseningsymptomsisusuallywithaninhaledshortactingbeta2agonistsuchassalbutamoland
corticosteroidstakenbymouth.[14]Inveryseverecases,intravenouscorticosteroids,magnesiumsulfate,and
hospitalizationmayberequired.[15]
In2013,242millionpeoplegloballyhadasthmaupfrom183millionin1990.[16]Itcausedabout489,000
deathsin2013,[17]mostofwhichoccurredinthedevelopingworld.[2]Itoftenbeginsinchildhood.[2]Therates
ofasthmahaveincreasedsignificantlysincethe1960s.[18]AsthmawasrecognizedasearlyasAncient
Egypt.[19]ThewordasthmaisfromtheGreek,sthmawhichmeans"panting".[20]

Contents
1 Signsandsymptoms
https://en.wikipedia.org/wiki/Asthma

Peakflowmetersareusedtomeasurethepeak
expiratoryflowrate,importantinbothmonitoring
anddiagnosingasthma. [1]
Classificationandexternalresources
Specialty

Pulmonology

ICD10

J45(http://apps.who.int/classifications/
icd10/browse/2016/en#/J45)

ICD9CM

493(http://www.icd9data.com/getICD
9Code.ashx?icd9=493)

OMIM

600807(http://omim.org/entry/60080
7)
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1 Signsandsymptoms
1.1 Associatedconditions
2 Causes
2.1 Environmental
2.2 Genetic
2.3 Medicalconditions
2.4 Exacerbation
3 Pathophysiology
4 Diagnosis
4.1 Spirometry
4.2 Others
4.3 Classification
4.4 Differentialdiagnosis
5 Prevention
6 Management
6.1 Lifestylemodification
6.2 Medications
6.3 Others
6.4 Alternativemedicine
7 Prognosis
8 Epidemiology
9 Economics
10 History
11 References
12 Externallinks

DiseasesDB 1006(http://www.diseasesdatabase.co
m/ddb1006.htm)
MedlinePlus 000141(http://www.nlm.nih.gov/medl
ineplus/ency/article/000141.htm)
eMedicine

article/806890(http://emedicine.medsc
ape.com/article/806890overview)

PatientUK Asthma(http://patient.info/doctor/bro
nchialasthma)
MeSH

D001249(https://www.nlm.nih.gov/cg
i/mesh/2016/MB_cgi?field=uid&term
=D001249)

Signsandsymptoms
Asthmaischaracterizedbyrecurrentepisodesofwheezing,shortnessofbreath,chesttightness,and
coughing.[21]Sputummaybeproducedfromthelungbycoughingbutisoftenhardtobringup.[22]During
recoveryfromanattack,itmayappearpuslikeduetohighlevelsofwhitebloodcellscalledeosinophils.[23]
Symptomsareusuallyworseatnightandintheearlymorningorinresponsetoexerciseorcoldair.[24]Some
peoplewithasthmararelyexperiencesymptoms,usuallyinresponsetotriggers,whereasothersmayhave
markedandpersistentsymptoms.[25]

Wheezing
0:00

MENU

Thesoundofwheezingasheardwitha
stethoscope.
Problemsplayingthisfile?Seemediahelp.

Associatedconditions
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Anumberofotherhealthconditionsoccurmorefrequentlyinthosewithasthma,includinggastroesophagealrefluxdisease(GERD),rhinosinusitis,and
obstructivesleepapnea.[26]Psychologicaldisordersarealsomorecommon,[27]withanxietydisordersoccurringinbetween1652%andmooddisordersin14
41%.[28]However,itisnotknownifasthmacausespsychologicalproblemsorifpsychologicalproblemsleadtoasthma.[29]Thosewithasthma,especiallyifitis
poorlycontrolled,areathighriskforradiocontrastreactions.[30]

Causes
Asthmaiscausedbyacombinationofcomplexandincompletelyunderstoodenvironmentalandgeneticinteractions.[5][31]Thesefactorsinfluencebothitsseverity
anditsresponsivenesstotreatment.[32]Itisbelievedthattherecentincreasedratesofasthmaareduetochangingepigenetics(heritablefactorsotherthanthose
relatedtotheDNAsequence)andachanginglivingenvironment.[33]Onsetbeforeage12ismorelikelyduetogeneticinfluence,whileonsetafter12ismore
likelyduetoenvironmentalinfluence.[34]

Environmental
Manyenvironmentalfactorshavebeenassociatedwithasthma'sdevelopmentandexacerbationincludingallergens,airpollution,andotherenvironmental
chemicals.[35]Smokingduringpregnancyandafterdeliveryisassociatedwithagreaterriskofasthmalikesymptoms.[36]Lowairqualityfromfactorssuchas
trafficpollutionorhighozonelevels,[37]hasbeenassociatedwithbothasthmadevelopmentandincreasedasthmaseverity.[38]Overhalfofcasesinchildreninthe
UnitedStatesoccurinareaswithairqualitybelowEPAstandards.[39]Exposuretoindoorvolatileorganiccompoundsmaybeatriggerforasthmaformaldehyde
exposure,forexample,hasapositiveassociation.[40]Also,phthalatesincertaintypesofPVCareassociatedwithasthmainchildrenandadults.[41][42]
Thereisanassociationbetweenacetaminophen(paracetamol)useandasthma.[43]Themajorityoftheevidencedoesnot,however,supportacausalrole.[44]A
2014reviewfoundthattheassociationdisappearedwhenrespiratoryinfectionsweretakenintoaccount.[45]Usebyamotherduringpregnancyisalsoassociated
withanincreasedriskasispsychologicalstressduringpregnancy.[46][47]
Asthmaisassociatedwithexposuretoindoorallergens.[48]Commonindoorallergensincludedustmites,cockroaches,animaldander(fragmentsoffuror
feathers),andmold.[49][50]Effortstodecreasedustmiteshavebeenfoundtobeineffectiveonsymptomsinsensitizedsubjects.[51][52]Certainviralrespiratory
infections,suchasrespiratorysyncytialvirusandrhinovirus,[20]mayincreasetheriskofdevelopingasthmawhenacquiredasyoungchildren.[53]Certainother
infections,however,maydecreasetherisk.[20]
Hygienehypothesis

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Thehygienehypothesisattemptstoexplaintheincreasedratesofasthmaworldwideasadirectandunintendedresultofreducedexposure,duringchildhood,to
nonpathogenicbacteriaandviruses.[54][55]Ithasbeenproposedthatthereducedexposuretobacteriaandvirusesisdue,inpart,toincreasedcleanlinessand
decreasedfamilysizeinmodernsocieties.[56]Exposuretobacterialendotoxininearlychildhoodmaypreventthedevelopmentofasthma,butexposureatanolder
agemayprovokebronchoconstriction.[57]Evidencesupportingthehygienehypothesisincludeslowerratesofasthmaonfarmsandinhouseholdswithpets.[56]
Useofantibioticsinearlylifehasbeenlinkedtothedevelopmentofasthma.[58]Also,deliveryviacaesareansectionisassociatedwithanincreasedrisk(estimated
at2080%)ofasthmathisincreasedriskisattributedtothelackofhealthybacterialcolonizationthatthenewbornwouldhaveacquiredfrompassagethrough
thebirthcanal.[59][60]Thereisalinkbetweenasthmaandthedegreeofaffluence.[61]

Genetic
Familyhistoryisariskfactorforasthma,withmanydifferentgenesbeingimplicated.[63]Ifoneidenticaltwinis
affected,theprobabilityoftheotherhavingthediseaseisapproximately25%.[63]Bytheendof2005,25genes
hadbeenassociatedwithasthmainsixormoreseparatepopulations,includingGSTM1,IL10,CTLA4,
SPINK5,LTC4S,IL4RandADAM33,amongothers.[64]Manyofthesegenesarerelatedtotheimmunesystem
ormodulatinginflammation.Evenamongthislistofgenessupportedbyhighlyreplicatedstudies,resultshave
notbeenconsistentamongallpopulationstested.[64]In2006over100geneswereassociatedwithasthmainone
geneticassociationstudyalone[64]morecontinuetobefound.[65]

CD14endotoxininteractionbasedonCD14
SNPC159T[62]
Endotoxinlevels CCgenotype TTgenotype
Highexposure

Lowrisk

Highrisk

Lowexposure

Highrisk

Lowrisk

Somegeneticvariantsmayonlycauseasthmawhentheyarecombinedwithspecificenvironmentalexposures.[5]Anexampleisaspecificsinglenucleotide
polymorphismintheCD14regionandexposuretoendotoxin(abacterialproduct).Endotoxinexposurecancomefromseveralenvironmentalsourcesincluding
tobaccosmoke,dogs,andfarms.Riskforasthma,then,isdeterminedbybothaperson'sgeneticsandthelevelofendotoxinexposure.[62]

Medicalconditions
Atriadofatopiceczema,allergicrhinitisandasthmaiscalledatopy.[66]Thestrongestriskfactorfordevelopingasthmaisahistoryofatopicdisease[53]with
asthmaoccurringatamuchgreaterrateinthosewhohaveeithereczemaorhayfever.[67]Asthmahasbeenassociatedwitheosinophilicgranulomatosiswith
polyangiitis(formerlyknownasChurgStrausssyndrome),anautoimmunediseaseandvasculitis.[68]Individualswithcertaintypesofurticariamayalso
experiencesymptomsofasthma.[66]
Thereisacorrelationbetweenobesityandtheriskofasthmawithbothhavingincreasedinrecentyears.[69][70]Severalfactorsmaybeatplayincludingdecreased
respiratoryfunctionduetoabuildupoffatandthefactthatadiposetissueleadstoaproinflammatorystate.[71]

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Betablockermedicationssuchaspropranololcantriggerasthmainthosewhoaresusceptible.[72]Cardioselectivebetablockers,however,appearsafeinthosewith
mildormoderatedisease.[73][74]Othermedicationsthatcancauseproblemsinasthmaticsareangiotensinconvertingenzymeinhibitors,aspirin,andNSAIDs.[75]

Exacerbation
Someindividualswillhavestableasthmaforweeksormonthsandthensuddenlydevelopanepisodeofacuteasthma.Differentindividualsreacttovariousfactors
indifferentways.[76]Mostindividualscandevelopsevereexacerbationfromanumberoftriggeringagents.[76]
Homefactorsthatcanleadtoexacerbationofasthmaincludedust,animaldander(especiallycatanddoghair),cockroachallergensandmold.[76][77]Perfumesare
acommoncauseofacuteattacksinwomenandchildren.Bothviralandbacterialinfectionsoftheupperrespiratorytractcanworsenthedisease.[76]Psychological
stressmayworsensymptomsitisthoughtthatstressalterstheimmunesystemandthusincreasestheairwayinflammatoryresponsetoallergensand
irritants.[38][78]

Pathophysiology
Asthmaistheresultofchronicinflammationoftheconductingzoneoftheairways(mostespeciallythebronchiandbronchioles),whichsubsequentlyresultsin
increasedcontractabilityofthesurroundingsmoothmuscles.Thisamongotherfactorsleadstoboutsofnarrowingoftheairwayandtheclassicsymptomsof
wheezing.Thenarrowingistypicallyreversiblewithorwithouttreatment.Occasionallytheairwaysthemselveschange.[21]Typicalchangesintheairwaysinclude
anincreaseineosinophilsandthickeningofthelaminareticularis.Chronicallytheairways'smoothmusclemayincreaseinsizealongwithanincreaseinthe
numbersofmucousglands.Othercelltypesinvolvedinclude:Tlymphocytes,macrophages,andneutrophils.Theremayalsobeinvolvementofothercomponents
oftheimmunesystemincluding:cytokines,chemokines,histamine,andleukotrienesamongothers.[20]

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FigureAshowsthe
locationofthelungs
andairwaysinthe
body.FigureBshowsa
crosssectionofa
normalairway.Figure
Cshowsacross
sectionofanairway
duringasthma
symptoms.

Obstructionofthe
Diagramofasthma
lumenofabronchiole
bymucoidexudate,
gobletcellmetaplasia,
andepithelialbasement
membranethickening
inapersonwith
asthma.

Diagnosis
Whileasthmaisawellrecognizedcondition,thereisnotoneuniversalagreedupondefinition.[20]ItisdefinedbytheGlobalInitiativeforAsthmaas"achronic
inflammatorydisorderoftheairwaysinwhichmanycellsandcellularelementsplayarole.Thechronicinflammationisassociatedwithairwayhyper
responsivenessthatleadstorecurrentepisodesofwheezing,breathlessness,chesttightnessandcoughingparticularlyatnightorintheearlymorning.These
episodesareusuallyassociatedwithwidespreadbutvariableairflowobstructionwithinthelungthatisoftenreversibleeitherspontaneouslyorwithtreatment".[21]
Thereiscurrentlynoprecisetestforthediagnosis,whichistypicallybasedonthepatternofsymptomsandresponsetotherapyovertime.[6][20]Adiagnosisof
asthmashouldbesuspectedifthereisahistoryofrecurrentwheezing,coughingordifficultybreathingandthesesymptomsoccurorworsenduetoexercise,viral
infections,allergensorairpollution.[79]Spirometryisthenusedtoconfirmthediagnosis.[79]Inchildrenundertheageofsixthediagnosisismoredifficultasthey
aretooyoungforspirometry.[80]

Spirometry

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Spirometryisrecommendedtoaidindiagnosisandmanagement.[81][82]Itisthesinglebesttestforasthma.IftheFEV1measuredbythistechniqueimprovesmore
than12%followingadministrationofabronchodilatorsuchassalbutamol,thisissupportiveofthediagnosis.Ithowevermaybenormalinthosewithahistoryof
mildasthma,notcurrentlyactingup.[20]Ascaffeineisabronchodilatorinpeoplewithasthma,theuseofcaffeinebeforealungfunctiontestmayinterferewiththe
results.[83]SinglebreathdiffusingcapacitycanhelpdifferentiateasthmafromCOPD.[20]Itisreasonabletoperformspirometryeveryoneortwoyearstofollow
howwellaperson'sasthmaiscontrolled.[84]

Others
Themethacholinechallengeinvolvestheinhalationofincreasingconcentrationsofasubstancethatcausesairwaynarrowinginthosepredisposed.Ifnegativeit
meansthatapersondoesnothaveasthmaifpositive,however,itisnotspecificforthedisease.[20]
Othersupportiveevidenceincludes:a20%differenceinpeakexpiratoryflowrateonatleastthreedaysinaweekforatleasttwoweeks,a20%improvementof
peakflowfollowingtreatmentwitheithersalbutamol,inhaledcorticosteroidsorprednisone,ora20%decreaseinpeakflowfollowingexposuretoatrigger.[85]
Testingpeakexpiratoryflowismorevariablethanspirometry,however,andthusnotrecommendedforroutinediagnosis.Itmaybeusefulfordailyself
monitoringinthosewithmoderatetoseverediseaseandforcheckingtheeffectivenessofnewmedications.Itmayalsobehelpfulinguidingtreatmentinthose
withacuteexacerbations.[86]

Classification
Asthmaisclinicallyclassifiedaccordingtothefrequencyof
symptoms,forcedexpiratoryvolumeinonesecond(FEV1),
andpeakexpiratoryflowrate.[7]Asthmamayalsobeclassified
asatopic(extrinsic)ornonatopic(intrinsic),basedonwhether
symptomsareprecipitatedbyallergens(atopic)ornot(non
atopic).[8]Whileasthmaisclassifiedbasedonseverity,atthe
momentthereisnoclearmethodforclassifyingdifferent
subgroupsofasthmabeyondthissystem.[87]Findingwaysto
identifysubgroupsthatrespondwelltodifferenttypesof
treatmentsisacurrentcriticalgoalofasthmaresearch.[87]

Severity

Clinicalclassification(12yearsold)[7]
FEV1
Symptom
Nighttime %FEV1of
frequency
symptoms
predicted Variability

SABAuse

Intermittent

2/week

2/month

80%

<20%

2days/week

Mildpersistent

>2/week

34/month

80%

2030%

>2days/week

Moderate
persistent

Daily

>1/week

6080%

>30%

daily

Severepersistent

Continuously

Frequent
(7/week)

<60%

>30%

twice/day

Althoughasthmaisachronicobstructivecondition,itisnot
consideredasapartofchronicobstructivepulmonarydiseaseasthistermrefersspecificallytocombinationsofdiseasethatareirreversiblesuchasbronchiectasis,
chronicbronchitis,andemphysema.[88]Unlikethesediseases,theairwayobstructioninasthmaisusuallyreversiblehowever,ifleftuntreated,thechronic

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inflammationfromasthmacanleadthelungstobecomeirreversiblyobstructedduetoairwayremodeling.[89]Incontrasttoemphysema,asthmaaffectsthe
bronchi,notthealveoli.[90]
Asthmaexacerbation
Anacuteasthmaexacerbationiscommonlyreferredtoasanasthmaattack.The
classicsymptomsareshortnessofbreath,wheezing,andchesttightness.[20]The
wheezingismostoftenwhenbreathingout.[92]Whilethesearetheprimary
symptomsofasthma,[93]somepeoplepresentprimarilywithcoughing,andin
severecases,airmotionmaybesignificantlyimpairedsuchthatnowheezingis
heard.[91]Inchildren,chestpainisoftenpresent.[94]
Signswhichoccurduringanasthmaattackincludetheuseofaccessorymusclesof
respiration(sternocleidomastoidandscalenemusclesoftheneck),theremaybea
paradoxicalpulse(apulsethatisweakerduringinhalationandstrongerduring
exhalation),andoverinflationofthechest.[95]Abluecoloroftheskinandnails
mayoccurfromlackofoxygen.[96]
Inamildexacerbationthepeakexpiratoryflowrate(PEFR)is200L/minor
50%ofthepredictedbest.[97]Moderateisdefinedasbetween80and200L/min
or25%and50%ofthepredictedbestwhilesevereisdefinedas80L/minor
25%ofthepredictedbest.[97]
Acutesevereasthma,previouslyknownasstatusasthmaticus,isanacute
exacerbationofasthmathatdoesnotrespondtostandardtreatmentsof
bronchodilatorsandcorticosteroids.[98]Halfofcasesareduetoinfectionswith
otherscausedbyallergen,airpollution,orinsufficientorinappropriatemedication
use.[98]

Nearfatal

Lifethreatening
(anyoneof)

Severityofanacuteexacerbation[91]
HighPaCO2and/orrequiringmechanicalventilation
Clinicalsigns

Measurements

Alteredlevelofconsciousness

Peakflow<33%

Exhaustion

Oxygensaturation<92%

Arrhythmia

PaO2<8kPa

Lowbloodpressure

"Normal"PaCO2

Cyanosis
Silentchest
Poorrespiratoryeffort
Peakflow3350%
Acutesevere
(anyoneof)

Respiratoryrate25breathsperminute
Heartrate110beatsperminute
Unabletocompletesentencesinonebreath
Worseningsymptoms

Moderate

Peakflow5080%bestorpredicted
Nofeaturesofacutesevereasthma

Brittleasthmaisakindofasthmadistinguishablebyrecurrent,severeattacks.[91]Type1brittleasthmaisadiseasewithwidepeakflowvariability,despiteintense
medication.Type2brittleasthmaisbackgroundwellcontrolledasthmawithsuddensevereexacerbations.[91]
Exerciseinduced

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Exercisecantriggerbronchoconstrictionbothinpeoplewithorwithoutasthma.[99]Itoccursinmostpeoplewithasthmaandupto20%ofpeoplewithout
asthma.[99]Exerciseinducedbronchoconstrictioniscommoninprofessionalathletes.Thehighestratesareamongcyclists(upto45%),swimmers,andcross
countryskiers.[100]Whileitmayoccurwithanyweatherconditionsitismorecommonwhenitisdryandcold.[101]Inhaledbeta2agonistsdonotappearto
improveathleticperformanceamongthosewithoutasthma[102]howeveroraldosesmayimproveenduranceandstrength.[103][104]
Occupational
Asthmaasaresultof(orworsenedby)workplaceexposures,isacommonlyreportedoccupationaldisease.[105]Manycaseshoweverarenotreportedor
recognizedassuch.[106][107]Itisestimatedthat525%ofasthmacasesinadultsareworkrelated.Afewhundreddifferentagentshavebeenimplicatedwiththe
mostcommonbeing:isocyanates,grainandwooddust,colophony,solderingflux,latex,animals,andaldehydes.Theemploymentassociatedwiththehighestrisk
ofproblemsinclude:thosewhospraypaint,bakersandthosewhoprocessfood,nurses,chemicalworkers,thosewhoworkwithanimals,welders,hairdressersand
timberworkers.[105]
Aspirininducedasthma
Aspirinexacerbatedrespiratorydisease,alsoknownasaspirininducedasthma,affectsupto9%ofasthmatics.[108]Reactionsmayalsooccurtoother
NSAIDs.[109]Peopleaffectedoftenalsohavetroublewithnasalpolyps.[109]InpeoplewhoareaffectedlowdosesparacetamolorCOX2inhibitorsaregenerally
safe.[110]
Alcoholinducedasthma
Alcoholmayworsenasthmaticsymptomsinuptoathirdofpeople.[111]ThismaybeevenmorecommoninsomeethnicgroupssuchastheJapaneseandthose
withaspirininducedasthma.[111]Otherstudieshavefoundimprovementinasthmaticsymptomsfromalcohol.[111]
Nonallergicasthma
Nonallergicasthma,alsoknownasintrinsicornonatopicasthmamakesupbetween10and33%ofcases.Thereisnegativeskintesttocommoninhalantallergens
andnormalserumconcentrationsofIgE.Oftenitstartslaterinlifeandwomenaremorecommonlyaffectedthanmen.Usualtreatmentsmaynotworkaswell.[112]

Differentialdiagnosis

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Manyotherconditionscancausesymptomssimilartothoseofasthma.Inchildren,otherupperairwaydiseasessuchasallergicrhinitisandsinusitisshouldbe
consideredaswellasothercausesofairwayobstructionincluding:foreignbodyaspiration,trachealstenosisorlaryngotracheomalacia,vascularrings,enlarged
lymphnodesorneckmasses.[113]Bronchiolitisandotherviralinfectionsmayalsoproducewheezing.[114]Inadults,COPD,congestiveheartfailure,airway
masses,aswellasdruginducedcoughingduetoACEinhibitorsshouldbeconsidered.Inbothpopulationsvocalcorddysfunctionmaypresentsimilarly.[113]
Chronicobstructivepulmonarydiseasecancoexistwithasthmaandcanoccurasacomplicationofchronicasthma.Aftertheageof65,mostpeoplewith
obstructiveairwaydiseasewillhaveasthmaandCOPD.Inthissetting,COPDcanbedifferentiatedbyincreasedairwayneutrophils,abnormallyincreasedwall
thickness,andincreasedsmoothmuscleinthebronchi.However,thislevelofinvestigationisnotperformedduetoCOPDandasthmasharingsimilarprinciplesof
management:corticosteroids,longactingbetaagonists,andsmokingcessation.[115]Itcloselyresemblesasthmainsymptoms,iscorrelatedwithmoreexposureto
cigarettesmoke,anolderage,lesssymptomreversibilityafterbronchodilatoradministration,anddecreasedlikelihoodoffamilyhistoryofatopy.[116][117]

Prevention
Theevidencefortheeffectivenessofmeasurestopreventthedevelopmentofasthmaisweak.[118]Someshowpromiseincluding:limitingsmokeexposurebothin
uteroandafterdelivery,breastfeeding,andincreasedexposuretodaycareorlargefamiliesbutnonearewellsupportedenoughtoberecommendedforthis
indication.[118]Earlypetexposuremaybeuseful.[119]Resultsfromexposuretopetsatothertimesareinconclusive[120]anditisonlyrecommendedthatpetsbe
removedfromthehomeifapersonhasallergicsymptomstosaidpet.[121]Dietaryrestrictionsduringpregnancyorwhenbreastfeedinghavenotbeenfoundtobe
effectiveandthusarenotrecommended.[121]Reducingoreliminatingcompoundsknowntosensitivepeoplefromtheworkplacemaybeeffective.[105]Itisnot
clearifannualinfluenzavaccinationseffectstheriskofexacerbations.[122]Immunizationhowever,isrecommendedbytheWorldHealthOrganization.[123]
Smokingbansareeffectiveindecreasingexacerbationsofasthma.[124]

Management
Whilethereisnocureforasthma,symptomscantypicallybeimproved.[125]Aspecific,customizedplanforproactivelymonitoringandmanagingsymptoms
shouldbecreated.Thisplanshouldincludethereductionofexposuretoallergens,testingtoassesstheseverityofsymptoms,andtheusageofmedications.The
treatmentplanshouldbewrittendownandadviseadjustmentstotreatmentaccordingtochangesinsymptoms.[126]
Themosteffectivetreatmentforasthmaisidentifyingtriggers,suchascigarettesmoke,pets,oraspirin,andeliminatingexposuretothem.Iftriggeravoidanceis
insufficient,theuseofmedicationisrecommended.Pharmaceuticaldrugsareselectedbasedon,amongotherthings,theseverityofillnessandthefrequencyof
symptoms.Specificmedicationsforasthmaarebroadlyclassifiedintofastactingandlongactingcategories.[127][128]
Bronchodilatorsarerecommendedforshorttermreliefofsymptoms.Inthosewithoccasionalattacks,noothermedicationisneeded.Ifmildpersistentdiseaseis
present(morethantwoattacksaweek),lowdoseinhaledcorticosteroidsoralternatively,anoralleukotrieneantagonistoramastcellstabilizerisrecommended.
Forthosewhohavedailyattacks,ahigherdoseofinhaledcorticosteroidsisused.Inamoderateorsevereexacerbation,oralcorticosteroidsareaddedtothese
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treatments.[14]

Lifestylemodification
Avoidanceoftriggersisakeycomponentofimprovingcontrolandpreventingattacks.Themostcommontriggersincludeallergens,smoke(tobaccoandother),
airpollution,nonselectivebetablockers,andsulfitecontainingfoods.[129][130]Cigarettesmokingandsecondhandsmoke(passivesmoke)mayreducethe
effectivenessofmedicationssuchascorticosteroids.[131]Lawsthatlimitsmokingdecreasethenumberofpeoplehospitalizedforasthma.[132]Dustmitecontrol
measures,includingairfiltration,chemicalstokillmites,vacuuming,mattresscoversandothersmethodshadnoeffectonasthmasymptoms.[51]Overall,exercise
isbeneficialinpeoplewithstableasthma.[133]Yogacouldprovidesmallimprovementsinqualityoflifeandsymptomsinpeoplewithasthma.[134]

Medications
Medicationsusedtotreatasthmaaredividedintotwogeneralclasses:quickreliefmedicationsusedtotreatacutesymptomsandlongtermcontrolmedications
usedtopreventfurtherexacerbation.[127]Antibioticsaregenerallynotneededforsuddenworseningofsymptoms.[135]
Fastacting
Shortactingbeta2adrenoceptoragonists(SABA),suchassalbutamol(albuterolUSAN)arethefirstlinetreatmentforasthmasymptoms.[14]Theyare
recommendedbeforeexerciseinthosewithexerciseinducedsymptoms.[136]
Anticholinergicmedications,suchasipratropiumbromide,provideadditionalbenefitwhenusedincombinationwithSABAinthosewithmoderateor
severesymptoms.[14]AnticholinergicbronchodilatorscanalsobeusedifapersoncannottolerateaSABA.[88]Ifachildrequiresadmissiontohospital
additionalipratropiumdoesnotappeartohelpoveraSABA.[137]
Older,lessselectiveadrenergicagonists,suchasinhaledepinephrine,havesimilarefficacytoSABAs.[138]Theyarehowevernotrecommendeddueto
concernsregardingexcessivecardiacstimulation.[139]
Longtermcontrol
Corticosteroidsaregenerallyconsideredthemosteffectivetreatmentavailableforlongtermcontrol.[127]Inhaledformssuchasbeclomethasoneareusually
usedexceptinthecaseofseverepersistentdisease,inwhichoralcorticosteroidsmaybeneeded.[127]Itisusuallyrecommendedthatinhaledformulationsbe
usedonceortwicedaily,dependingontheseverityofsymptoms.[140]
Longactingbetaadrenoceptoragonists(LABA)suchassalmeterolandformoterolcanimproveasthmacontrol,atleastinadults,whengivenin
combinationwithinhaledcorticosteroids.[141]Inchildrenthisbenefitisuncertain.[141][142]Whenusedwithoutsteroidstheyincreasetheriskofsevereside
effects[143]andevenwithcorticosteroidstheymayslightlyincreasetherisk.[144][145]
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Leukotrienereceptorantagonists(suchasmontelukastandzafirlukast)maybeusedinadditiontoinhaled
corticosteroids,typicallyalsoinconjunctionwithaLABA.[13][127]Evidenceisinsufficienttosupportuseinacute
exacerbations.[146][147]Inchildrentheyappeartobeoflittlebenefitwhenaddedtoinhaledsteroids,[148]andthesame
appliesinadolescentsandadults.[149]Theyareusefulbythemselves.[150]Inthoseunderfiveyearsofage,theywere
thepreferredaddontherapyafterinhaledcorticosteroidsbytheBritishThoracicSocietyin2009.[151]Asimilarclass
ofdrugs,5LOXinhibitors,maybeusedasanalternativeinthechronictreatmentofmildtomoderateasthmaamong
olderchildrenandadults.[13][152]Asof2013thereisonemedicationinthisfamilyknownaszileuton.[13]
Mastcellstabilizers(suchascromolynsodium)areanothernonpreferredalternativetocorticosteroids.[127]
Deliverymethods
Medicationsaretypicallyprovidedasmetereddoseinhalers(MDIs)incombinationwithanasthmaspacerorasadry
powderinhaler.Thespacerisaplasticcylinderthatmixesthemedicationwithair,makingiteasiertoreceiveafulldoseof
thedrug.Anebulizermayalsobeused.Nebulizersandspacersareequallyeffectiveinthosewithmildtomoderate
symptoms.However,insufficientevidenceisavailabletodeterminewhetheradifferenceexistsinthosewithsevere
disease.[153]
Adverseeffects
Longtermuseofinhaledcorticosteroidsatconventionaldosescarriesaminorriskofadverseeffects.[154]Risksincludethe
developmentofcataractsandamildregressioninstature.[154][155]

Salbutamolmetereddoseinhaler
commonlyusedtotreatasthma
attacks.

Others
Whenasthmaisunresponsivetousualmedications,otheroptionsareavailableforbothemergencymanagementandpreventionofflareups.Foremergency
managementotheroptionsinclude:
Oxygentoalleviatehypoxiaifsaturationsfallbelow92%.[156]
Corticosteroidbymoutharerecommendedwithfivedaysofprednisonebeingthesame2daysofdexamethasone.[157]
Magnesiumsulfateintravenoustreatmentincreasesbronchodilationwhenusedinadditiontoothertreatmentinmoderatesevereacuteasthma
attacks.[15][158][159]Inadultsitresultsinareductionofhospitaladmissions.[160]
Heliox,amixtureofheliumandoxygen,mayalsobeconsideredinsevereunresponsivecases.[15]
Intravenoussalbutamolisnotsupportedbyavailableevidenceandisthususedonlyinextremecases.[156]
Methylxanthines(suchastheophylline)wereoncewidelyused,butdonotaddsignificantlytotheeffectsofinhaledbetaagonists.[156]Theiruseinacute
exacerbationsiscontroversial.[161]
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Thedissociativeanestheticketamineistheoreticallyusefulifintubationandmechanicalventilationisneededin
peoplewhoareapproachingrespiratoryarresthowever,thereisnoevidencefromclinicaltrialstosupportthis.[162]It
isunclearifnoninvasivepositivepressureventilationinchildrenisofuseasithasnotbeensufficientlystudied.[163]
ForthosewithseverepersistentasthmanotcontrolledbyinhaledcorticosteroidsandLABAs,bronchialthermoplastymay
beanoption.[164]Itinvolvesthedeliveryofcontrolledthermalenergytotheairwaywallduringaseriesof
bronchoscopies.[164][165]Whileitmayincreaseexacerbationfrequencyinthefirstfewmonthsitappearstodecreasethe
subsequentrate.Effectsbeyondoneyearareunknown.[166]Evidencesuggeststhatsublingualimmunotherapyinthosewith
bothallergicrhinitisandasthmaimproveoutcomes.[167]

Alternativemedicine
Manypeoplewithasthma,likethosewithotherchronicdisorders,usealternativetreatmentssurveysshowthatroughly
50%usesomeformofunconventionaltherapy.[168][169]Thereislittledatatosupporttheeffectivenessofmostofthese
therapies.EvidenceisinsufficienttosupporttheusageofVitaminC.[170]Thereistentativesupportforitsuseinexercise
inducedbrochospasm.[171]Inpeoplewithmildtomoderateasthma,treatmentwithvitaminDsupplementationislikelyto
reducetheriskofasthmaexacerbations.[172]
Acupunctureisnotrecommendedforthetreatmentasthereisinsufficientevidencetosupportitsuse.[173][174]Airionisers
shownoevidencethattheyimproveasthmasymptomsorbenefitlungfunctionthisappliedequallytopositiveand
negativeiongenerators.[175]

Fluticasonepropionatemetereddose
inhalercommonlyusedforlongterm
control.

Manualtherapies,includingosteopathic,chiropractic,physiotherapeuticandrespiratorytherapeuticmaneuvers,haveinsufficientevidencetosupporttheirusein
treatingasthma.[176]TheButeykobreathingtechniqueforcontrollinghyperventilationmayresultinareductioninmedicationusehowever,thetechniquedoesnot
haveanyeffectonlungfunction.[128]Thusanexpertpanelfeltthatevidencewasinsufficienttosupportitsuse.[173]

Prognosis
Theprognosisforasthmaisgenerallygood,especiallyforchildrenwithmilddisease.[178]Mortalityhasdecreasedoverthelastfewdecadesduetobetter
recognitionandimprovementincare.[179]In2010thedeathratewas170permillionformalesand90permillionforfemales.[180]Ratesverybetweencountriesby
100fold.[180]

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Globallyitcausesmoderateorseveredisabilityin19.4millionpeopleasof2004(16millionofwhichareinlowand
middleincomecountries).[181]Ofasthmadiagnosedduringchildhood,halfofcaseswillnolongercarrythediagnosis
afteradecade.[63]Airwayremodelingisobserved,butitisunknownwhethertheserepresentharmfulorbeneficial
changes.[182]Earlytreatmentwithcorticosteroidsseemstopreventoramelioratesadeclineinlungfunction.[183]
Asthmainchildrenalsohasnegativeeffectsonqualityoflifeoftheirparents.[184]

Epidemiology

Asthmadeathspermillionpersonsin2012

Asof2011,235330millionpeopleworldwideareaffectedbyasthma,[185][186][187]andapproximately250,000
345,000peopledieperyearfromthedisease.[21][188]Ratesvarybetweencountrieswithprevalencesbetween1and
18%.[21]Itismorecommonindevelopedthandevelopingcountries.[21]OnethusseeslowerratesinAsia,Eastern
EuropeandAfrica.[20]Withindevelopedcountriesitismorecommoninthosewhoareeconomicallydisadvantaged
whileincontrastindevelopingcountriesitismorecommoninthe
affluent.[21]Thereasonforthesedifferencesisnotwellknown.[21]Low
andmiddleincomecountriesmakeupmorethan80%ofthe
mortality.[189]

Ratesofasthmaindifferentcountriesofthe
worldasof2004.
nodata

67%

<1%

78%

12%

810%

Whileasthmaistwiceascommoninboysasgirls,[21]severeasthma
occursatequalrates.[190]Incontrastadultwomenhaveahigherrateof
asthmathanmen[21]anditismorecommonintheyoungthanthe
old.[20]Inchildren,asthmawasthemostcommonreasonforadmission
tothehospitalfollowinganemergencydepartmentvisitintheUSin
2011.[191]

Globalratesofasthmahaveincreasedsignificantlybetweenthe1960s
and2008[18][192]withitbeingrecognizedasamajorpublichealth
34%
12.515%
problemsincethe1970s.[20]Ratesofasthmahaveplateauedinthe
45%
>15%
developedworldsincethemid1990swithrecentincreasesprimarilyin
56%
thedevelopingworld.[193]Asthmaaffectsapproximately7%ofthe
populationoftheUnitedStates[143]and5%ofpeopleintheUnited
Kingdom.[194]Canada,AustraliaandNewZealandhaveratesofabout1415%.[195]
23%

1012.5%

https://en.wikipedia.org/wiki/Asthma

010

2432

6795

1113

3343

96251

1417

4450

1823

5166

Disabilityadjustedlifeyearforasthmaper
100,000inhabitantsin2004. [177]
nodata

350400

<100

400450

100150

450500

150200

500550

200250

550600

250300

>600

300350

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Economics
From2000to2010,theaveragecostperasthmarelatedhospitalstayintheUnitedStatesforchildrenremainedrelativelystableatabout$3,600,whereasthe
averagecostperasthmarelatedhospitalstayforadultsincreasedfrom$5,200to$6,600.[196]In2010,Medicaidwasthemostfrequentprimarypayeramong
childrenandadultsaged1844yearsintheUnitedStatesprivateinsurancewasthesecondmostfrequentpayer.[196]Amongbothchildrenandadultsinthelowest
incomecommunitiesintheUnitedStatesthereisahigherrateofhospitalstaysforasthmain2010thanthoseinthehighestincomecommunities.[196]

History
AsthmawasrecognizedinAncientEgyptandwastreatedbydrinkinganincensemixtureknownaskyphi.[19]Itwas
officiallynamedasaspecificrespiratoryproblembyHippocratescirca450BC,withtheGreekwordfor"panting"forming
thebasisofourmodernname.[20]In200BCitwasbelievedtobeatleastpartlyrelatedtotheemotions.[28]
In1873,oneofthefirstpapersinmodernmedicineonthesubjecttriedtoexplainthepathophysiologyofthediseasewhile
onein1872,concludedthatasthmacanbecuredbyrubbingthechestwithchloroformliniment.[197][198]Medicaltreatment
in1880,includedtheuseofintravenousdosesofadrugcalledpilocarpin.[199]In1886,F.H.Bosworththeorizeda
connectionbetweenasthmaandhayfever.[200]Epinephrinewasfirstreferredtointhetreatmentofasthmain1905.[201]
Oralcorticosteroidsbegantobeusedforthisconditioninthe1950swhileinhaledcorticosteroidsandselectiveshortacting
betaagonistcameintowideuseinthe1960s.[202][203]
Anotableandwelldocumentedcaseinthe19thcenturywasthatofyoungTheodoreRoosevelt(18581919).Atthattime
therewasnoeffectivetreatment.Roosevelt'syouthwasinlargepartshapedbyhispoorhealthpartlyrelatedtohisasthma.
Heexperiencedrecurringnighttimeasthmaattacksthatcausedtheexperienceofbeingsmotheredtodeath,terrifyingthe
boyandhisparents.[204]

EbersPapyrusdetailingtreatmentof
asthma

Duringthe1930sto1950s,asthmawasknownasoneofthe"holyseven"psychosomaticillnesses.Itscausewas
consideredtobepsychological,withtreatmentoftenbasedonpsychoanalysisandothertalkingcures.[205]Asthese
psychoanalystsinterpretedtheasthmaticwheezeasthesuppressedcryofthechildforitsmother,theyconsideredthetreatmentofdepressiontobeespecially
importantforindividualswithasthma.[205]

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1907advertisementfor
Grimault'sIndianCigarettes,
emphasisingtheiralleged
efficacyforthereliefof
asthma

References
1.GINA2011,p.18
2."AsthmaFactsheetN307".WHO.November2013.Archivedfromtheoriginalon
June29,2011.Retrieved3March2016.
3.NHLBIGuideline2007,pp.1112
4.BritishGuideline2009,p.4
5.MartinezFD(2007)."Genes,environments,developmentandasthma:a
reappraisal".EuropeanRespiratoryJournal.29(1):17984.
doi:10.1183/09031936.00087906.PMID17197483.
6.Lemanske,R.F.Busse,W.W.(February2010)."Asthma:clinicalexpressionand
molecularmechanisms".J.AllergyClin.Immunol.125(2Suppl2):S95102.
doi:10.1016/j.jaci.2009.10.047.PMC2853245 .PMID20176271.

https://en.wikipedia.org/wiki/Asthma

7.YawnBP(September2008)."Factorsaccountingforasthmavariability:achieving
optimalsymptomcontrolforindividualpatients"(PDF).PrimaryCareRespiratory
Journal.17(3):138147.doi:10.3132/pcrj.2008.00004.PMID18264646.
Archived(PDF)fromtheoriginalon20100304.
8.Kumar,VinayAbbas,AbulKFausto,NelsonAster,Jon,eds.(2010).Robbins
andCotranpathologicbasisofdisease(8thed.).Saunders.p.688.ISBN9781
416031215.OCLC643462931.
9.Stedman'sMedicalDictionary(28ed.).LippincottWilliamsandWilkins.2005.
ISBN0781733901.
10.NHLBIGuideline2007,pp.169172
11.GINA2011,p.71
12.GINA2011,p.33
16/24

11/10/2016

AsthmaWikipedia

13.ScottJP,PetersGoldenM(September2013)."Antileukotrieneagentsforthe
treatmentoflungdisease".Am.J.Respir.Crit.CareMed.188(5):538544.
doi:10.1164/rccm.2013010023PP.PMID23822826.
14.NHLBIGuideline2007,p.214
15.NHLBIGuideline2007,pp.373375
16.GlobalBurdenofDiseaseStudy2013,Collaborators(22August2015)."Global,
regional,andnationalincidence,prevalence,andyearslivedwithdisabilityfor301
acuteandchronicdiseasesandinjuriesin188countries,19902013:asystematic
analysisfortheGlobalBurdenofDiseaseStudy2013.".Lancet(London,
England).386(9995):743800.doi:10.1016/s01406736(15)606924.
PMID26063472.
17.GBD2013MortalityandCausesofDeath,Collaborators(10January2015).
"Global,regional,andnationalagesexspecificallcauseandcausespecific
mortalityfor240causesofdeath,19902013:asystematicanalysisfortheGlobal
BurdenofDiseaseStudy2013.".Lancet(London,England).385(9963):11771.
doi:10.1016/s01406736(14)616822.PMC4340604 .PMID25530442.
18.AnandanC,NurmatovU,vanSchayckOC,SheikhA(February2010)."Isthe
prevalenceofasthmadeclining?Systematicreviewofepidemiologicalstudies".
Allergy.65(2):15267.doi:10.1111/j.13989995.2009.02244.x.PMID19912154.
19.MannicheL(1999).Sacredluxuries:fragrance,aromatherapy,andcosmeticsin
ancientEgypt.CornellUniversityPress.pp.49.ISBN9780801437205.
20.Murray,JohnF.(2010)."Ch.38Asthma".InMason,RobertJ.Murray,JohnF.
Broaddus,V.CourtneyNadel,JayA.Martin,ThomasR.King,Jr.,Talmadge
E.Schraufnagel,DeanE.MurrayandNadel'stextbookofrespiratorymedicine
(5thed.).Elsevier.ISBN1416047107.
21.GINA2011,pp.25
22.Jindal,editorinchiefSK(2011).Textbookofpulmonaryandcriticalcare
medicine.NewDelhi:JaypeeBrothersMedicalPublishers.p.242.ISBN97893
50250730.
23.George,RonaldB.(2005).Chestmedicine:essentialsofpulmonaryandcritical
caremedicine(5thed.).Philadelphia,PA:LippincottWilliams&Wilkins.p.62.
ISBN9780781752732.
24.BritishGuideline2009,p.14
25.GINA2011,pp.89
26.BouletLP(April2009)."Influenceofcomorbidconditionsonasthma".European
RespiratoryJournal.33(4):897906.doi:10.1183/09031936.00121308.
PMID19336592.
27.Boulet,LPBoulay,M(June2011)."Asthmarelatedcomorbidities".Expert
reviewofrespiratorymedicine.5(3):37793.doi:10.1586/ers.11.34.
PMID21702660.
28.editors,AndrewHarver,HarryKotses,(2010).Asthma,healthandsocietya
publichealthperspective.NewYork:Springer.p.315.ISBN9780387782850.
https://en.wikipedia.org/wiki/Asthma

29.Thomas,MBruton,AMoffat,MCleland,J(September2011)."Asthmaand
psychologicaldysfunction".Primarycarerespiratoryjournal:journalofthe
GeneralPracticeAirwaysGroup.20(3):2506.doi:10.4104/pcrj.2011.00058.
PMID21674122.
30.Webb,editedbyHenrikS.Thomsen,JudithA.W.(2014).Contrastmedia:safety
issuesandESURguidelines.(Thirded.).Dordrecht:Springer.p.54.ISBN9783
642367243.
31.Miller,RLHoSM(March2008)."Environmentalepigeneticsandasthma:
currentconceptsandcallforstudies".AmericanJournalofRespiratoryand
CriticalCareMedicine.177(6):567573.doi:10.1164/rccm.2007101511PP.
PMC2267336 .PMID18187692.
32.ChoudhrySSeiboldMABorrellLNetal.(2007)."Dissectingcomplexdiseases
incomplexpopulations:asthmainlatinoamericans".ProcAmThoracSoc.4(3):
22633.doi:10.1513/pats.200701029AW.PMC2647623 .PMID17607004.
33.Dietert,RR(September2011)."Maternalandchildhoodasthma:riskfactors,
interactions,andramifications".Reproductivetoxicology(Elmsford,N.Y.).32(2):
198204.doi:10.1016/j.reprotox.2011.04.007.PMID21575714.
34.Tan,DJWalters,EHPerret,JLLodge,CJLowe,AJMatheson,MC
Dharmage,SC(February2015)."Ageofasthmaonsetasadeterminantof
differentasthmaphenotypesinadults:asystematicreviewandmetaanalysisof
theliterature.".Expertreviewofrespiratorymedicine.9(1):10923.
doi:10.1586/17476348.2015.1000311.PMID25584929.
35.Kelly,FJFussell,JC(August2011)."Airpollutionandairwaydisease".Clinical
andExperimentalAllergy.41(8):105971.doi:10.1111/j.1365
2222.2011.03776.x.PMID21623970.
36.GINA2011,p.6
37.GINA2011,p.61
38.Gold,D.R.Wright,R.(2005)."Populationdisparitiesinasthma".AnnuRev
PublicHealth.26:89113.doi:10.1146/annurev.publhealth.26.021304.144528.
PMID15760282.
39.AmericanLung,Association(June2001)."Urbanairpollutionandhealth
inequities:aworkshopreport.".EnvironmentalHealthPerspectives.109Suppl3:
35774.doi:10.1289/ehp.01109s3357.PMC1240553 .PMID11427385.
40.McGwin,GLienert,JKennedy,JI(March2010)."Formaldehydeexposureand
asthmainchildren:asystematicreview".EnvironmentalHealthPerspectives.118
(3):3137.doi:10.1289/ehp.0901143.PMC2854756 .PMID20064771.
41.Jaakkola,J.J.Knight,T.L.(July2008)."Theroleofexposuretophthalatesfrom
polyvinylchlorideproductsinthedevelopmentofasthmaandallergies:a
systematicreviewandmetaanalysis".EnvironHealthPerspect.116(7):84553.
doi:10.1289/ehp.10846.PMC2453150 .PMID18629304.

17/24

11/10/2016

AsthmaWikipedia

42.Bornehag,CGNanberg,E(April2010)."Phthalateexposureandasthmain
children".Internationaljournalofandrology.33(2):33345.doi:10.1111/j.1365
2605.2009.01023.x.PMID20059582.
43.Henderson,AJShaheen,SO(Mar2013)."Acetaminophenandasthma.".
PaediatricRespiratoryReviews.14(1):915quiz16.
doi:10.1016/j.prrv.2012.04.004.PMID23347656.
44.Heintze,KPetersen,KU(Jun2013)."Thecaseofdrugcausationofchildhood
asthma:antibioticsandparacetamol.".Europeanjournalofclinicalpharmacology.
69(6):1197209.doi:10.1007/s0022801214637.PMC3651816 .
PMID23292157.
45.Cheelo,MLodge,CJDharmage,SCSimpson,JAMatheson,MHeinrich,J
Lowe,AJ(26November2014)."Paracetamolexposureinpregnancyandearly
childhoodanddevelopmentofchildhoodasthma:asystematicreviewandmeta
analysis.".ArchivesofDiseaseinChildhood.100:819.doi:10.1136/archdischild
2012303043.PMID25429049.
46.Eyers,SWeatherall,MJefferies,SBeasley,R(Apr2011)."Paracetamolin
pregnancyandtheriskofwheezinginoffspring:asystematicreviewandmeta
analysis.".ClinicalandExperimentalAllergy.41(4):4829.doi:10.1111/j.1365
2222.2010.03691.x.PMID21338428.
47.vandeLoo,KFvanGelder,MMRoukema,JRoeleveld,NMerkus,PJ
Verhaak,CM(January2016)."Prenatalmaternalpsychologicalstressand
childhoodasthmaandwheezing:ametaanalysis.".TheEuropeanrespiratory
journal.47(1):13346.doi:10.1183/13993003.002992015.PMID26541526.
48.Ahluwalia,SKMatsui,EC(April2011)."Theindoorenvironmentanditseffects
onchildhoodasthma".CurrentOpinioninAllergyandClinicalImmunology.11
(2):13743.doi:10.1097/ACI.0b013e3283445921.PMID21301330.
49.Arshad,SH(January2010)."Doesexposuretoindoorallergenscontributetothe
developmentofasthmaandallergy?".Currentallergyandasthmareports.10(1):
4955.doi:10.1007/s1188200900826.PMID20425514.
50.Custovic,ASimpson,A(2012)."Theroleofinhalantallergensinallergic
airwaysdisease".JournalofInvestigationalAllergologyandClinicalImmunology.
22(6):393401qiuzfollow401.PMID23101182.
51.PCGtzscheHKJohansen(2008).Gtzsche,PeterC,ed."Housedustmite
controlmeasuresforasthma".CochraneDatabaseofSystematicReviews(2):
CD001187.doi:10.1002/14651858.CD001187.pub3.PMID18425868.
52.Calderon,Moisesetal.(2015)."Respiratoryallergycausedbyhousedustmites:
Whatdowereallyknow?".JournalofAllergyandClinicalImmunology.136:38
48.doi:10.1016/j.jaci.2014.10.012.
53.NHLBIGuideline2007,p.11
54.Ramsey,CDCelednJC(January2005)."Thehygienehypothesisandasthma".
CurrentOpinioninPulmonaryMedicine.11(1):1420.
doi:10.1097/01.mcp.0000145791.13714.ae.PMID15591883.
https://en.wikipedia.org/wiki/Asthma

55.Bufford,JDGernJE(May2005)."Thehygienehypothesisrevisited".
ImmunologyandAllergyClinicsofNorthAmerica.25(2):247262.
doi:10.1016/j.iac.2005.03.005.PMID15878454.
56.Brooks,CPearce,NDouwes,J(February2013)."Thehygienehypothesisin
allergyandasthma:anupdate".CurrentOpinioninAllergyandClinical
Immunology.13(1):707.doi:10.1097/ACI.0b013e32835ad0d2.PMID23103806.
57.Rao,DPhipatanakul,W(October2011)."Impactofenvironmentalcontrolson
childhoodasthma.".Currentallergyandasthmareports.11(5):41420.
doi:10.1007/s1188201102067.PMID21710109.
58.Murk,WRisnes,KRBracken,MB(June2011)."Prenatalorearlylifeexposure
toantibioticsandriskofchildhoodasthma:asystematicreview".Pediatrics.127
(6):112538.doi:10.1542/peds.20102092.PMID21606151.
59.BritishGuideline2009,p.72
60.Neu,JRushing,J(June2011)."Cesareanversusvaginaldelivery:longterm
infantoutcomesandthehygienehypothesis".Clinicsinperinatology.38(2):321
31.doi:10.1016/j.clp.2011.03.008.PMC3110651 .PMID21645799.
61.VonHertzen,LCHaahtela,T(February2004)."Asthmaandatopythepriceof
affluence?".Allergy.59(2):12437.doi:10.1046/j.13989995.2003.00433.x.
PMID14763924.
62.MartinezFD(2007)."CD14,endotoxin,andasthmarisk:actionsand
interactions".ProcAmThoracSoc.4(3):2215.doi:10.1513/pats.200702
035AW.PMC2647622 .PMID17607003.
63.Elward,GrahamDouglas,KurtisS.(2010).Asthma.London:MansonPub.
pp.2729.ISBN9781840765137.
64.OberC,HoffjanS(2006)."Asthmagenetics2006:thelongandwindingroadto
genediscovery".GenesImmun.7(2):95100.doi:10.1038/sj.gene.6364284.
PMID16395390.
65.Halapi,EBjornsdottir,US(January2009)."Overviewonthecurrentstatusof
asthmagenetics".Theclinicalrespiratoryjournal.3(1):27.doi:10.1111/j.1752
699X.2008.00119.x.PMID20298365.
66.Rapini,RonaldP.Bolognia,JeanL.Jorizzo,JosephL.(2007).Dermatology:2
VolumeSet.St.Louis:Mosby.ISBN1416029990.
67.GINA2011,p.4
68.J.C.JennetteR.J.FalkP.A.Baconetal.(January2013)."2012Revised
InternationalChapelHillConsensusConferenceNomenclatureofVasculitides".
Arthritis&Rheumatism.65(1):111.doi:10.1002/art.37715.PMID23045170.
69.BeutherDA(January2010)."Recentinsightintoobesityandasthma".Current
OpinioninPulmonaryMedicine.16(1):6470.
doi:10.1097/MCP.0b013e3283338fa7.PMID19844182.
70.HolguinF,FitzpatrickA(March2010)."Obesity,asthma,andoxidativestress".J.
Appl.Physiol.108(3):7549.doi:10.1152/japplphysiol.00702.2009.
PMID19926826.
18/24

11/10/2016

AsthmaWikipedia

71.WoodLG,GibsonPG(July2009)."Dietaryfactorsleadtoinnateimmune
activationinasthma".Pharmacol.Ther.123(1):3753.
doi:10.1016/j.pharmthera.2009.03.015.PMID19375453.
72.O'RourkeST(October2007)."Antianginalactionsofbetaadrenoceptor
antagonists".AmJPharmEduc.71(5):95.doi:10.5688/aj710595.PMC2064893
.PMID17998992.
73.Salpeter,SOrmiston,TSalpeter,E(2002)."Cardioselectivebetablockersfor
reversibleairwaydisease.".TheCochranedatabaseofsystematicreviews(4):
CD002992.doi:10.1002/14651858.CD002992.PMID12519582.
74.Morales,DRJackson,CLipworth,BJDonnan,PTGuthrie,B(Nov7,2013).
"Adverserespiratoryeffectofacutebetablockerexposureinasthma:asystematic
reviewandmetaanalysisofrandomizedcontrolledtrials.".Chest.145(4):779
86.doi:10.1378/chest.131235.PMID24202435.
75.Covar,RAMacomber,BASzefler,SJ(February2005)."Medicationsasasthma
triggers".ImmunologyandallergyclinicsofNorthAmerica.25(1):16990.
doi:10.1016/j.iac.2004.09.009.PMID15579370.
76.BaxiSN,PhipatanakulW(April2010)."Theroleofallergenexposureand
avoidanceinasthma".AdolescMedStateArtRev.21(1):5771,viiiix.
PMC2975603 .PMID20568555.
77.Sharpe,RABearman,NThornton,CRHusk,KOsborne,NJ(January2015).
"Indoorfungaldiversityandasthma:ametaanalysisandsystematicreviewofrisk
factors.".TheJournalofallergyandclinicalimmunology.135(1):11022.
doi:10.1016/j.jaci.2014.07.002.PMID25159468.
78.ChenE,MillerGE(2007)."Stressandinflammationinexacerbationsofasthma".
BrainBehavImmun.21(8):9939.doi:10.1016/j.bbi.2007.03.009.PMC2077080
.PMID17493786.
79.NHLBIGuideline2007,p.42
80.GINA2011,p.20
81.AmericanAcademyofAllergy,Asthma,andImmunology."Fivethingsphysicians
andpatientsshouldquestion"(PDF).Choosingwisely:aninitiativeoftheABIM
Foundation.AmericanAcademyofAllergy,Asthma,andImmunology.Retrieved
August14,2012.
82.ThirdExpertPanelontheDiagnosisandManagementofAsthma(2007).
Guidelinesforthediagnosisandmanagementofasthma.NationalHeart,Lung,
andBloodInstitute(US).074051.
83.Welsh,EJ.Bara,A.Barley,E.Cates,CJ.(2010).Welsh,EmmaJ,ed.
"Caffeineforasthma".CochraneDatabaseofSystematicReviews:CD001112.
doi:10.1002/14651858.CD001112.pub2.PMID20091514.
84.NHLBIGuideline2007,p.58
85.PinnockH,ShahR(2007)."Asthma".BMJ.334(7598):84750.
doi:10.1136/bmj.39140.634896.BE.PMC1853223 .PMID17446617.
86.NHLBIGuideline2007,p.59
https://en.wikipedia.org/wiki/Asthma

87.MooreWC,PascualRM(June2010)."Updateinasthma2009".American
JournalofRespiratoryandCriticalCareMedicine.181(11):11817.
doi:10.1164/rccm.2010030321UP.PMC3269238 .PMID20516492.
88.Self,TimothyChrisman,CaryFinch,Christopher(2009)."22.Asthma".In
MaryAnneKodaKimble,BrianKAlldredgeetal.Appliedtherapeutics:the
clinicaluseofdrugs(9thed.).Philadelphia:LippincottWilliams&Wilkins.
OCLC230848069.
89.Delacourt,C(June2004)."Consquencesbronchiquesdel'asthmenontrait"
[Bronchialchangesinuntreatedasthma].ArchivesdePdiatrie.11(Suppl.2):
71s73s.doi:10.1016/S0929693X(04)900036.PMID15301800.
90.Schiffman,George(18December2009)."Chronicobstructivepulmonarydisease".
MedicineNet.Archivedfromtheoriginalon28August2010.Retrieved
2September2010.
91.BritishGuideline2009,p.54
92.CurrentReviewofAsthma.London:CurrentMedicineGroup.2003.p.42.
ISBN9781461310952.
93.Barnes,PJ(2008)."Asthma".InFauci,AnthonySBraunwald,E,Kasper,DL.
Harrison'sPrinciplesofInternalMedicine(17thed.).NewYork:McGrawHill.
pp.15961607.ISBN9780071466332.
94.McMahon,Maureen(2011).Pediatricsacompetencybasedcompanion.
Philadelphia,PA:Saunders/Elsevier.ISBN9781416053507.
95.MaitreB,SimilowskiT,DerenneJP(September1995)."Physicalexaminationof
theadultpatientwithrespiratorydiseases:inspectionandpalpation".European
RespiratoryJournal.8(9):158493.PMID8575588.
96.Werner,HA(June2001)."Statusasthmaticusinchildren:areview".Chest.119
(6):15961607.doi:10.1378/chest.119.6.1913.PMID11399724.
97.ShiberJR,SantanaJ(May2006)."Dyspnea".Med.Clin.NorthAm.90(3):453
79.doi:10.1016/j.mcna.2005.11.006.PMID16473100.
98.Shah,RSaltoun,CA(MayJun2012)."Chapter14:Acutesevereasthma(status
asthmaticus)".AllergyandAsthmaProceedings.33Suppl1(3):S4750.
doi:10.2500/aap.2012.33.3547.PMID22794687.
99.Khan,DA(JanFeb2012)."Exerciseinducedbronchoconstriction:burdenand
prevalence".AllergyandAsthmaProceedings.33(1):16.
doi:10.2500/aap.2012.33.3507.PMID22370526.
100.Wuestenfeld,JCWolfarthB(Jan2013)."Specialconsiderationsforadolescent
athleticandasthmaticpatients".OpenAccessJournalofSportsMedicine.4:17.
doi:10.2147/OAJSM.S23438.PMC3871903 .PMID24379703.
101.GINA2011,p.17

19/24

11/10/2016

AsthmaWikipedia

102.Carlsen,KHAnderson,SDBjermer,LBonini,SBrusasco,VCanonica,W
Cummiskey,JDelgado,LDelGiacco,SRDrobnic,FHaahtela,TLarsson,K
Palange,PPopov,TvanCauwenberge,P(May2008).EuropeanRespiratory,
SocietyEuropeanAcademyofAllergyandClinical,ImmunologyGA(2)LEN,.
"Treatmentofexerciseinducedasthma,respiratoryandallergicdisordersinsports
andtherelationshiptodoping:PartIIofthereportfromtheJointTaskForceof
EuropeanRespiratorySociety(ERS)andEuropeanAcademyofAllergyand
ClinicalImmunology(EAACI)incooperationwithGA(2)LEN".Allergy.63(5):
492505.doi:10.1111/j.13989995.2008.01663.x.PMID18394123.
103.Kindermann,W(2007)."Doinhaledbeta(2)agonistshaveanergogenicpotential
innonasthmaticcompetitiveathletes?".Sportsmedicine(Auckland,N.Z.).37(2):
95102.doi:10.2165/0000725620073702000001.PMID17241101.
104.Pluim,BMdeHon,OStaal,JBLimpens,JKuipers,HOverbeek,SE
Zwinderman,AHScholten,RJ(Jan1,2011)."Agonistsandphysical
performance:asystematicreviewandmetaanalysisofrandomizedcontrolled
trials".Sportsmedicine(Auckland,N.Z.).41(1):3957.doi:10.2165/11537540
00000000000000.PMID21142283.
105.Baur,XAasen,TBBurge,PSHeederik,DHenneberger,PKMaestrelli,P
Schlnssen,VVandenplas,OWilken,D(Jun1,2012).ERSTaskForceonthe
ManagementofWorkrelated,Asthma."Themanagementofworkrelatedasthma
guidelines:abroaderperspective".EuropeanRespiratoryReview.21(124):125
39.doi:10.1183/09059180.00004711.PMID22654084.
106.Kunnamo,ed.inchief:Ilkka(2005).Evidencebasedmedicineguidelines.
Chichester:Wiley.p.214.ISBN9780470011843.
107.Kraft,editors,MarioCastro,Monica(2008).Clinicalasthma.Philadelphia:
Mosby/Elsevier.pp.Chapter42.ISBN9780323070812.
108.Chang,JEWhite,ASimon,RAStevenson,DD(2012)."Aspirinexacerbated
respiratorydisease:burdenofdisease.".AllergyandAsthmaProceedings.33(2):
11721.doi:10.2500/aap.2012.33.3541.PMID22525387.
109.Kowalski,MLMakowska,JSBlanca,MBavbek,SBochenek,GBousquet,J
Bousquet,PCelik,GDemoly,PGomes,ERNiankowskaMogilnicka,E
Romano,ASanchezBorges,MSanz,MTorres,MJDeWeck,ASzczeklik,
ABrockow,K(July2011)."Hypersensitivitytononsteroidalantiinflammatory
drugs(NSAIDs)classification,diagnosisandmanagement:reviewofthe
EAACI/ENDA(#)andGA2LEN/HANNA*.".Allergy.66(7):81829.
doi:10.1111/j.13989995.2011.02557.x.PMID21631520.
110.Knowles,SRDrucker,AMWeber,EAShear,NH(July2007)."Management
optionsforpatientswithaspirinandnonsteroidalantiinflammatorydrug
sensitivity.".TheAnnalsofpharmacotherapy.41(7):1191200.
doi:10.1345/aph.1k023.PMID17609236.

https://en.wikipedia.org/wiki/Asthma

111.Adams,KERans,TS(December2013)."Adversereactionstoalcoholand
alcoholicbeverages.".AnnalsofAllergy,Asthma&Immunology.111(6):43945.
doi:10.1016/j.anai.2013.09.016.PMID24267355.
112.Peters,SP(2014)."Asthmaphenotypes:nonallergic(intrinsic)asthma.".The
journalofallergyandclinicalimmunology.Inpractice.2(6):6502.
doi:10.1016/j.jaip.2014.09.006.PMID25439352.
113.NHLBIGuideline2007,p.46
114.Lichtenstein,Richard(2013).Pediatricemergencies.Philadelphia,Pa.:Elsevier.
p.1022.ISBN9780323227339.
115.GibsonPG,McDonaldVM,MarksGB(September2010)."Asthmainolder
adults".Lancet.376(9743):80313.doi:10.1016/S01406736(10)610872.
PMID20816547.
116.Hargreave,FEParameswaran,K(August2006)."Asthma,COPDandbronchitis
arejustcomponentsofairwaydisease".EuropeanRespiratoryJournal.28(2):
2647.doi:10.1183/09031936.06.00056106.PMID16880365.
117.Diaz,P.Knoell(2009)."23.Chronicobstructivepulmonarydisease".Applied
therapeutics:theclinicaluseofdrugs(9thed.).Philadelphia:LippincottWilliams
&Wilkins.
118.NHLBIGuideline2007,pp.1845
119.Lodge,CJAllen,KJLowe,AJHill,DJHosking,CSAbramson,MJ
Dharmage,SC(2012)."Perinatalcatanddogexposureandtheriskofasthmaand
allergyintheurbanenvironment:asystematicreviewoflongitudinalstudies".
Clinical&developmentalimmunology.2012:176484.doi:10.1155/2012/176484.
PMC3251799 .PMID22235226.
120.Chen,CMTischer,CSchnappinger,MHeinrich,J(January2010)."Theroleof
catsanddogsinasthmaandallergyasystematicreview".Internationaljournal
ofhygieneandenvironmentalhealth.213(1):131.
doi:10.1016/j.ijheh.2009.12.003.PMID20053584.
121.Prescott,SLTang,ML(May2,2005).AustralasianSocietyofClinical
Immunologyand,Allergy."TheAustralasianSocietyofClinicalImmunologyand
Allergypositionstatement:Summaryofallergypreventioninchildren".The
MedicaljournalofAustralia.182(9):4647.PMID15865590.
122.Cates,CJRowe,BH(Feb28,2013)."Vaccinesforpreventinginfluenzainpeople
withasthma.".TheCochranedatabaseofsystematicreviews.2:CD000364.
doi:10.1002/14651858.CD000364.pub4.PMID23450529.
123."StrategicAdvisoryGroupofExpertsonImmunizationreportofthe
extraordinarymeetingontheinfluenzaA(H1N1)2009pandemic,7July2009.".
WklyEpidemiolRec.84(30):3014.Jul24,2009.PMID19630186.
124.Been,JVNurmatov,UBCox,BNawrot,TSvanSchayck,CPSheikh,A(May
3,2014)."Effectofsmokefreelegislationonperinatalandchildhealth:a
systematicreviewandmetaanalysis.".Lancet.383(9928):154960.
doi:10.1016/S01406736(14)600829.PMID24680633.
20/24

11/10/2016

AsthmaWikipedia

125.Ripoll,BrianC.Leutholtz,Ignacio(2011).Exerciseanddiseasemanagement(2nd
ed.).BocaRaton:CRCPress.p.100.ISBN9781439827598.
126.GINA2011,p.56
127.NHLBIGuideline2007,p.213
128."BritishGuidelineontheManagementofAsthma"(PDF).ScottishIntercollegiate
GuidelinesNetwork.2008.Archived(PDF)fromtheoriginalon19August2008.
Retrieved20080804.
129.NHLBIGuideline2007,p.69
130.ThomsonNC,SpearsM(2005)."Theinfluenceofsmokingonthetreatment
responseinpatientswithasthma".CurrentOpinioninAllergyandClinical
Immunology.5(1):5763.doi:10.1097/0013083220050200000011.
PMID15643345.
131.StapletonM,HowardThompsonA,GeorgeC,HooverRM,SelfTH(2011).
"Smokingandasthma".JAmBoardFamMed.24(3):31322.
doi:10.3122/jabfm.2011.03.100180.PMID21551404.
132.Been,Jasper(Mar28,2014)."Effectofsmokefreelegislationonperinataland
childhealth:asystematicreviewandmetaanalysis".Lancet.383(9928):154960.
doi:10.1016/S01406736(14)600829.PMID24680633.
133.Carson,KVChandratilleke,MGPicot,JBrinn,MPEsterman,AJSmith,BJ
(30September2013)."Physicaltrainingforasthma.".TheCochranedatabaseof
systematicreviews.9:CD001116.doi:10.1002/14651858.CD001116.pub4.
PMID24085631.
134.Yang,ZuYaoZhong,HuiBinMao,ChenYuan,JinQiuHuang,YaFangWu,
XinYinGao,YuanMeiTang,JinLing(27April2016)."Yogaforasthma".
CochraneDatabaseofSystematicReviews.JohnWiley&Sons,Ltd.
doi:10.1002/14651858.cd010346.pub2.Retrieved29April2016.
135."QRG153Britishguidelineonthemanagementofasthma"(PDF).SIGN.
September2016.Retrieved6October2016.
136.ParsonsJP,HallstrandTS,MastronardeJG,etal.(May2013)."Anofficial
AmericanThoracicSocietyclinicalpracticeguideline:exerciseinduced
bronchoconstriction".Am.J.Respir.Crit.CareMed.187(9):101627.
doi:10.1164/rccm.2013030437ST.PMID23634861.
137.Vzina,KChauhan,BFDucharme,FM(Jul31,2014)."Inhaledanticholinergics
andshortactingbeta(2)agonistsversusshortactingbeta2agonistsalonefor
childrenwithacuteasthmainhospital.".TheCochranedatabaseofsystematic
reviews.7:CD010283.doi:10.1002/14651858.CD010283.pub2.PMID25080126.
138.RodrigoGJ,NanniniLJ(2006)."Comparisonbetweennebulizedadrenalineand
beta2agonistsforthetreatmentofacuteasthma.Ametaanalysisofrandomized
trials".AmJEmergMed.24(2):21722.doi:10.1016/j.ajem.2005.10.008.
PMID16490653.
139.NHLBIGuideline2007,p.351
140.NHLBIGuideline2007,p.218
https://en.wikipedia.org/wiki/Asthma

141.Ducharme,FMNiChroinin,MGreenstone,ILasserson,TJ(May12,2010).
Ducharme,FrancineM,ed."Additionoflongactingbeta2agoniststoinhaled
corticosteroidsversussamedoseinhaledcorticosteroidsforchronicasthmain
adultsandchildren".CochraneDatabaseofSystematicReviews(5):CD005535.
doi:10.1002/14651858.CD005535.pub2.PMID20464739.
142.Ducharme,FMNiChroinin,MGreenstone,ILasserson,TJ(Apr14,2010).
Ducharme,FrancineM,ed."Additionoflongactingbeta2agoniststoinhaled
steroidsversushigherdoseinhaledcorticosteroidsinadultsandchildrenwith
persistentasthma".CochraneDatabaseofSystematicReviews(4):CD005533.
doi:10.1002/14651858.CD005533.pub2.PMID20393943.
143.FantaCH(March2009)."Asthma".NewEnglandJournalofMedicine.360(10):
100214.doi:10.1056/NEJMra0804579.PMID19264689.
144.Cates,CJCates,MJ(Apr18,2012).Cates,ChristopherJ,ed."Regulartreatment
withformoterolforchronicasthma:seriousadverseevents".CochraneDatabase
ofSystematicReviews.4:CD006923.doi:10.1002/14651858.CD006923.pub3.
PMID22513944.
145.Cates,CJCates,MJ(Jul16,2008).Cates,ChristopherJ,ed."Regulartreatment
withsalmeterolforchronicasthma:seriousadverseevents".CochraneDatabase
ofSystematicReviews(3):CD006363.doi:10.1002/14651858.CD006363.pub2.
PMID18646149.
146.GINA2011,p.74
147.Watts,KChavasse,RJ(May16,2012).Watts,Kirsty,ed."Leukotrienereceptor
antagonistsinadditiontousualcareforacuteasthmainadultsandchildren".
CochraneDatabaseofSystematicReviews.5:CD006100.
doi:10.1002/14651858.CD006100.pub2.PMID22592708.
148.Chauhan,BFBenSalah,RDucharme,FM(Oct2,2013)."Additionofanti
leukotrieneagentstoinhaledcorticosteroidsinchildrenwithpersistentasthma.".
TheCochranedatabaseofsystematicreviews.10:CD009585.
doi:10.1002/14651858.CD009585.pub2.PMID24089325.
149.Miligkos,MichaelBannuru,RaveendharaR.Alkofide,HadeelKher,Sucharita
R.Schmid,ChristopherH.Balk,EthanM.(22September2015)."Leukotriene
ReceptorAntagonistsVersusPlacebointheTreatmentofAsthmainAdultsand
Adolescents".AnnalsofInternalMedicine.163(10):75667.doi:10.7326/M15
1059.PMID26390230.
150.Miligkos,MBannuru,RRAlkofide,HKher,SRSchmid,CHBalk,EM(17
November2015)."Leukotrienereceptorantagonistsversusplacebointhe
treatmentofasthmainadultsandadolescents:asystematicreviewandmeta
analysis.".AnnalsofInternalMedicine.163(10):75667.doi:10.7326/m151059.
PMID26390230.
151.BritishGuideline2009,p.43
152."Zyflo(Zileutontablets)"(PDF).UnitedStatesFoodandDrugAdministration.
CornerstoneTherapeuticsInc.June2012.p.1.Retrieved12December2014.
21/24

11/10/2016

AsthmaWikipedia

153.NHLBIGuideline2007,p.250
154.Rachelefsky,G(January2009)."Inhaledcorticosteroidsandasthmacontrolin
children:assessingimpairmentandrisk".Pediatrics.123(1):35366.
doi:10.1542/peds.20073273.PMID19117903.
155.DahlR(August2006)."Systemicsideeffectsofinhaledcorticosteroidsinpatients
withasthma".RespirMed.100(8):130717.doi:10.1016/j.rmed.2005.11.020.
PMID16412623.
156.RodrigoGJ,RodrigoC,HallJB(2004)."Acuteasthmainadults:areview".
Chest.125(3):1081102.doi:10.1378/chest.125.3.1081.PMID15006973.
157.Keeney,GEGray,MPMorrison,AKLevas,MNKessler,EAHill,GD
Gorelick,MHJackson,JL(Mar2014)."Dexamethasoneforacuteasthma
exacerbationsinchildren:ametaanalysis.".Pediatrics.133(3):4939.
doi:10.1542/peds.20132273.PMID24515516.
158.Noppen,M.(August2002)."MagnesiumTreatmentforAsthma:WhereDoWe
Stand?".Chest.122(2):3968.doi:10.1378/chest.122.2.396.PMID12171805.
159.Griffiths,BKew,KM(29April2016)."Intravenousmagnesiumsulfatefor
treatingchildrenwithacuteasthmaintheemergencydepartment.".TheCochrane
databaseofsystematicreviews.4:CD011050.
doi:10.1002/14651858.CD011050.pub2.PMID27126744.
160.Kew,KMKirtchuk,LMichell,CI(28May2014)."Intravenousmagnesium
sulfatefortreatingadultswithacuteasthmaintheemergencydepartment.".The
Cochranedatabaseofsystematicreviews.5:CD010909.
doi:10.1002/14651858.CD010909.pub2.PMID24865567.
161.GINA2011,p.37
162.NHLBIGuideline2007,p.399
163.Korang,SKFeinberg,JWetterslev,JJakobsen,JC(30September2016)."Non
invasivepositivepressureventilationforacuteasthmainchildren.".TheCochrane
databaseofsystematicreviews.9:CD012067.PMID27687114.
164.Castro,MMusani,AIMayse,MLShargill,NS(April2010)."Bronchial
thermoplasty:anoveltechniqueinthetreatmentofsevereasthma".Therapeutic
advancesinrespiratorydisease.4(2):10116.doi:10.1177/1753465810367505.
PMID20435668.
165.Boulet,LPLaviolette,M(MayJun2012)."Istherearoleforbronchial
thermoplastyinthetreatmentofasthma?".CanadianRespiratoryJournal.19(3):
1912.doi:10.1155/2012/853731.PMC3418092 .PMID22679610.
166.GINA2011,p.70
167.Lin,SYErekosima,NKim,JMRamanathan,MSuarezCuervo,C
Chelladurai,YWard,DSegal,JB(27March2013)."SublingualImmunotherapy
fortheTreatmentofAllergicRhinoconjunctivitisandAsthmaASystematic
Review".JAMA.309(12):127888.doi:10.1001/jama.2013.2049.
PMID23532243.
https://en.wikipedia.org/wiki/Asthma

168.BlancPD,TrupinL,EarnestG,KatzPP,YelinEH,EisnerMD(2001).
"Alternativetherapiesamongadultswithareporteddiagnosisofasthmaor
rhinosinusitis:datafromapopulationbasedsurvey".Chest.120(5):14617.
doi:10.1378/chest.120.5.1461.PMID11713120.
169.ShenfieldG,LimE,AllenH(2002)."Surveyoftheuseofcomplementary
medicinesandtherapiesinchildrenwithasthma".JPaediatrChildHealth.38(3):
2527.doi:10.1046/j.14401754.2002.00770.x.PMID12047692.
170.KaurB,RoweBH,ArnoldE(2009).WelshEJ,ed."VitaminCsupplementation
forasthma".CochraneDatabaseofSystematicReviews(1):CD000993.
doi:10.1002/14651858.CD000993.pub3.PMID19160185.
171.Hemil,H(2013)."VitaminCmayalleviateexerciseinducedbronchoconstriction:
ametaanalysis.".BMJOpen.3(6):e002416.doi:10.1136/bmjopen2012002416.
PMID23794586.
172.Martineau,ARCates,CJUrashima,MJensen,MGriffiths,APNurmatov,U
Sheikh,AGriffiths,CJ(5September2016)."VitaminDforthemanagementof
asthma.".TheCochranedatabaseofsystematicreviews.9:CD011511.
PMID27595415.
173.NHLBIGuideline2007,p.240
174.McCarneyRW,BrinkhausB,LassersonTJ,LindeK(2004).McCarneyRW,ed.
"Acupunctureforchronicasthma".CochraneDatabaseofSystematicReviews(1):
CD000008.doi:10.1002/14651858.CD000008.pub2.PMID14973944.
175.Blackhall,KAppleton,SCates,CJ(Sep12,2012).Blackhall,Karen,ed.
"Ionisersforchronicasthma".CochraneDatabaseofSystematicReviews.9:
CD002986.doi:10.1002/14651858.CD002986.pub2.PMID22972060.
176.HondrasMA,LindeK,JonesAP(2005).HondrasMA,ed."Manualtherapyfor
asthma".CochraneDatabaseofSystematicReviews(2):CD001002.
doi:10.1002/14651858.CD001002.pub2.PMID15846609.
177."WHODiseaseandinjurycountryestimates".WorldHealthOrganization.2009.
Archivedfromtheoriginalon11November2009.RetrievedNovember11,2009.
178.Sergel,MichelleJ.Cydulka,RitaK.(September2009)."Ch.75:Asthma".In
Wolfson,AllanB.HarwoodNuss,Ann.HarwoodNuss'ClinicalPracticeof
EmergencyMedicine(5thed.).LippincottWilliams&Wilkins.pp.432.
ISBN9780781789431.
179.NHLBIGuideline2007,p.1
180."TheGlobalAsthmaReport2014".Retrieved10May2016.
181.Organization,WorldHealth(2008).Theglobalburdenofdisease:2004update.
([OnlineAusg.]ed.).Geneva,Switzerland:WorldHealthOrganization.p.35.
ISBN9789241563710.
182.MaddoxL,SchwartzDA(2002)."Thepathophysiologyofasthma".Annu.Rev.
Med.53:47798.doi:10.1146/annurev.med.53.082901.103921.PMID11818486.

22/24

11/10/2016

AsthmaWikipedia

183.BeckettPA,HowarthPH(2003)."Pharmacotherapyandairwayremodellingin
asthma?".Thorax.58(2):16374.doi:10.1136/thorax.58.2.163.PMC1746582 .
PMID12554904.
184.Silva,NCarona,CCrespo,CCanavarro,MC(June2015)."Qualityoflifein
pediatricasthmapatientsandtheirparents:ametaanalysison20yearsof
research.".Expertreviewofpharmacoeconomics&outcomesresearch.15(3):
499519.doi:10.1586/14737167.2015.1008459.PMID25651982.
185."WorldHealthOrganizationFactSheetFactsheetNo307:Asthma".2011.
Archivedfromtheoriginalon20110629.RetrievedJan17,2013.
186.GINA2011,p.3
187.Vos,Tetal.(December2012)."Yearslivedwithdisability(YLDs)for1160
sequelaeof289diseasesandinjuries19902010:asystematicanalysisforthe
GlobalBurdenofDiseaseStudy2010".Lancet.380(9859):216396.
doi:10.1016/S01406736(12)617292.PMID23245607.
188.Lozano,R(Dec15,2012)."Globalandregionalmortalityfrom235causesof
deathfor20agegroupsin1990and2010:asystematicanalysisfortheGlobal
BurdenofDiseaseStudy2010.".Lancet.380(9859):2095128.
doi:10.1016/S01406736(12)617280.PMID23245604.
189.WorldHealthOrganization."WHO:Asthma".Archivedfromtheoriginalon15
December2007.Retrieved20071229.
190.BushA,MenziesGowA(December2009)."Phenotypicdifferencesbetween
pediatricandadultasthma".ProcAmThoracSoc.6(8):7129.
doi:10.1513/pats.200906046DP.PMID20008882.
191.WeissAJ,WierLM,StocksC,BlanchardJ(June2014)."Overviewof
EmergencyDepartmentVisitsintheUnitedStates,2011".HCUPStatisticalBrief
#174.Rockville,MD:AgencyforHealthcareResearchandQuality.
192.GrantEN,WagnerR,WeissKB(August1999)."Observationsonemerging
patternsofasthmainoursociety".JAllergyClinImmunol.104(2Pt2):S1S9.
doi:10.1016/S00916749(99)70268X.PMID10452783.
193.Bousquet,JBousquet,PJGodard,PDaures,JP(July2005)."Thepublichealth
implicationsofasthma".BulletinoftheWorldHealthOrganization.83(7):548
54.PMC2626301 .PMID16175830.
194.Anderson,HRGuptaRStrachanDPLimbES(January2007)."50yearsof
asthma:UKtrendsfrom1955to2004".Thorax.62(1):8590.
doi:10.1136/thx.2006.066407.PMC2111282 .PMID17189533.

195.Masoli,Matthew(2004).GlobalBurdenofAsthma(PDF).p.9.
196.BarrettML,WierLM,WashingtonR(January2014)."TrendsinPediatricand
AdultHospitalStaysforAsthma,20002010.".HCUPStatisticalBrief#169.
Rockville,MD:AgencyforHealthcareResearchandQuality.
197.ThorowgoodJC(November1873)."Onbronchialasthma".BritishMedical
Journal.2(673):600.doi:10.1136/bmj.2.673.600.PMC2294647 .
PMID20747287.
198.GaskoinG(March1872)."Onthetreatmentofasthma".BritishMedicalJournal.
1(587):339.doi:10.1136/bmj.1.587.339.PMC2297349 .PMID20746575.
199.BerkartJB(June1880)."Thetreatmentofasthma".BritishMedicalJournal.1
(1016):9178.doi:10.1136/bmj.1.1016.917.PMC2240555 .PMID20749537.
BerkartJB(June1880)."Thetreatmentofasthma".BritishMedicalJournal.1
(1017):9602.doi:10.1136/bmj.1.1017.960.PMC2240530 .PMID20749546.
200.BosworthFH(1886)."Hayfever,asthma,andalliedaffections".Transactionsof
theAnnualMeetingoftheAmericanClimatologicalAssociation.2:15170.
PMC2526599 .PMID21407325.
201.DoigRL(February1905)."Epinephrinespeciallyinasthma".CaliforniaState
JournalofMedicine.3(2):545.PMC1650334 .PMID18733372.
202.vonMutius,EDrazen,JM(Mar1,2012)."Apatientwithasthmaseeksmedical
advicein1828,1928,and2012".NewEnglandJournalofMedicine.366(9):827
34.doi:10.1056/NEJMra1102783.PMID22375974.
203.CromptonG(December2006)."Abriefhistoryofinhaledasthmatherapyoverthe
lastfiftyyears".Primarycarerespiratoryjournal:journaloftheGeneral
PracticeAirwaysGroup.15(6):32631.doi:10.1016/j.pcrj.2006.09.002.
PMID17092772.
204.DavidMcCullough(1981).MorningsonHorseback:TheStoryofan
ExtraordinaryFamily,aVanishedWayofLifeandtheUniqueChildWhoBecame
TheodoreRoosevelt.SimonandSchuster.pp.93108.
205.OpolskiM,WilsonI(September2005)."Asthmaanddepression:apragmatic
reviewoftheliteratureandrecommendationsforfutureresearch".ClinPract
EpidemolMentHealth.1:18.doi:10.1186/17450179118.PMC1253523 .
PMID16185365.

References
NationalAsthmaEducationandPreventionProgram(NAEPP)(2007)."ExpertPanelReport3:GuidelinesfortheDiagnosisandManagementofAsthma"(PDF).National
HeartLungandBloodInstitute.
"BritishGuidelineontheManagementofAsthma"(PDF).BritishThoracicSociety.2012[2008].
"GlobalStrategyforAsthmaManagementandPrevention"(PDF).GlobalInitiativeforAsthma.2011.Archivedfromtheoriginal(PDF)on20160701.
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