THE 2002 OFFICIAL PATIENT’S SOURCEBOOK
on
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The 2002 Official Patient’s Sourcebook on Asthma: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83137-8 1. Asthma-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail:
[email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this sourcebook.
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Dedication To the healthcare professionals dedicating their time and efforts to the study of asthma.
Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to asthma. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
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About ICON Health Publications In addition to asthma, Official Patient’s Sourcebooks are available for the following related topics: ·
The Official Patient's Sourcebook on Bronchopulmonary Dysplasia
·
The Official Patient's Sourcebook on Chronic Obstructive Pulmonary Disease
·
The Official Patient's Sourcebook on Cystic Fibrosis
·
The Official Patient's Sourcebook on Idiopathic Pulmonary Fibrosis
·
The Official Patient's Sourcebook on Primary Pulmonary Hypertension
·
The Official Patient's Sourcebook on Pulmonary Lymphangioleiomyomatosis
·
The Official Patient's Sourcebook on Respiratory Failure
·
The Official Patient's Sourcebook on Sarcoidosis
To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
Contents vii
Table of Contents INTRODUCTION...................................................................................... 1
Overview............................................................................................................... 1 Organization......................................................................................................... 3 Scope ..................................................................................................................... 3 Moving Forward................................................................................................... 4
PART I: THE ESSENTIALS ................................................. 7 CHAPTER 1. THE ESSENTIALS ON ASTHMA: GUIDELINES .................... 9
Overview............................................................................................................... 9 What Is Asthma? ................................................................................................ 11 Common Symptoms of Asthma .......................................................................... 12 How to Take Care of Your Asthma..................................................................... 12 Is Your Asthma Under Control?........................................................................ 13 Taking the Right Medicines at the Right Times................................................. 14 The Long-Term-Control Medicines.................................................................... 15 How to Use Your Metered-Does Inhaler the Right Way ................................... 16 How to Use Your Peak Flow Meter.................................................................... 17 How to Take Your Peak Flow ............................................................................. 19 How to Control Things that Make Your Asthma Worse ................................... 20 For More Information......................................................................................... 23 More Guideline Sources ..................................................................................... 24 Vocabulary Builder............................................................................................. 36
CHAPTER 2. SEEKING GUIDANCE ....................................................... 41
Overview............................................................................................................. 41 Associations and Asthma ................................................................................... 41 Finding More Associations................................................................................. 51 Finding Doctors.................................................................................................. 53 Selecting Your Doctor ........................................................................................ 55 Working with Your Doctor ................................................................................ 55 Broader Health-Related Resources ..................................................................... 57 Vocabulary Builder............................................................................................. 57
CHAPTER 3. CLINICAL TRIALS AND ASTHMA .................................... 63
Overview............................................................................................................. 63 Recent Trials on Asthma .................................................................................... 66 Benefits and Risks............................................................................................... 82 Keeping Current on Clinical Trials.................................................................... 85 General References.............................................................................................. 86 Vocabulary Builder............................................................................................. 87
PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL.................................................. 91
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CHAPTER 4. STUDIES ON ASTHMA...................................................... 93
Overview............................................................................................................. 93 The Combined Health Information Database ..................................................... 93 Federally-Funded Research on Asthma .............................................................. 94 E-Journals: PubMed Central ............................................................................ 103 The National Library of Medicine: PubMed .................................................... 108 Vocabulary Builder........................................................................................... 115
CHAPTER 5. PATENTS ON ASTHMA .................................................. 121
Overview........................................................................................................... 121 Patents on Asthma............................................................................................ 122 Patent Applications on Asthma........................................................................ 134 Keeping Current ............................................................................................... 145 Vocabulary Builder........................................................................................... 146
CHAPTER 6. BOOKS ON ASTHMA ...................................................... 153
Overview........................................................................................................... 153 Book Summaries: Federal Agencies .................................................................. 153 The National Library of Medicine Book Index ................................................. 155 Chapters on Asthma ......................................................................................... 158 Directories......................................................................................................... 158 General Home References ................................................................................. 159 Vocabulary Builder........................................................................................... 160
CHAPTER 7. MULTIMEDIA ON ASTHMA ........................................... 163
Overview........................................................................................................... 163 Video Recordings .............................................................................................. 163 Audio Recordings ............................................................................................. 165 Bibliography: Multimedia on Asthma.............................................................. 165 Vocabulary Builder........................................................................................... 168
CHAPTER 8. PERIODICALS AND NEWS ON ASTHMA ........................ 171
Overview........................................................................................................... 171 News Services & Press Releases ....................................................................... 171 Newsletters on Asthma..................................................................................... 183 Newsletter Articles ........................................................................................... 183 Academic Periodicals covering Asthma............................................................ 184 Vocabulary Builder........................................................................................... 186
CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES ................... 187
Overview........................................................................................................... 187 NIH Guidelines................................................................................................. 187 NIH Databases.................................................................................................. 190 Other Commercial Databases ........................................................................... 198 The Genome Project and Asthma ..................................................................... 198 Specialized References....................................................................................... 203
CHAPTER 10. DISSERTATIONS ON ASTHMA...................................... 205
Overview........................................................................................................... 205
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Dissertations on Asthma .................................................................................. 205 Keeping Current ............................................................................................... 207 Vocabulary Builder........................................................................................... 207
PART III. APPENDICES .................................................. 209 APPENDIX A. RESEARCHING YOUR MEDICATIONS.......................... 211
Overview........................................................................................................... 211 Your Medications: The Basics .......................................................................... 212 Learning More about Your Medications .......................................................... 213 Commercial Databases...................................................................................... 220 Contraindications and Interactions (Hidden Dangers) ................................... 233 A Final Warning .............................................................................................. 234 General References............................................................................................ 235 Vocabulary Builder........................................................................................... 235
APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ................... 241
Overview........................................................................................................... 241 What Is CAM? ................................................................................................. 241 What Are the Domains of Alternative Medicine?............................................ 242 Can Alternatives Affect My Treatment? ......................................................... 245 Finding CAM References on Asthma............................................................... 246 Additional Web Resources................................................................................ 263 General References............................................................................................ 310
APPENDIX C. RESEARCHING NUTRITION ......................................... 313
Overview........................................................................................................... 313 Food and Nutrition: General Principles........................................................... 314 Finding Studies on Asthma.............................................................................. 318 Federal Resources on Nutrition........................................................................ 322 Additional Web Resources................................................................................ 322 Vocabulary Builder........................................................................................... 342
APPENDIX D. FINDING MEDICAL LIBRARIES.................................... 345
Overview........................................................................................................... 345 Preparation ....................................................................................................... 345 Finding a Local Medical Library ...................................................................... 346 Medical Libraries Open to the Public............................................................... 346
APPENDIX E. YOUR RIGHTS AND INSURANCE ................................. 353
Overview........................................................................................................... 353 Your Rights as a Patient................................................................................... 353 Patient Responsibilities .................................................................................... 357 Choosing an Insurance Plan............................................................................. 358 Medicare and Medicaid .................................................................................... 360 NORD’s Medication Assistance Programs ..................................................... 363 Additional Resources ........................................................................................ 364 Vocabulary Builder........................................................................................... 365
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ONLINE GLOSSARIES.................................................... 367 Online Dictionary Directories.......................................................................... 373
ASTHMA GLOSSARY ..................................................... 375 General Dictionaries and Glossaries ................................................................ 405
INDEX................................................................................... 407
Introduction
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INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don’t know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3
Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2
2
Asthma
Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor’s offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The Official Patient’s Sourcebook on Asthma has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to asthma, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on asthma. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on asthma should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on appropriate
Introduction
3
options is always up to the patient in consultation with their physician and healthcare providers.
Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching asthma (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to asthma. It also gives you sources of information that can help you find a doctor in your local area specializing in treating asthma. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with asthma. Part II moves on to advanced research dedicated to asthma. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on asthma. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “freeto-use” options. Part III provides appendices of useful background reading for all patients with asthma or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with asthma. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with asthma.
Scope While this sourcebook covers asthma, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that asthma is often considered a synonym or a condition closely related to the following: ·
Bronchial Asthma
·
Bronchospasm
·
Occupational Asthma
4
Asthma
·
Pediatric Asthma
·
Reactive Airway Disease
In addition to synonyms and related conditions, physicians may refer to asthma using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world’s illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for asthma:4 ·
493 asthma
·
493.0 extrinsic asthma
·
493.1 intrinsic asthma
·
493.2 chronic obstructive asthma
·
493.9 asthma, unspecified
For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to asthma. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.
Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson’s approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as
4 This list is based on the official version of the World Health Organization’s 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”
Introduction
5
recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. Why “Internet age”? All too often, patients diagnosed with asthma will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with asthma is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of asthma, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors
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PART I: THE ESSENTIALS
ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on asthma. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your doctor or healthcare provider may have already explained the essentials of asthma to you or even given you a pamphlet or brochure describing asthma. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.
Guidelines
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CHAPTER 1. THE ESSENTIALS ON ASTHMA: GUIDELINES Overview Official agencies, as well as federally-funded institutions supported by national grants, frequently publish a variety of guidelines on asthma. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on asthma can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internetbased services that post them.
The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on asthma. Originally founded in 1887, the NIH is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.
5
Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.
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There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with asthma and associated conditions: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Heart, Lung, and Blood Institute (NHLBI); guidelines at http://www.nhlbi.nih.gov/guidelines/index.htm
Among these, the National Heart, Lung, and Blood Institute (NHLBI) is particularly noteworthy. The NHLBI provides leadership for a national program in diseases of the heart, blood vessels, lung, and blood; blood resources; and sleep disorders.6 Since October 1997, the NHLBI has also had administrative responsibility for the NIH Woman’s Health Initiative. The Institute plans, conducts, fosters, and supports an integrated and coordinated program of basic research, clinical investigations and trials, observational studies, and demonstration and education projects. Research is related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases; and sleep disorders. The NHLBI plans and directs research in development and evaluation of interventions and devices related to prevention, treatment, and rehabilitation of patients suffering from such diseases and disorders. It also supports research on clinical use of blood and all aspects of the management of blood resources. Research is conducted in the Institute’s own laboratories and by scientific institutions and individuals supported by research grants and contracts. For health professionals and the public, the NHLBI conducts educational activities, including development and dissemination of materials in the above areas, with an emphasis on prevention. Within the NHLBI, the Division of Lung Diseases (DLD) maintains surveillance over developments in pulmonary research and assesses the Nation’s need for research on the causes, prevention, diagnosis, and This paragraph has been adapted from the NHLBI: http://www.nhlbi.nih.gov/about/org/mission.htm. “Adapted” signifies that a passage is reproduced exactly or slightly edited for this book. 6
Guidelines 11
treatment of pulmonary diseases.7 Also within the purview of the Division are: technology development, application of research findings, and research training and career development in pulmonary diseases. The DLD plans and directs the research and training programs which encompass basic research, applied research and development, clinical investigations, clinical trials, and demonstration and education research. Two programs comprise the Division of Lung Diseases, Airway Biology and Disease Program, and the Lung Biology and Disease Program. The following patient guideline was recently published by the NHLBI and the DLD on asthma.
What Is Asthma?8 If you have asthma, you are not alone. More than 14 million people in the United States have this lung disease. Of these, almost 5 million are children. Asthma is a problem among all races. But the asthma death rate and hospitalization rate for blacks are three times the rate of whites. Proper asthma care could prevent these problems for all.
Asthma Is a Serious Lung Disease Asthma makes the sides of the airways in your lungs inflamed or swollen all the time. See the drawing below. Your airways react to things like smoke, dust, pollen, or other things. Your airways narrow or become smaller.
Adapted from the DLD: http://www.nhlbi.nih.gov/about/dld/index.htm. For more information, contact: Division of Lung Diseases; National Heart, Lung and Blood Institute; Attn: Web Site Inquiries; Two Rockledge Center, Suite 10122, 6701 Rockledge Dr., MSC 7952; Bethesda, Maryland 20892-7952. 8 Adapted from The National Heart, Lung, and Blood Institute: http://www.nhlbi.nih.gov/health/public/lung/asthma/asth_fs.htm. 7
12 Asthma
Asthma that is not well controlled can cause many problems. People miss work or school, go to the hospital, or even die because of their asthma. But you do not have to put up with the problems asthma can cause.
Your Asthma Can Be Controlled with Proper Care With your doctor’s help, you can control your asthma and become free of symptoms most of the time. But your asthma does NOT go away when your symptoms go away. You need to keep taking care of your asthma. Your asthma cannot be cured—having asthma is a part of your life. So you need to make taking care of your asthma a part of your life. This is true even if your asthma is mild.
Common Symptoms of Asthma You may have all of these symptoms, some of them, or just one. Symptoms can be mild or severe. ·
Coughing
·
Wheezing (a whistling noise when you breathe)
·
Chest tightness (the feeling that someone is squeezing or sitting on your chest)
·
Shortness of breath
How to Take Care of Your Asthma ·
Work with your doctor and see him or her at least every 6 months.
·
Take your asthma medicines exactly as your doctor tells you.
·
Watch for signs that your asthma is getting worse and act quickly.
·
Stay away from or control things that make your asthma worse.
How to Work with Your Doctor ·
Agree on clear treatment goals with your doctor
·
Agree on what things you need to do. Then do them.
Guidelines 13
·
Ask questions until you feel you know what your doctor wants you to do, when you should do it, and why. Tell your doctor if you think you will have trouble doing what is asked. You can work together to find a treatment plan that is right for you.
·
Write down the things you are supposed to do before you leave the doctor’s office, or soon after.
·
Put up reminders to yourself to take your medicine on time.
·
Put these notes in places where you will see them.
·
See your doctor at least every 6 months to check your asthma and review your treatment.
·
Call for an appointment if you need one.
·
Prepare a day or two before each doctor’s visit:
·
Talk to your doctor about your answers. Also, talk about any changes in your home or work that may have made your asthma worse.
·
Write down questions and concerns to discuss with your doctor. Include ALL of your concerns, even those you think are not a big deal.
·
Bring your medicines and written action plan to each visit. If you use a peak flow meter, bring it to each visit.
Is Your Asthma Under Control? Answer these questions just before each doctor’s visit. In the past 2 weeks, have you coughed, wheezed, felt short of breath, or had chest tightness: ·
During the day?
·
At night, causing you to wake up?
·
During or soon after exercise?
·
Have you needed more “quick-relief “ medicine than usual?
·
Has your asthma kept you from doing anything you wanted to do?
·
If yes, what was it?
·
Have your asthma medicines caused you any problems, like shakiness, sore throat, or upset stomach?
14 Asthma
In the past few months: ·
Have you missed school or work because of your asthma?
·
Have you gone to the emergency room or hospital because of your asthma?
What your answers mean: ·
All “no” answers?—Your asthma is under control.
·
Read this guide to help you keep your asthma under control.
·
One or more “yes” answers?—Something needs to be done.
Taking the Right Medicines at the Right Times There are two main kinds of medicines for asthma: (1) those that help with the long-term control of asthma and (2) those that give short-term quick relief from asthma symptoms.
Long-Term-Control Medicines Are Taken Every Day to Control Asthma Long-term-control medicines will prevent symptoms and control asthma. But it often takes a few weeks before you feel the full effects of this medicine. Ask your doctor about taking daily long-term-control medicine if you: ·
Have asthma symptoms three or more times a week
·
Have asthma symptoms at night three or more times a month.
If you need a long-term-control medicine, you will need to keep taking your medicine each day, even when you feel well. This is the only way you can keep your asthma under control. Make taking your long-term control medicine a part of your daily routine—just like eating, sleeping, and brushing your teeth.
Quick-Relief Medicines Are Taken Only When Needed Inhaled quick-relief medicine quickly relaxes and opens your airways and relieves asthma symptoms. But it only helps for about 4 hours. Quick-relief
Guidelines 15
medicine cannot keep symptoms from coming back—only long-term control medicines can do that. Take quick-relief medicine when you first begin to feel symptoms— like coughing, wheezing, chest tightness, or shortness of breath. Your doctor may tell you to use a peak flow meter to help you know when to take your inhaled quick relief medicines. Do not delay taking your quick relief medicine when you have symptoms. This can keep you from having a really bad asthma attack. Tell your doctor if you notice you are using more of this medicine than usual. This is often a sign that your long-term-control medicine needs to be changed or increased.
The Long-Term-Control Medicines The most effective long-term control medicines are those that reduce swelling in your airways (inflammation). These medicines include inhaled steroids, cromolyn, and nedocromil.
Inhaled Steroids and Steroid Tablets Inhaled steroids and steroid tablets or liquids are the strongest long-termcontrol medicines. The steroids used for asthma are NOT the same as the unsafe steroids some athletes take to build muscles. Inhaled steroids are used to prevent symptoms and control mild, moderate, and severe asthma. Inhaled steroids are safe when taken at recommended doses. This is because the medicine goes right to your lungs where you need it. This reduces the amount of medicine you need and the chance of any side effects. Steroid tablets or liquids are used safely for short times to quickly bring asthma under control. They are also used longer term to control the most severe asthma.
Cromolyn and Nedocromil Cromolyn and nedocromil are often the choice of medicine for children with mild asthma. Inhaled long-acting beta2-agonists are used to help control moderate-tosevere asthma and to prevent nighttime symptoms. Long-acting beta2agonists do not reduce inflammation. Therefore, patients taking this
16 Asthma
medicine also need to take inhaled steroids. Inhaled long acting beta2agonists should not be used for quick relief of asthma attacks. Sustained-release theophylline or sustained-release beta2- agonist tablets can help prevent nighttime symptoms. These medicines are used with inhaled steroids, nedocromil, or cromolyn. Theophylline is sometimes used by itself to treat mild asthma. The dose for theophylline must be checked over time to prevent side effects. Zileuton and zafirlukast are a more recent type of long-term control medicine. Studies so far show that it is used mainly for mild asthma in patients 12 years of age and older.
How to Use Your Metered-Does Inhaler the Right Way Using an inhaler seems simple, but most patients do not use it the right way. When you use your inhaler the wrong way, less medicine gets to your lungs. (Your doctor may give you other types of inhalers.) For the next 2 weeks, read these steps aloud as you do them or ask someone to read them to you. Ask your doctor or nurse to check how well you are using your inhaler. Use your inhaler in one of the three ways pictured below (A or B are best, but C can be used if you have trouble with A and B). Steps for Using Your Inhaler Getting ready: ·
Take off the cap and shake the inhaler.
·
Breathe out all the way.
·
Hold your inhaler the way your doctor said (A, B, or C below).
Breathe in slowly: ·
As you start breathing in slowly through your mouth, press down on the inhaler one time. (If you use a holding chamber, first press down on the inhaler. Within 5 seconds, begin to breathe in slowly.)
·
Keep breathing in slowly, as deeply as you can.
Hold your breath: ·
Hold your breath as you count to 10 slowly, if you can.
Guidelines 17
·
For inhaled quick-relief medicine (beta2-agonists), wait about 1 minute between puffs. There is no need to wait between puffs for other medicines.
Clean your inhaler as needed: ·
Look at the hole where the medicine sprays out from your inhaler. If you see “powder” in or around the hole, clean the inhaler. Remove the metal canister from the L-shaped plastic mouthpiece. Rinse only the mouthpiece and cap in warm water. Let them dry overnight. In the morning, put the canister back inside. Put the cap on.
Know when to replace your inhaler: ·
For medicines you take each day (an example): Say your new canister has 200 puffs (number of puffs is listed on canister) and you are told to take 8 puffs per day. So this canister will last 25 days. If you started using this inhaler on May 1, replace it on or before May 25. You can write the date on your canister. For quick-relief medicine take as needed and count each puff. Do not put your canister in water to see if it is empty. This does not work.
How to Use Your Peak Flow Meter A peak flow meter helps you check how well your asthma is controlled. Peak flow meters are most helpful for people with moderate or severe asthma. This guide will tell you (1) how to find your personal best peak flow number, (2) how to use your personal best number to set your peak flow
18 Asthma
zones, (3) how to take your peak flow, and (4) when to take your peak flow to check your asthma each day. Starting Out: Find Your Personal Best Peak Flow Number To find your personal best peak flow number, take your peak flow each day for 2 to 3 weeks. Your asthma should be under good control during this time. Take your peak flow as close to the times listed below as you can. These times for taking your peak flow are only for finding your personal best peak flow. ·
Between noon and 2:00 p.m. each day
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Each time you take your quickrelief medicine to relieve symptoms (measure your peak flow after you take your medicine)
·
Any other time your doctor suggests Write down the number you get for each peak flow reading. The highest peak flow number you had during the 2 to 3 weeks is your personal best. Your personal best can change over time. Ask your doctor when to check for a new personal best. To check your asthma each day, you will take your peak flow in the morning. Your Peak Flow Zones Your peak flow zones are based on your personal best peak flow number. The zones will help you check your asthma and take the right actions to keep it controlled. The colors used with each zone come from the traffic light.
·
Green Zone (80 to 100 percent of your personal best) signals good control. Take your usual daily long-term-control medicines, if you take any. Keep taking these medicines even when you are in the yellow or red zones.
·
Yellow Zone (50 to 79 percent of your personal best) signals caution: your asthma is getting worse. Add quick-relief medicines. You might need to increase other asthma medicines as directed by your doctor.
·
Red Zone (below 50 percent of your personal best) signals medical alert! Add or increase quick-relief medicines and call your doctor now. Ask your doctor to write an action plan for you that tells you:
·
The peak flow numbers for your green, yellow, and red zones. Mark the zones on your peak flow meter with colored tape or a marker.
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The medicines you should take while in each peak flow zone.
Guidelines 19
How to Take Your Peak Flow ·
Move the marker to the bottom of the numbered scale.
·
Stand up or sit up straight.
·
Take a deep breath. Fill your lungs all the way.
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Hold your breath while you place the mouthpiece in your mouth, between your teeth. Close your lips around it. Do not put your tongue inside the hole.
·
Blow out as hard and fast as you can. Your peak flow meter will measure how fast you can blow out air.
·
Write down the number you get. But if you cough or make a mistake, do not write down the number. Do it over again.
·
Repeat the above steps two more times. Write down the highest of the three numbers. This is your peak flow number.
·
Check to see which peak flow zone your peak flow number is in. Do the actions your doctor told you to do while in that zone. Your doctor may ask you to write down your peak flow numbers each day. You can do this on a calendar or other paper. This will help you and your doctor see how your asthma is doing over time. Checking Your Asthma: When to Use Your Peak Flow Meter
·
Every morning when you wake up, before you take medicine. Make this part of your daily routine.
·
When you are having asthma symptoms or an attack. And after taking medicine for the attack. This can tell you how bad your asthma attack is and whether your medicine is working.
·
Any other time your doctor suggests.
If you use more than one peak flow meter (such as at home and at school), be sure that both meters are the same brand. Bring to each of your doctor’s visits: ·
Your peak flow meter.
·
Your peak flow numbers if you have written them down each day.
Also, ask your doctor or nurse to check how you use your peak flow meter— just to be sure you are doing it right.
20 Asthma
How to Control Things that Make Your Asthma Worse You can help prevent asthma attacks by staying away from things that make your asthma worse. This guide suggests many ways to help you do this. You need to find out what makes your asthma worse. Some things that make asthma worse for some people are not a problem for others. You do not need to do all of the things listed in this guide. Look at the things listed in dark print below. Put a check next to the ones that you know make your asthma worse. Ask your doctor to help you find out what else makes your asthma worse. Then, decide with your doctor what steps you will take. Start with the things in your bedroom that bother your asthma. Try something simple first. Tobacco Smoke ·
If you smoke, ask your doctor for ways to help you quit. Ask family members to quit smoking, too.
·
Do not allow smoking in your home or around you.
·
Be sure no one smokes at a child’s day care center.
Dust Mites Many people with asthma are allergic to dust mites. Dust mites are like tiny “bugs” you cannot see that live in cloth or carpet. Things that will help the most: ·
Encase your mattress in a special dust-proof cover
·
Encase your pillow in a special dust-proof cover* or wash the pillow each week in hot water. Water must be hotter than 1300F to kill the mites.
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Wash the sheets and blankets on your bed each week in hot water.
Other things that can help: ·
Reduce indoor humidity to less than 50 percent. Dehumidifiers or central air conditioners can do this.
·
Try not to sleep or lie on cloth-covered cushions or furniture.
·
Remove carpets from your bedroom and those laid on concrete, if you can.
Guidelines 21
·
Keep stuffed toys out of the bed or wash the toys weekly in hot water.
Animal Dander Some people are allergic to the flakes of skin or dried saliva from animals with fur or feathers. The best thing to do: ·
Keep furred or feathered pets out of your home.
If you can’t keep the pet outdoors, then: ·
Keep the pet out of your bedroom and keep the bedroom door closed.
·
Cover the air vents in your bedroom with heavy material to filter the air
·
Remove carpets and furniture covered with cloth from your home. If that is not possible, keep the pet out of the rooms where these are.
Cockroaches Many people with asthma are allergic to the dried droppings and remains of cockroaches. The best thing to do: ·
Keep all food out of your bedroom.
·
Keep food and garbage in closed containers (never leave food out).
·
Use poison baits, powders, gels, or paste (for example, boric acid). You can also use traps.
·
If a spray is used to kill roaches, stay out of the room until the odor goes away.
Vacuum Cleaning ·
Try to get someone else to vacuum for you once or twice a week, if you can.
·
Stay out of rooms while they are being vacuumed and for a short while afterward.
22 Asthma
·
If you vacuum, use a dust mask (from a hardware store), a doublelayered or microfilter vacuum cleaner bag, or a vacuum cleaner with a HEPA filter.
Indoor Mold ·
Fix leaky faucets, pipes, or other sources of water.
·
Clean moldy surfaces with a cleaner that has bleach in it.
Pollen and Outdoor Mold What to do during your allergy season (when pollen or mold spore counts are high): ·
Try to keep your windows closed.
·
Stay indoors with windows closed during the midday and afternoon, if you can. Pollen and some mold spore counts are highest at that time.
·
Ask your doctor whether you need to take or increase anti-inflammatory medicine before your allergy season starts.
Smoke, Strong Odors, and Sprays ·
If possible, do not use a wood-burning stove, kerosene heater, or fireplace.
·
Try to stay away from strong odors and sprays, such as perfume, talcum powder, hair spray, and paints.
Exercise, Sports, Work, or Play ·
You should be able to be active without symptoms. See your doctor if you have asthma symptoms when you are active—like when you exercise, do sports, play, or work hard.
·
Ask your doctor about taking medicine before you exercise to prevent symptoms.
·
Warm up for about 6 to 10 minutes before you exercise.
·
Try not to work or play hard outside when the air pollution or pollen levels (if you are allergic to the pollen) are high.
Guidelines 23
Other Things that Can Make Asthma Worse ·
Flu: Get a flu shot.
·
Sulfites in foods: Do not drink beer or wine or eat shrimp, dried fruit, or processed potatoes if they cause asthma symptoms.
·
Cold air: Cover your nose and mouth with a scarf on cold or windy days.
·
Other medicines: Tell your doctor about all the medicines you may take. Include cold medicines, aspirin, and even eye drops.
For More Information Contact these groups to learn more about asthma: National Asthma Education and Prevention Program NHLBI Information Center P.O. Box 30105 Bethesda, MD 20824-0105 301-251-1222 http://www.nhlbi.nih.gov/nhlbi/nhlbi.htm Allergy and Asthma Network/Mothers of Asthmatics, Inc. 800-878-4403 http://www.podi.com/health/aanma American Academy of Allergy, Asthma, and Immunology 800-822-2762 http://www.aaaai.org American College of Allergy, Asthma, and Immunology 800-842-7777 http://allergy.mcg.edu American Lung Association 800-586-4872 http://www.lungusa.org Asthma and Allergy Foundation of America 800-727-8462 http://www.aafa.org
24 Asthma
National Jewish Medical and Research Center (Lung Line®) 800-222-5864 http://www.njc.org
More Guideline Sources The guideline above on asthma is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to asthma. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with asthma. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly.
Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following as being relevant to asthma: ·
Guides On asthma Asthma http://www.nlm.nih.gov/medlineplus/ency/article/000141.htm Asthma http://www.nlm.nih.gov/medlineplus/asthma.html Asthma in Children http://www.nlm.nih.gov/medlineplus/asthmainchildren.html Asthma http://www.nlm.nih.gov/medlineplus/tutorials/asthmaloader.html
Guidelines 25
·
Other Guides Occupational asthma http://www.nlm.nih.gov/medlineplus/ency/article/000110.htm Pediatric asthma http://www.nlm.nih.gov/medlineplus/ency/article/000990.htm Directories http://www.nlm.nih.gov/medlineplus/directories.html Allergy http://www.nlm.nih.gov/medlineplus/allergy.html
Within the health topic page dedicated to asthma, the following was recently recommended to patients: ·
General/Overviews Asthma http://www.nlm.nih.gov/medlineplus/tutorials/asthmaloader.html Asthma Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DS00021 Breath of Life Source: National Library of Medicine http://www.nlm.nih.gov/hmd/breath/breathhome.html
·
Diagnosis/Symptoms Spirometry Source: National Lung Health Education Program http://www.nlhep.org/spirom1.html
·
Treatment Asthma Inhalers Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ01081 Asthma Medications Source: American Academy of Family Physicians http://familydoctor.org/handouts/573.html
26 Asthma
Asthma: Controller and Quick-Relief Medicines Source: American Academy of Family Physicians http://familydoctor.org/handouts/665.html ·
Specific Conditions/Aspects Asthma and Bone Health Source: Osteoporosis and Related Bone Diseases-National Resource Center http://www.osteo.org/newfile.asp?doc=r610i&doctitle=Asthma%2B and%2BBone%2BHealth&doctype=HTML%2BFact%2BSheet Asthma: A Concern for Minority Populations Source: National Institute of Allergy and Infectious Diseases http://www.niaid.nih.gov/factsheets/asthma.htm Asthma: Can Drinking Wine Trigger Symptoms? Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ00375 Exercise-Induced Asthma Source: American Academy of Allergy, Asthma, and Immunology http://www.aaaai.org/patients/spotlight/exercise_induced_asthma /default.stm Guide To Health Care Plans Source: American Academy of Allergy, Asthma, and Immunology http://www.aaaai.org/patients/publicedmat/tips/guidetohealthcar eplans.stm Influenza: Serious Problem for People with Asthma Source: American Lung Association http://www.lungusa.org/diseases/influ_factsheet.html Occupational Asthma: Wheezing at Work Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ01140 Take An Asthma Quiz Source: Environmental Protection Agency http://www.epa.gov/iaq/asthma/quiz/index.html Traveling with Allergies Source: American Academy of Allergy, Asthma, and Immunology http://www.aaaai.org/patients/topicofthemonth/archived/0300.stm Your Guide to Exercising with Asthma Source: McGraw-Hill Companies http://www.physsportsmed.com/issues/1998/06jun/dis_pa.htm
Guidelines 27
·
Children Childhood Asthma: An Overview Source: American Lung Association http://www.lungusa.org/asthma/ascchildhoo.html Jill's Asthma Story Source: Nemours Foundation http://kidshealth.org/kid/health_problems/allergy/asthma.html
·
From the National Institutes of Health Controlling Your Asthma Source: img src='/medlineplus/images/linkpdf.gif' width='100' height='17' border=0 alt='Links to PDF File'> (National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov/health/public/lung/asthma/asth_fs.pdf Focus On: Asthma Source: National Institute of Allergy and Infectious Diseases http://www.niaid.nih.gov/newsroom/focuson/asthma01/
·
Latest News Asthma Researchers Present New Results, New Perspectives on the Disease Source: 02/26/2002, National Institute of Allergy and Infectious Diseases http://www.niaid.nih.gov/newsroom/releases/aaaai.htm Pets May Raise Asthma Risk Among Adolescents Source: 05/21/2002, Reuters Health http://www.nlm.nih.gov/medlineplus/news/fullstory_7698.html Preterm Birth Risk Higher If Mom's Asthma Untreated Source: 05/20/2002, Reuters Health http://www.nlm.nih.gov/medlineplus/news/fullstory_7677.html Treating Nasal Congestion Can Cut Asthma Attacks Source: 05/03/2002, Reuters Health http://www.nlm.nih.gov/medlineplus/news/fullstory_7429.html
28 Asthma
·
Law and Policy Metered-Dose Inhaler Information - Frequently Asked Questions Source: Food and Drug Administration http://www.fda.gov/cder/mdi/mdifaqs.htm
·
Organizations Allergy, Asthma and Immunology Online Source: American College of Allergy, Asthma & Immunology http://allergy.mcg.edu/ American Academy of Allergy, Asthma & Immunology Source: American Academy of Allergy, Asthma, and Immunology http://www.aaaai.org/ American Lung Association http://www.lungusa.org/index.html Asthma and Allergy Foundation of America http://www.aafa.org/ EPA, Office of Indoor Air Quality (IAQ) Source: Environmental Protection Agency, Indoor Environments Division http://www.epa.gov/iaq/index.html National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov/index.htm National Institute of Allergy and Infectious Diseases http://www.niaid.nih.gov/
·
Prevention/Screening Asthma and Allergy Prevention Source: National Institute of Environmental Health Sciences http://www.niehs.nih.gov/airborne/prevent/intro.html
·
Research Asthma Research Centers Final Report 2001 Source: American Lung Association http://www.lungusa.org/arc/arc01_a.html CDC Study Links Improved Air Quality with Decreased Emergency Visits for Asthma Source: Centers for Disease Control and Prevention http://www.cdc.gov/od/oc/media/pressrel/r010221.htm
Guidelines 29
Don't Get Rid of That Cat Yet, Say Asthma Researchers Source: National Institute of Allergy and Infectious Diseases http://www.nih.gov/news/pr/mar2001/niaid-08a.htm Groundbreaking Study Reveals That Flu Shots Are Safe For People With Asthma Source: American Lung Association http://www.lungusa.org/press/association/ala_112201.html NHLBI Researchers Find Long-Acting Beta-Agonists Not as Effective as Inhaled Corticosteroids in Treating Persistent Asthma Source: National Heart, Lung, and Blood Institute http://www.nih.gov/news/pr/may2001/nhlbi-22.htm NHLBI Supported Study Finds Inhaled Steroids Accelerate Bone Loss in Women with Asthma Source: National Heart, Lung, and Blood Institute http://www.nih.gov/news/pr/sep2001/nhlbi-26.htm Primary Prevention of Asthma: The EIPPAC Study Source: National Institute of Environmental Health Sciences http://www.niehs.nih.gov/airborne/research/primary.html ·
Statistics Allergy Statistics Source: National Institute of Allergy and Infectious Diseases http://www.niaid.nih.gov/factsheets/allergystat.htm FASTATS: Asthma Source: National Center for Health Statistics http://www.cdc.gov/nchs/fastats/asthma.htm Minority Lung Disease Data: Asthma Source: American Lung Association http://www.lungusa.org/pub/minority/asthma_00.html New Estimates for Asthma Tracked Source: National Center for Health Statistics http://www.cdc.gov/nchs/releases/01facts/asthma.htm
·
Teenagers How Can I Deal With My Asthma? Source: Nemours Foundation http://kidshealth.org/teen/question/illness_infection/asthma_mgm t.html
30 Asthma
·
Women Asthma and Pregnancy Source: American Academy of Allergy, Asthma, and Immunology http://www.aaaai.org/patients/topicofthemonth/archived/0800/pr egnancy.stm
If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on asthma and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·
Your child and asthma Source: Albuquerque, NM: Pediatric Pulmonary Center, University of New Mexico. 1993. 30 pp. Contact: Available from University of New Mexico, Pediatric Pulmonary Center, Department of Pediatrics, Albuquerque, NM 87131. Telephone: (505) 272-5551. Summary: This pamphlet is designed to help parents whose children have asthma. It provides a brief explanation of the disease, warning signs and treatment/medication, and how to keep children active and exercising with asthma.
Guidelines 31
·
Asthma Awareness Day: A planning guide Source: Bethesda, MD: National Institute of Allergy and Infectious Diseases. 1995. 5 items. Contact: Available from National Institute of Allergy and Infectious Diseases, Building 31, Room 7A-50, MSC 2520, 9000 Rockville Pike, Bethesda, MD 20892-2520. Telephone: (301) 496-5717 / fax: (301) 4020120 / e-mail: Link @ URL pulls up form. Available at no charge. Summary: This kit includes resource material to organize an Asthma Awareness Day. It explains how to create the event, how to manage logistical arrangements, how to promote the event and work with the media, followup to the event, and how to find resources and materials for program planning. Special outreach efforts for blacks and Hispanic Americans are included.
The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “asthma” or synonyms. The following was recently posted: ·
Asthma. Source: University of Michigan Health System.; 1996 December (revised 2000 Jan); 14 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1507&sSearch_string=asthma
·
Diagnosis and management of asthma. Source: Institute for Clinical Systems Improvement.; 1994 August (revised 2001 Jul); 36 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2252&sSearch_string=asthma
32 Asthma
·
Evidence based clinical practice guideline for managing an acute exacerbation of asthma. Source: Cincinnati Children's Hospital Medical Center.; 1999; 12 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1197&sSearch_string=asthma
·
Expert Panel Report 2: guidelines for the diagnosis and management of asthma. Source: National Asthma Education and Prevention Program/National Heart, Lung, and Blood Institute (U.S.).; 1997 July (reprinted 1998 April, 1999 Mar); 146 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 0335&sSearch_string=asthma
·
Global initiative for asthma. Source: National Heart, Lung, and Blood Institute (U.S.)/World Health Organization.; 1995 January (revised 1998); 249 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1116&sSearch_string=asthma
·
Long term management of asthma by classification. Source: Community Collaboration on Healthcare Quality.; 1998 May; 6 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1390&sSearch_string=asthma
·
Long-term management of asthma. Source: Finnish Medical Society Duodecim.; 2001 January 4; Various pagings http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1832&sSearch_string=asthma
Guidelines 33
Healthfinder™
Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·
All About Asthma Book Summary: This is a story about a girl with asthma. If you have asthma this book was written for you. Source: American Academy of Allergy, Asthma and Immunology http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=5674
·
Allergy and Asthma Puzzles Summary: Children can choose and print out a picture from this page for a fun activity. Source: American Academy of Allergy, Asthma and Immunology http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=5679
·
Allergy, Asthma & Immunology Online Summary: This site functions as an information and news service for patients and their families, purchasers of group health care programs, and the news media. Source: American College of Allergy, Asthma & Immunology http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=2881
34 Asthma
·
American Academy of Allergy, Asthma and Immunology Physician Referral Database Summary: Use this database to search for an Amer member physician in your area. You may search this database in four ways: by distance, state, country, physician name and physician specialty. Source: American Academy of Allergy, Asthma and Immunology http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=4938
·
Asthma & Physical Activity in the School Summary: Designed for use by classroom teachers, physical education teachers and coaches, this publication is meant to assist them to help in managing and controlling their students' asthma so that he or she Source: National Heart, Lung, and Blood Institute, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=843
·
Asthma and Allergy Coloring Book Summary: A coloring book to help kids feel better when their allergies or asthma bother them. You can choose any superhero from the coloring book to color. Source: American Academy of Allergy, Asthma and Immunology http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=5675
·
Asthma and Allergy Prevention Summary: This Web site was designed to help you survive the seasons by providing information on asthma, allergies, allergens, and asthma irritants such as cigarette smoke, cockroaches, dustmites, house dust, Source: National Institute of Environmental Health Sciences, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6300
Guidelines 35
·
Asthma and Allergy Statistics Summary: This fact sheet provides statistical information about asthma in the United States including prevalence, mortality rates, and treatment costs. Source: National Institute of Allergy and Infectious Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=825
·
Asthma Camp Directory Summary: Using this directory, you and your family can find an asthma camp where you will get special care for your asthma. Asthma summer camps are in many states. Source: American Lung Association http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=5682
·
Asthma Education: Interactive Guidelines Summary: An interactive program designed to facilitate the incorporation of the current National Asthma Education Guidelines into clinical practice and to quickly obtain individualized patient recommendations. Source: Educational Institution--Follow the Resource URL for More Information http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=4102
The NIH Search Utility After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to asthma. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific
36 Asthma
disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.
Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
·
drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html
·
Family Village: http://www.familyvillage.wisc.edu/specific.htm
·
Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
·
Med Help International: http://www.medhelp.org/HealthTopics/A.html
·
Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
·
Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
·
WebMDÒHealth: http://my.webmd.com/health_topics
Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Abdominal: Pertaining to the abdomen. [EU] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Airways: Tubes that carry air into and out of the lungs. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Allergen: A antigenic substance capable of producing immediate-type hypersensitivity (allergy). [EU] Anaphylaxis: An acute hypersensitivity reaction due to exposure to a previously encountered antigen. The reaction may include rapidly
Guidelines 37
progressing urticaria, respiratory distress, vascular collapse, systemic shock, and death. [NIH] Antihistamine: A drug that counteracts the action of histamine. The antihistamines are of two types. The conventional ones, as those used in allergies, block the H1 histamine receptors, whereas the others block the H2 receptors. Called also antihistaminic. [EU] Cardiovascular: Pertaining to the heart and blood vessels. [EU] Chronic: Of long duration; frequently recurring. [NIH] Congestion: Abnormal fluid accumulation in the body, especially the lungs. [NIH]
Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Corticosteroids: Drugs that mimic the action of a group of hormones produced by adrenal glands; they are anti-inflammatory and act as bronchodilators. [NIH] Dermatitis: Inflammation of the skin. [EU] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Eczema: A pruritic papulovesicular dermatitis occurring as a reaction to many endogenous and exogenous agents, characterized in the acute stage by erythema, edema associated with a serous exudate between the cells of the epidermis (spongiosis) and an inflammatory infiltrate in the dermis, oozing and vesiculation, and crusting and scaling; and in the more chronic stages by lichenification or thickening or both, signs of excoriations, and hyperpigmentation or hypopigmentation or both. Atopic dermatitis is the most common type of dermatitis. Called also eczematous dermatitis. [EU] Endoscopy: Visual inspection of any cavity of the body by means of an endoscope. [EU] Enterocolitis: Inflammation involving both the small intestine and the colon; see also enteritis. [EU] Enzyme: Substance, made by living cells, that causes specific chemical changes. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Gastrointestinal: Pertaining to or communicating with the stomach and
38 Asthma
intestine, as a gastrointestinal fistula. [EU] Gels: Colloids with a solid continuous phase and liquid as the dispersed phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting colloid is called a sol. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Hernia: (he protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [EU] Idiosyncrasy: An abnormal susceptibility to some drug, protein, or other agent which is peculiar to the individual. [EU] Immunization: Protection from disease by administering vaccines that induce the body to form antibodies against infectious agents. [NIH] Inflammation: Response of the body tissues to injury; typical signs are swelling, redness, and pain. [NIH] Irritants: Drugs that act locally on cutaneous or mucosal surfaces to produce inflammation; those that cause redness due to hyperemia are rubefacients; those that raise blisters are vesicants and those that penetrate sebaceous glands and cause abscesses are pustulants; tear gases and mustard gases are also irritants. [NIH] Kerosene: A refined petroleum fraction used as a fuel as well as a solvent. [NIH]
Laryngitis: Inflammation of the larynx, a condition attended with dryness and soreness of the throat, hoarseness, cough and dysphagia. [EU] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH]
Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Otolaryngology: A surgical specialty concerned with the study and treatment of disorders of the ear, nose, and throat. [NIH] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Prevalence: The number of events, e.g., instances of a given disease or other condition, in a given population at a designated time. When used without qualification, the term usually refers to the situation at specific point in time (point prevalence). Prevalence is a number, not a rate. [NIH]
Guidelines 39
Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Pulmonary: Relating to the lungs. [NIH] Reflux: A backward or return flow. [EU] Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] Respiratory: Pertaining to respiration. [EU] Salicylates: The salts, esters of salicylic acids, or salicylate esters of an organic acid. Some of these have analgesic, antipyretic, and antiinflammatory activities by inhibiting prostaglandin synthesis. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spirometry: Measurement of volume of air inhaled or exhaled by the lung. [NIH]
Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Sulfites: Inorganic salts of sulfurous acid. [NIH] Systemic: Relating to a process that affects the body generally; in this instance, the way in which blood is supplied through the aorta to all body organs except the lungs. [NIH] Vaccine: A suspension of attenuated or killed microorganisms (bacteria, viruses, or rickettsiae), administered for the prevention, amelioration or treatment of infectious diseases. [EU] Wheezing: Breathing with a rasp or whistling sound; a sign of airway constriction or obstruction. [NIH]
Seeking Guidance 41
CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with asthma. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.9 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with asthma. The chapter ends with a discussion on how to find a doctor that is right for you.
Associations and Asthma As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of an illness can be as taxing as the physical side.10 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your condition can all Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 10 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 9
42 Asthma
influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. In addition to associations or groups that your doctor might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your insurance provider to find out if the cost will be covered): ·
Allergy and Asthma Disease Management Center c/o American Academy of Allergy, Asthma and Immunology Address: 611 East Wells Street Milwaukee, WI 53202 Telephone: 800-822-2762 Web Site: http://www.aaaai.org/aadmc/default.htm Background: The Allergy and Asthma Disease Management Center (AADMC) is an online, interactive Internet site designed to be an information resource serving the needs of healthcare professionals. The Center offers access to current literature and news in the allergy and asthma fields; provides information on meetings, seminars, and conferences; provides a limited, online consulting service; and provides links to other sources of information. Topics of interest include all aspects of allergy, asthma, and immunology. Relevant area(s) of interest: Allergy; Anaphylaxis; Asthma; Childhood asthma; Dermatitis; Exercise induced asthma; Food Allergy; Immunology; Immunotherapy; Latex allergy; Medication allergy
·
Allergy and Asthma Network-Mothers of Asthmatics, Inc Address: Allergy and Asthma Network-Mothers of Asthmatics, Inc. 2751 Prosperity Avenue, Suite 150, Fairfax, VA 22031 Telephone: (703) 641-9595 Toll-free: (800) 878-440 Fax: (703) 573-7794 Email:
[email protected] Web Site: http://www.aanma.org Background: The Allergy and Asthma Network-Mothers of Asthmatics, Inc. (AAN-MA) is a not-for-profit organization dedicated to helping individuals affected by asthma and allergy through education, support, and resources. Established in 1985 and currently consisting of 5,000
Seeking Guidance 43
members, AAN-MA works to educate the general public; provide an essential communication link among the home, school, physicians, the pharmaceutical industry, and the government on allergies and asthma; offer emotional support to affected individuals and their families; and provide accurate guidance and clearly written resources on allergies and asthma. AAN-MA has a toll-free hotline and offers a variety of materials including a monthly newsletter, various publications, and videos on allergies and asthma. AAN-MA also maintains a web site at http://www.podi.com/health/aanma. Relevant area(s) of interest: Asthma ·
Allergy/Asthma Information Association Address: Box 100 Toronto, Ontario M9W 5K9 Telephone: (416) 679-9521 Voice; (416) 679-9524 Fax; (800)611-7011 Email:
[email protected] Web Site: http://www.aaia.ca Background: The Allergy/Asthma Information Association (AAIA) is a national organization that helps people with allergies and their families cope with hay fever, food allergies, asthma, and many other similar conditions. The association provides an allergy and asthma information service, educational workshops and seminars, and advocacy programs for the rights of people with allergies and asthma. Issues of concern include ingredient listings on packaged foods and cosmetics, content labeling on fabrics and clothing, and labeling of nonmedical ingredients on medications. AAIA offers a sympathetic ear and accurate, up-to-date information to help understand your allergy or asthma condition, and to show how to prevent or reduce the severity of symptoms. Relevant area(s) of interest: Allergies; Asthma; Respiratory diseases
·
American Academy of Allergy Asthma and Immunology Address: American Academy of Allergy Asthma and Immunology 611 East Wells Street, Milwaukee, WI 53202 Telephone: (414) 272-6071 Toll-free: (800) 822-2762 Fax: (414) 276-3349 Email:
[email protected] Web Site: http://www.aaaai.org Background: The American Academy of Allergy, Asthma and Immunology (AAAAI) is an international, not-for-profit professional
44 Asthma
medical specialty organization representing allergists, clinical immunologists, allied health professionals, and other physicians with a special interest in allergy and immunology. Established in 1943 by the merger of the American Association for the Study of Allergy and the Association for the Study of Asthma and Allied Conditions, the AAAAI is dedicated to advancing the knowledge and practice of allergy, fostering the education of students and the public, encouraging union and cooperation among those working in the field, and promoting and stimulating research and the study of allergic diseases. The AAAAI is currently organized into several major 'interest sections' consisting of Asthma, Rhinitis, and Other Respiratory Diseases; Basic and Clinical Immunology; Dermatologic Diseases; Environmental and Occupational Disorders; Food and Drug Reactions and Anaphylaxis; and Mechanisms of Allergy. The AAAAI also engages in patient advocacy and lobbying activities, provides physician referrals, engages in patient education, and provides a variety of informational materials. The Academy currently has more than 5,400 members in the United States, Canada, and over 40 additional countries. Relevant area(s) of interest: Asthma ·
American Academy of Allergy, Asthma and Immunology Address: 611 East Wells St. Milwaukee, WI 53202-3889 Telephone: (800) 822-2762 (toll-free physician and referral line) Web Site: http://www.aaaai.org Background: The American Academy of Allergy, Asthma, and Immunology (AAAAI). AAAAI has six interest sections that were created in 1988 to increase members' participation in the Academy's activities. These sections are Asthma, Rhinitis, and Respiratory Diseases; Basic and Clinical Immunology; Dermatologic Diseases; Environmental and Occupational Disorders; Food and Drug Reactions; and Mechanisms of Allergy. Currently, there are over 5,000 AAAAI members in the United States, Canada, and foreign countries. The academy aims to (1) increase knowledge about the practice of allergy and immunology, (2) educate both the public and students, (3) encourage professionals in the field to help and cooperate with one another, and (4) promote research in the field. The AAAAI achieves these goals in a variety of ways. It holds an annual meeting in which a postgraduate program and scientific sessions are held. It sponsors continuing medical education (CME) programs that are approved for credit by the American Medical Association. The AAAAI's Learning Resource Center (LRC) serves as an information resource and job placement service for physicians in the field. AAAAI's
Seeking Guidance 45
research council offers members the opportunity to participate in group research projects. The Academy also issues guidelines and position statements on diagnostic and therapeutic procedures which are published in the Journal of Allergy and Clinical Immunology. In addition, AAAAI has an Information and Referral Service that responds to public inquiries about asthma and allergic diseases and makes referrals to allergists. Relevant area(s) of interest: Allergy; Asthma; Immunology ·
American College of Allergy, Asthma and Immunology Address: 85 West Algonquin Road, Suite 550 Arlington Heights, IL 60005 Telephone: (847) 427-1200 Fax: (847) 427-1294 Email:
[email protected] Web Site: http://www.allergy.mcg.edu/ Background: The American College of Allergy, Asthma and Immunology (ACAAI) is a professional association of approximately 4,000 allergists/immunologists. Established in 1942, the ACAAI is dedicated to improving the quality of patient care in allergy and immunology through research, advocacy, and professional and public education. Its goals and activities include maintaining and advancing the diagnostic and therapeutic skills of members and foster their appropriate application; sponsoring and conducting educational and scientific programs and publications; and developing and disseminating educational information for members, patients, health plan purchasers and administrators, and other physicians and health professionals. ACAAI answers inquiries, distributes publications, maintains two Internet sites (one for the public, one for members), and makes referrals to other sources of information. Publication(s): Asthma Disease Management Resource Manual; Guidelines for the Diagnosis and Management of Asthma; Expert Care and Immunotherapy for Asthma; Guidelines for the Management of Latex Allergies and Safe Use in Health Care Facilities; Allergy-Clinical Immunology - Learning Objectives for Medical Students; Practice Parameters for Allergy Diagnostic Testing; Practice Parameters for Allergen Immunotherapy. A publications list is available or visit ACAAI's Internet sites for more information. Relevant area(s) of interest: Allergy; Asthma; Immunology; Managed care
46 Asthma
·
American Lung Association Address: American Lung Association 1740 Broadway, New York, NY 10019 Telephone: (212) 315-8700 Fax: (212) 265-5642 Toll- free: (800) 586-4872 Email:
[email protected] Web Site: http://www.lungusa.org Background: The American Lung Association (ALA) is a national not-forprofit voluntary health organization dedicated to the prevention, cure, and control of all types of lung disease such as asthma, emphysema, tuberculosis, and lung cancer. This is accomplished through programs of community service, public health education, advocacy, and research. The ALA was established in 1904 as the National Association for the Study and Prevention of Tuberculosis. As the number of tuberculosis cases declined over the years, the association widened its focus to include other forms of lung disease and, in 1973, changed its name to the American Lung Association. The Association offers assistance through support groups, genetic counseling, patient networking, referrals, and the development and dissemination of educational materials. Such materials include reports, brochures, audiovisual aids, and Spanish language materials. Relevant area(s) of interest: Asthma
·
American Thoracic Society Address: American Thoracic Society 1740 Broadway, New York, NY 10019 Telephone: (212) 315-8700 http://www.thoracic.org
E-mail:
None
Website:
Web Site: http://www.thoracic.org Background: The American Thoracic Society (ATS) is an international professional and scientific society that focuses on respiratory and critical care medicine. Established in 1905, the Society currently has approximately 12,500 members in the United States and around the world. The ATS membership is dedicated to preventing and fighting respiratory disease through research, education, patient care, and advocacy. The Society's long range goal is to decrease morbidity and mortality from respiratory disorders and life threatening acute illnesses. In keeping with these goals, the American Thoracic Society also serves as the medical section of the American Lung Association and interacts with
Seeking Guidance 47
both national and international organizations that have similar goals. One of the Society's primary activities is its annual International Scientific Conference, an international forum for physicians and scientists who work in pulmonary and critical care medicine. Sessions are held on such topics as pneumonia, asthma, critical care, tuberculosis, pediatric pulmonology, sleep apnea, environmental and occupational lung disease, nursing studies, cell biology, lung structure and function, and AIDS. The ATS also is committed to advocating for key state and federal health issues. Through its ATS Advocacy Network, the Society works to educate Congress and federal agencies about tobacco control, health care policy, environmental policy, medical reimbursement issues, research funding, and other public policy issues. The ATS has also earned full accreditation by the Accreditation Council on Continuing Medical Education for direct sponsorship of educational activities as well as joint sponsorships with ATS chapters and local Lung Associations. In addition, the ATS publishes two journals including the 'American Journal of Respiratory and Critical Care Medicine' (AJRCCM) and the 'American Journal of Respiratory Cell and Molecular Biology' (AJRCMB). The AJRCCM focuses on human biology and disease as well as animal and in vitro studies that contribute to the understanding of pathophysiology and treatment of pulmonary disease. The AJRCMB publishes papers that report significant and original observations in the area of pulmonary biology. ·
Asthma and Allergy Foundation of America Address: 1233 20th St. NW, Suite 402 Washington, DC 20036 Telephone: (202) 466-7643; (800) 7-ASTHMA Fax: (202) 466-8940 Email:
[email protected] Web Site: http://www.aafa.org Background: The Asthma and Allergy Foundation of America (AAFA) is a nonprofit organization that works to control and find a cure for asthma and allergic diseases. The foundation supports research projects, patient and public education programs, public policy and governmental advocacy efforts, and public awareness campaigns. There is direct individual and family support through its nationwide network of chapters and support groups for adults, parents and adolescents. Relevant area(s) of interest: Allergies; Asthma; Respiratory diseases
48 Asthma
·
Asthma and Allergy Foundation of America, Inc Address: Asthma and Allergy Foundation of America, Inc. 1125 15th Street N.W., Suite 502, Washington, DC 20005 Telephone: (202) 466-7643 Toll-free: (800) 727-8462 Fax: (202) 466-8940 Email:
[email protected] Web Site: http://www.aafa.org Background: The Asthma and Allergy Foundation of America, Inc. (AAFA) is a private, not-for-profit organization dedicated to finding a cure for and controlling asthma and allergic diseases. AAFA serves the estimated 50 million individuals with asthma and allergic disorders through the support of research, patient and public education programs, public and governmental advocacy, and a nationwide network of chapters and education/support groups. Educational materials include a bi-monthly newsletter 'ADVANCE,' a support group newsletter, and a resource list brochure. Asthma and Allergy Foundation of America maintains a web site at http://www.aafa.org. Relevant area(s) of interest: Asthma
·
Canadian Lung Association Address: Canadian Lung Association 1900 City Park Drive, Suite 508, Blair Business Park, Gloucester, Ontario, K1J 1A3, Canada Telephone: (613) 747-6776 Fax: (613) 747-7430 Email:
[email protected] Web Site: http://www.lung.ca/ Background: The Canadian Lung Association is a national nonprofit organization that is dedicated to improving respiratory health and combating disease of and environmental threats to the lungs. The Association works to fulfill its mission by promoting research, increasing public awareness, and providing patient support programs. Established in 1900, the Association is an umbrella organization that currently consists of 10 provincial and one territorial association. Each provincial association maintains a professional staff including health educators who work with volunteers to develop and conduct community program services. One of the Association's primary objectives is to reduce tobacco use by influencing people to quit or not to start smoking, promoting smoke-free workplaces, and supporting legislation to regulate or prohibit smoking in public enclosed areas. In addition, the Canadian Lung
Seeking Guidance 49
Association is committed to supporting respiratory health and respiratory disease research at several levels. Nationally, the Association provides research funding that is administered by the Canadian Thoracic Society, the Canadian Nurses Respiratory Society, and the Physiotherapy Cardio-Respiratory Society. Each member association also supports research at the provincial level. The Canadian Lung Association also provides a variety of educational materials and has a web site on the Internet. Relevant area(s) of interest: Asthma ·
Magic Johnson Foundation Address: 600 Corporate Pointe, Suite 1080 Culver City, CA 90230 Telephone: 1 (888) 624-4205 Web Site: http://www.magicjohnson.org Background: The Magic Johnson Foundation was founded in 1991 to fund organizations providing HIV/AIDS prevention programs and care for persons living with HIV/AIDS (PLWAs), particularly those that target minority communities. The Foundation has since responded to the growing need to address all aspects of our youth's lives by extending its mission to include in its focus supporting community-based organizations that serve the health, educational and social needs of children residing in inner-city communities. The Foundation's purpose is to allocate grants to, and partner with, non-profit agencies for the good of our children and our future by raising funds and/or awareness through corporate, foundation, and individual support. Relevant area(s) of interest: Asthma /prev/treatment; Breast cancer programs; HIV/ prevention; Inner-city youth; Youth mentoring
·
National Emphysema Foundation Address: National Emphysema Foundation Norwalk Hospital, Chest Medicine, Norwalk, CT 06856 Fax: (203) 854-9191 Email:
[email protected] Web Site: http://emphysemafoundation.org Background: The National Emphysema Foundation (NEF) is a not-forprofit organization dedicated to improving the lives of individuals affected by emphysema, asthma, and related disorders through education, research, and direct patient care. Emphysema is a lung disease characterized by destructive changes of the tiny air sacs in the lungs
50 Asthma
(alveoli). Asthma is a common condition characterized by recurrent episodes of wheezing and shortness of breath due to widespread narrowing of the airways in the lungs. Established in 1971, the National Emphysema Foundation is sponsored by the Hinds Research Center, Norwalk Hospital, Norwalk, Connecticut. The Foundation works with academic institutions and public agencies worldwide to study emphysema and to heighten awareness of the disease internationally. In addition, the Foundation is committed to serving as a source of information on emphysema and other lung diseases. The Foundation's comments are based on professional advice, published experience, and expert opinion but do not represent therapeutic recommendation nor prescription. The Foundation also maintains a web site on the Internet that discusses the organization's mission and goals and provides understandable information on pulmonary health, emphysema, asthma, and related disorders. Relevant area(s) of interest: Asthma ·
National Heart, Lung, and Blood Institute Information Center Address: Bethesda, MD 20824-0105 P.O. Box 30105 Telephone: (301) 251-1222 Email:
[email protected] Web Site: http://www.nhlbi.nih.gov/ Background: The National Heart, Lung, and Blood Institute (NHLBI) Information Center responds to inquiries and disseminates information and publications on high blood pressure, cholesterol, smoking, asthma, heart attack, sleep disorders, and other topics related to heart, lung, and blood disorders. The organization provides referrals, reference information, and publications, some of which are available in Spanish and French, to consumers. Publication(s): Catalog; newsletter. Relevant area(s) of interest: Asthma; Blood and lymphatic diseases; Blood pressure disorders; Cardiovascular diseases; Heart diseases; Hematologic diseases; Hypertension; Lung diseases; Respiratory diseases; Smoking
·
Second Wind Lung Transplant Association, Inc Address: Second Wind Lung Transplant Association, Inc. 300 South Duncan Avenue, Suite 227, Clearwater, FL 33755 Telephone: (510) 523-9983 Toll-free: (888) 222-2690 Fax: (727) 442- 9762
Seeking Guidance 51
Email:
[email protected] Web Site: http://www.2ndwind.org Background: Second Wind Lung Transplant Association, Inc. is a not-forprofit organization dedicated to improving the quality of life for lung transplant recipients, lung surgery candidates, people with related pulmonary concerns, and their families. The Association provides support, advocacy, education, information, and guidance through a spirit of service, 'adding years to their lives and life to their years.' Established in 1995 by a group of lung transplant recipients, candidates, and their families, Second Wind has quarterly support group meetings to provide educational programs (e.g., on nutrition, effects of medications and exercise, physical therapy) for both lung transplant candidates and recipients; to share experiences; and to enjoy social activities. Second Wind also is developing a directory of candidates and lung transplant recipients to provide networking opportunities; is establishing a mentor program to offer fellowship to affected individuals and families during the transplant experience; and is planning to establish low-cost Lung Transplant Housing near transplant hospitals for use by candidate and recipient transplant affected individuals and their support person. In addition, the organization provides educational programs; seeks to increase Organ Donor Awareness; and provides a quarterly newsletter entitled 'AirWays' to their members. The Second Wind Lung Transplant Association also has a web site on the Internet that provides information to individuals who seek information on lung transplantation. The site also provides linkage to information on certain specific pulmonary disorders; describes Second Wind's mentoring program; and provides information concerning financing lung transplantation. Such information includes listings of organizations that may provide advocacy, assistance with fund-raising, financial grants, and/or medication or pharmaceutical payment assistance grants or programs. Relevant area(s) of interest: Asthma
Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for patient associations.
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The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about asthma. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.
DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “asthma” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.
The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “asthma”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “asthma” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with asthma. You should check back periodically with this database since it is updated every 3 months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option
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called “Organizational Database (ODB)” and type “asthma” (or a synonym) in the search box.
Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective. The following Internet links may be of particular interest: ·
The Allergy and Asthma Network / Mothers of Asthmatics Web Site http://www.aanma.org/
·
Tips of All Sorts - Asthma http://www.tipsofallsorts.com/asthma.html
·
Asthma Support and Sharing Group http://www.asthmasupport.org/
·
Asthma Discussion List http://maelstrom.stjohns.edu/archives/asthma-l.html
Finding Doctors One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with asthma must go through the process of selecting a physician. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:11 ·
If you are in a managed care plan, check the plan’s list of doctors first.
·
Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals.
11
This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
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·
Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide.
·
Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide.
Additional steps you can take to locate doctors include the following: ·
Check with the associations listed earlier in this chapter.
·
Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors.
·
The American Board of Medical Specialties can tell you if your doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at 12 http://www.abms.org/newsearch.asp. You can also contact the ABMS by phone at 1-866-ASK-ABMS.
·
You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA’s Web site: http://www.amaassn.org/aps/amahg.htm.
If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.
While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified. 12
Seeking Guidance 55
Selecting Your Doctor13 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your health insurance plan and if he or she is taking new patients. If the doctor is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen physician. During the first visit you will have the opportunity to evaluate your doctor and to find out if you feel comfortable with him or her. Ask yourself, did the doctor: ·
Give me a chance to ask questions about asthma?
·
Really listen to my questions?
·
Answer in terms I understood?
·
Show respect for me?
·
Ask me questions?
·
Make me feel comfortable?
·
Address the health problem(s) I came with?
·
Ask me my preferences about different kinds of treatments for asthma?
·
Spend enough time with me?
Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.
Working with Your Doctor14 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·
You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.
·
It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.
13 This
section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. 14 This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
56 Asthma
·
Bring a “health history” list with you (and keep it up to date).
·
Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.
·
Tell your doctor about any natural or alternative medicines you are taking.
·
Bring other medical information, such as x-ray films, test results, and medical records.
·
Ask questions. If you don’t, your doctor will assume that you understood everything that was said.
·
Write down your questions before your visit. List the most important ones first to make sure that they are addressed.
·
Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.
·
Ask your doctor to draw pictures if you think that this would help you understand.
·
Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.
·
Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.
·
Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.
·
After leaving the doctor’s office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.
By following these steps, you will enhance the relationship you will have with your physician.
Seeking Guidance 57
Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:15 ·
Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html
·
Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html
·
Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html
Vocabulary Builder The following vocabulary builder provides definitions of words used in this chapter that have not been defined in previous chapters: Alveoli: Tiny sac-like air spaces in the lungs where transfer of carbon dioxide from blood into the lungs and oxygen from air into blood takes place. [NIH] Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH] Anorexia: Lack or loss of the appetite for food. [EU] Anthropometry: The technique that deals with the measurement of the size, weight, and proportions of the human or other primate body. [NIH] Antifungal: Destructive to fungi, or suppressing their reproduction or growth; effective against fungal infections. [EU] Antioxidant: One of many widely used synthetic or natural substances added to a product to prevent or delay its deterioration by action of oxygen in the air. Rubber, paints, vegetable oils, and prepared foods commonly contain antioxidants. [EU] Anxiety: The unpleasant emotional state consisting of psychophysiological You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
15
58 Asthma
responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Apnea: A transient absence of spontaneous respiration. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH]
Aspergillosis: Infections with fungi of the genus aspergillus. [NIH] Aspiration: The act of inhaling. [EU] Bronchitis: Inflammation of one or more bronchi. [EU] Bronchopulmonary: Pertaining to the lungs and air passages. [NIH] Cardiopulmonary: Pertaining to the heart and lungs. [EU] Cell: Basic subunit of every living organism; the simplest unit that can exist as an independent living system. [NIH] Cholesterol: A soft, waxy substance manufactured by the body and used in the production of hormones, bile acid, and vitamin D and present in all parts of the body, including the nervous system, muscle, skin, liver, intestines, and heart. Blood cholesterol circulates in the bloodstream. Dietary cholesterol is found in foods of animal origin. [NIH] Colic: Paroxysms of pain. This condition usually occurs in the abdominal region but may occur in other body regions as well. [NIH] Colorectal: Pertaining to or affecting the colon and rectum. [EU] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Cryptococcosis: Infection with a fungus of the species cryptococcus neoformans. [NIH] Cues: Signals for an action; that specific portion of a perceptual field or pattern of stimuli to which a subject has learned to respond. [NIH] Dermatomycoses: Superficial infections of the skin or its appendages by any of various fungi. [NIH] Dysplasia: Abnormal development or growth. [NIH] Emphysema: Chronic lung disease in which there is permanent destruction of alveoli. [NIH] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly
Seeking Guidance 59
involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Extracorporeal: Situated or occurring outside the body. [EU] Extravascular: Situated or occurring outside a vessel or the vessels. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Fetus: Unborn offspring from 7 or 8 weeks after conception until birth. [NIH] Fibrosis: Process by which inflamed tissue becomes scarred. [NIH] Gastroscopy: Endoscopic examination, therapy or surgery of the interior of the stomach. [NIH] Granuloma: A relatively small nodular inflammatory lesion containing grouped mononuclear phagocytes, caused by infectious and noninfectious agents. [NIH] Hyperbaric: Characterized by greater than normal pressure or weight; applied to gases under greater than atmospheric pressure, as hyperbaric oxygen, or to a solution of greater specific gravity than another taken as a standard of reference. [EU] Hypertension: High blood pressure (i.e., abnormally high blood pressure tension involving systolic and/or diastolic levels). The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure defines hypertension as a systolic blood pressure of 140 mm Hg or greater, a diastolic blood pressure of 90 mm Hg or greater, or taking hypertensive medication. The cause may be adrenal, benign, essential, Goldblatt's, idiopathic, malignant pate, portal, postpartum, primary, pulmonary, renal or renovascular. [NIH] Hypodermic: Applied or administered beneath the skin. [EU] Hysterectomy: The operation of excising the uterus, performed either through the abdominal wall (abdominal h.) or through the vagina (vaginal h.) [EU] Immunogenetics: A branch of genetics which deals with the genetic basis of the immune response. [NIH] Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection. [NIH]
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Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intravascular: Within a vessel or vessels. [EU] Lithotripsy: The destruction of a calculus of the kidney, ureter, bladder, or gallbladder by physical forces, including crushing with a lithotriptor through a catheter. Focused percutaneous ultrasound and focused hydraulic shock waves may be used without surgery. Lithotripsy does not include the dissolving of stones by acids or litholysis. Lithotripsy by laser is lithotripsy, laser. [NIH] Malaise: A vague feeling of bodily discomfort. [EU] MEDLARS: A computerized biomedical bibliographic storage and retrieval system operated by the National Library of Medicine. From it a monthly and cumulated Index Medicus is generated and through it the online system, MEDLINE, as well as many other databases, is operated. [NIH] Menopause: The cessation of menstruation in the human female, which begins at about the age of 50. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microorganism: A microscopic organism; those of medical interest include bacteria, viruses, fungi and protozoa. [EU] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Motility: The ability to move spontaneously. [EU] Neuroleptic: A term coined to refer to the effects on cognition and behaviour of antipsychotic drugs, which produce a state of apathy, lack of initiative, and limited range of emotion and in psychotic patients cause a reduction in confusion and agitation and normalization of psychomotor activity. [EU] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Postnatal: Occurring after birth, with reference to the newborn. [EU] Preoperative: Preceding an operation. [EU] Prophylaxis: The prevention of disease; preventive treatment. [EU]
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Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Radiotherapy: The treatment of disease by ionizing radiation. [EU] Radon: Radon. A naturally radioactive element with atomic symbol Rn, atomic number 86, and atomic weight 222. It is a member of the noble gas family and released during the decay of radium and found in soil. There is a link between exposure to radon and lung cancer. [NIH] Rhinitis: Inflammation of the mucous membrane of the nose. [EU] Sarcoidosis: An idiopathic systemic inflammatory granulomatous disorder comprised of epithelioid and multinucleated giant cells with little necrosis. It usually invades the lungs with fibrosis and may also involve lymph nodes, skin, liver, spleen, eyes, phalangeal bones, and parotid glands. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Surgical: Of, pertaining to, or correctable by surgery. [EU] Sympathetic: 1. pertaining to, caused by, or exhibiting sympathy. 2. a sympathetic nerve or the sympathetic nervous system. [EU] Syphilis: A contagious venereal disease caused by the spirochete treponema pallidum. [NIH] Thoracic: Pertaining to or affecting the chest. [EU] Toxic: Pertaining to, due to, or of the nature of a poison or toxin; manifesting the symptoms of severe infection. [EU] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of mycobacterium. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Vasculitis: Inflammation of a vessel, angiitis. [EU] Ventilation: The process of exchange of air between the lungs and the atmosphere leading to exchange of gases in the blood. [NIH]
Clinical Trials 63
CHAPTER 3. CLINICAL TRIALS AND ASTHMA Overview Very few medical conditions have a single treatment. The basic treatment guidelines that your physician has discussed with you, or those that you have found using the techniques discussed in Chapter 1, may provide you with all that you will require. For some patients, current treatments can be enhanced with new or innovative techniques currently under investigation. In this chapter, we will describe how clinical trials work and show you how to keep informed of trials concerning asthma.
What Is a Clinical Trial?16 Clinical trials involve the participation of people in medical research. Most medical research begins with studies in test tubes and on animals. Treatments that show promise in these early studies may then be tried with people. The only sure way to find out whether a new treatment is safe, effective, and better than other treatments for asthma is to try it on patients in a clinical trial.
The discussion in this chapter has been adapted from the NIH and the NEI: www.nei.nih.gov/netrials/ctivr.htm.
16
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What Kinds of Clinical Trials Are There? Clinical trials are carried out in three phases: ·
Phase I. Researchers first conduct Phase I trials with small numbers of patients and healthy volunteers. If the new treatment is a medication, researchers also try to determine how much of it can be given safely.
·
Phase II. Researchers conduct Phase II trials in small numbers of patients to find out the effect of a new treatment on asthma.
·
Phase III. Finally, researchers conduct Phase III trials to find out how new treatments for asthma compare with standard treatments already being used. Phase III trials also help to determine if new treatments have any side effects. These trials--which may involve hundreds, perhaps thousands, of people--can also compare new treatments with no treatment. How Is a Clinical Trial Conducted?
Various organizations support clinical trials at medical centers, hospitals, universities, and doctors’ offices across the United States. The “principal investigator” is the researcher in charge of the study at each facility participating in the clinical trial. Most clinical trial researchers are medical doctors, academic researchers, and specialists. The “clinic coordinator” knows all about how the study works and makes all the arrangements for your visits. All doctors and researchers who take part in the study on asthma carefully follow a detailed treatment plan called a protocol. This plan fully explains how the doctors will treat you in the study. The “protocol” ensures that all patients are treated in the same way, no matter where they receive care. Clinical trials are controlled. This means that researchers compare the effects of the new treatment with those of the standard treatment. In some cases, when no standard treatment exists, the new treatment is compared with no treatment. Patients who receive the new treatment are in the treatment group. Patients who receive a standard treatment or no treatment are in the “control” group. In some clinical trials, patients in the treatment group get a new medication while those in the control group get a placebo. A placebo is a harmless substance, a “dummy” pill, that has no effect on asthma. In other clinical trials, where a new surgery or device (not a medicine) is being tested, patients in the control group may receive a “sham treatment.” This
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treatment, like a placebo, has no effect on asthma and does not harm patients. Researchers assign patients “randomly” to the treatment or control group. This is like flipping a coin to decide which patients are in each group. If you choose to participate in a clinical trial, you will not know which group you will be appointed to. The chance of any patient getting the new treatment is about 50 percent. You cannot request to receive the new treatment instead of the placebo or sham treatment. Often, you will not know until the study is over whether you have been in the treatment group or the control group. This is called a “masked” study. In some trials, neither doctors nor patients know who is getting which treatment. This is called a “double masked” study. These types of trials help to ensure that the perceptions of the patients or doctors will not affect the study results. Natural History Studies Unlike clinical trials in which patient volunteers may receive new treatments, natural history studies provide important information to researchers on how asthma develops over time. A natural history study follows patient volunteers to see how factors such as age, sex, race, or family history might make some people more or less at risk for asthma. A natural history study may also tell researchers if diet, lifestyle, or occupation affects how a disease or disorder develops and progresses. Results from these studies provide information that helps answer questions such as: How fast will a disease or disorder usually progress? How bad will the condition become? Will treatment be needed? What Is Expected of Patients in a Clinical Trial? Not everyone can take part in a clinical trial for a specific disease or disorder. Each study enrolls patients with certain features or eligibility criteria. These criteria may include the type and stage of disease or disorder, as well as, the age and previous treatment history of the patient. You or your doctor can contact the sponsoring organization to find out more about specific clinical trials and their eligibility criteria. If you are interested in joining a clinical trial, your doctor must contact one of the trial’s investigators and provide details about your diagnosis and medical history. If you participate in a clinical trial, you may be required to have a number of medical tests. You may also need to take medications and/or undergo
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surgery. Depending upon the treatment and the examination procedure, you may be required to receive inpatient hospital care. Or, you may have to return to the medical facility for follow-up examinations. These exams help find out how well the treatment is working. Follow-up studies can take months or years. However, the success of the clinical trial often depends on learning what happens to patients over a long period of time. Only patients who continue to return for follow-up examinations can provide this important long-term information.
Recent Trials on Asthma The National Institutes of Health and other organizations sponsor trials on various diseases and disorders. Because funding for research goes to the medical areas that show promising research opportunities, it is not possible for the NIH or others to sponsor clinical trials for every disease and disorder at all times. The following lists recent trials dedicated to asthma.17 If the trial listed by the NIH is still recruiting, you may be eligible. If it is no longer recruiting or has been completed, then you can contact the sponsors to learn more about the study and, if published, the results. Further information on the trial is available at the Web site indicated. Please note that some trials may no longer be recruiting patients or are otherwise closed. Before contacting sponsors of a clinical trial, consult with your physician who can help you determine if you might benefit from participation. ·
Asthma Clinical Research Network (ACRN) Condition(s): Asthma; Lung Diseases Study Status: This study is currently recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To establish a network of interactive asthma clinical research groups to maintain the required infrastructure to perform multiple therapeutic trials in asthmatic patients, thus facilitating rapid evaluation of new and existing therapeutic approaches. Phase(s): Phase III Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00000577
17
These are listed at www.ClinicalTrials.gov.
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·
Childhood Asthma Research and Education (CARE) Network Condition(s): Asthma; Lung Diseases Study Status: This study is currently recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To evaluate current and novel therapies and management strategies for children with asthma. The emphasis is on clinical trials that help identify optimal therapy for children with different asthma phenotypes, genotypes, and ethnic backgrounds and children at different developmental stages. Phase(s): Phase III Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00000622
·
Community Based Study of Adult Onset Asthma Condition(s): Asthma; Lung Diseases Study Status: This study is currently recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To identify the role of irritant exposure in adult-onset asthma by simultaneously using both clinical and case control methods in a community-based perspective study of asthma incidence. Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00005544
·
Role of T-Cells in Asthma Condition(s): Asthma Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID) Purpose - Excerpt: This study will examine the movement of T cells (a type of white blood cell) from the blood to the lungs in patients with asthma after exposure to an allergen, such as cat dander or pollen. Asthma is in large part due to inflammation of the bronchi (the breathing tubes of the lungs), causing heat, swelling and redness. T cells play a major role in the inflammatory reaction. A better understanding of T cell migration to the lungs after allergen exposure may lead to improved therapies for asthma. Patients between 18 and 50 years of age with mild allergic asthma may be eligible for this study. In addition, patients and
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healthy normal volunteers between 18 and 65 years of age may participate in a sub-study (blood draw) of this protocol. Participants will undergo the following procedures: Visit 1 (screening visit) - Blood tests for blood counts and HIV - Urine pregnancy test for women of childbearing potential. Visit 2 - Physical examination and electrocardiogram (EKG) - Prick skin testing - A drop of allergen extract is put on the skin and the underlying skin is scratched with a needle. A positive test resembles an insect bite and may itch. - Intradermal skin tests - Increasing concentrations of a drop of diluted allergen are injected into the skin and the allergic response is monitored until a 5-mm swelling (1/4 inch) swelling develops. - Methacholine challenge - The subject has repeated pulmonary function (breathing) tests after breathing methacholine, a drug that temporarily (for 5 to 10 minutes) worsens asthma symptoms. - Physician evaluation and repeat pulmonary function test Visit 3 - Allergen bronchoprovocaton - This test will be done in patients whose physical evaluation and breathing test permit them to continue with the study. A heparin lock (needle device that stays in a vein to allow multiple blood draws without repeated sticks) is placed. The subject breathes 5 breaths of allergen through a nebulizer (device that creates a mist), followed by a breathing test. This procedure will be repeated with increasingly higher allergen doses until lung function significantly declines or for a maximum of 6 doses. Subjects are monitored for 8 hours after the last dose. Blood samples of 50 ml each (3.5 tablespoons) are collected at 1, 3, 5 and 8 hours, and a physician evaluation is done at the end of the 8 hours. Additional 50-mm blood samples are collected the following two mornings. Visit 4 - Physician evaluation, blood test for anemia and pulmonary function test - Serial blood draws - 50 ml of blood will be drawn, followed by salt-water nebulization and another 50-ml blood draw after 1 hour. Additional 50ml blood samples will be drawn 7 hours later and then on the next two mornings. Participants in the sub-study portion of this protocol will undergo the screening blood test, prick skin testing, breathing test after methacholine inhalation and a 100 ml-blood draw. These tests will be done in three sessions. Study Type: Observational Contact(s): Maryland; National Institute of Allergy and Infectious Diseases (NIAID), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800411-1222
[email protected]; TTY 1-866-411-1010 Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00001408
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·
Sample Collections from the Airways of Asthmatic Patients Condition(s): Asthma; Healthy Study Status: This study is currently recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: Fiberoptic bronchoscopy is a procedure which involves passing a pencil-thin tube into the lung in order to collect fluid and cells from the airways. Fiberoptic bronchoscopy can collect cells from the walls of airways by gently brushing them (bronchial brushing). In addition, squirting small amounts of sterile water in to the airway and gently suctioning it back into the bronchoscope (bronchoalveolar lavage) collects cells. In this study, researchers plan to perform these tests on patients with asthma and normal volunteers. This research may help to improve the understanding of the processes involved in airway inflammation and asthma. Study Type: Observational Contact(s): Maryland; National Heart, Lung and Blood Institute (NHLBI), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800-411-1222
[email protected]; TTY 1-866-411-1010 Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00001888
·
Study of Daclizumab in Patients with Chronic, Persistent Asthma Condition(s): Asthma Study Status: This study is currently recruiting patients. Sponsor(s): Protein Design Labs Purpose - Excerpt: The purpose of the study is to evaluate an investigational medication to treat chronic persistent asthma. The research is being conducted at up to 22 clinical research sites in the US and is open to both men and women ages 18 to 70 years old. Participants in the study will have a number of visits to a research site over a 10month period. All study-related care and medication is provided to qualified participants at no cost: this includes all visits, examinations and laboratory work. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00028288
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·
Study of TNFR:Fc (Enbrel) in the Treatment of Asthma Condition(s): Asthma Study Status: This study is currently recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: The proposed study is a phase II clinical trial of TNFR:Fc therapy in a segmental allergen bronchoprovocation model of atopic asthma. The goal of this study is to assess whether inhibition of tumor necrosis factor (TNF) bioactivity can attenuate airway inflammation in mild-to-moderate allergic asthmatics. This protocol will utilize a randomized, double-blind, placebo-controlled trial design. TNF bioactivity will be inhibited via systemic administration (e.g., subcutaneous injection) of a dimeric fusion protein consisting of the extracellular ligand binding domain of the 75-kilodalton TNF receptor linked to the Fc portion of human IgG1 (TNFR:Fc, Immunex). The data generated by this study will address the utility of anti-TNF therapy for patients with asthma. Phase(s): Phase II Study Type: Interventional Contact(s): Maryland; National Heart, Lung and Blood Institute (NHLBI), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800-411-1222
[email protected]; TTY 1-866-411-1010 Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00001893
·
Antibiotics in Infancy-Risk Factor for Childhood Asthma Condition(s): Asthma; Lung Diseases Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To examine possible relationships between antibiotic use, as determined by prescriptions filled, and asthma in children ages 6 to 7. Study Type: Epidemiology Contact(s): Ownby, Dennis R. Augusta, Georgia, United States . Study chairs or principal investigators: Ownby, Dennis R., Study Chair; Medical College of Georgia Augusta, Georgia, United States Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00037726
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·
Asthma & Exposure to Peaks in Particulate Air Pollution Condition(s): Asthma Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Environmental Health Sciences (NIEHS) Purpose - Excerpt: We are testing the following two hypotheses: 1) Peaks in hourly exposures to airborne particulate matter (PM) of outdoor origin will be more closely associated with acute asthmatic responses to particles than 24-hour average exposures in susceptible individuals; 2) Personal exposure to PM, and estimated particle dose to the lungs, will be more closely associated with daily asthma severity than standard outdoor particle concentrations measured as 24-hour averages at governmental monitoring sites. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00013728
·
Childhood Asthma Management Program (CAMP) Condition(s): Asthma; Lung Diseases Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To evaluate the long term effects of anti-inflammatory therapy compared to bronchodilator therapy on the course of asthma, particularly on lung function and bronchial hyperresponsiveness, and on physical and psychosocial growth and development. Phase(s): Phase III Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00000575
·
Chromosome 5Q Gene Variants and Asthma-Related Traits Condition(s): Asthma; Lung Diseases Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To identify gene variants in human chromosome 5Q31-33 that may be involved in the pathogenesis of asthma. Study Type: Genetic Epidemiology
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Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00006511 ·
Chronic Life Stress and Incident Asthma in Adult Women Condition(s): Asthma; Lung Diseases Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To prospectively examine the association between a specific chronic life stressor (i.e., intimate violence exposure) and adult asthma in women. Study Type: Epidemiology Contact(s): Wright, Rosalind J. Boston, Massachusetts, United States . Study chairs or principal investigators: Wright, Rosalind J., Study Chair; Brigham and Women's Hospital Boston, Massachusetts, United States Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00006498
·
Collaborative Studies on the Genetics of Asthma (CSGA) Condition(s): Asthma; Lung Diseases Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To conduct molecular genetic studies in human pedigrees in order to identify the major genes responsible for asthma. Study Type: Epidemiology, Genetic Epidemiology Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00005500
·
Community Based Study on Occupational Asthma Condition(s): Asthma; Lung Diseases Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To examine the occupations, industries and exposures in the work-place which are associated with a high risk for asthma and other adverse respiratory health effects, with particular emphasis on specific exposures of predominantly female occupations (irritants, detergents and other asthmagens), and of other high risk major occupations which have not been adequately examined.
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Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00005755 ·
Controlling Asthma at School Condition(s): Asthma; Lung Diseases Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To implement and evaluate a coordinated set of activities for asthma identification, education, management, and prevention in the predominantly minority inner city schools in the Detroit metropolitan area. Study Type: Demonstration and Education Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00005735
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Endotoxin and Bronchial Inflammation in Asthma Condition(s): Asthma; Lung Diseases Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To evaluate airway inflammation in persons with asthma exposed to endotoxin, a common occupational air contaminant. Subjects are subsequently challenged with allergen. Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00005550
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Epidemiology of Symptom Perception in Childhood Asthma Condition(s): Asthma; Lung Diseases Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To investigate the determinants of valid symptom perception in childhood asthma and the relation of symptom perception to asthma morbidity. Study Type: Behavioral Medicine, Epidemiology Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00005461
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Exposure of Children with Asthma to Household Environmental Tobacco Smoke Condition(s): Asthma; Lung Diseases Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To examine whether or not primary school-aged children with asthma from low-income households have lower household environmental tobacco smoke (ETS) exposure than matched control children. Study Type: Epidemiology Contact(s): Walboldt, Frederick Denver, Colorado, United States . Study chairs or principal investigators: Walboldt, Frederick, Study Chair; National Jewish Medical & Research Center Denver, Colorado, United States Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00035685
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Genetic Epidemiology of Asthma in Costa Rica Condition(s): Asthma; Lung Diseases Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To identify genetic factors that influence the development of asthma in Hispanics. Study Type: Genetic Epidemiology Contact(s): Weiss, Scott T. Boston, Massachusetts, United States . Study chairs or principal investigators: Weiss, Scott T., Study Chair; Brigham and Women's Hospital Boston, Massachusetts, United States Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00021840
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Genetics of Asthma and Bronchial Hyperresponsiveness Condition(s): Asthma; Lung Diseases Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To investigate the genetics of asthma by reexamining a carefully characterized population of patients with asthma, and by studying their families. Study Type: Epidemiology Contact(s): see Web site below
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Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00005359 ·
Impact of Adult Asthma Condition(s): Asthma; Lung Diseases Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To assess the separate and interactive effects of asthma severity, subspecialty practice variation, asthma-related psychosocial variables, and other factors on asthma outcomes, including asthmaspecific quality of life and activity limitations, health care utilization for asthma, and direct and indirect costs of asthma. Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00005564
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Intervention to Improve Asthma Management/Prevention Condition(s): Asthma; Lung Diseases Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To implement and evaluate a comprehensive asthma education and prevention program in all 54 public elementary schools in the predominantly minority Birmingham, Alabama school system. Study Type: Demonstration and Education Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00005734
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Adherence in the Childhood Asthma Management Program Condition(s): Asthma; Lung Diseases Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI); National Institute of Nursing Research (NINR) Purpose - Excerpt: To evaluate three adherence promoting interventions within the Childhood Asthma Management Program (CAMP), an eight center clinical trial that compared pediatric asthma therapies in children five to twelve years old. Study Type: Analysis of Clinical Trials Contact(s): see Web site below
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Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00005705 ·
Asthma Partnership for Minority Children Condition(s): Asthma; Lung Diseases Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To evaluate the efficacy of a community-based intervention to improve asthma management for parents, children and health care providers. Study Type: Demonstration and Education Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00005716
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Childhood Asthma Program in NYC Health Department Clinics Condition(s): Asthma; Lung Diseases Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To demonstrate that the New York City Department of Health Child Health Clinics could improve the health status of Black and Hispanic children with asthma by providing them with a comprehensive system of continuity of care that included pharmacologic treatment, family health education and community outreach. Study Type: Demonstration and Education Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00005713
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Clinical Epidemiology of Asthma in An HMO Condition(s): Asthma; Lung Diseases Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To provide information on morbidity and health care utilization for asthma for a large, well-defined population over a 20 year period. Study Type: Epidemiology Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00005291
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Community Intervention for Minority Children with Asthma Condition(s): Asthma; Lung Diseases Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To test the effectiveness of school-based asthma education interventions, community-based asthma health workers' programs and the combination of these on asthmatic children. Also, to examine the separate and combined impact of asthma interventions designed to address problems associated with effective asthma selfmanagement amd difficulties in establishing and maintaining continuity of medical care. Study Type: Demonstration and Education Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00005715
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Develop and Implement Asthma Controlling Strategies Condition(s): Asthma; Lung Diseases Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To develop and implement asthma controlling strategies for inner city and high risk populations. Study Type: Demonstration and Education Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00005732
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Development and Evaluation of Community Asthma Program Condition(s): Asthma; Lung Diseases Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To evaluate a community organization approach to promoting asthma management in four neighborhoods in St. Louis with predominantly low income, Black populations. Study Type: Demonstration and Education Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00005714
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Disability Among Adults with Asthma Condition(s): Asthma; Lung Diseases Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To identify risk factors for work disability among adults with asthma treated by pulmonary and allergy specialists. Study Type: Epidemiology Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00005440
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Epidemiology of Pediatric Asthma Hospitalization Condition(s): Asthma; Lung Diseases Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To study three possible, but yet unproven, influences on pediatric asthma hospitalization rates - diagnostic substitution, different systems of medical care, and asthma medication use. Study Type: Epidemiology Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00005445
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Family Process, Adherence, and Child Asthma Outcome Condition(s): Asthma; Lung Diseases Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To examine the role of family processes in asthma regulation in three groups of children with mild to moderate asthma. Study Type: Longitudinal Human Study Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00005390
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Intervention for Hispanic Children with Asthma Condition(s): Asthma; Lung Diseases Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI)
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Purpose - Excerpt: To design, implement, and evaluate an intervention program for Hispanic children with asthma which included both a physician education and a patient/family education component. Study Type: Demonstration and Education Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00005711 ·
Magnesium and Asthma - Clinical Trials Condition(s): Asthma Study Status: This study is not yet open for patient recruitment. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: Asthma currently affects an estimated 14 million Americans. A number of studies have found an association between low dietary magnesium (Mg) intake and increased asthma incidence and severity of symptoms. However, clinical intervention trials are necessary to directly assess whether there is a true protective or preventative causal relationship between low Mg and asthma. In our study, we will assess the effects of one year of oral Mg supplements or placebo on clinical markers of asthma control, indirect biomarkers of inflammation, bronchial hyperresponsiveness, and indices of oxidative defense and damage in subjects with mild to moderate persistent asthma. Phase(s): Phase II Study Type: Interventional Contact(s): California; Veterans Administration Medical Center - Mather, Sacramento, California, 95655, United States; Sarah Kuhl, M.D. 916-8437107
[email protected]; Sarah Kuhl, M.D., Ph.D., Principal Investigator; Judith S. Stern, Sc.D., R.D., Principal Investigator Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00029510
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Multicenter Asthma Research Collaboration Condition(s): Asthma; Lung Diseases Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To study the epidemiology of emergency asthma by focusing on three Multicenter Asthma Research Collaboration (MARC) databases collected over a two-year period in adult and pediatric emergency departments.
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Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00005563 ·
NHLBI/NICHD Collaborative Studies of Asthma in Pregnancy Condition(s): Asthma; Lung Diseases Study Status: This study is completed. Sponsor(s): National Institute of Child Health and Human Development (NICHD); National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To conduct a collaborative program of research on asthma and pregnancy consisting of two studies: the Asthma in Pregnancy Study (APS) is an observational study to evaluate relationships between asthma severity and treatment programs and perinatal outcome, and the Asthma Therapy in Pregnancy Trial (ATPT) is a randomized clinical trial of inhaled beclomethasone versus theophylline in the treatment of moderate asthma during pregnancy. Both studies are conducted in the Maternal-Fetal Medicine Unit (MFMU) Network, an ongoing group of participating obstetric centers supported by the National Institute of Child Health and Human Development. Studies are co-funded by the NHLBI. Phase(s): Phase III Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00000578
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Predictors of Hospital-Based Care in Asthma Condition(s): Asthma; Lung Diseases Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To identify clinical predictors of episodes of hospitalbased care in people with asthma. Study Type: Epidemiology Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00005484
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Risk Factors For Asthma in Laboratory Animal Allergy Condition(s): Asthma; Lung Diseases Study Status: This study is completed.
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Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To identify risk factors which predispose individuals to develop asthma and other manifestations of allergic disease on exposure to laboratory animals in the workplace. Study Type: Epidemiology Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00005283 ·
Self Management Education Asthma Condition(s): Asthma; Lung Diseases Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To evaluate the effects of a new statewide program to enhance identification, referral and provision of care to rural families of Hispanic children with moderately severe to severe asthma. Specifically, to determine if comprehensive medical care (CMC) plus an educational self-management program for rural Hispanic children and their families had an impact on asthma morbidity, as well as on cost and family adaptation. Study Type: Demonstration and Education Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00005712
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The Genetics of Environmental Asthma Condition(s): Asthma Study Status: This study is not yet open for patient recruitment. Sponsor(s): National Center for Research Resources (NCRR) Purpose - Excerpt: In this project, we hypothesize that polymorphisms of genes expressed by the airway epithelia in asthmatics following specific airway challenges predispose individuals to the development of asthma. To test this hypothesis, we plan to identify the genes that are differentially expressed by airway epithelial cells following challenge with stimuli that induce acquired (house dust mite) or innate (LPS) immune responses, and then determine whether polymorphisms in these genes are associated with the development of asthma in a separate, well characterized, familial cohort of asthmatics. This is a powerful approach that is designed to identify novel genes that are associated with both asthma pathogenesis (differentially expressed in the exposure-response
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study) and asthma susceptibility (genetically associated with asthma in a linkage/association study). Study Type: Observational Contact(s): North Carolina; Duke University Medical Center, Durham, North Carolina, 27710, United States; David A. Schwartz, M.D., MPH 919-668-0380 Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00018096
Benefits and Risks18 What Are the Benefits of Participating in a Clinical Trial? If you are interested in a clinical trial, it is important to realize that your participation can bring many benefits to you and society at large: ·
A new treatment could be more effective than the current treatment for asthma. Although only half of the participants in a clinical trial receive the experimental treatment, if the new treatment is proved to be more effective and safer than the current treatment, then those patients who did not receive the new treatment during the clinical trial may be among the first to benefit from it when the study is over.
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If the treatment is effective, then it may improve health or prevent diseases or disorders.
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Clinical trial patients receive the highest quality of medical care. Experts watch them closely during the study and may continue to follow them after the study is over.
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People who take part in trials contribute to scientific discoveries that may help other people with asthma. In cases where certain diseases or disorders run in families, your participation may lead to better care or prevention for your family members.
This section has been adapted from ClinicalTrials.gov, a service of the National Institutes of Health: http://www.clinicaltrials.gov/ct/gui/c/a1r/info/whatis?JServSessionIdzone_ct=9jmun6f2 91. 18
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The Informed Consent Once you agree to take part in a clinical trial, you will be asked to sign an “informed consent.” This document explains a clinical trial’s risks and benefits, the researcher’s expectations of you, and your rights as a patient. What Are the Risks? Clinical trials may involve risks as well as benefits. Whether or not a new treatment will work cannot be known ahead of time. There is always a chance that a new treatment may not work better than a standard treatment. There is also the possibility that it may be harmful. The treatment you receive may cause side effects that are serious enough to require medical attention. How Is Patient Safety Protected? Clinical trials can raise fears of the unknown. Understanding the safeguards that protect patients can ease some of these fears. Before a clinical trial begins, researchers must get approval from their hospital’s Institutional Review Board (IRB), an advisory group that makes sure a clinical trial is designed to protect patient safety. During a clinical trial, doctors will closely watch you to see if the treatment is working and if you are experiencing any side effects. All the results are carefully recorded and reviewed. In many cases, experts from the Data and Safety Monitoring Committee carefully monitor each clinical trial and can recommend that a study be stopped at any time. You will only be asked to take part in a clinical trial as a volunteer giving informed consent. What Are a Patient’s Rights in a Clinical Trial? If you are eligible for a clinical trial, you will be given information to help you decide whether or not you want to participate. As a patient, you have the right to: ·
Information on all known risks and benefits of the treatments in the study.
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Know how the researchers plan to carry out the study, for how long, and where.
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Know what is expected of you.
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Know any costs involved for you or your insurance provider.
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Know before any of your medical or personal information is shared with other researchers involved in the clinical trial.
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Talk openly with doctors and ask any questions.
After you join a clinical trial, you have the right to: ·
Leave the study at any time. Participation is strictly voluntary. However, you should not enroll if you do not plan to complete the study.
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Receive any new information about the new treatment.
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Continue to ask questions and get answers.
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Maintain your privacy. Your name will not appear in any reports based on the study.
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Know whether you participated in the treatment group or the control group (once the study has been completed).
What about Costs? In some clinical trials, the research facility pays for treatment costs and other associated expenses. You or your insurance provider may have to pay for costs that are considered standard care. These things may include inpatient hospital care, laboratory and other tests, and medical procedures. You also may need to pay for travel between your home and the clinic. You should find out about costs before committing to participation in the trial. If you have health insurance, find out exactly what it will cover. If you don’t have health insurance, or if your insurance company will not cover your costs, talk to the clinic staff about other options for covering the cost of your care. What Should You Ask before Deciding to Join a Clinical Trial? Questions you should ask when thinking about joining a clinical trial include the following: ·
What is the purpose of the clinical trial?
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What are the standard treatments for asthma? Why do researchers think the new treatment may be better? What is likely to happen to me with or without the new treatment?
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·
What tests and treatments will I need? Will I need surgery? Medication? Hospitalization?
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How long will the treatment last? How often will I have to come back for follow-up exams?
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What are the treatment’s possible benefits to my condition? What are the short- and long-term risks? What are the possible side effects?
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Will the treatment be uncomfortable? Will it make me feel sick? If so, for how long?
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How will my health be monitored?
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Where will I need to go for the clinical trial? How will I get there?
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How much will it cost to be in the study? What costs are covered by the study? How much will my health insurance cover?
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Will I be able to see my own doctor? Who will be in charge of my care?
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Will taking part in the study affect my daily life? Do I have time to participate?
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How do I feel about taking part in a clinical trial? Are there family members or friends who may benefit from my contributions to new medical knowledge?
Keeping Current on Clinical Trials Various government agencies maintain databases on trials. The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide patients, family members, and physicians with current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to their Web site (www.clinicaltrials.gov) and search by “asthma” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The
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following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: ·
For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/
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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html
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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm
General References The following references describe clinical trials and experimental medical research. They have been selected to ensure that they are likely to be available from your local or online bookseller or university medical library. These references are usually written for healthcare professionals, so you may consider consulting with a librarian or bookseller who might recommend a particular reference. The following includes some of the most readily available references (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
A Guide to Patient Recruitment : Today’s Best Practices & Proven Strategies by Diana L. Anderson; Paperback - 350 pages (2001), CenterWatch, Inc.; ISBN: 1930624115; http://www.amazon.com/exec/obidos/ASIN/1930624115/icongroupinterna
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A Step-By-Step Guide to Clinical Trials by Marilyn Mulay, R.N., M.S., OCN; Spiral-bound - 143 pages Spiral edition (2001), Jones & Bartlett Pub; ISBN: 0763715697; http://www.amazon.com/exec/obidos/ASIN/0763715697/icongroupinterna
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The CenterWatch Directory of Drugs in Clinical Trials by CenterWatch; Paperback - 656 pages (2000), CenterWatch, Inc.; ISBN: 0967302935; http://www.amazon.com/exec/obidos/ASIN/0967302935/icongroupinterna
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The Complete Guide to Informed Consent in Clinical Trials by Terry Hartnett (Editor); Paperback - 164 pages (2000), PharmSource Information Services, Inc.; ISBN: 0970153309; http://www.amazon.com/exec/obidos/ASIN/0970153309/icongroupinterna
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Dictionary for Clinical Trials by Simon Day; Paperback - 228 pages (1999), John Wiley & Sons; ISBN: 0471985961; http://www.amazon.com/exec/obidos/ASIN/0471985961/icongroupinterna
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Extending Medicare Reimbursement in Clinical Trials by Institute of Medicine Staff (Editor), et al; Paperback 1st edition (2000), National Academy Press; ISBN: 0309068886; http://www.amazon.com/exec/obidos/ASIN/0309068886/icongroupinterna
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Handbook of Clinical Trials by Marcus Flather (Editor); Paperback (2001), Remedica Pub Ltd; ISBN: 1901346293; http://www.amazon.com/exec/obidos/ASIN/1901346293/icongroupinterna
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH]
Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Antibiotic: A drug that kills or inhibits the growth of bacteria. [NIH] Beclomethasone: An anti-inflammatory, synthetic glucocorticoid. It is used topically as an anti-inflammatory agent and in aerosol form for the treatment of asthma. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchodilator: A drug that relaxes the smooth muscles in the constricted airway. [NIH] Bronchoscope: A long, narrow tube with a light at the end that is used by the doctor for direct observation of the airways, as well as for suction of tissue and other materials. [NIH] Bronchoscopy: A technique for visualizing the interior of bronchi and instilling or removing fluid or tissue samples by passing a lighted tube (bronchoscope) through the nose or mouth into the bronchi. [NIH] Causal: Pertaining to a cause; directed against a cause. [EU] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] EKG: Measurement of electrical activity during heartbeats. [NIH] Electrocardiogram:
Measurement of electrical activity during heartbeats.
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[NIH]
Endogenous: Developing or originating within the organisms or arising from causes within the organism. [EU] Endotoxin: Toxin from cell walls of bacteria. [NIH] Extracellular: Outside a cell or cells. [EU] Genotype: The entire genetic makeup of an individual. The fundamental constitution of an organism in terms of its hereditary factors. A group of organisms in which each has the same hereditary characteristics. [NIH] Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts. [NIH] Hypersensitivity: A state of altered reactivity in which the body reacts with an exaggerated immune response to a foreign substance. Hypersensitivity reactions are classified as immediate or delayed, types I and IV, respectively, in the Gell and Coombs classification (q.v.) of immune responses. [EU] Inhalation: The drawing of air or other substances into the lungs. [EU] Lavage: To wash the interior of a body organ. [NIH] Mucus: A thick fluid produced by the lining of some organs of the body. [NIH]
Necrosis: The sum of the morphological changes indicative of cell death and caused by the progressive degradative action of enzymes; it may affect groups of cells or part of a structure or an organ. [EU] Particle: A tiny mass of material. [EU] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenotype: The entire physical, biochemical, and physiological makeup of an individual as determined by his or her genes and by the environment in the broad sense. [NIH] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface
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receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Recombinant: 1. a cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Rhinovirus: A genus of picornaviridae inhabiting primarily the respiratory tract of mammalian hosts. It includes the human strains associated with common colds. [NIH] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Symptomatic: 1. pertaining to or of the nature of a symptom. 2. indicative (of a particular disease or disorder). 3. exhibiting the symptoms of a particular disease but having a different cause. 4. directed at the allying of symptoms, as symptomatic treatment. [EU] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU]
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PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL
ABOUT PART II In Part II, we introduce you to additional resources and advanced research on asthma. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on asthma. In Part II, as in Part I, our objective is not to interpret the latest advances on asthma or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with asthma is suggested.
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CHAPTER 4. STUDIES ON ASTHMA Overview Every year, academic studies are published on asthma or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on asthma. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on asthma and teach you how to keep current on new studies as they are published or undertaken by the scientific community.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and asthma, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the
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format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “asthma” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·
Use of Complementary Therapies in Childhood Asthma Source: Pediatric Asthma, Allergy and Immunology. 12(1): 29-32. 1998. Summary: This journal article reports a study of the use of complementary therapies in childhood asthma. A questionnaire was mailed to 17,000 members of the National Asthma Campaign, United Kingdom; an estimated 4,000 of these members had children under age 16 years. Of the 1,471 respondents, 33 percent reported they had tried some form of complementary medicine for their children. The most popular therapies were homeopathy (15 percent), breathing techniques (15 percent), herbalism (6 percent), and osteopathy (2 percent). Twentysix percent of respondents felt that the complementary therapies had improved their children's symptoms to some or a great extent, 34 percent felt that symptoms had improved slightly or not at all, and the rest did not answer this question. The amount of money spent on complementary therapies generally was modest. The author concludes that complementary medicine frequently is used for childhood asthma, and that these therapies generally are perceived as being moderately helpful. The article has 1 table and 15 references.
Federally-Funded Research on Asthma The U.S. Government supports a variety of research studies relating to asthma and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.19 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally-funded biomedical research projects conducted at Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
19
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universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to asthma and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally-funded studies use animals or simulated models to explore asthma and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for asthma: ·
Project Title: Asthma Clinical Research Network Center Principal Investigator & Institution: Boushey, Homer A.; Professor of Medicine; Cardiovascular Research Inst; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94143 Timing: Fiscal Year 2000; Project Start 0-SEP-1993; Project End 1-AUG2003 Summary: This application proposes to continue the participation of investigators at UCSF in an interactive network of six centers, the Asthma Clinical Research Network (ACRN) in conducting studies of novel therapies for asthma and in disseminating findings to the practicing community. The need for such a network was suggested by increases in the mortality, morbidity, prevalence, and costs of asthma, by research studies showing that asthma is linked to airway inflammation, and by the accelerating rate of development of potentially effective, but also potentially costly treatments. Defining the place of these new therapies was seen as requiring collaborative, multi-center studies examining subjects reflecting the diversity of the U.S. population. In its first 5 years, the ACRN established an interactive infrastructure and added a research site at Harlem Hospital, New York, which serves a predominantly minority population. The ACRN completed and published trials of the effects of regular use of a Beta-agonist in mild asthma("BAGS") and of the efficacy of colchicine as an alternate to an inhaled corticosteroid (ICS) in moderate asthma. It is now conducting trials comparing a long-acting Beta-agonist, an ICS, and the combination of the two in moderate to severe asthma. We are about to start a 5th study to establish doses of different ICS with equivalent effects on cortisol secretion. These studies have been presented at meetings of the ATS, ACCP, and AAAAI, as have 10-12 ancillary studies analyzing the performance of clinical research. The ACRN has also reported its findings from subgroup analysis of the
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"BAGS" study: that subjects with different genotypes for the Betaadrenergic receptor are differently affected by regular use of albuterol. This application proposes continued participation of the UCSF Asthma Clinical Research group in the multicentered, collaborative trials of the ACRN. The studies proposed include a comparison of the clinical efficacy of doses of different inhaled corticosteroids with equal systemic effects, a prospective study of regular use of an inhaled Beta-agonist in subjects stratified by genotypes for the Beta-adrenergic receptor, a study of the efficacy of a leukotriene pathway antagonist in enabling reduction or elimination of inhaled corticosteroid therapy in subjects with mild or moderate persistent asthma, and other studies illustrated briefly in this application, but modified or replaced by the ACRN Steering Committee in response to new information or the release of new forms of therapy. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Automated System for Telephonic Mgmt of Asthma Principal Investigator & Institution: Albisser, Am M.; Better Control Medical Computers (Bcmc) 1413 20Th St, Unit 207 Miami Beach, Fl 33139 Timing: Fiscal Year 2000; Project Start 0-SEP-1997; Project End 1-MAR2001 Summary: Asthma is a highly prevalent disease with a significant morbidity leading to emergency room visits, hospitalizations and absenteeism from work and school. Two major factors contributing to asthma morbidity (and mortality) are failure to detect asthma decompensation and use of inappropriate treatment strategies. Asthma severity can be assessed by clinical symptoms and peak flow measurements. There are internationally accepted guidelines for asthma management. However, rapid translation of asthma symptoms into a change in therapy is frequently impeded by the patient's inability to understand self management, reluctance to contact the health care provider, or delays in feedback from the provider to the patient. The objective of the proposal is to develop and clinically evaluate a new Automated System for Telephonic Home Management of Asthma. We describe the design and alpha testing of a dynamic relational database (DRdb) suitable for use either in a isolated PC or in a distributed computer system to support daily reporting and facilitate all provider monitoring. The resulting DRdb accepts information about the patient, their specific diagnoses and treatment regimens. Each DRdb is accessible on-line, linked through LAN or WAN and captures the patient's symptoms and measurements at the moment when they are reported. Because the patient's history is electronically available, the DRdb can dynamically support the health professional to relay instructions
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immediately. Generally these instructions are pre-defined by the patient's doctor for the reported symptom set. Automation of these procedures may be possible. Specifically, we are developing a custom telephone interface, conducting a clinical trial in both adult and pediatric populations in which asthma management is under constant physician direction and where asthma intervention is (I) computer-assisted, (II) computer-mediated, or (III) according to conventional methods (Control Group). We measure end-points relevant to disease managers(costs), to health care providers(time) and to asthmatic patients(respiratory outcomes). The goals of the Asthma system described in this proposal are to save time (efficacy), and increase patient and health care provider satisfaction (attractiveness). PROPOSED COMMERCIAL APPLICATION: The commercial application of this grant may be attractive to Health Maintenance Organizations, Medicare and Medicaid as well as those who see the need for cost containment. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Collaborative Study of the Genetics of Asthma Principal Investigator & Institution: Beaty, Terri H.; Professor; Epidemiology; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2000; Project Start 0-SEP-1992; Project End 1-AUG2002 Summary: Asthma is a respiratory disease characterized by variable airways obstruction, airways inflammation and bronchial hyperresponsiveness (BHR). There are increases in asthma mortality and prevalence in the US, especially in African- Americans. Multiple studies suggest that both genetic and environmental factors are important in asthma susceptibility. The aim of the Collaborative Study of the Genetics of Asthma (CSGA) is to identify asthma susceptibility loci. The CSGA is composed of four centers (Johns Hopkins University, University of Chicago, University of Maryland, University of Minnesota, and a data coordinating center at Bowman Gray). At each center, families were ascertained through two siblings with asthma. All family members were characterized with spirometry, bronchial responsiveness to methacholine or reversibility testing, skin-tests and questionnaire data. The initial genome screen has been completed on the first 237 sib pairs from three racial groups (African-American, Caucasian and Hispanic), and genotyping On the remaining family members and families will be completed before the start of the renewal proposal. Therefore, the initial aim of the CSGA to map susceptibility regions has been completed, with detection of several novel chromosomal regions, and replication of
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several regions previously linked to associated phenotypes. In order to determine the importance of these regions in asthma susceptibility and the impact of environmental rink factors, we propose to l) evaluate the evidence for linkage in the complete CSGA data using 2-point, multipoint and multilocus approaches for asthma and associated phenotypes (including BHR, total serum IgE and skin test reactivity to standardized allergens); 2) perform fine mapping studies of regions using additional genetic markers to obtain a < 2 cM map; 3) identify candidate genes and novel sequence variants; and 4) characterize a patient population with asthma to study identified variants with respect to asthma severity and bronchial inflammation. These studies will allow us to identify asthma susceptibility genes and their variants, interactions with other genes and environmental risk factors, as well as provide insight for the development of improved treatment and ultimate prevention of asthma. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Community Partnership for Asthma Prevention Principal Investigator & Institution: Bryant-Stephens, Tyra; ; Children's Hospital of Philadelphia 34Th St and Civic Ctr Blvd Philadelphia, Pa 19104 Timing: Fiscal Year 2001; Project Start 5-SEP-2001; Project End 1-AUG2005 Summary: (provided by applicant) Despite the development of new asthma medicines and treatment, asthma morbidly continues to rise. This is especially true for the urban, poor, minority population. Other modalities of intervention must be tried in order to change the rise in asthma morbidity. Studies have demonstrated that asthma education improves the asthmatic's course of disease. Studies have also demonstrated that removal of common indoor asthma triggers leads to a reduction in inpatient visits and use of rescue medications. The broad, long-term objective of the proposed project is to reduce the morbidity associated with environmentally triggered asthma in urban, economically disadvantaged communities. In order to achieve this objective, this project proposes to develop a model, comprehensive community asthma prevention program by combining, expanding, and disseminating two well-established programs of the Children's Hospital of Philadelphia's Community Asthma Prevention Program (CAPP) into a comprehensive asthma program run in the community with community involvement. This will be accomplished through partnership of The Children's Hospital of Philadelphia (CHOP) Primary Care Department, with the community-based Children's Services, Inc.(CSI) Family Centers and environmental scientists at the Department of Earth and Environmental
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Sciences at the University of Pennsylvania (E&ES). The central hypothesis of the proposed research is this: A comprehensive self-sustaining community-based asthma prevention program that involves the partnership of The Children's Hospital of Philadelphia's CAPP, CSI Family Centers, and the Department of Earth and Environmental Sciences, with its included Institute of Environmental Studies, will lead to a reduction in asthma morbidity and an improved quality of life for members of that community. The specific aims are: 1) create a comprehensive asthma prevention program by combining home asthma education with home asthma trigger removal into one comprehensive asthma prevention program to be offered to members of CSI Family Centers and CHOP primary care families who live in West and Southwest Philadelphia, 2) evaluate 300 families enrolled into this comprehensive asthma prevention program over the course of four years for decreased hospitalizations, decreased emergency room visits, and improved quality of life, 3) increase asthma educational activities offered within the Family Centers, 4) train Parent Asthma Scholars to conduct asthma classes within the CSI Family Centers through the train-thetrainer model which has proven successful for CAPP. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Outcomes?
Does
Shared
Decision-Making
Improve
Asthma
Principal Investigator & Institution: Buist, Aline S.; Associate Professor of Medicine; Kaiser Foundation Research Institute 1800 Harrison St, 16Th Fl Oakland, Ca 94612 Timing: Fiscal Year 2001; Project Start 1-JUN-2001; Project End 1-MAY2006 Summary: (Applicant's Abstract) Although much is now known about asthma, and there is effective asthma treatment, only about half of the patients with persistent asthma adhere to their prescribed long-term controller medication. One way to change this might be to involve patients more in decisions about their treatment. We propose a five-year project to develop and evaluate the effectiveness of a new model of clinician-patient interaction, shared decision-making, in improving outcomes in adults aged 18-70 years with suboptimally controlled, mildmoderate persistent asthma. The shared decision-making model (SD) will be compared in a randomized, controlled clinical trial with a model based on national asthma guidelines (MG), and with usual care (UC). Primary outcomes will be asthma-related quality of life and acute asthma health care; secondary outcomes will be asthma control, adherence, symptomfree days, lung function, dispensings of asthma medications, satisfaction
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with asthma care, asthma- related costs, and total asthma-related health care utilization. The project will be carried out in Kaiser Permanente Northwest (KPNW) and KP Hawaii (KPH) and will have two phases. In Phase 1 we will adapt the two intervention programs from asthma education programs that we have developed, and shared decisionmaking programs developed by our consultants. We will pretest them to ensure that they are culturally appropriate for the target populations. In the second phase, the randomized clinical trial, we will recruit 342 patients (2/3 from KPNW and 1/3 from KPH) with suboptimally controlled persistent asthma, using the KP administrative databases. Eligible patients will be randomized on a 1:1:1 basis into three groups: management by shared decision- making, management by guidelines, and usual care. Patients in the two intervention groups will each meet with a care manager for two one-hour sessions, have their management plan reviewed and modified as necessary using the model for their group assignment, and will subsequently be called at three, six, and nine months. All participants will be followed for two years with outcome data collected at 12 and 24 months. If effective, this model can be incorporated into clinical practice to improve asthma outcomes and reduce costs. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Effects of Asthma Severity and Medication in Pregnancy Principal Investigator & Institution: Bracken, Michael B.; Professor and Head; Epidemiology and Public Health; Yale University New Haven, Ct 06520 Timing: Fiscal Year 2000; Project Start 1-SEP-1996; Project End 1-AUG2001 Summary: (Adapted from Investigator's Abstract) The prevalence rate of asthma in the general population appears to have increased substantially in recent years with a concomitant rise in gestational asthma. Recent data suggest that as many as 5% of pregnancies are complicated with asthma, and this appears particularly high in pregnancies of black (9%) and Hispanic (14%) women. This increased prevalence rate has not been accompanied by improved understanding about potential risks of asthma and asthma medications on pregnancy outcome or by improved knowledge about the influence of pregnancy itself on asthma symptomatology. The investigators propose to conduct a prospective study, stratified and frequency matched by race and ethnicity, of 13,000 women screened in early pregnancy. Study groups will compare 1,100 women with a prior diagnosis of asthma and 1,650 unexposed controls; providing 50% white, 30% Hispanic and 20% black study subjects.
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Asthmatic women will be monitored using spirometry and objective clinical criteria throughout pregnancy for symptom changes and medication use. The study will primarily estimate increased risk, owed to asthma symptoms and asthma medication (particularly bronchodilators), on preterm labor, preterm delivery, and intrauterine growth retardation. Secondary outcomes are gestational hypertension, pre eclampsia and spontaneous abortion. Known and suspected risk factors for the pregnancy outcomes and asthma will be studied to evaluate their role in the etiology of gestational asthma, to control for confounding, and assess effect modification. The asthmatic risk factors of primary interest will be evaluated at discrete points in pregnancy, permitting an analysis of their effect at different stages of pregnancy. With at least 80% power, the study will be able to detect increased risks of 2.0 in the least prevalent primary outcomes. The investigators state that this study will contribute data necessary to clarify clinical guidelines for managing asthma during pregnancy. Estimates of any elevated risk of adverse pregnancy outcome owed to asthma or asthma medication will be identified. In particular, any differences in the natural history, risks, and management of gestational asthma among white, black and Hispanic will be described. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Impact of Adult Asthma Principal Investigator & Institution: Blanc, Paul D.; Professor; Medicine; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94143 Timing: Fiscal Year 2000; Project Start 0-JUL-1997; Project End 0-JUN2002 Summary: The aim of this study is to assess the separate and interactive effects of asthma severity, subspecialty practice variation, asthma-related psychosocial variables, and other factors on asthma outcomes, including asthma-specific quality of life and activity limitations, health care utilization for asthma, and direct and indirect costs of asthma. Asthma is both common and costly. Neither the risk factors of poor outcome nor the predictors of better outcome are not well understood. Illness severity is clearly an important predictive factor in asthma, but may explain less variability in outcome than other determinants, such as patient-perceived asthma control, other asthma-related psychosocial measures, and the kind and extent of subspecialty care for asthma. By quantifying predictors of asthma-specific quality of life, functional status, services utilization, and the direct and indirect illness costs of asthma, this study addresses a major research gap in secondary and tertiary prevention efforts. A random sample of pulmonary and allergy subspecialists
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initially enrolled 600 persons with asthma identified in patient visit logs. This established panel has completed 45 minute baseline and follow-up computer-assisted telephone interviews (CATI); 539 (90%) have been successfully re-interviewed after 18 months of follow-up. A supplemental sampling frame of persons with asthma identified from family practitioners is in progress (target baseline n=180) and an additional referent group (n=200) with rhinitis, but without asthma is planned. Interviews will assess disease severity and other covariables using validated survey instruments. Pulmonary function and medical records will be used to validate severity in a sub-sample of subjects. The proposed study extends longitudinal follow-up study of this cohort. Its analysis will test predictive models for the asthma outcomes of interest. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Management
Parent
Youth
Teamwork
in
Pediatric
Asthma
Principal Investigator & Institution: Adams, Christina D.; Psychology; West Virginia University Morgantown, Wv 26506 Timing: Fiscal Year 2001; Project Start 1-JUL-2001; Project End 0-JUN2003 Summary: (Provided by Applicant) Noncompliance with medication regimens is a prevalent problem for pediatric asthma patients, particularly within the preadolescent and adolescent age range. The proposed study will investigate the effectiveness of an intervention aimed at promoting parent-youth partnership in managing asthma. Forty-five patients (ages 9-13 years) with asthma will be randomly assigned to one of three groups: Teamwork Intervention (TI), Attention Control (AC), or Standard Core (SC). TI and AC groups will receive four, 30-minute, office-based treatment sessions in a pediatric asthma and allergy clinic. These visits will be scheduled approximately once a month for four (4) months, with follow-up data being gathered approximately 6months following the last treatment visit. The TI intervention is the focus of the study and will consist of strategies (e.g., realistic expectations, positive communication, negotiation and contracting) used in Robin and Foster's (1989) behavioral-family systems model of family functioning. These strategies, however, will be addressing directly the parent-youth partnership in asthma management. Additionally, basic principles of "promoting and fading," a behavior modification procedure, will be used to structure the systematic process by which youth will be encouraged to adhere to medication in an increasingly independent manner. In contrast, the AC group will receive structured reviews of asthma educational materials typically given to this patient population. SC participants, on
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the other hand, will have no contact with the research team beyond that necessary to gather data. Outcome data will include objective measures of medication adherence, parental involvement in asthma management, parent-adolescent conflict, and health outcome (e.g., lung functioning). It is hypothesized that when compared to the AC and SC participants, TI families will have greater adherence to medication use, increased parental involvement in the child's asthma management tasks, nonclinical levels of parent-adolescent conflict, and better patients' health outcome. Results are anticipated to assist health care providers in understanding how to use an office-based intervention, which requires little time and effort, to encourage parental involvement and parentyouth teamwork in the management of children's asthma. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
E-Journals: PubMed Central20 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).21 Access to this growing archive of e-journals is free and unrestricted.22 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “asthma” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for asthma in the PubMed Central database: ·
A first trial of retrospective collaboration for positional cloning in complex inheritance: Assay of the cytokine region on chromosome 5 by the Consortium on Asthma Genetics (COAG) by C. Lonjou, K. Barnes, H. Chen, W. O. C. M. Cookson, K. A. Deichmann, I. P. Hall, J. W. Holloway, T. Laitinen, L. J. Palmer, M. Wjst, and N. E. Morton; 2000 September 26 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27128
Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 21 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 22 The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 20
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·
A qualitative study of action plans for asthma by Jo Douglass, Rosalie Aroni, Dianne Goeman, Kay Stewart, Susan Sawyer, Frank Thien, and Michael Abramson; 2002 April 27 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=102774
·
Advising parents of asthmatic children on passive smoking: randomised controlled trial by Linda Irvine, Iain K Crombie, Roland A Clark, Peter W Slane, Colin Feyerabend, Kirsty E Goodman, and John I Cater; 1999 May 29 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27890
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Airway obstruction in asthma: does the response to a deep inspiration matter? by Jeffrey J. Fredberg; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=59515
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Childhood infections and asthma: at the crossroads of the hygiene and Barker hypotheses by Kelan G. Tantisira and Scott T. Weiss; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=64800
·
Chronic obstructive pulmonary disease, asthma and protective effects of food intake: from hypothesis to evidence? by Henriette A. Smit; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=59508
·
Cost effectiveness analysis of inhaled anticholinergics for acute childhood and adolescent asthma by Joanne Lord, Francine M Ducharme, Ronald J Stamp, Peter Littlejohns, and Rachel Churchill; 1999 December 4 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28292
·
Dose-response relation of inhaled fluticasone propionate in adolescents and adults with asthma: meta-analysis by Shaun Holt, Aneta Suder, Mark Weatherall, Soo Cheng, Philippa Shirtcliffe, and Richard Beasley; 2001 August 4 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=35344
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Double trouble: impact of inappropriate use of asthma medication on the use of health care resources by Aslam H. Anis, Larry D. Lynd, Xiaohua Wang, Greg King, John J. Spinelli, Mark Fitzgerald, Tony Bai, and Peter Pare; 2001 March 6 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=80815
·
Early childhood infectious diseases and the development of asthma up to school age: a birth cohort study by Sabina Illi, Erika von Mutius, Susanne Lau, Renate Bergmann, Bodo Niggemann, Christine Sommerfeld, Ulrich Wahn, and the MAS Group; 2001 February 17 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=26566
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Effect of asthma and its treatment on growth: four year follow up of cohort of children from general practices in Tayside, Scotland by C
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McCowan, R G Neville, G E Thomas, I K Crombie, R A Clark, I W Ricketts, A Y Cairns, F C Warner, S A Greene, and E White; 1998 February 28 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28474 ·
Effect of peer led programme for asthma education in adolescents: cluster randomised controlled trial by Smita Shah, Jennifer K Peat, Evalynn J Mazurski, Han Wang, Doungkamol Sindhusake, Colleen Bruce, Richard L Henry, and Peter G Gibson; 2001 March 10 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=26550
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Evaluation of readability and accuracy of information leaflets in general practice for patients with asthma by Helen Smith, Susan Gooding, Richard Brown, and Anthony Frew; 1998 July 25 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28620
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Identifying asthma and chronic obstructive pulmonary disease in patients with persistent cough presenting to general practitioners: descriptive study by H A Thiadens, G H de Bock, F W Dekker, J A N Huysman, J C van Houwelingen, M P Springer, and D S Postma; 1998 April 25 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28529
·
Income-based drug benefit policy: impact on receipt of inhaled corticosteroid prescriptions by Manitoba children with asthma by Anita L. Kozyrskyj, Cameron A. Mustard, Mary S. Cheang, and F. Estelle R. Simons; 2001 October 2 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=81497
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Influences on hospital admission for asthma in south Asian and white adults: qualitative interview study by Chris Griffiths, Gurmit Kaur, Madeleine Gantley, Gene Feder, Sheila Hillier, Jill Goddard, and Geoff Packe; 2001 October 27 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=59689
·
Interactions between genes and environmental factors in asthma and atopy: new developments by Claudia Sengler, Susanne Lau, Ulrich Wahn, and Renate Nickel; 2002 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=64818
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Intergenerational 20 year trends in the prevalence of asthma and hay fever in adults: the Midspan family study surveys of parents and offspring by Mark N Upton, Alex McConnachie, Charles McSharry, Carole L Hart, George Davey Smith, Charles R Gillis, and Graham C M Watt; 2000 July 8 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27429
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Meta-analysis of increased dose of inhaled steroid or addition of salmeterol in symptomatic asthma (MIASMA) by Stephen Shrewsbury, Stephen Pyke, and Mark Britton; 2000 May 20 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27379
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Mimicking microbial 'education' of the immune system: a strategy to revert the epidemic trend of atopy and allergic asthma? by Paolo Maria Matricardi and Sergio Bonini; 2000 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=59551
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Neurotrophins in bronchial asthma by Harald Renz; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=59513
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NO chemical events in the human airway during the immediate and late antigen-induced asthmatic response by Raed A. Dweik, Suzy A. A. Comhair, Benjamin Gaston, Frederik B. J. M. Thunnissen, Carol Farver, Mary Jane Thomassen, Mani Kavuru, Jeffrey Hammel, Husam M. AbuSoud, and Serpil C. Erzurum; 2001 February 27 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=30188
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Population based study of risk factors for underdiagnosis of asthma in adolescence: Odense schoolchild study by Hans C Siersted, Jesper Boldsen, Henrik S Hansen, Gert Mostgaard, and Niels Hyldebrandt; 1998 February 28 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28467
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Prevalence of dysfunctional breathing in patients treated for asthma in primary care: cross sectional survey by Mike Thomas, R K McKinley, Elaine Freeman, and Chris Foy; 2001 May 5 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=31263
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Qualitative study of views of health professionals and patients on guided self management plans for asthma by Alan Jones, Roisin Pill, and Stephanie Adams; 2000 December 16 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27554
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Questionnaire study of effect of sex and age on the prevalence of wheeze and asthma in adolescence by Andrea Venn, Sarah Lewis, Marie Cooper, Jennifer Hill, and John Britton; 1998 June 27 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28592
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Randomised comparison of cost effectiveness of guided self management and traditional treatment of asthma in Finland by Aarne Lahdensuo, Tari Haahtela, Jaakko Herrala, Tuomo Kava, Kirsti Kiviranta, Paula Kuusisto, Markku Pekurinen, Erkki Peramaki, Seppo Saarelainen, Thore Svahn, and Bengt Liljas; 1998 April 11 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28518
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Randomised, placebo controlled trial of effect of a leukotriene receptor antagonist, montelukast, on tapering inhaled corticosteroids in asthmatic patients by Claes-Goran Lofdahl, Theodore F Reiss, Jonathan A Leff, Elliot Israel, Michael J Noonan, Albert F Finn, Beth C Seidenberg, Thomas Capizzi, Sudeep Kundu, and Philippe Godard; 1999 July 10 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28156
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Reduced risk of hospital admission for childhood asthma among Scottish twins: record linkage study by David P Strachan, Sarah E Moran, Kevin McInneny, and Mary Smalls; 2000 September 23 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27487
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Research pointers:Peak expiratory flow sequence in acute exacerbations of asthma by Surinder S Birring, Ernest Heartin, Tim J Williams, Christopher E Brightling, and Ian D Pavord; 2001 May 26 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=31923
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Risk factors for hospitalization among adults with asthma: the influence of sociodemographic factors and asthma severity by Mark D. Eisner, Patricia P. Katz, Edward H. Yelin, Stephen C. Shiboski, and Paul D. Blanc; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=56211
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Role of gob-5 in mucus overproduction and airway hyperresponsiveness in asthma by Atsushi Nakanishi, Shigeru Morita, Hiroki Iwashita, Yoji Sagiya, Yasuko Ashida, Hideo Shirafuji, Yukio Fujisawa, Osamu Nishimura, and Masahiko Fujino; 2001 April 24 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=33183
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Should inhaled anticholinergics be added to [beta]2 agonists for treating acute childhood and adolescent asthma? A systematic review by Laurie H Plotnick and Francine M Ducharme; 1998 October 10 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28680
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Small airway inflammation in asthma by Meri K. Tulic, Pota Christodoulopoulos, and Qutayba Hamid; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=64806
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Synergism between allergens and viruses and risk of hospital admission with asthma: case-control study by Rosalind M Green, Adnan Custovic, Gwen Sanderson, Jenny Hunter, Sebastian L Johnston, and Ashley Woodcock; 2002 March 30 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=100316
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Systematic reviews and meta-analyses on treatment of asthma: critical evaluation by Alejandro R Jadad, Michael Moher, George P Browman, Lynda Booker, Christopher Sigouin, Mario Fuentes, and Robert Stevens; 2000 February 26 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27295
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The role of surfactant in asthma by Jens M. Hohlfeld; 2002 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=64815
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Understanding childhood asthma in focus groups: perspectives from mothers of different ethnic backgrounds by Rachel Cane, Caroline Pao, and Sheila McKenzie; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=58588
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Use of ultramolecular potencies of allergen to treat asthmatic people allergic to house dust mite: double blind randomised controlled clinical trial by G T Lewith, A D Watkins, M E Hyland, S Shaw, J A Broomfield, G Dolan, and S T Holgate; 2002 March 2 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=67767
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Using single nucleotide polymorphisms as a means to understanding the pathophysiology of asthma by Lyle J. Palmer and William OCM Cookson; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=59575
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.23 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with asthma, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
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“asthma” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “asthma” (hyperlinks lead to article summaries): ·
Classification and management of brittle asthma. Author(s): Ayres JG. Source: Br J Hosp Med. 1997 April 16-May 6; 57(8): 387-9. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9274664&dopt=Abstract
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Clinical characteristics of chemical sensitivity: an illustrative case history of asthma and MCS. Author(s): Ross GH. Source: Environmental Health Perspectives. 1997 March; 105 Suppl 2: 437-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9167976&dopt=Abstract
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Clinical observation on 25 cases of hormone dependent bronchial asthma treated by acupuncture. Author(s): Hu J. Source: J Tradit Chin Med. 1998 March; 18(1): 27-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10437259&dopt=Abstract
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Clinical study of yoga techniques in university students with asthma: a controlled study. Author(s): Vedanthan PK, Kesavalu LN, Murthy KC, Duvall K, Hall MJ, Baker S, Nagarathna S. Source: Allergy and Asthma Proceedings : the Official Journal of Regional and State Allergy Societies. 1998 January-February; 19(1): 3-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9532318&dopt=Abstract
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Clinical-ecology approach to asthma. Author(s): Shambaugh GE. Source: Lancet. 1998 February 14; 351(9101): 529-30. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9482486&dopt=Abstract
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Combined use of acupuncture and blood-injection at the back-shu points for treatment of allergic asthma--a report of 80 cases. Author(s): Lai X. Source: J Tradit Chin Med. 1997 September; 17(3): 207-10. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10437197&dopt=Abstract
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Complementary therapies for asthma. Author(s): Parkman CA. Source: Case Manager. 2002 March-April; 13(2): 24-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11901365&dopt=Abstract
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Complementary therapies for asthma: what patients use. Author(s): Ernst E. Source: The Journal of Asthma : Official Journal of the Association for the Care of Asthma. 1998; 35(8): 667-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9860087&dopt=Abstract
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Complementary/alternative medicine for asthma: we do not know what we need to know. Author(s): Ernst E. Source: Chest. 1999 January; 115(1): 1-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9925051&dopt=Abstract
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Complementary/alternative medicine in the treatment of asthma. Author(s): Graham DM, Blaiss MS. Source: Ann Allergy Asthma Immunol. 2000 December; 85(6 Pt 1): 438-47; Quiz 447-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11152164&dopt=Abstract
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Cyclosporin as an oral corticosteroid sparing agent in stable asthma. Author(s): Evans DJ, Cullinan P, Geddes DM. Source: Cochrane Database Syst Rev. 2001; (2): Cd002993. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11406057&dopt=Abstract
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Detection of intracellular cytokines during antioxidant supplementation in corticoid-dependent asthmatics and modulation of adhesion molecule expression on cultured endothelial cells. Author(s): Horvathova M, Jahnova E, Gazdik F. Source: Biological Trace Element Research. 2001 October; 83(1): 17-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11693999&dopt=Abstract
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Dietary supplementation with fish oil rich in omega-3 polyunsaturated fatty acids in children with bronchial asthma. Author(s): Nagakura T, Matsuda S, Shichijyo K, Sugimoto H, Hata K. Source: The European Respiratory Journal : Official Journal of the European Society for Clinical Respiratory Physiology. 2000 November; 16(5): 861-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11153584&dopt=Abstract
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Differential role of CD80 and CD86 on alveolar macrophages in the presentation of allergen to T lymphocytes in asthma. Author(s): Balbo P, Silvestri M, Rossi GA, Crimi E, Burastero SE. Source: Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology. 2001 April; 31(4): 625-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11359432&dopt=Abstract
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Disease management of atopic dermatitis: a practice parameter. Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology, and the Joint Council of Allergy, Asthma and Immunology. Work Group on Atopic Dermatitis. Author(s): Leung DY, Hanifin JM, Charlesworth EN, Li JT, Bernstein IL, Berger WE, Blessing-Moore J, Fineman S, Lee FE, Nicklas RA, Spector SL. Source: Ann Allergy Asthma Immunol. 1997 September; 79(3): 197-211. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9305225&dopt=Abstract
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Effect of selenium supplementation in asthmatic subjects on the expression of endothelial cell adhesion molecules in culture. Author(s): Horvathova M, Jahnova E, Gazdik F.
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Source: Biological Trace Element Research. 1999 July; 69(1): 15-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10383096&dopt=Abstract ·
Effects of absorbed components of saiboku-to on the release of leukotrienes from polymorphonuclear leukocytes of patients with bronchial asthma. Author(s): Niitsuma T, Morita S, Hayashi T, Homma M, Oka K. Source: Methods Find Exp Clin Pharmacol. 2001 March; 23(2): 99-104. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11484418&dopt=Abstract
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Effects of perilla seed oil supplementation on leukotriene generation by leucocytes in patients with asthma associated with lipometabolism. Author(s): Okamoto M, Mitsunobu F, Ashida K, Mifune T, Hosaki Y, Tsugeno H, Harada S, Tanizaki Y, Kataoka M, Niiya K, Harada M. Source: International Archives of Allergy and Immunology. 2000 June; 122(2): 137-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10878492&dopt=Abstract
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Effects of photochemical air pollution and allergen exposure on upper respiratory tract inflammation in asthmatics. Author(s): Hiltermann TJ, de Bruijne CR, Stolk J, Zwinderman AH, Spieksma FT, Roemer W, Steerenberg PA, Fischer PH, van Bree L, Hiemstra PS. Source: American Journal of Respiratory and Critical Care Medicine. 1997 December; 156(6): 1765-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9412553&dopt=Abstract
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Emotionally triggered asthma: a review of research literature and some hypotheses for self-regulation therapies. Author(s): Lehrer PM. Source: Applied Psychophysiology and Biofeedback. 1998 March; 23(1): 13-41. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9653510&dopt=Abstract
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Empirically supported treatments of disease-related symptoms in pediatric psychology: asthma, diabetes, and cancer. Author(s): McQuaid EL, Nassau JH.
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Source: Journal of Pediatric Psychology. 1999 August; 24(4): 305-28. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10431495&dopt=Abstract ·
Empowering adolescents with asthma to take control through adaptation. Author(s): Hennessy-Harstad EB. Source: Journal of Pediatric Health Care : Official Publication of National Association of Pediatric Nurse Associates & Practitioners. 1999 November-December; 13(6 Pt 1): 273-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10889673&dopt=Abstract
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Epigallocatechin gallate-induced histamine release in patients with green tea-induced asthma. Author(s): Shirai T, Sato A, Chida K, Hayakawa H, Akiyama J, Iwata M, Taniguchi M, Reshad K, Hara Y. Source: Ann Allergy Asthma Immunol. 1997 July; 79(1): 65-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9236503&dopt=Abstract
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Exposure to Parthenium hysterophorous pollen extract leads to bronchospasm in stable patients of bronchial asthma. Author(s): Gupta D, Suresh PV, Behera D, Jindal SK. Source: J Assoc Physicians India. 1998 June; 46(6): 518-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11273249&dopt=Abstract
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Expression of adhesion molecules and effect of disodium cromoglycate treatment in asthmatics. Author(s): Jahnova E, Horvathova M, Gazdik F. Source: Physiological Research / Academia Scientiarum Bohemoslovaca. 1998; 47(6): 439-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10453751&dopt=Abstract
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Fatal asthma in a child after use of an animal shampoo containing pyrethrin. Author(s): Wagner SL.
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Source: The Western Journal of Medicine. 2000 August; 173(2): 86-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10924422&dopt=Abstract ·
Flow-dependency of exhaled nitric oxide in children with asthma and cystic fibrosis. Author(s): Kroesbergen A, Jobsis Q, Bel EH, Hop WC, de Jongste JC. Source: The European Respiratory Journal : Official Journal of the European Society for Clinical Respiratory Physiology. 1999 October; 14(4): 871-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10573235&dopt=Abstract
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Further studies on the chronotherapy of asthma with inhaled steroids: the effect of dosage timing on drug efficacy. Author(s): Pincus DJ, Humeston TR, Martin RJ. Source: The Journal of Allergy and Clinical Immunology. 1997 December; 100(6 Pt 1): 771-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9438485&dopt=Abstract
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Glucocorticoid-resistant asthma. Author(s): Loke TK, Sousa AR, Corrigan CJ, Lee TH. Source: Curr Allergy Asthma Rep. 2002 March; 2(2): 144-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11892094&dopt=Abstract
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Gold as an oral corticosteroid sparing agent in stable asthma. Author(s): Evans DJ, Cullinan P, Geddes DM. Source: Cochrane Database Syst Rev. 2001; (2): Cd002985. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11406053&dopt=Abstract
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Herbal interventions in asthma and allergy. Author(s): Bielory L, Lupoli K. Source: The Journal of Asthma : Official Journal of the Association for the Care of Asthma. 1999; 36(1): 1-65. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10077136&dopt=Abstract
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Herbal medicines for asthma: a systematic review. Author(s): Huntley A, Ernst E. Source: Thorax. 2000 November; 55(11): 925-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11050261&dopt=Abstract
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Herbalism for the treatment of asthma. Author(s): Yoshida S. Source: Chest. 1999 August; 116(2): 582. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10453897&dopt=Abstract
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Homeopathic remedies for asthma. Author(s): Malthouse S. Source: Can Fam Physician. 1997 November; 43: 1917. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9386874&dopt=Abstract
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Homeopathy for chronic asthma. Author(s): Linde K, Jobst KA. Source: Cochrane Database Syst Rev. 2000; (2): Cd000353. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10796532&dopt=Abstract
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Hypnosis and asthma: a critical review. Author(s): Hackman RM, Stern JS, Gershwin ME. Source: The Journal of Asthma : Official Journal of the Association for the Care of Asthma. 2000 February; 37(1): 1-15. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10724294&dopt=Abstract
Vocabulary Builder Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH]
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Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Albuterol: A racemic mixture with a 1:1 ratio of the r-isomer, levalbuterol, and s-albuterol. It is a short-acting beta2-adrenergic agonist with its main clinical use in asthma. [NIH] Antibodies: Specific proteins produced by the body's immune system that bind with foreign proteins (antigens). [NIH] Anticholinergic: An agent that blocks the parasympathetic nerves. Called also parasympatholytic. [EU] Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Auricular: Pertaining to an auricle or to the ear, and, formerly, to an atrium of the heart. [EU] Bronchoconstriction: Tightening of the muscles surrounding the bronchi, the tubes that branch from the windpipe. [NIH] Bronchospasm: Spasmodic contraction of the smooth muscle of the bronchi, as occurs in asthma. [EU] Chromosomal: Pertaining to chromosomes. [EU] Chronotherapy: The adaptation of the administration of drugs to circadian rhythms. The concept is based on the response of biological functions to time-related events, such as the low point in epinephrine levels between 10 p.m. and 4 a.m. or the elevated histamine levels between midnight and 4 a.m. The treatment is aimed at supporting normal rhythms or modifying therapy based on known variations in body rhythms. While chronotherapy is commonly used in cancer chemotherapy, it is not restricted to cancer therapy or to chemotherapy. [NIH] Comorbidity: Two or more diseases or conditions existing together in an individual. [NIH]
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Concomitant: Accompanying; accessory; joined with another. [EU] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Decompensation: Failure of compensation; cardiac decompensation is marked by dyspnea, venous engorgement, and edema. [EU] Dilate: Relax; expand. [NIH] Eclampsia: Convulsions and coma occurring in a pregnant or puerperal woman, associated with preeclampsia, i.e., with hypertension, edema, and/or proteinuria. [EU] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other health-related event occurring in such outbreaks. [EU] Ethnopharmacology: The study of the actions and properties of drugs, usually derived from medicinal plants, indigenous to a population or ethnic group. [NIH] Folklore: The common orally transmitted traditions, myths, festivals, songs, superstitions, and stories of all peoples. [NIH] Glutamine: A non-essential amino acid present abundantly throught the body and is involved in many metabolic processes. It is synthesized from glutamic acid and ammonia. It is the principal carrier of nitrogen in the body and is an important energy source for many cells. [NIH] Haplotypes: The genetic constitution of individuals with respect to one member of a pair of allelic genes, or sets of genes that are closely linked and tend to be inherited together such as those of the major histocompatibility complex. [NIH] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH]
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Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Kava: Dried rhizome and roots of Piper methysticum, a shrub native to Oceania and known for its anti-anxiety and sedative properties. Heavy usage results in some adverse effects. It contains alkaloids, lactones, kawain, methysticin, mucilage, starch, and yangonin. Kava is also the name of the pungent beverage prepared from the plant's roots. [NIH] Leukotrienes: A family of biologically active compounds derived from arachidonic acid by oxidative metabolism through the 5-lipoxygenase pathway. They participate in host defense reactions and pathophysiological conditions such as immediate hypersensitivity and inflammation. They have potent actions on many essential organs and systems, including the cardiovascular, pulmonary, and central nervous system as well as the gastrointestinal tract and the immune system. [NIH] Membrane: Thin, flexible film of proteins and lipids that encloses the contents of a cell; it controls the substances that go into and come out of the cell. Also, a thin layer of tissue that covers the surface or lines the cavity of an organ. [NIH] Nickel: Nickel. A trace element with the atomic symbol Ni, atomic number 28, and atomic weight 58.69. It is a cofactor of the enzyme urease. [NIH] Outpatients: Persons who receive ambulatory care at an outpatient department or clinic without room and board being provided. [NIH] Paediatric: Of or relating to the care and medical treatment of children; belonging to or concerned with paediatrics. [EU] Palpation: Application of fingers with light pressure to the surface of the body to determine consistence of parts beneath in physical diagnosis; includes palpation for determining the outlines of organs. [NIH] Pharmacokinetics: The action of drugs in the body over a period of time, including the processes of absorption, distribution, localization in tissues, biotransformation, and excretion. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychopharmacology: The study of the effects of drugs on mental and behavioral activity. [NIH] Psychophysiology: The study of the physiological basis of human and animal behavior. [NIH]
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Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]
Quercetin: Aglucon of quercetrin, rutin, and other glycosides. It is widely distributed in the plant kingdom, especially in rinds and barks, clover blossoms, and ragweed pollen. [NIH] Refractory: Not readily yielding to treatment. [EU] Remission: A diminution or abatement of the symptoms of a disease; also the period during which such diminution occurs. [EU] Respiration: Process of exchanging oxygen from the air for carbon dioxide from the body; includes the mechanical process of breathing, gas exchange, and oxygen and carbon dioxide transport to and from the cells. [NIH] Rhinorrhea: The free discharge of a thin nasal mucus. [EU] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Sensitization: 1. administration of antigen to induce a primary immune response; priming; immunization. 2. exposure to allergen that results in the development of hypersensitivity. 3. the coating of erythrocytes with antibody so that they are subject to lysis by complement in the presence of homologous antigen, the first stage of a complement fixation test. [EU] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Sputum: Matter ejected from the lungs, bronchi, and trachea, through the mouth. [EU] Stasis: A word termination indicating the maintenance of (or maintaining) a constant level; preventing increase or multiplication. [EU] Sublingual: Located beneath the tongue. [EU] Surfactant: A fat-containing protein in the respiratory passages which reduces the surface tension of pulmonary fluids and contributes to the elastic properties of pulmonary tissue. [NIH] Terbutaline: A selective beta-2 adrenergic agonist used as a bronchodilator and tocolytic. [NIH]
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Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Vertebral: Of or pertaining to a vertebra. [EU] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH]
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CHAPTER 5. PATENTS ON ASTHMA Overview You can learn about innovations relating to asthma by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.24 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available to patients with asthma within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available to patients with asthma. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.
24Adapted
from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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Patents on Asthma By performing a patent search focusing on asthma, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on asthma: ·
Methods and materials for the diagnosis or prognosis of asthma Inventor(s): Cookson; William Osmond Charles Michael (Oxford, GB), Moffatt; Miriam Fleur (Bicester, GB) Assignee(s): ISIS Innovation Limited (Oxford, GB) Patent Number: 6,387,615 Date filed: April 10, 1998 Abstract: The present invention is directed to a method for diagnosing an individual as being asthmatic, or of having a predisposition to asthma, and a kit therefor, which method comprises demonstrating in the individual the presence or absence of an unusual variant form of a polynucleotide sequence in the MHC region of chromosome 6p, said unusual variant form being associated with an increased secretion of TNF. Excerpt(s): This invention relates to diagnosis of asthma and to materials and methods relating thereto. ... Asthma is a disease which is becoming more prevalent and is the most common disease of childhood (1). Most asthma in children and young adults is initiated by IgE mediated allergy (atopy) to inhaled allergens such as house dust mite and cat dander However, not all asthmatics are atopic, and most atopic individuals do not have asthma. Thus, factors in addition to atopy are necessary to induce the disease (2,3). Asthma is strongly familial, and is due to the interaction between genetic and environmental factors. The genetic factors are thought to be variants of normal genes ("polymorphisms") which alter their function to predispose to asthma. ... Asthma may be identified by recurrent wheeze and intermittent air flow limitation. An asthmatic tendency may be quantified by the measurement of bronchial hyper-responsiveness in which an individual's dose-response curve to a
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broncho-constrictor such as histamine or methacholine is constructed. The curve is commonly summarised by the dose which results in a 20% fall in air flow (PD20) or the slope of the curve between the initial air flow measurement and the last dose given (slope). Web site: http://www.delphion.com/details?pn=US06387615__ ·
Method for determining asthma susceptibility Inventor(s): Hershey; Gurjit K. Khurana (Cincinnati, OH) Assignee(s): Children's Hospital Medical Center (Cincinnati, OH) Patent Number: 6,379,890 Date filed: December 10, 1999 Abstract: A method for determining whether an individual is susceptible for asthma is disclosed. In addition, a method for predicting the severity of asthma in a patient is also disclosed. These methods involve determining whether an individual carries an allelic variation in the IL-4 receptor that leads to increased receptor signaling as a predictor of asthma and asthma severity. Excerpt(s): This invention relates to systems and methods for screening patients for their susceptibility and severity of asthma. More specifically, this invention relates to determining a patient's susceptibility or potential severity of asthma by analysis of the IL-4 receptor. ... Asthma is a chronic inflammatory disorder and, in genetically-susceptible individuals, this inflammation leads to increased airway responsiveness to a variety of stimuli, and recurrent airway obstruction. It is the most common chronic disease of childhood and the most common reason for pediatric hospital admission. Although it is clear that both environmental and genetic influences are important in the development of asthma, the pathogenesis of this disease remains unclear. ... Several candidate genes and loci have been linked to asthma and atopy, including IL-4, HLA complex, Fc.epsilon.RI.beta., .beta.2 adrenergic receptor and chromosomal regions such as the cytokine cluster on 5q31-32, supporting the polygenic nature of these complex diseases. Delineating the genes which contribute to the development of asthma, and dissecting the mechanisms by which these genes alter the host response to environmental challenge (antigen, viral, etc.) are keys steps to furthering our knowledge of the pathogenesis of asthma. Web site: http://www.delphion.com/details?pn=US06379890__
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Antithrombin agents in treatment of asthma Inventor(s): Panettieri; Reynold (Ambler, PA), Murray; Richard (Philadelphia, PA) Assignee(s): The Trustees of the University of Pennsylvania (Philadelphia, PA) Patent Number: 6,355,626 Date filed: May 13, 1994 Abstract: Methods of inhibiting calcium release and proliferation in human airway smooth muscle cells by contacting cells with an antithrombin agent are provided. These antithrombin agents are useful in the treatment of asthma. Excerpt(s): Stimulation of platelets has also been shown to result in the release of various mediators that may lead to an extension of inflammation and intensify the immune response. Recent reports have suggested that platelets may play an important role in the inflammatory process of human asthma. Therefore several researchers have been studying the effects of thrombin on platelet aggregation and its effects on asthma. ... Nedocromil sodium is used therapeutically as an antiinflammatory drug in the treatment of asthma. Roth et al., J. Allergy Clin Immunol., 91(6):1217, 1993, demonstrated that nedocromil sodium interferes with thrombin- and platelet activating factor-mediated platelet activation. The inhibition of platelet activation demonstrated in these studies was proposed to contribute to the antiinflammatory effects of nedocromil sodium in asthma. ... Thrombin stimulation of human platelets has also been shown to result in the release of a preformed proteinaceous human eosinophil (Eo) chemotactic activity. Kameoyoshi et al., J. Exp Med. 176:587, 1992. This finding was suggested to serve as additional evidence for the recent understanding that platelets contribute to inflammatory reactions of allergic asthma. Web site: http://www.delphion.com/details?pn=US06355626__
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Methods for treatment of asthma using S-oxybutynin Inventor(s): Jerussi; Thomas P. (Framingham, MA) Assignee(s): Sepracor Inc. (Marlborough, MA) Patent Number: 6,294,582 Date filed: May 17, 2000
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Abstract: Substantially optically pure S-oxybutynin, or a pharmaceutically acceptable salt thereof, is administered as a treatment for asthma. Such treatment is provided while reducing the adverse effects associated with the administration of racemic oxybutynin. Excerpt(s): Asthma, bronchitis and emphysema are known as Chronic Obstructive Pulmonary Diseases (COPD). COPD is characterized as generalized airways obstruction, particularly of small airways, associated with varying degrees of symptoms of chronic bronchitis, asthma, and emphysema. The term COPD was introduced because these conditions often coexist, and it may be difficult in an individual case to decide which is the major condition producing the obstruction. Airways obstruction is defined as an increased resistance to airflow during forced expiration. It may result from narrowing or obliteration of airways secondary to intrinsic airways disease, from excessive collapse of airways during a forced expiration secondary to pulmonary emphysema, from bronchospasm as in asthma, or may be due to a combination of these factors. Although obstruction of large airways may occur in all these disorders, particularly in asthma, patients with severe COPD characteristically have major abnormalities in their small airways, namely those less than 2 mm internal diameter, and much of their airways obstruction is situated in this zone. The airways obstruction is irreversible except for that which can be ascribed to asthma. ... Asthma is a reversible obstructive pulmonary disorder (ROPD) characterized by increased responsiveness of the airway, resulting in airway obstruction. Airway obstruction is defined as an increased resistance to air flow during forced expiration. In asthma, airway obstruction typically results from bronchospasm. The underlying mechanisms causing asthma are unknown, but inherited or acquired imbalance of adrenergic and cholinergic control of airway diameter has been implicated. Asthmatics manifesting such imbalance have hyperactive bronchi and, even without symptoms, bronchoconstriction may be present. Overt asthma attacks may occur when such individuals are subjected to various stresses, such as viral respiratory infection, exercise, emotional upset, nonspecific factors (e.g., changes in barometric pressure or temperature), inhalation of cold air or irritants (e.g., gasoline fumes, fresh paint and noxious odors, or cigarette smoke), exposure to specific allergens, and ingestion of aspirin or sulfites in sensitive individuals. Those whose asthma is precipitated by allergens (most commonly airborne pollens and molds, house dust, animal danders) and whose symptoms are IgE-mediated are said to have allergic or "extrinsic" asthma. They account for about 10 to 20% of adult asthmatics; in another 30 to 50%, symptomatic episodes seem to be triggered by non-allergenic factors (e.g., infection, irritants, emotional factors), and these patients are said to have non-allergic or
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"intrinsic" asthma. In many persons, both allergenic and non-allergenic factors are significant. ... There is a continuing need for treatments for asthma, particularly those that minimize side effects. Web site: http://www.delphion.com/details?pn=US06294582__ ·
System and method for remotely monitoring asthma severity Inventor(s): Finkelstein; Joseph (New York, NY), Hripcsak; George (New York, NY) Assignee(s): The Trustees of Columbia University in the City of New York (New York, NY) Patent Number: 6,283,923 Date filed: June 3, 1998 Abstract: A system for remotely monitoring asthma severity includes a remotely located asthma monitoring station for administering a patient self-test and for gathering test data and relevant patient information indicative of asthmatic symptoms, and a central processing facility for receiving the test data and patient information from the remote monitoring station, determining whether the test data is valid, analyzing valid test data to generate test results and an appropriate response message to the monitoring station, storing the test results in a central data repository, and disseminating the test results and response message in a timely manner as required. The monitoring system also includes a remotely located diagnosis/evaluation station for displaying the test results, response messages and other patient information. Selectable data links are provided for real-time reciprocal exchange of the test data, test results, response message and patient information between said monitoring station, said central processing facility and said diagnosis/evaluation station. Preferably, the remote monitoring station, central processing facility and remote diagnosis/evaluation station are connected via the Internet wherein the test results can be accessed via a conventional Web browser. Excerpt(s): The present invention relates in general to the field of remote monitoring and diagnosing asthma and related symptoms. More particularly, the present invention relates to a system and method for remotely monitoring asthma severity in real-time via wireless and landline communications systems. ... Approximately 15 million Americans suffer in varying degrees from different forms of asthma. In 1990 alone, nearly 6.2 billion dollars were spent in total in the United States on asthma-related costs. Approximately 2 billion dollars of this amount were spent on in-patient hospital and emergency room services,
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and approximately 2.6 billion dollars on indirect costs such as loss of work, child care and premature death. See K. B. Weiss, P. J. Gergen and T. A. Hodgson, "An Economic Evaluation of Asthma in the United States," New Eng. J. Med., vol. 326, pp. 862-866 (1992). Despite advances in the treatment of asthma, the morbidity and mortality of the disease has increased significantly during the past several years. Moreover, asthma continues to present significant management problems for patients trying to cope with the disease on a day-to-day basis and for physicians providing medical care and treatment. ... A common problem in assessing the severity of asthmatic symptoms is that patients frequently misperceive and underestimate the severity of airway obstruction. See E. R. McFadden, R. Kiser and W. J. De Groot, "Acute Bronchial Asthma: Relations Between Clinical and Physiological Manifestations," New Eng. J. Med., vol. 288, pp. 221-225 (1973); A. R. Rubinfeld, "Pain MCF: Perception of Asthma," The Lancet, pp. 882-884 (1976). Consequently, inhome monitoring of asthmatic symptoms, combined with patient education, has been shown to significantly reduce the incidence of asthma exacerbation and subsequent hospitalization. See "Li JTC. Home Peak Expiratory Flow Rate Monitoring in Patients With Asthma.," Mayo Clin. Proc., vol. 70, pp. 649-656 (1995). Web site: http://www.delphion.com/details?pn=US06283923__ ·
Composition for treating asthma Inventor(s): Ahmed; Magda Abdel Fattah (1035-45ST, Brooklyn, NY 11219) Assignee(s): none reported Patent Number: 6,281,248 Date filed: February 16, 2000 Abstract: A method of treating asthma that includes the step of controlling the asthma by ingesting a composition which includes a selective serotonin reuptake inhibitor that is sertraline hydrochloride. Chronic administration of the sertraline thereof downregulates brain norepinephrine receptors. The increased output of the brain norepinephrine receptors increases the dilation of the bronchi. Sertraline has no significant affinity for adrenergic (alpha.sub.1, alpha.sub.2, beta), cholinergic, GABA, dopaminergic, histaminergic, serotonergic (5HT.sub.1A, 5HT.sub.1B, 5HT.sub.2), or benzodiazepine receptors. Antagonism of such receptors has been hypothesized to be associated with various adverse anticholinergic, sedative, and cardiovascular effects.
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Excerpt(s): The present invention relates to a composition. More particularly, the present invention relates to a composition for treating asthma. ... The frequency of occurrence of allergic diseases, particularly bronchial asthma is continuously increasing. Social-economical and environmental conditions, enhancement of affectivity of the diagnosis, and the lack of an adequate, really healing therapy provide background of this increase. Despite for or partially even due to the elevated drug consumption, the mortality ratio also shows a rising tendency. ... Bronchial asthma is characterized by bronchospasm caused by contraction of the bronchial smooth muscle, increased secretion of mucus from the bronchi, and edema of the respiratory mucosa. Web site: http://www.delphion.com/details?pn=US06281248__ ·
Methods of treating asthma with interleukin-9 antibodies Inventor(s): Levitt; Roy Clifford (Ambler, PA), Maloy; W. Lee (Landsdale, PA), Kari; U. Prasad (Hatfield, PA), Nicolaides; Nicholas C. (Media, PA) Assignee(s): Genaera Corporation (Plymouth Meeting, PA) Patent Number: 6,261,559 Date filed: June 4, 1999 Abstract: A C to T DNA variation at position 3365 in exon 5 of the human Asthma Associated Factor 1 (AAF1) produces the predicted amino acid substitution of a methionine for a threonine at codon 117 of AAF1. When this substitution occurs in both alleles in one individual, it is associated with less evidence of atopic allergy including asthma, fewer abnormal skin test responses, and a lower serum total IgE. Thus, applicant has identified the existence of a non-asthmatic, non-atopic phenotype characterized by methionine at codon 117 when it occurs in both AAF1 gene products in one individual. Excerpt(s): This invention relates to regulating IL-9 activity and treating atopic allergies and related disorders like asthma, based upon the relationship between IL-9 and its receptor. ... Atopic allergy is an ecogenetic disorder, where genetic background dictates the response to environmental stimuli. The disorder is generally characterized by an increased ability of lymphocytes to produce IgE antibodies in response to ubiquitous antigens. Activation of the immune system by these antigens leads to allergic inflammation and may occur after ingestion, penetration through the skin, or after inhalation. When this immune activation occurs and pulmonary inflammation ensues this disorder is broadly characterized as asthma. Certain cells are critical to this inflammatory reaction and they include T cells and antigen presenting cells, B cells that
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produce IgE, and mast cells/basophils and eosinophils that bind IgE. These inflammatory cells accumulate at the site of allergic inflammation and the toxic products they release contribute to the tissue destruction related to the disorder. ... While asthma is generally defined as an inflammatory disorder of the airways, clinical symptoms arise from intermittent air flow obstruction. It is a chronic disabling disorder that appears to be increasing in prevalence and severity.sup.1. It is estimated that 30-40% of the population suffer with atopic allergy, and 15% of children and 5% of adults in the population suffer from asthma..sup.1 Thus, an enormous burden is placed on our health care resources. Web site: http://www.delphion.com/details?pn=US06261559__ ·
Methods of using norastemizole in combination with leukotriene inhibitors to treat or prevent asthma Inventor(s): Rubin; Paul D. (Sudbury, MA) Assignee(s): Sepracor Inc. (Marlborough, MA) Patent Number: 6,248,308 Date filed: April 14, 1998 Abstract: Methods and pharmaceutical compositions employing norastemizole and a leukotriene inhibitor for the treatment or prevention of inflammation or allergic disorders, such as asthma or the symptoms thereof. Also included are methods and compositions employing norastemizole and a decongestant for the treatment or prevention of inflammation or allergic disorders, such as asthma or the symptoms thereof. Excerpt(s): The invention relates to methods of treating asthma, inflammation, and allergic conditions. In another aspect, this invention relates to the use of antihistamines and leukotriene inhibitors, and compositions containing them. ... Weintraub et al., Hosp. Formul., 22:91827 (1987) describes clinical efficacy of astemizole in the treatment of both seasonal and perennial allergies. It has also been suggested that astemizole would be useful for the treatment of asthma. ... Zafirlukast, sold commercially as ACCOLATE.RTM., is another type of leukotriene inhibitor. This leukotriene inhibitor is a leukotriene receptor antagonist (LTRA) of leukotriene D.sub.4 and E.sub.4, and has the chemical name 4(5-cyclopentyloxy-carbonylamino-1-methyl-indol-8-ylmethyl)-3methoxy-N-o -tolylsulfonylbenzamide. Cysteinyl leukotriene production and receptor occupation have been correlated with the pathophysiology of asthma. In vitro studies indicated that zafirlukast antagonized the contractile activity of three leukotrienes in conducting airway smooth
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muscle from laboratory animals and humans; prevented intradermal LTD.sub.4 -induced increases in cutaneous vascular permeability; and inhibited inhaled LTD.sub.4 -induced influx of eosinophils into animal lungs. In some patients, zafirlukast has been reported to cause headache, infection, nausea, diarrhea, pain, asthenia, abdominal pain, dizziness, myalgia, fever, vomiting, SGPT elevation, and dyspepsia. [Physician's Desk Reference, 52 ed., Medical Economics Co., Inc., 3148-49 (1998)]. Web site: http://www.delphion.com/details?pn=US06248308__ ·
Substituted tetralins, chromans and related compounds in the treatment of asthma Inventor(s): Eggler; James F. (Stonington, CT), Marfat; Anthony (Mystic, CT), Melvin, Jr.; Lawrence S. (Ledyard, CT) Assignee(s): Pfizer Inc, (New York, NY) Patent Number: 6,166,031 Date filed: April 11, 1990 Abstract: Substituted tetralins, chromans and related compounds which, by inhibiting 5-lipoxygenase enzyme and/or blocking leukotriene receptors, are useful in the prevention or treatment of asthma, arthritis, psoriasis, ulcers, myocardial infarction and related disease states in mammals; pharmaceutical compositions comprising said compounds; a method of treatment with said compounds; and intermediates useful in the synthesis of said compounds. Excerpt(s): The present invention is directed to substituted tetralins, chromans and related compounds of the formula (I), depicted below, which by inhibiting 5-lipoxygenase enzyme and/or blocking leukotriene receptors, are useful in the prevention or treatment of asthma, arthritis, psoriasis, ulcers, myocardial infarction and related disease states in mammals. The present invention is also directed to pharmaceutical compositions, a method of treatment and to intermediates useful in the synthesis of said compounds of the formula (I). ... Also forming a part of the present invention are pharmaceutical compositions for administration to a mammal which comprise a compound of the formula (I) and a pharmaceutically acceptable carrier; and a method of inhibiting 5lipoxygenase enzyme and/or blocking leukotriene D4 receptors in a mammal, so as to prevent or treat asthma (particularly in man), arthritis, psoriasis, gastrointestinal ulcers, or myocardial infarction. ... Concerning the biological activity of the present compounds, it is known that arachidonic acid is metabolized in mammals by means of two distinct pathways, one leading to prostaglandins and thromboxanes, the other to
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several oxidative products called leukotrienes, which are designated by letter number combinations such as B4, C4 and D4. The first step in this oxidative pathway is the oxidation of arachidonic acid under the influence of 5-lipoxygenase enzyme, an enzyme which is generally inhibited by the compounds (I) of the present invention, thus blocking the synthesis of all leukotrienes. That in itself provides the mechanism sufficient for the utility of the present compounds in the treatment or prevention or asthma (where LTC4 and LTD4 are understood to be mediators), arthritis (where LTB4 is understood to be a mediator in inflammation), psoriasis (where LTB4 is understood to be a mediator), ulcers (where LTC4 and LTD4 are understood to be mediators) and myocardial infarction (where LTB4 is understood to be a mediator). Supplementing this enzyme inhibitory activity is the general ability of the present compounds to antagonize leukotriene D4 (i.e., block LTD4 receptors). In general, the present compounds also antagonize leukotriene B4. For a review concerning leukotrienes, see Bailey et al., Ann. Reports Med. Chem. 17, pp. 203-217 (1982). Web site: http://www.delphion.com/details?pn=US06166031__ ·
Asthma treatment Inventor(s): Patel; Jitendra Rambhai (Rughnathji Pole, Ahmedabadi Bazar, Nadiad 387 001, IN), Patel; Devendra Rambhai (78-09 24th Ave., Jackson Heights, NY 11370) Assignee(s): none reported Patent Number: 6,149,914 Date filed: July 12, 1999 Abstract: A composition (10) for treating the symptoms of bronchial asthma in a human requiring such treatment includes an orally effective amount of dried (28), powdered (30) interior bark from the sacred fig tree of India, Ficus religiosa (12). The composition (10)is admixed with a foodstuff such a rice pudding (14), for ingestion by the patient. Excerpt(s): The instant invention relates generally to compositions for treating the symptoms of asthma in a human patient, and specifically to an orally administered composition derived from natural sources for treating the symptoms of bronchial asthma. ... Bronchial asthma is a relatively common lung disorder characterized by periodic attacks of wheezing alternating with periods of relatively normal breathing. While bronchial asthma is usually intrinsic (no cause can be demonstrated), it is occasionally caused by a specific allergy (e.g., pollen, mold, dander, dust). Although most individuals with asthma will have some positive
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allergy tests, the allergy is not necessarily the cause of the asthma symptoms. ... Symptoms can occur spontaneously or can be triggered by respiratory infections, exercise, cold air, tobacco smoke or other pollutants, or by allergies to foods, drugs or other irritants, such as chemicals, dust mites, feathers, food additives, fumes, mold, animal dander, and the like. Other things can also trigger asthmatic episodes: anxiety, fear, laughing, stress or anxiety, low blood sugar, adrenal disorders, temperature changes, extremes of dryness or humidity, or respiratory infections. The muscles of the bronchial tree become tight and the lining of the air passages become swollen, reducing airflow and producing a wheezing sound. Mucus production is generally increased. Web site: http://www.delphion.com/details?pn=US06149914__ ·
Method and kit for predicting susceptibility to asthma Inventor(s): Duff; Gordon W. (Sheffield, GB), di Giovine; Franco (Sheffield, GB), Barnes; Peter (Sheffield, GB), Lim; Samson (Sheffield, GB) Assignee(s): Interleukin Genetics, Inc. (San Antonio, TX) Patent Number: 6,140,047 Date filed: January 12, 1998 Abstract: The present invention provides a novel method for the early prediction of a propensity to develop chronic obstructive airway disorders such as asthma. The present invention also provides kits for the early determination of the propensity to develop such a disorder. The method consists of detecting the presence of one or more alleles of an IL1B haplotype, specifically the IL-1b (+3954) and the IL-1B (-511) loci. The presence of allele 2 at the IL-1b (+3954) locus indicates increased risk for a chronic obstructive airway disorder. The presence of allele 2 at the IL-1B (-511) locus indicates susceptibility to more severe expression of chronic obstructive airway disorders. Excerpt(s): This invention relates to methods and kits for the identification of susceptibility to chronic obstructive airway diseases or disorders. Specifically, the method involves the detection of at least one allele in an IL-1B haplotype, such as an allele at the IL-1B (+3954) locus, which is indicative of an increased susceptibility to chronic obstructive airway disease such as asthma. Additionally, the method also involves the detection of an allele at the IL-1B (-511) locus, the presence of which is indicative of an increased susceptibility to severe asthma. Also included in the present invention are kits for the methods herein described. ... Chronic obstructive lung disease and chronic obstructive airway disease (COAD) are broad terms used to describe not a disease entity, but rather
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a complex of conditions that have in common airflow limitation or airflow obstruction. COAD includes asthma, emphysema, chronic bronchitis, and chronic bronchiolitis. The sites of airway obstruction in COADs vary from the upper airways to the most peripheral bronchioles. The exact cause of most diseases of the airways is not well understood. The definition of airway diseases add to the confusion. Chronic bronchitis is defined clinically by the chronic presence of cough and sputum production. Emphysema, on the other hand, is defined anatomically, on the basis of the breakdown of lung tissue and the enlargement of the alveolar sacs. COADs all have airway narrowing as a disease parameter and they also share inflammation as a component of the disease process. ... Asthma is a chronic lung disease characterized by coughing, chest tightness, shortness of breath, and wheezing due to a reversible obstruction of airflow resulting from inflammation and hyperresponsiveness of the airways. In sensitized individuals, inhalation of allergens may produce inflammation of the airway lining, and precipitate a flare-up of asthma. Asthma may also occur as a result of other inflammatory stimuli, such as respiratory tract infections. Individuals who have become sensitized to specific foods may have severely and possibly life-threatening reactions after ingestion of these substances. Asthma, once thought of as a "simple" hypersensitivity reaction, is now known to be a complex condition with a probable spectrum of causes and contributing factors, with airway inflammation as its central attribute. Pulmonary researchers liken it to arteriosclerosis, in the sense that there are many interactive aspects. Many of the contributing factors are now under intensive study, including the chemical reactions that take place in the asthmatic process; the nature of cell-cell communication, the way information is conveyed from one cell or type of cell to another; and the role, reactive or other, of the epithelium. Allergies contribute to both the incidence and severity of asthmatic symptoms. An allergy (also known as immediate hypersensitivity) is defined as an abnormal sensitivity to a substance which is normally tolerated and generally considered harmless, and for which the triggering event is dose-independent, as opposed to a dose-dependent idiosyncratic reaction to a substance. While all immune responses occur as a result of exposure to foreign substances, allergic reactions are distinct from the protective or enhanced "immunity" conferred by immunizations or natural infection. Only about a quarter of the children with asthma outgrow the condition when their airways reach adult size; for the rest, the condition is a lifelong ordeal. The condition persists, according to a research report published by the American Lung Association, in 85 percent of women and in 72 percent of men. (Journal of Allergy and Clinical Immunology Vol. 96:5 11/96). Web site: http://www.delphion.com/details?pn=US06140047__
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Therapeutic treatment for asthma Inventor(s): Ways; Douglas Kirk (Indianapolis, IN) Assignee(s): Eli Lilly and Company (Indianapolis, IN) Patent Number: 6,103,712 Date filed: February 22, 1999 Abstract: A method for treating asthma and disease conditions associated therewith is disclosed, particularly using the isozyme selective PKC inhibitor, (S)-3,4-[N,N'-1,1'-((2"-ethoxy)-3'"-(O)-4'"-(N,N-dimethylamino)butane)-bi s-(3,3'-indoly1)]-1 (H)-pyrrole-2,5-dione and its pharmaceutically acceptable salts. Excerpt(s): The present invention is broadly directed to a method for inhibiting pulmonary vascular permeability, bronchial smooth muscle contractility, and airway hyperactivity. The present invention is particularly directed to the use of a particular class of isozyme selective Protein Kinase C (PKC) inhibitors for treating asthma and the syndromes associated therewith. ... We believe protein kinase C (PKC) is involved in the signal transduction pathways that mediate the disease conditions associated with asthma, e.g., airway hyperactivity, bronchial smooth muscle contraction, and extravasation of fluid from the vascular into the interstitial space of the lung. Inflammatory responses that accompany the asthmatic attack activate PKC in bronchial smooth muscle cells. Activation of PKC stimulates smooth muscle contraction including the smooth muscles of the respiratory tract (Itoh et al., 1993, J. Physiol. 397: 401; Peiper et al., 1996, Pflugers Arch. Eur. J. Physiol. 432: R47). ... Presently, no effective therapy is available for asthma. Elimination of the causative agent(s) from the environment of an allergic asthmatic is the most successful means available of treating this condition. Desensitization or immunotherapy with extracts of the suspected allergens also has enjoyed widespread favor, but controlled studies are limited and have not proved it to be highly effective. Web site: http://www.delphion.com/details?pn=US06103712__
Patent Applications on Asthma As of December 2000, U.S. patent applications are open to public viewing.25 Applications are patent requests which have yet to be granted (the process to 25
This has been a common practice outside the United States prior to December 2000.
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achieve a patent can take several years). The following patent applications have been filed since December 2000 relating to asthma: ·
Method for treating asthma using pregabalin Inventor(s): Schrier, Denis J. ; (Ann Arbor, MI), Taylor, Charles Price JR. ; (Chelsea, MI) Correspondence: David R. Kurlandsky; Warner-Lambert Company; 2800 Plymouth Road; Ann Arbor; MI; 48105; US Patent Application Number: 20020058706 Date filed: September 14, 2001 Abstract: This invention relates to a method for preventing asthma and related inflammatory disease in mammals. This invention also relates to a method for treating or alleviating the symptoms of asthma and related inflammatory disease in mammals. Excerpt(s): This invention relates to a method for preventing asthma and related inflammatory disease in mammals. This invention also relates to a method for treating or alleviating the symptoms of asthma and related inflammatory disease in mammals. ... Asthma is a lung disease characterized by (1) airways obstruction that is reversible (but not completely in some patients), either spontaneously or with treatments, (2) airways inflammation, and (3) increased airways responsiveness to a variety of stimuli. Asthma involves airways obstruction which is due to a combination of factors that include (1) spasm of airways smooth muscle; (2) edema of airways mucosa; (3) increased mucus secretion; (4) cellular, especially eosinophilic, infiltration of the airways walls; and (5) injury and desquamation of the airways epithelium (see generally The Merck Manual of Diagnosis and Therapy, 7th edition, Berkow R. ed., Merck Research Laboratories, Rahway, N.J., 1992:34). About 10 million asthmatics live in the United States. From 1980 to 1987 there has been a 29% increase in the prevalence rates of asthma, and from 1970 to 1987 hospital discharge rates for asthma nearly tripled. More alarmingly, the mortality rate from asthma worldwide is increasing, in the United States alone increasing 37% from 1980 to 1987. ... The alleviation or prevention of asthma related inflammation is highly desirable, for both human reasons and as an adjunct to proper effective clinical management of asthmatic disease. Aside from prophylactic steps to minimize exposure to certain environmental factors, and nonspecific exacerbating factors, treatment of asthma is conveniently considered as management of the acute attack and day-to-day therapy. Conventional methods of treatment can be classified under five groups of drug therapies: beta-adrenergic agents, theophylline, corticosteroids, cromolyn sodium, and
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anticholinergic agents (Windt M., "Asthma: Evolving Therapeutic Regimens," SPECTRUM Phamaceuticals, Decision Resources, Inc., 1991:23-1 to -7). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Diagnostic methods for asthma Inventor(s): Hazen, Stan ; (Pepper Pike, OH), Wu, Weijia ; (Cleveland, OH), Schmitt, David ; (Lakewood, OH) Correspondence: Calfee Halter & Griswold, LLP; 800 Superior Avenue; Suite 1400; Cleveland; Oh; 44114; US Patent Application Number: 20020048775 Date filed: August 16, 2001 Abstract: Screening methods for asthma and analogous diseases in which activated eosinophils are found at the disease site are provided. The methods involle assaying for the presence of brominated tyrosine species in a bodily sample which has been obtained from a test subject. The brominated tyrosine species are either free in the sample or protein bound. In one embodiment, the assay involve measuring the amount of a brominated tyrosine species, particularly 3-bromotyrosine, 3,5dibromotyrosine, or combinations thereof (referred to hereinafter collectively as the "diagnostic marker") in a bodily sample from the test subject. In another embodiment for determining the prognosis of asthma in a test subject, the concentration or content of the diagnostic marker is determined in bodily samples taken from the test subject over successive time intervals. The concentrations are compared to determine the prognosis of the asthma. In another embodiment of the invention for monitoring the response of the test subject to treatment with an antiasthmatic drug, the concentration or content of the diagnostic marker is measured in bodily samples obtained from the test subject before and after such treatment. The present invention also relates to a diagnostic kit and to a diagnostic reagent for diagnosing asthma and analogous diseases which are associated with activated eosinophils. Excerpt(s): This invention relates to novel methods for diagnosing and screening for diseases which involve accumulation of activated eosinophils at the disease site. More particularly, this invention is directed to methods for diagnosing asthma. ... Asthma is clinically defined as reversible obstructive airway disease. Symptoms of asthma range from chronic cough and wheezing to severe difficulty in breathing and respiratory failure. Acute severe asthma (status asthmaticus) refers to an attack of increased severity that is unresponsive to routine therapy
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and that, if severe enough, can lead to death. ... Chronic inflammation of the respiratory mucosa plays a fundamental role in the pathogenesis of asthma. Chronic inflammation causes increased mucus production which, along with asthmatic induced bronchospasms, leads to narrowing of the airways of the lung. The net result is a decrease in airway exchange in the lungs, decreased oxygenation of blood and tissues, and increased work of breathing. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Methods for treating allergic asthma using descarboethoxyloratadine Inventor(s): Handley, Dean A. ; (Westborough, MA), Rubin, Paul D. ; (Sudbury, MA) Correspondence: Pennie & Edmonds LLP; 1667 K Street NW; Suite 1000; Washington; DC; 20006 Patent Application Number: 20020040034 Date filed: April 24, 2000 Abstract: Methods utilizing descarboethoxyloratadine ("DCL"), for the treatment of allergic disorders, while avoiding the concomitant liability of adverse side-effects associated with other non-sedating antihistamines. Also included are methods for the treatment of allergic asthma using DCL and either a decongestant or a leukotriene inhibitor, while avoiding the concomitant liability of adverse side-effects associated with other non-sedating antihistamines. The invention also encompasses the administration of DCL in a nasal or oral spray. Excerpt(s): Clissold et al., Drugs 37: 42, 50-54 (1989) describes studies showing loratadine as effective for use in seasonal and perennial rhinitis, colds (with pseudoephedrine), and chronic urticaria. It has also been suggested that loratadine would be useful for the treatment of allergic asthma. Temple et al. Prostaglandins 35: 549-554 (1988). ... In one aspect, this invention provides, a method of treating allergic asthma in a human while avoiding the concomitant liability of adverse side-effects associated with the administration of non-sedating antihistamines, comprising administering to a human a composition, said composition comprising (i) a therapeutically effective amount of DCL or a pharmaceutically acceptable salt thereof; (ii) a therapeutically effective amount of a decongestant; and a pharmaceutically acceptable carrier. ... The invention also provides a method of treating allergic asthma in a human while avoiding the concomitant liability of adverse side-effects associated with the administration of non-sedating antihistamines, comprising administering to a human a composition, said composition comprising (i)
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a therapeutically effective amount of DCL or a pharmaceutically acceptable salt thereof; (ii) a leukotriene inhibitor selected from the group consisting of 5-lipoxygenase inhibitors, 5-lipoxygenase activating protein antagonists, and leukotriene D.sub.4 antagonists; and a pharmaceutically acceptable carrier. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Use of Calcitonin Gene-Related Peptide in the Prevention and Alleviation of Asthma and Related Bronchospastic Pulmonary Diseases Inventor(s): Cadieux, Alain ; (Roch Forest, Ca) Correspondence: Stephen A Bent; Foley & Lardner; Washington Harbour; 3000 K Street NW Suite 500; Washington; DC; 200075109 Patent Application Number: 20020037846 Date filed: December 30, 1999 Abstract: The present invention relates to the use of calcitonin generelated peptide (CGRP) in the prevention and alleviation of asthmatic symptoms. In contrast to other therapeutic agents now in use, CGRP combines both bronchoprotector and anti-inflammatory properties. Furthermore, it prevents both early and late phase bronchial responses associated with an asthma attack and its effective dose is small enough that undesirable haemodynamic side effects are not present. Excerpt(s): The present invention teaches that calcitonin gene-related peptide (CGRP), a neurotransmitter present in sensory nerves of several mammalian species, including humans, displays potent and efficient bronchoprotector and anti-inflammatory properties. More specifically, the present invention discloses that CGRP, when administered by inhalation to mammals, is capable of reducing the accumulation of eosinophils in the bronchial walls and of preventing bronchospastic airway responses, especially reversible airway hyperreactivity such as that encountered in bronchial asthma. ... Bronchial asthma may be defined as a clinical syndrome characterized by outbursts of suffocation and of severe discomfort, especially when air is exhaled from the lungs. These asthma outbursts or asthma attacks often occur after exertions or during the night, are reversible either spontaneously or following treatments and are generally the result of bronchial obstructions. Three major factors contribute to these obstructions: a spasm (contraction) of the smooth muscles surrounding the airways, an inflammation of the bronchial walls accompanied by an effusion of fluid (oedema) and an hypersecretion of mucus. Although the relative contribution of each of these conditions is unknown, the net result is an increase in airway
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resistance, hyperinflation of the lungs and thorax, as well as abnormal distribution of ventilation and pulmonary blood flow. Thus, when an asthma attack occurs, breathing becomes difficult and may be accompanied by wheezing, coughing and dyspnea. ... A major feature of this disorder is the propensity of the airways of asthmatics to respond in an abnormally exaggerated way (bronchial hyperreactivity) to a large variety of apparently unrelated stimuli such as allergic triggers, cigarette smoke, dust, pollens, chemical products, irritating vapours, cold air, food substances, physical exertion, stress, etc. Because of this increase in the sensitivity of the airways (10 to 1000 times normal), asthma has for a long time been regarded as a disease of the large airways which was believed to be caused mainly by mucus secretion and extensive narrowing of the tracheobronchi which consequently made breathing difficult for asthmatics. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Compositions & formulations with an epiandrosterone or a ubiquinone & kits & their use for treatment of asthma symptoms & for reducing adenosine/adenosine receptor levels Inventor(s): Nyce, Jonathan W. ; (Titusville, NJ) Correspondence: Epigenesis Pharmaceuticals; 7 Clark Drive; Canbury; NJ; 08520; US Patent Application Number: 20020032160 Date filed: April 24, 2001 Abstract: A composition and various formulations comprise preventative or therapeutic amounts of an epiandrosterone, analogue thereof or salt thereof, and/or a ubiquinone or salt thereof, and a pharmaceutically or veterinarily acceptable carrier or diluent. The composition and formulations are useful for treating bronchoconstriction, respiratory tract inflammation and allergies, asthma, and cancer. A method of treating diseases associated with low adenosine levels or adenosine depletion comprises administering folinic acid or a pharmaceutically acceptable salt hereof in a preventative or therapeutic amount, or an amount effective to treat adenosine depletion. Excerpt(s): This invention concerns itself with a method of treating bronchoconstriction, lung inflammation and allergies, asthma, and cancer by administering an epiandrosterone, analogs thereof, a ubiquinone, and/or their pharmaceutically acceptable salts. This invention also concerns itself with a method of treating adenosine depletion by administration of folinic acid or a pharmaceutically acceptable salt
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thereof. ... Adenosine is a purine that contributes to intermediary metabolism and participates in the regulation of physiological activity in a variety of mammalian tissues. Adenosine participates in many local regulatory mechanisms, such as those occurring in synapses in the central nervous system (CNS) and at neuroeffector junctions in the peripheral nervous system. In the CNS, adenosine inhibits the release of a variety of neurotransmitters, such as acetylcholine, noradrenaline, dopamine, serotonin, glutamate, and GABA; depresses neurotransmission; reduces neuronal firing to induce spinal analgesia and possesses anxiolytic properties. In the heart, adenosine suppresses pacemaker activity, slows AV conduction, possesses antiarrhythmic and arrhythmogenic effects, modulates autonomic control and triggers the synthesis and release of prostaglandins. In addition, adenosine has potent vasodilatory effects and modulates vascular tone. Adenosine is currently being used clinically for the treatment of super ventricular tachycardia and other cardia anomalies. Adenosine analogues also are being investigated for use as anticonvulsant, anxiolytic and neuro protective agents. Adenosine has also been implicated as a primary determinant underlying the symptoms of bronchial asthma and other respiratory diseases, the induction of bronchoconstriction and the contraction of airway smooth muscle. Moreover, adenosine causes bronchoconstriction in asthmatics but not in non-asthmatics. Other experimental data suggest the possibility that adenosine receptors may also be involved in allergic and inflammatory responses. It has been postulated that the modulation of signal transduction at the surface of inflammatory cells influences acute inflammation. Adenosine is said to inhibit the production of super-oxide by stimulated neutrophils. Moreover, the treatment of experimental allergic uveitis produced a marked reduction in inflammation. Adenosine may attenuate this behavior by reducing the hyperactivity of the central dopaminergic system. ... Diseases and conditions, such as asthma, are common diseases in industrialized countries, and in the United States alone account for extremely high health care costs. These diseases or conditions have recently been increasing at an alarming rate, both in terms of prevalence, morbidity and mortality. In spite of this, their underlying causes still remain poorly understood. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Method for treatment of asthma syndrome Inventor(s): Hoang, Ba X. ; (San Jose, CA), Levine, Stephen A. ; (Kentfield, CA) Correspondence: Perkins Coie LLP; P.O. box 2168; Menlo Park; CA; 94026; US Patent Application Number: 20020018817 Date filed: September 17, 2001 Abstract: A method of treating asthma in a patient is disclosed. The method includes administering to the patient, a therapeutically effective amount of (i) Moschus moschiferus or its active ingredient muscone, (ii) Calculus Bovis or its major active ingredients cholic acid and urodesoxychloic acid, or (iii) Placental extract or powder from humans or mammals. The compound is preferably administered orally, twice or three time a day. Excerpt(s): Despite developments in understanding the nature of asthma and developing new treatment procedures, the occurrence of asthma has increased significantly over the last 20 years. Hospital admissions for asthma treatment have increased and deaths attributed to asthma have doubled since 1976. Today, nearly 20 million Americans suffer from asthma, of which about 5 million are children. ... Asthma is traditionally divided to: allergic (extrinsic) and non-allergic (intrinsic) types of asthma. However, this classification has no impact in selecting a therapy for acute asthma attacks, in preventive treatments or in prognosis of asthma severity. Treatments of asthma are the same for both types of asthma. Physicians try to treat every symptom of asthma and make adjustments or changes in asthma therapy. But these adjustments are based on patients'responses to the various drugs without comprehensive understanding or explanation. The uniform therapeutic strategy and unpredictable responses of the patients to different therapeutic agents represent a formidable problem for asthma treatments as well as preventive therapy. ... Currently, there are six major classes of asthma medications: (i) steroidal anti-inflammatories, (ii) allergy-blocking agents (cromolyn sodium and nedocromil sodium), (iii) beta-agonists; (iv) xanthines (theophylline); (v) anti-cholinenergics; and (vi) antileukotrienes. Among these, glucocorticosteroids are the most effective therapy available for asthma. Therapy with inhaled glucocorticosteroids is now recommended at a much earlier stage. However, despite their proven efficacy in the treatment of asthma, enthusiasm for their use has been gradual due to reported systemic side effects and the extensive periods of use by patients such as children. Because of this concern, less effective therapies are often preferred. Cromolyn sodium and nedocromil
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sodium are less effective in controlling asthma than inhaled glucocorticoids. They need to be taken four times daily and although they may be useful for some patients with mild asthma, their efficacy often decreases in long-term therapy. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Methods and compositions for treatment of asthma Inventor(s): Brodor, Samuel ; (Weston, FL), Ahmed, Tahir ; (Coral Gables, FL) Correspondence: Baker Norton Pharmaceuticals, Inc.; 4400 Biscayne Boulevard; Miami; FL; 33137; US Patent Application Number: 20020013373 Date filed: January 29, 2001 Abstract: The present invention comprises methods and compositions for the treatment of bronchorestrictive disorders, including asthma, in humans or animals. The methods and compositions are effective in treatment of inflammatory responses, such as those found in asthma and other related pathologies. Excerpt(s): The present invention relates to methods and compositions for the treatment of pathologies associated with asthma and inflammatory responses in a human or animal. In particular, the present invention comprises compositions and methods for the treatment of asthma by administration of pharmaceutical preparations including Dpropranolol. ... More than ten million persons in the United States suffer from asthma and related inflammatory lung diseases. The numbers of persons with asthma is increasing both in the United States and worldwide. The morbidity associated with asthma makes asthma a major medical condition. Asthma is the most common chronic disease of childhood and the leading cause among chronic illnesses of school absences. Asthma in humans results in an estimated 27 million patient visits, 6 million lost workdays, and 90.5 million days of restricted activity per year. In addition to its morbidity, the mortality rate for asthma is growing worldwide. Additionally, asthma reactions are a growing problem for animals. In particular, the horse racing industry is affected by horses that suffer from asthmatic reactions. ... Asthma is a lung disease characterized by a usually reversible airway obstruction, airway inflammation and increased airway responsiveness to stimuli. The airway obstruction in an asthma attack is thought to be due to the combination of bronchospasm of the smooth muscles of the bronchial tree, increased mucous section, edema of airway mucosa due to increased
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vascular permeability, cellular infiltration of the airway walls, and injury to airway epithelium. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Method and apparatus for educating asthma sufferers and caregivers Inventor(s): Rasche, Jeanette D. ; (Evans, GA), Whitlock, Warren ; (Evans, GA) Correspondence: Office of the Staff Judge Advocate; U.S. Army Medical Research and Material Command; ATT: MCMR-JA (Ms. Elizabeth Arwine); 504 Scott Street; Fort Detrick; MD; 21702-5012; US Patent Application Number: 20010055750 Date filed: April 10, 2001 Abstract: A method and system preferably is for use in treating asthma patients by applying a score to the severity of the asthma based on answers to a series of questions. The system further preferably includes interactive education including what is asthma, how to lessen the likelihood of asthma attacks, and how to treat an asthma attack. Excerpt(s): The invention is directed at an assessment method and apparatus for asthma patients and healthcare providers to use in assessing a particular case of asthma and/or learning about different aspects of asthma. More particularly, the invention relates to a scoring system for determining the severity of asthma and the current situation of an asthma patient. ... Over 100 million people worldwide have asthma. Uncontrolled asthma can lead to emergency room visits, hospitalizations and reduced quality of life. There are clinical practice guidelines for asthma that define the "right things to do" in delivering consistent and standardized asthma care. These guidelines have been developed by a panel of medical experts, and distributed to medical facilities and individual health care providers in the form of extensive documentation. Often times, the valuable information contained within the asthma clinical practice guidelines is not utilized because it is not readily accessible to the health care providers or patient when it is needed. In most cases, these guidelines are placed on a shelf or in a file cabinet, and remain largely unaddressed or unreferenced, if not entirely forgotten. The inaccessibility or inconvenience of the material contained within the asthma clinical practice guidelines results in asthma patients receiving variable care that may lead to uncontrolled asthma. ... The problem of how to score an individual patient's asthma severity has not been clear. Asthma specialists often use expensive pulmonary function testing to
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assess severity, some providers, use peak flow meter readings, or other "questionnaires," and most do not use a specific tool at all. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Methods and compositions for treating asthma, atherosclerosis and inflammatory diseases using optically pure (-zileuton Inventor(s): Gray, Nancy M. ; (Marlborough, MA) Correspondence: Heslin & Rothenberg, PC; 5 Columbia Circle; Albany; NY; 12203 Patent Application Number: 20010009917 Date filed: March 5, 2001 Abstract: Methods and compositions are disclosed utilizing optically pure (+)-zileuton for the treatment of asthma, rheumatoid arthritis and ulcerative colitis in humans while substantially reducing the concomitant liability of adverse effects associated with the racemic mixture of zileuton. (+)-Zileuton is an inhibitor of 5-lipoxygenase and is therefore useful in the treatment of other conditions related to elevated leukotriene levels (+)-Zileuton is also an antioxidant and is therefore useful in treating or preventing atherosclerosis. Excerpt(s): This invention relates to novel compositions of matter containing optically pure (+)-zileuton. These compositions possess potent activity in treating asthma, ulcerative colitis, rheumatoid arthritis, psoriasis, allergic rhinitis and other diseases including those that would benefit from a selective inhibition of 5-lipoxygenase. By virtue of the antioxidant activity of (+)-zileuton, the compositions are also useful for treating atherosclerosis. Optically pure (+)-zileuton provides this treatment while substantially reducing adverse effects including, but not limited to, headache, nausea, fatigue, diarrhea, dyspepsia, chills, dizziness and paresthesia, which are associated with the administration of the racemic mixture of zileuton. Also disclosed are methods for treating the above described conditions in a human while substantially reducing the adverse effects that are associated with the racemic mixture of zileuton by administering the (+) isomer of zileuton to said human. ... Racemic zileuton has been in clinical trials in the United States for use in rheumatoid arthritis [Weinblatt et al., J. Rheumatology 19, 1537-1541 (1992)], for asthma [Israel et al., N. Eng. J. Med. 323, 1740-1744 (1990)], for ulcerative colitis [Laursen et al., Lancet 335, 683-6835 (1990)] and for allergen induced nasal congestion [Knapp, N. Eng. J. Med. 323, 1745-1748 (1990)]. The results of the preliminary clinical studies indicate that racemic zileuton may be clinically useful in all of these disease states
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because of its suppression of leukotriene production. ... The leukotrienes are a family of highly potent biological substances derived from arachidonic acid and are believed to be involved in mediating a spectrum of human disorders. Considerable evidence suggests that the leukotrienes contribute to the asthmatic response and that they are mediators of other inflammatory diseases (see Carter, et al. op. cit.). Because several 5lipoxygenase metabolites are likely to be generated at sites undergoing pathological reactions, and because these metabolites then act in concert to produce the clinical condition, it is thought advantageous to inhibit the formation of the constellation of metabolites to achieve therapeutic benefit. Since 5-lipoxygenase is the first enzymatic step in the conversion of arachidonic acid to leukotrienes, its inhibition should decrease the production of all of the pro-inflammatory metabolites. Racemic zileuton has been found to be a very selective inhibitor of mammalian 5lipoxygenase with little inhibitory effect on human platelet 12lipoxygenase, soybean 15-lipoxygenase or sheep seminal vesicle cyclooxygenase. In human volunteers doses of 800 mg p.o. twice per day for four weeks resulted in 75 to 85% decreases in LTB.sub.4 and statistically significant improvement in symptoms of rheumatoid arthritis. (Weinblatt op. cit.) One hundred percent of the patients receiving racemic zileuton reported an adverse event during the four week trial. The adverse events included headaches, nausea, fatigue, diarrhea, dyspepsia, chills, dizziness, paresthesia and infections. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with asthma, you can access the U.S. Patent Office archive via the Internet at no cost to you. This archive is available at the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “asthma” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on asthma. You can also use this procedure to view pending patent applications concerning asthma. Simply go back to the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.
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Vocabulary Builder Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Antiarrhythmic: An agent that prevents or alleviates cardiac arrhythmia. [EU]
Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antigens: Substances that are recognized by the immune system and induce an immune reaction. [NIH] Anxiolytic: An anxiolytic or antianxiety agent. [EU] Arrhythmia: An irregular heartbeat. [NIH] Arrhythmogenic: Producing or promoting arrhythmia. [EU] Asthenia: Lack or loss of strength and energy, weakness. [EU] Autonomic: Self-controlling; functionally independent. [EU] Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH] Bronchiole: The smaller airways of the lungs. [NIH] Bronchiolitis: Inflammation of the bronchioles, usually caused by a viral infection. [NIH] Budesonide: A glucocorticoid used in the management of asthma, the treatment of various skin disorders, and allergic rhinitis. [NIH] Calcitonin: A peptide hormone that lowers calcium concentration in the blood. In humans, it is released by thyroid cells and acts to decrease the formation and absorptive activity of osteoclasts. Its role in regulating plasma calcium is much greater in children and in certain diseases than in normal adults. [NIH] Cardiac: Pertaining to the heart. [EU] Chromans: Benzopyrans saturated in the 2 and 3 positions. [NIH]
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Collapse: 1. a state of extreme prostration and depression, with failure of circulation. 2. abnormal falling in of the walls of any part of organ. [EU] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Confusion: Disturbed orientation in regard to time, place, or person, sometimes accompanied by disordered consciousness. [EU] Contractility: stimulus. [EU]
Capacity for becoming short in response to a suitable
Decongestant: An agent that reduces congestion or swelling. [EU] Desensitization: The prevention or reduction of immediate hypersensitivity reactions by administration of graded doses of allergen; called also hyposensitization and immunotherapy. [EU] Desquamation: The shedding of epithelial elements, chiefly of the skin, in scales or small sheets; exfoliation. [EU] Diurnal: Occurring during the day. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dyspepsia: Impairment of the power of function of digestion; usually applied to epigastric discomfort following meals. [EU] Dyspnea: Shortness of breath; difficult or labored breathing. [NIH] Edema: Abnormal fluid accumulation in body tissues. [NIH] Effusion: The escape of fluid into a part or tissue, as an exudation or a transudation. [EU] Epithelium: The covering of internal and external surfaces of the body, including the lining of vessels and other small cavities. It consists of cells joined by small amounts of cementing substances. Epithelium is classified into types on the basis of the number of layers deep and the shape of the superficial cells. [EU] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Extravasation: A discharge or escape, as of blood, from a vessel into the tissues. [EU] GABA: The most common inhibitory neurotransmitter in the central nervous system. [NIH] Hepatic: Pertaining to the liver. [EU] Hyperkinesia: Abnormally hyperactivity. [EU]
increased
motor
function
or
activity;
Hypersecretion: Excessive secretion. [EU] Immunity: The condition of being immune; the protection against infectious
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disease conferred either by the immune response generated by immunization or previous infection or by other nonimmunologic factors (innate i.). [EU] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infarction: 1. the formation of an infarct. 2. an infarct. [EU] Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]
Intravenous: Within a vein or veins. [EU] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Lipoxygenase: An enzyme of the oxidoreductase class that catalyzes reactions between linoleate and other fatty acids and oxygen to form hydroperoxy-fatty acid derivatives. Related enzymes in this class include the arachidonate lipoxygenases, arachidonate 5-lipoxygenase, arachidonate 12lipoxygenase, and arachidonate 15-lipoxygenase. ec 1.13.11.12. [NIH] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medicament: A medicinal substance or agent. [EU] Metabolite: process. [EU]
Any substance produced by metabolism or by a metabolic
Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Myalgia: Pain in a muscle or muscles. [EU] Nervousness: Excessive excitability and irritability, with mental and physical unrest. [EU] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite
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or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrophil: Having an affinity for neutral dyes. [EU] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Oedema: The presence of abnormally large amounts of fluid in the intercellular tissue spaces of the body; usually applied to demonstrable accumulation of excessive fluid in the subcutaneous tissues. Edema may be localized, due to venous or lymphatic obstruction or to increased vascular permeability, or it may be systemic due to heart failure or renal disease. Collections of edema fluid are designated according to the site, e.g. ascites (peritoneal cavity), hydrothorax (pleural cavity), and hydropericardium (pericardial sac). Massive generalized edema is called anasarca. [EU] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU] Oxygenation: To provide with oxygen. [NIH] Pacemaker: An object or substance that influences the rate at which a certain phenomenon occurs; often used alone to indicate the natural cardiac pacemaker or an artificial cardiac pacemaker. In biochemistry, a substance whose rate of reaction sets the pace for a series of interrelated reactions. [EU] Perennial: Lasting through the year of for several years. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Propranolol: A widely used non-cardioselective beta-adrenergic antagonist. Propranolol is used in the treatment or prevention of many disorders including acute myocardial infarction, arrhythmias, angina pectoris, hypertension, hypertensive emergencies, hyperthyroidism, migraine, pheochromocytoma, menopause, and anxiety. [NIH] Prostaglandins: A group of compounds derived from unsaturated 20carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase
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pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH] Psoriasis: A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis. [NIH] Rheumatology: A subspecialty of internal medicine concerned with the study of inflammatory or degenerative processes and metabolic derangement of connective tissue structures which pertain to a variety of musculoskeletal disorders, such as arthritis. [NIH] Sedative: 1. allaying activity and excitement. 2. an agent that allays excitement. [EU] Sertraline: A selective serotonin uptake inhibitor that is used in the treatment of depression. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Tachycardia: Excessive rapidity in the action of the heart; the term is usually applied to a heart rate above 100 per minute and may be qualified as atrial, junctional (nodal), or ventricular, and as paroxysmal. [EU] Tachyphylaxis: 1. rapid immunization against the effect of toxic doses of an extract or serum by previous injection of small doses. 2. rapidly decreasing response to a drug or physiologically active agent after administration of a few doses. [EU] Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [NIH]
Thromboxanes: Physiologically active compounds found in many organs of the body. They are formed in vivo from the prostaglandin endoperoxides and cause platelet aggregation, contraction of arteries, and other biological effects. Thromboxanes are important mediators of the actions of polyunsaturated fatty acids transformed by cyclooxygenase. [NIH]
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Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Tremor: An involuntary trembling or quivering. [EU] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ubiquinone: A lipid-soluble benzoquinone which is involved in electron transport in mitochondrial preparations. The compound occurs in the majority of aerobic organisms, from bacteria to higher plants and animals. [NIH]
Ulcer: A local defect, or excavation, of the surface of an organ or tissue; which is produced by the sloughing of inflammatory necrotic tissue. [EU] Urticaria: Pathology: a transient condition of the skin, usually caused by an allergic reaction, characterized by pale or reddened irregular, elevated patches and severe itching; hives. [EU] Uveitis: An inflammation of part or all of the uvea, the middle (vascular) tunic of the eye, and commonly involving the other tunics (the sclera and cornea, and the retina). [EU] Ventricular: Pertaining to a ventricle. [EU] Xanthines: Purine bases found in body tissues and fluids and in some plants. [NIH]
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CHAPTER 6. BOOKS ON ASTHMA Overview This chapter provides bibliographic book references relating to asthma. You have many options to locate books on asthma. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on asthma include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “asthma” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on asthma:
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Young People and Chronic Illness: True Stories, Help and Hope Source: Minneapolis, MN: Free Spirit Publishing. 1998. 199 p. Contact: Available from Free Spirit Publishing. 400 First Avenue North, Suite 616, Minneapolis, MN 55401-1724. (612) 338-2068. Fax (612) 3375050. E-mail:
[email protected]. Website: www.freespirit.com. PRICE: $14.95 plus shipping and handling. ISBN: 1575420414. Summary: This book offers information and advice about coping with a chronic illness during adolescence and young adulthood. Part one profiles 10 adolescents and young adults who are learning to balance their chronic illness and their active lives. Illnesses include diabetes, juvenile rheumatoid arthritis, asthma, leukemia, a congenital heart defect, epilepsy, hemophilia, lupus, and Crohn's disease. These young men and women share their stories and advice from discovery and diagnosis to management of day-to-day medical decisions, symptoms, family, friends, and school. Each story is followed by a question and answer section that provides more information about each illness, as well as a list of resources. Part two presents steps for managing the illness, ways to develop a good patient-doctor relationship, tips on telling friends and classmates about the illness, advice on communicating with family, strategies for coping with school, and suggestions on handling a fear of hospitals. It also provides information on support groups and national organizations.
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Living a Healthy Life With Chronic Conditions: Self-Management of Heart Disease, Arthritis, Stroke, Diabetes, Asthma, Bronchitis, Emphysema and Others Source: Palo Alto, CA: Bull Publishing Company. 1994. 296 p. Contact: Available from Bull Publishing Company. P.O. Box 208, Palo Alto, CA 94302-0208. (800) 676-2855 or (415) 322-2855. Fax (415) 327-3300. E-mail:
[email protected]. PRICE: $14.95. ISBN: 0923521283. Summary: This book is a complete self-management guide for people with chronic diseases. The authors focus on day-to-day living skills, in the context of the specific chronic diseases, including heart disease, arthritis, stroke, diabetes, asthma, bronchitis, and emphysema. General topics include the psychological aspects to self-management; finding resources; smoking and quitting; understanding common symptoms; using one's mind to manage symptoms; exercising for fun and fitness; exercising for flexibility and strength; exercising for endurance; exercising tips for people with specific chronic diseases; the importance of communication; durable powers of attorney for health care; eating well; and managing medications. The chapter on diabetes covers diabetes
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and its causes; maintaining an appropriate blood glucose level; symptoms of hyperglycemia and hypoglycemia; dietary management; exercise; insulin injections; oral medications; emotions; self-monitoring of blood glucose and urine; the complications of diabetes; and diabetes resources. Each chapter includes limited references and a subject index concludes the volume.
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “asthma” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:26 ·
ABC of asthma. Author: John Rees, Dipak Kanabar; Year: 2000; London: BMJ Books, 2000; ISBN: 0727912615 (pbk.) http://www.amazon.com/exec/obidos/ASIN/0727912615/icongroupin terna
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Advances in asthma management. Author: editor, Nancy Saltmarsh; Year: 1999; Atlanta, GA: American Health Consultants, c1999
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Ambulatory care clinical skills program: asthma management module. Author: Kenreigh, Charlotte Anne; Year: 2000; Bethesda, MD: American Society of Health-System Pharmacists, c2000; ISBN: 1879907941 http://www.amazon.com/exec/obidos/ASIN/1879907941/icongroupin terna
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Asthma: mechanisms and protocols. Author: edited by K. Fan Chung and Ian Adcock; Year: 2000; Totowa, N.J.: Humana Press, c2000; ISBN: 089603626X (alk. paper)
In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
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http://www.amazon.com/exec/obidos/ASIN/089603626X/icongroupi nterna ·
Asthma and respiratory infections. Author: edited by David P. Skoner; Year: 2001; New York: Marcel Dekker, c2001; ISBN: 0824777107 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0824777107/icongroupin terna
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Asthma epidemic: prospects for controlling an escalating public health crisis: a background paper. Author: prepared by Richard E. Hegner; Year: 2000; Washington, D.C.: National Health Policy Forum, [2000]
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Asthma in practice. Author: Mark Levy and Sean Hilton; Year: 1999; London: Royal College of General Practitioners, 1999; ISBN: 0850842433
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Asthma management for the new millennium. Author: editor, Gordon Mallarkey; Year: 1999; Auckland; Philadelphia: Adis International, c1999; ISBN: 0864710585 (pbk.) http://www.amazon.com/exec/obidos/ASIN/0864710585/icongroupin terna
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Asthma sourcebook: basic comnsumer health information about asthma, including symptoms, traditional and nontraditional remedies, treatament advances, quality-of-life aids, medical research updates, and the role of allergies, exercise, age, the environmen. Author: Nystad, Wenche; Year: 2000; Detroit, MI: Omnigraphics, c2000; ISBN: 0780803817 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0780803817/icongroupin terna
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Attack asthma: report with technical appendices: why America needs a public health defense system to battle environmental threats. Author: Kavuru, Mani S; Year: 2000; Baltimore, Md.: Pew Environmental Health Commission at the Johns Hopkins School of Public Health, [2000?]
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Bronchial asthma: principles of diagnosis and treatment. Author: edited by M. Eric Gershwin and Timothy E. Albertson; Year: 2001; Totowa, N.J.: Humana, c2001; ISBN: 0896038610 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0896038610/icongroupin terna
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Childhood asthma: the most common chronic disease among children. Author: Greg O'Neill and Laura Summer; Year: 2000; Washington, DC: National Academy on an Aging Society, 2000
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Clearing the air: asthma and indoor air exposures. Author: Committee on the Assessment of Asthma and Indoor Air, Division of Health Promotion and Disease Prevention, Institute of Medicine; Year: 2000; Washington, D.C.: National Academy Press, 2000; ISBN: 0309064961
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http://www.amazon.com/exec/obidos/ASIN/0309064961/icongroupin terna ·
Combination therapy for asthma and chronic obstructive pulmonary disease. Author: edited by Richard J. Martin, Monica Kraft; Year: 2000; New York: Marcel Dekker, c2000; ISBN: 0824703715 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0824703715/icongroupin terna
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Contemporary diagnosis and management of allergic diseases and asthma. Author: James E. Gern, William W. Busse; Year: 1999; Newtown, Pa.: Handbooks in Health Care, c1999; ISBN: 1884065473 http://www.amazon.com/exec/obidos/ASIN/1884065473/icongroupin terna
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Diagnosis and management of asthma. Author: Mani S. Kavuru, Herbert P. Wiedemann; Year: 1998; Caddo, OK: Professional Communications, c1998; ISBN: 1884735266 http://www.amazon.com/exec/obidos/ASIN/1884735266/icongroupin terna
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Drug strategies in asthma. Author: Wells Healthcare Communications; Year: 2000; New York: M. Dekker, c2000; ISBN: 0824703294 (alk. paper)
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Effect of improving the home environment on asthma: a pilot study: final report. Author: submitted to Virginia Salares, Canada Mortgage and Housing Corporation; submitted by Buchan, Lawton, Parent Ltd; Year: 1999; Ottawa: CMHC, c1999; ISBN: 0660179091
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Environmental asthma. Author: edited by Robert K. Bush; Year: 2001; New York: Marcel Dekker, c2001; ISBN: 0824703014 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0824703014/icongroupin terna
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Epidemiological studies of asthma among school children. Author: by Wenche Nystad; Year: 1999; Bergen: Norsk forening for epidemiologi, 1999; ISBN: 8273641392
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Human airway inflammation: sampling techniques and analytical protocols. Author: edited by Duncan F. Rogers and Louise E. Donnelly; Year: 2001; Totowa, N.J.: Humana, c2001; ISBN: 0896039234 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0896039234/icongroupin terna
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Immunological mechanisms in asthma and allergic diseases. Author: volume editor, Douglas S. Robinson; Year: 2000; Basel; New York: Karger, 2000; ISBN: 3805571127 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/3805571127/icongroupin terna
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Primary care management of asthma in adults: North of England Evidence Based Guideline Development Project. Author: Centre for Health Services Research, University of Newcastle upon Tyne; Year: 1999; [Newcastle upon Tyne]: Centre for Health Services Research, University of Newcastle upon Tyne, [1999]; ISBN: 1870399927 (pbk.)
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Severe asthma: pathogenesis and clinical management. Author: edited by Stanley J. Szefler, Donald Y.M. Leung; Year: 2001; New York: M. Dekker, c2001; ISBN: 0824705521 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0824705521/icongroupin terna
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Understanding asthma: a management companion. Author: editors, Ronald S. Walls, Christine R. Jenkins; Year: 2000; Sydney: MacLennan + Petty, 2000; ISBN: 0864331428 http://www.amazon.com/exec/obidos/ASIN/0864331428/icongroupin terna
Chapters on Asthma Frequently, asthma will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with asthma, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and asthma using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “asthma” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books.
Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to asthma have been published that consolidate information across various sources. These too might be useful in gaining access to additional guidance on asthma. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:27 You will need to limit your search to “Directories” and asthma using the “Detailed Search” option. Go directly to the following hyperlink:
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American Academy of Allergy and Immunology Membership Directory Source: 1990. Contact: American Academy of Allergy Asthma and Immunology, 611 E. Wells St., Milwaukee, WI 53202. (414) 272-6071. A photocopy of this material is available from the CDC National Prevention Information Network Document Delivery Service, P.O. Box 6003, Rockville, MD 20849-6003. (800) 458-5231. Summary: This directory of the American Academy of Allergy and Immunology provides information on its members, some of which are involved in treating and researching Acquired immunodeficiency syndrome (AIDS), caused by Human immunodeficiency virus (HIV). Entries provide addresses, telephone numbers, degree and certification data, place and dates where residency was performed, hospital affiliation, and society membership and interest areas, as well as other data. The directory also provides the organization's by-laws and constitution, the American Board of Allergy and Immunology, essentials of accredited programs, and listings of accredited programs in allergy/immunology and regional, State, and local allergy societies.
General Home References In addition to references for asthma, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Anatomica : The Complete Home Medical Reference by Peter Forrestal (Editor); Hardcover (2000), Book Sales; ISBN: 1740480309; http://www.amazon.com/exec/obidos/ASIN/1740480309/icongroupinterna · The Breathing Disorders Sourcebook by Francis V. Adams, M.D.; Paperback - 240 pages (November 1998), McGraw Hill - NTC; ISBN: 073730006X; http://www.amazon.com/exec/obidos/ASIN/073730006X/icongroupinterna · The HarperCollins Illustrated Medical Dictionary : The Complete Home Medical Dictionary by Ida G. Dox, et al; Paperback - 656 pages 4th edition http://chid.nih.gov/detail/detail.html. To find directories, use the drop boxes at the bottom of the search page where “You may refine your search by”. For publication date, select “All Years”, select language and the format option “Directory”. By making these selections and typing in “asthma” (or synonyms) into the “For these words:” box, you will only receive results on directories dealing with asthma. You should check back periodically with this database as it is updated every three months.
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(2001), Harper Resource; ISBN: 0062736469; http://www.amazon.com/exec/obidos/ASIN/0062736469/icongroupinterna · The Merck Manual of Medical Information: Home Edition (Merck Manual of Medical Information Home Edition (Trade Paper) by Robert Berkow (Editor), Mark H. Beers, M.D. (Editor); Paperback - 1536 pages (2000), Pocket Books; ISBN: 0671027263; http://www.amazon.com/exec/obidos/ASIN/0671027263/icongroupinterna · Stedman’s Cardiovascular & Pulmonary Words: Includes Respiratory; Paperback - 888 pages, 3rd edition (June 15, 2001), Lippincott, Williams & Wilkins Publishers; ISBN: 0781730562; http://www.amazon.com/exec/obidos/ASIN/0781730562/icongroupinterna
Vocabulary Builder Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Antiviral: Destroying viruses or suppressing their replication. [EU] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Barium: An element of the alkaline earth group of metals. It has an atomic symbol Ba, atomic number 56, and atomic weight 138. All of its acid-soluble salts are poisonous. [NIH] Carbohydrates: A nutrient that supplies 4 calories/gram. They may be simple or complex. Simple carbohydrates are called sugars, and complex carbohydrates are called starch and fiber (cellulose). An organic compound—containing carbon, hydrogen, and oxygen—that is formed by photosynthesis in plants. Carbohydrates are heat producing and are classified as monosaccharides, disaccharides, or polysaccharides. [NIH] Cystitis: Inflammation of the urinary bladder. [EU] Dermatology: A medical specialty concerned with the skin, its structure, functions, diseases, and treatment. [NIH] Dyslipidemia: Disorders in the lipoprotein metabolism; classified as hypercholesterolemia, hypertriglyceridemia, combined hyperlipidemia, and low levels of high-density lipoprotein (HDL) cholesterol. All of the dyslipidemias can be primary or secondary. Both elevated levels of lowdensity lipoprotein (LDL) cholesterol and low levels of HDL cholesterol
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predispose to premature atherosclerosis. [NIH] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Gluten: The protein of wheat and other grains which gives to the dough its tough elastic character. [EU] Hepatitis: Inflammation of the liver. [EU] Hoarseness: An unnaturally deep or rough quality of voice. [NIH] Hydration: The condition of being combined with water. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Interferons: Proteins secreted by vertebrate cells in response to a wide variety of inducers. They confer resistance against many different viruses, inhibit proliferation of normal and malignant cells, impede multiplication of intracellular parasites, enhance macrophage and granulocyte phagocytosis, augment natural killer cell activity, and show several other immunomodulatory functions. [NIH] Laryngectomy: Total or partial excision of the larynx. [NIH] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Osteoarthritis: Noninflammatory degenerative joint disease occurring chiefly in older persons, characterized by degeneration of the articular
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cartilage, hypertrophy of bone at the margins, and changes in the synovial membrane. It is accompanied by pain and stiffness. [NIH] Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the islets of langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pelvic: Pertaining to the pelvis. [EU] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Perfusion: The passage of fluid through an organ. [NIH] Pharmacists: Those persons legally qualified by education and training to engage in the practice of pharmacy. [NIH] Phonation: The process of producing vocal sounds by means of vocal cords vibrating in an expiratory blast of air. [NIH] Pruritus: 1. itching; an unpleasant cutaneous sensation that provokes the desire to rub or scratch the skin to obtain relief. 2. any of various conditions marked by itching, the specific site or type being indicated by a modifying term. [EU] Sedentary: 1. sitting habitually; of inactive habits. 2. pertaining to a sitting posture. [EU] Stimulant: 1. producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. an agent or remedy that produces stimulation. [EU] Topical: Pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. [EU]
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CHAPTER 7. MULTIMEDIA ON ASTHMA Overview Information on asthma can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on asthma. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.
Video Recordings Most diseases do not have a video dedicated to them. If they do, they are often rather technical in nature. An excellent source of multimedia information on asthma is the Combined Health Information Database. You will need to limit your search to “video recording” and “asthma” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” By making these selections and typing “asthma” (or synonyms) into the “For these words:” box, you will only receive results on video productions. The following is a typical result when searching for video recordings on asthma:
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·
Common Childhood Illnesses Source: Princeton, NJ: Films for the Humanities and Sciences. 1991. (videocassette). Contact: Available from Films for the Humanities and Sciences. P.O. Box 2053, Princeton, NJ 08543-2053. (800) 257-5126 or (609) 275-1400. Fax (609) 275-3767. E-mail:
[email protected]. Website: www.films.com. PRICE: $79.95 plus shipping and handling. Order number BVT8149. Summary: This education video helps parents cope with a child who has lost his appetite, has pain around his ears, is running a low grade fever, and seems to have swollen lymph glands. How to determine if it is the mumps, or an ear infection, tonsillitis, or something else? This video offers an entertaining yet informative overview of common childhood illnesses, their symptoms, and possible at home and professional medical treatments, as well as how to decide if a health care provider should be consulted. School age children who have experienced the conditions describe each illness, how it felt, what it looked like, and how it was cared for. Viewers learn about the symptoms of and treatments for ear infections, common colds, mumps, tonsillitis, appendicitis, chickenpox, fevers, asthma, croup, measles, German measles, and abnormal bowel movements (constipation and diarrhea). The presentation offers a new approach to educating those involved in child care about the serious subject of childhood illnesses (AA-M).
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Coping and Connecting: Teens Talk About Living with a Chronic Illness Source: St. Paul, MN: Children's Health Care. 1997. (videocassette). Contact: Available from Children's Health Care. 345 North Smith Avenue, St. Paul, MN 55102. (612) 220-6765. PRICE: $29.95. Summary: In this videotape, teenagers and young adults talk candidly about what it's like to be diagnosed with a chronic or life threatening illness, the challenges they face, and what has helped them to cope. These young people, diagnosed with asthma, diabetes, cancer and other illnesses, encourage and provide hope to their peers. The videotape is designed to help teens learn they are not alone facing their illness and to learn ways to cope with the challenges, to help health care providers learn about the unique concerns of teenagers, and to help parents learn more about their child's experiences. The videotape can be viewed in its entirety or by diagnosis (just the section on diabetes, for example). The young woman with diabetes stresses how her illness has nurtured her independence and the importance of self care as the cornerstone of good diabetes management. The videotape is part of a program called
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Encourage. In Encourage, support is received in a variety of ways through group or individual involvement with other youth who have experienced a chronic illness. Peer helpers have learned to incorporate their experiences in a positive way and are prepared to support others who face similar challenges. (AA-M). ·
There is a future Source: Durham, NC: Duke University Medical Center. 1990. 1 videotape (14:30 minutes). Contact: Available from Julia Gaskel, Duke University Medical Center, Box 2916, Durham, NC 27710. Telephone: (919) 684-3401. $35.00 , rental $20.00. Summary: This videotape shows interviews of eight adolescents describing their struggles and the uncertainties of living with a chronic illness. The different illnesses include cancer, sickle cell disease, asthma, Hodgkin disease, and cystic fibrosis. These young people talk frankly about their problems and address issues such as friendship, independence, and the possibility of death.
Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Sound Recordings.” By making these selections and typing “asthma” (or synonyms) into the “For these words:” box, you will only receive results on sound recordings (again, most diseases do not have results, so do not expect to find many).
Bibliography: Multimedia on Asthma The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in asthma (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication
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date, author, or relevance. The following multimedia has been indexed on asthma. For more information, follow the hyperlink indicated: ·
Adult asthma. Source: a co-production of Audio Visual Communication Resources and Physician Education & Development; Year: 1997; Format: Videorecording; [Oakland, Calif.]: Kaiser Foundation Health Plan, c1997
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Allergic to the 20th century. Source: a presentation of Films for the Humanities & Sciences, BBC Education & Training; Year: 1997; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c1997
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Asthma : in search of answers. Source: a presentation of Films for the Humanities & Sciences; produced and distributed by Canadian Broadcasting Corporation; Year: 1997; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c1997
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Asthma in children. Source: Time Life Medical; produced in association with Sonalysts Studios; Year: 1996; Format: Videorecording; New York, NY: Patient Education Media, c1996
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Asthma therapy : what really works? Source: American Academy of Family Physicians; [produced by] MCR, Medical Communications Resources Incorporated; Year: 1994; Format: Videorecording; Kansas City, Mo.: AAFP, c1994
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Asthma, emphysema, and chronic bronchitis. Source: [presented by] Blanchard & Loeb Publishers, LLC; Year: 2000; Format: Videorecording; Newark, NJ: Blanchard & Loeb Publishers, c2000
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Asthma, emphysema, and chronic bronchitis. Source: produced by Blanchard & Loeb Publishers; Year: 2001; Format: Videorecording; Glenmoore, PA: Blanchard & Loeb Publishers, c2001
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Asthma. Source: [presented by] the Medical University of South Carolina, College of Medicine and Health Communications Network; Year: 1994; Format: Videorecording; Charleston, S.C.: The University, c1994
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Breath away. Source: National Jewish Center for Immunology and Respiratory Medicine; Year: 1998; Format: Videorecording; [Denver, Colo.]: National Jewish Center for Immunology and Respiratory Medicine, [1998]
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Breath of fresh air. Source: an Emitel Picture Palace production for Fisons Ltd. Pharmaceutical Division and McCormick Intermarco-Farner Limited; Year: 1981; Format: Videorecording; [England]: Fisons, c1981
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Contemporary management of asthma. Source: Chang S. Shim; Year: 1995; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, 1995
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Evidence-based asthma management. Source: J. Mark FitzGerald ... [et al.]; Year: 2001; Format: Edited by; Hamilton, Ont.: B.C. Decker, 2001
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Exercise-induced asthma : unleashing the potential. Source: presented as an educational service by Glaxo; a Health Science Media production; Year: 1993; Format: Videorecording; Research Triangle Park, NC: Glaxo, Educational Resource Center, 1995, c1993
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Faces of asthma : offline cut, 2. Source: 25/99; Year: 1999; Format: Videorecording; [Bethesda, Md.: Exhibition Program, History of Medicine Division, National Library of Medicine, 1999]
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Integrated approach to the management of allergy and asthma. Source: Ira Finegold; Year: 1998; Format: Videorecording; Clifton, N.J.: Network for Continuing Medical Education, c1998
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Living each breath, asthma : a dis-covery of self. Source: NLN video; produced by Atlantic Mediaworks Ltd; Year: 1994; Format: Videorecording; [Canada?]: WHOLECARE, c1994
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Living with asthma. Source: [presented by] Milner-Fenwick; Year: 2001; Format: Videorecording; Timonium, MD: Milner-Fenwick, c2001
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Living with asthma. Source: Video Architects; Year: 1999; Format: Videorecording; Sherborn, MA: Aquarius Health Care Videos, c1999
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Living, breathing, and beating asthma in the environment : a community's initiative. Source: Centers for Disease Control and Prevention, UNC School of Public Health; Year: 2000; Format: Videorecording; [Atlanta, Ga.]: Public Health Training Network, [2000]
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Mastering asthma. Source: a production of The Nemours Foundation [and] American Academy of Pediatrics; Year: 1998; Format: Videorecording; Wilmington, DE: Nemours Center for Children's Health Media; Elk Grove Village, IL: American Academy of Pediatrics; c1998
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National Heart, Lung, and Blood Institute's childhood asthma management program . Year: 1992; Format: Videorecording; Springfield, VA: Distributed by NTIS, National Audiovisual Center, [1992]
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New ways to treat asthma. Source: a presentation of Films for the Humanities & Sciences; Year: 1993; Format: Videorecording; Princeton, N.J.: Films for the Humanities and Sciences, c1993
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Practical evaluation and treatment of asthma. Source: the Cleveland Clinic Foundation; Year: 1995; Format: Videorecording; Cleveland, OH: Cleveland Clinic Foundation, c1995
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Problem of asthma in the world. Source: USA ; Year: 1998; Format: Videorecording; [Durham, N.C.]: GlaxoWellcome, [c1998]
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Pulmonary disorders in school-aged children. Source: [presented by] the Cleveland Clinic Foundation; Year: 1993; Format: Videorecording; [Cleveland, Ohio]: Cleveland Clinic Foundation, c1993
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Report on the homeopathic hay fever and asthma trials. Source: National Center for Homeopathy; Year: 1992; Format: Sound recording; Berkeley, CA: Conference Recording Service, 1992
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Statistical models in medicine : asthma and the bean. Source: a presentation of Films for the Humanities & Sciences; BBC; Year: 1997; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c1997
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Taking charge of asthma. Source: produced by Health Science Media; Year: 1997; Format: Videorecording; Research Triangle Park, NC: Glaxo Wellcome, Inc., [1997]
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Treatment of asthma in a managed care environment. Source: Marshfield Clinic, Saint Joseph's Hospital; a presentation of the Marshfield Video Network; Year: 1997; Format: Videorecording; Marshfield, WI: Marshfield Clinic, [1997]
Vocabulary Builder Anaphylactic: Pertaining to anaphylaxis. [EU] Ascites: Effusion and accumulation of serous fluid in the abdominal cavity; called also abdominal or peritoneal dropsy, hydroperitonia, and hydrops abdominis. [EU] Asymptomatic: Showing or causing no symptoms. [EU] Bronchiectasis: Chronic dilatation of the bronchi marked by fetid breath and paroxysmal coughing, with the expectoration of mucopurulent matter. It may effect the tube uniformly (cylindric b.), or occur in irregular pockets (sacculated b.) or the dilated tubes may have terminal bulbous enlargements (fusiform b.). [EU] Carcinoma: A malignant new growth made up of epithelial cells tending to infiltrate the surrounding tissues and give rise to metastases. [EU] Cholestasis: Impairment of biliary flow at any level from the hepatocyte to Vater's ampulla. [NIH] Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Croup: A condition characterized by resonant barking cough, hoarseness
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and persistant stridor and caused by allergy, foreign body, infection, or neoplasm. It occurs chiefly in infants and children. [NIH] Hepatocellular: Pertaining to or affecting liver cells. [EU] Infusion: The therapeutic introduction of a fluid other than blood, as saline solution, solution, into a vein. [EU] Intramuscular: Within the substance of a muscle. [EU] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Panniculitis: An inflammatory reaction of the subcutaneous fat, which may involve the connective tissue septa between the fat lobes, the septa lobules and vessels, or the fat lobules, characterized by the development of single or multiple cutaneous nodules. [EU] Tonsillitis: Inflammation of the tonsils, especially the palatine tonsils. [EU] Ulceration: 1. the formation or development of an ulcer. 2. an ulcer. [EU]
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CHAPTER 8. PERIODICALS AND NEWS ON ASTHMA Overview Keeping up on the news relating to asthma can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on asthma. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover asthma beyond and including those which are published by patient associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.
News Services & Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on asthma is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.
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PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “asthma” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased. The following is typical of press releases that can be found on PR Newswire: ·
Calming Fears, Easing Stress; Asthma Experts Answer Questions on Raising An Asthmatic Child Summary: Milwaukee, May 8 /PRNewswire/ -- Mothers of children with a chronic disease, such as asthma, face unique challenges as they balance caring for a sick child, responding to healthy siblings and handling health emergencies, according to the American Academy of Allergy, Asthma and Immunology. If your child has been recently diagnosed with asthma, you may be fearful, in denial and most likely have a lot of questions about asthma. Allergist/immunologist Kathleen Sheerin, MD, FAAAAI, answers some commonly asked questions about raising an asthmatic child.
Q. Can my asthmatic child have a normal childhood? A. Absolutely. An asthmatic child who receives proper medical care, takes his or her medications as prescribed and whose family implements environmental control measures can have normal active childhood.
According to the AAAAI, asthma that is under control means: -- No coughing. -- No shortness of breath, rapid breathing, wheezing or chest tightness. -- No waking up at night because of asthma symptoms. -- Normal activities, including play, sports and exercise. -- No episodes of asthma that require a doctor visit, emergency room visit or urgent care. -- No absences from school or activities for the child and no missed time from work for the parent or caregiver. -- Normal (or near normal) function.
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Q. Will my child outgrow their asthma? A. Unfortunately, we cannot predict the way a child's asthma will develop. In some children, their symptoms may seem to disappear, but there is always the potential for the symptoms to reemerge later. In other children, their symptoms may worsen -- but these symptoms can be managed.
Q. It is always a struggle to get my child to take her medication. What can I do to make it easier? A. It is important for your child to take medications as prescribed, even if she is feeling better. Taking daily controller medications helps prevent airway inflammation, which can lead to an asthma attack. Children may protest when it comes time to take their medications, but it may be because they don't understand their condition or the importance of their medication. Open, honest communication from the beginning is important for helping children adjust to having a long-term illness and how they need to care for themselves. They need to know that although they have a serious condition, with medication, they can have a normal, active life. Your physician can help you find age-appropriate ways to discuss asthma with your child. It is important that, as your child gets older, you involve them in making decisions about their health care and that they become responsible for taking their medication on schedule. They may not have control over whether they have asthma, but by involving them in health care decisions, they can gain some level of control over their care.
Q. Caring for my asthmatic child requires a little extra time and attention. Even though I divide my attention as evenly as possible, my nonasthmatic child is acting out to gain attention. How can I resolve these conflicts? A. Sibling rivalry can be an issue in any family. This rivalry can be intensified when one child has a chronic illness. When a child has a longterm illness that requires extra attention from parents, siblings tend to either be especially well behaved or act out in order to gain attention. The child's age and their perception of their sibling's illness will
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determine how they respond to the illness -- generally the older the child, the less likely they are to respond negatively. In either case, it is important for the siblings of children with asthma to understand the illness and what kinds of things are happening to their sibling. What young children imagine about illness is often far worse than reality. Whether your child is being very good or acting out, if you have to dedicate a lot of time to caring for your asthmatic child, you may want to schedule some one-on-one time with the other child. Plan a special afternoon of their favorite activities or prepare their favorite meal.
Q. Personally, I have been feeling worn out. My child's asthma has been flaring up over the last few days, work has been busy and the laundry is piling up. How can I cope with the stress? A. Coping with the fears and treatment requirements associated with asthma, in addition to all of your other work- and family-related duties is hard on a mother. First thing, be sure you are attending to your own needs for sleep and nutrition. Without these, you likely won't have the energy you need to get through the day. Second, it is important to have sources of support around you. Your spouse or partner can be a good source of support. You might also try to find local support groups for mothers of asthmatics. There are many lay organizations, like the Allergy and Asthma Network/Mothers of Asthmatics and the Allergy and Asthma Foundation of America, that specialize in providing support and services on a local level. These other mothers can share strategies for coping with the fears, stress and joys of raising an asthmatic child. Third, while it is perfectly acceptable for you to have fears about your child's condition, you needn't let them rule your life. You should read as much as you can about asthma. The more educated you are about asthma, the easier it will be for you to deal with the emotions that surface during asthma flare-ups. Your child's physician can point you to reputable information resources, like the AAAAI Web site ( http://www.aaaai.org ).
The AAAAI is the largest professional medical specialty organization in the United States representing allergists, asthma specialists and clinical
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immunologists, allied health professionals and others with a special interest in the research and treatment of allergic disease. Allergy/immunology specialists are pediatric or internal medicine physicians who have elected an additional two years of training to become specialized in the treatment of asthma, allergy and immunologic disease. Established in 1943, the Academy has more than 6,000 members in the United States, Canada and 60 other countries. The Academy serves as an advocate to the public by providing educational information through its Web site at http://www.aaaai.org or the toll-free physician referral and information line at 1-800-822-2762. Reuters The Reuters’ Medical News database can be very useful in exploring news archives relating to asthma. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/frame2/arch.html and search by “asthma” (or synonyms). The following was recently listed in this archive for asthma: ·
Inhaled budesonide more effective than cromolyn for young asthmatic children Source: Reuters Industry Breifing Date: May 27, 2002 http://www.reuters.gov/archive/2002/05/27/business/links/20020527 clin005.html
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Plasma endothelin-1 may be implicated in the pathophysiology of asthma Source: Reuters Medical News Date: May 23, 2002 http://www.reuters.gov/archive/2002/05/23/professional/links/20020 523clin006.html
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New CD-ROM game teaches kids about asthma Source: Reuters Health eLine Date: May 23, 2002 http://www.reuters.gov/archive/2002/05/23/eline/links/20020523elin 001.html
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Corticosteroids and leukotriene modifiers make for costly asthma therapy Source: Reuters Industry Breifing Date: May 22, 2002 http://www.reuters.gov/archive/2002/05/22/business/links/20020522 econ001.html
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Asthma drug may fight high-altitude lung condition Source: Reuters Health eLine Date: May 22, 2002 http://www.reuters.gov/archive/2002/05/22/eline/links/20020522elin 002.html
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Pets may raise asthma risk among adolescents Source: Reuters Health eLine Date: May 21, 2002 http://www.reuters.gov/archive/2002/05/21/eline/links/20020521elin 015.html
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Duration of asthma associated with irreversible airflow obstruction Source: Reuters Medical News Date: May 21, 2002 http://www.reuters.gov/archive/2002/05/21/professional/links/20020 521clin007.html
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African Americans with asthma show resistance to corticosteroids Source: Reuters Industry Breifing Date: May 21, 2002 http://www.reuters.gov/archive/2002/05/21/business/links/20020521 epid007.html
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Untreated asthma during pregnancy linked to preterm birth Source: Reuters Medical News Date: May 20, 2002 http://www.reuters.gov/archive/2002/05/20/professional/links/20020 520clin017.html
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Two tests most useful in diagnosing asthma in adults Source: Reuters Medical News Date: May 20, 2002 http://www.reuters.gov/archive/2002/05/20/professional/links/20020 520clin009.html
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Preterm birth risk higher if mom's asthma untreated Source: Reuters Health eLine Date: May 20, 2002 http://www.reuters.gov/archive/2002/05/20/eline/links/20020520elin 032.html
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Fluticasone more effective than montelukast in long-term asthma control Source: Reuters Industry Breifing Date: May 20, 2002 http://www.reuters.gov/archive/2002/05/20/business/links/20020520 clin006.html
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Pets increase the risk of asthma among adolescents Source: Reuters Medical News Date: May 17, 2002 http://www.reuters.gov/archive/2002/05/17/professional/links/20020 517epid001.html
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Zafirlukast may not be effective in older asthmatics Source: Reuters Industry Breifing Date: May 15, 2002 http://www.reuters.gov/archive/2002/05/15/business/links/20020515 clin001.html
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Better asthma care, education and insurance canl improve patient outcome Source: Reuters Medical News Date: May 14, 2002 http://www.reuters.gov/archive/2002/05/14/professional/links/20020 514plcy001.html
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Ivax asthma treatment gets US pediatric indication Source: Reuters Industry Breifing Date: May 13, 2002 http://www.reuters.gov/archive/2002/05/13/business/links/20020513 rglt007.html
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Type of gastroesophageal reflux unrelated to time of asthma symptoms in children Source: Reuters Medical News Date: May 09, 2002 http://www.reuters.gov/archive/2002/05/09/professional/links/20020 509clin001.html
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Asthma in high school athletes often undiagnosed and undertreated Source: Reuters Medical News Date: May 08, 2002 http://www.reuters.gov/archive/2002/05/08/professional/links/20020 508publ001.html
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3M recalls asthma inhalers Source: Reuters Industry Breifing Date: May 08, 2002 http://www.reuters.gov/archive/2002/05/08/business/links/20020508 inds017.html
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Steroid rhinitis treatment cuts need for emergency asthma care Source: Reuters Industry Breifing Date: May 07, 2002 http://www.reuters.gov/archive/2002/05/07/business/links/20020507 epid001.html
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MDI beats nebulizer in emergency asthma treatment Source: Reuters Industry Breifing Date: May 06, 2002 http://www.reuters.gov/archive/2002/05/06/business/links/20020506 clin005.html
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Experts call for action to improve childhood asthma Source: Reuters Health eLine Date: May 06, 2002 http://www.reuters.gov/archive/2002/05/06/eline/links/20020506elin 023.html
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Treating nasal congestion can cut asthma attacks Source: Reuters Health eLine Date: May 03, 2002 http://www.reuters.gov/archive/2002/05/03/eline/links/20020503elin 005.html
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New online journal devoted to children's asthma Source: Reuters Health eLine Date: May 03, 2002 http://www.reuters.gov/archive/2002/05/03/eline/links/20020503elin 011.html
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Indoor allergens may worsen asthma in women Source: Reuters Medical News Date: May 03, 2002 http://www.reuters.gov/archive/2002/05/03/professional/links/20020 503epid001.html
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Sinusitis linked to airway inflammation in severe asthmatics Source: Reuters Medical News Date: May 02, 2002 http://www.reuters.gov/archive/2002/05/02/professional/links/20020 502clin008.html
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Orchid, Merck-Medco in asthma study alliance Source: Reuters Industry Breifing Date: May 01, 2002 http://www.reuters.gov/archive/2002/05/01/business/links/20020501 inds007.html
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Montelukast protects against AMP challenge in asthmatics Source: Reuters Medical News Date: April 30, 2002 http://www.reuters.gov/archive/2002/04/30/professional/links/20020 430clin004.html
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Exercise raises adenosine in asthmatics, correlating with drop in lung function Source: Reuters Medical News Date: April 29, 2002 http://www.reuters.gov/archive/2002/04/29/professional/links/20020 429clin001.html
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Greenhouse work may pose asthma risk Source: Reuters Medical News Date: April 26, 2002 http://www.reuters.gov/archive/2002/04/26/professional/links/20020 426clin019.html
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Asthmatics show defective response to rhinoviruses Source: Reuters Medical News Date: April 26, 2002 http://www.reuters.gov/archive/2002/04/26/professional/links/20020 426clin001.html
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Greenhouse work can pose asthma risk: study Source: Reuters Health eLine Date: April 25, 2002 http://www.reuters.gov/archive/2002/04/25/eline/links/20020425elin 013.html
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Final exams up allergic reactions in asthmatics Source: Reuters Health eLine Date: April 25, 2002 http://www.reuters.gov/archive/2002/04/25/eline/links/20020425elin 006.html
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Undiagnosed asthma common in high school athletes Source: Reuters Health eLine Date: April 24, 2002 http://www.reuters.gov/archive/2002/04/24/eline/links/20020424elin 019.html
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Psychological disorders common in patients with severe asthma Source: Reuters Medical News Date: April 24, 2002 http://www.reuters.gov/archive/2002/04/24/professional/links/20020 424clin003.html
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Peak flow meters helpful in pediatric asthma monitoring Source: Reuters Medical News Date: April 23, 2002 http://www.reuters.gov/archive/2002/04/23/professional/links/20020 423clin001.html
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Lidocaine may be effective against severe steroid-dependent asthma Source: Reuters Industry Breifing Date: April 23, 2002 http://www.reuters.gov/archive/2002/04/23/business/links/20020423 scie003.html
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Diesel fumes have dual impact on asthmatics Source: Reuters Medical News Date: April 23, 2002 http://www.reuters.gov/archive/2002/04/23/professional/links/20020 423scie004.html
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Diesel fumes hit asthmatics with one-two punch Source: Reuters Health eLine Date: April 22, 2002 http://www.reuters.gov/archive/2002/04/22/eline/links/20020422elin 006.html
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Asthma-related airway remodeling shows extended response to corticosteroids Source: Reuters Medical News Date: April 22, 2002 http://www.reuters.gov/archive/2002/04/22/professional/links/20020 422clin002.html
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Inhaler technique often flawed in asthmatic children Source: Reuters Industry Breifing Date: April 17, 2002 http://www.reuters.gov/archive/2002/04/17/business/links/20020417 clin001.html
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Churg-Strauss syndrome rare in asthma patients Source: Reuters Medical News Date: April 11, 2002 http://www.reuters.gov/archive/2002/04/11/professional/links/20020 411epid001.html
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Montelukast has anti-inflammatory effect on the airways of asthma patients Source: Reuters Medical News Date: April 10, 2002 http://www.reuters.gov/archive/2002/04/10/professional/links/20020 410clin002.html
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Airway wall thickness tied to chronic asthma severity Source: Reuters Medical News Date: April 09, 2002 http://www.reuters.gov/archive/2002/04/09/professional/links/20020 409clin002.html
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Study finds asthma drug doesn't affect behavior Source: Reuters Health eLine Date: April 08, 2002 http://www.reuters.gov/archive/2002/04/08/eline/links/20020408elin 017.html
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Asthma outcomes likely to improve if patient literature were more readable Source: Reuters Medical News Date: April 05, 2002 http://www.reuters.gov/archive/2002/04/05/professional/links/20020 405prof001.html
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The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within their search engine. The following was recently indexed as relating to asthma: ·
Pets May Raise Asthma Risk Among Adolescents http://www.nlm.nih.gov/medlineplus/news/fullstory_7698.html
Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name.
Internet Wire Internet Wire is more focused on technology than the other wires. To access this site, go to http://www.internetwire.com and use the “Search Archive” option. Type in “asthma” (or synonyms). As this service is oriented to technology, you may wish to search for press releases covering diagnostic procedures or tests that you may have read about. Search Engines Free-to-view news can also be found in the news section of your favorite search engines such as the health view page on Yahoo. To view the page, go to http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “asthma” (or synonyms). If you know the name of a company that is relevant to asthma, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks.
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BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “asthma” (or synonyms).
Newsletters on Asthma Given their focus on current and relevant developments, newsletters are often more useful to patients than academic articles. You can find newsletters using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Your investigation must limit the search to “Newsletter” and “asthma.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” By making these selections and typing in “asthma” or synonyms into the “For these words:” box, you will only receive results on newsletters.
Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” By making these selections, and typing in “asthma” (or synonyms) into the “For these words:” box, you will only receive results on newsletter articles. You should check back periodically with this database as it is updated every 3 months. The following is a typical result when searching for newsletter articles on asthma: ·
You Asked Source: Sarcoidosis Networking. 10; September/October 1997.
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Contact: Pacific Northwest Sarcoid Association, Sarcoid Networking Association, 13925 80th Street East, Puyallup, WA 98372-3614. (253) 8453108. (253) 845-3108 (fax). Summary: This newsletter article for individuals with sarcoidosis answers questions about this disease. Questions address the issues of whether sarcoidosis and its associated skin rash are contagious; whether this disease is a form of cancer, acquired immune deficiency syndrome, or Hodgkin's Disease; and whether it is an allergic disease or can develop into asthma. Other questions deal with features that indicate whether sarcoidosis is serious, whether sarcoidosis causes diabetes, and whether shortness of breath could be fatal in an asthma attack.
Academic Periodicals covering Asthma Academic periodicals can be a highly technical yet valuable source of information on asthma. We have compiled the following list of periodicals known to publish articles relating to asthma and which are currently indexed within the National Library of Medicine’s PubMed database (follow hyperlinks to view more information, summaries, etc., for each). In addition to these sources, to keep current on articles written on asthma published by any of the periodicals listed below, you can simply follow the hyperlink indicated or go to the following Web site: www.ncbi.nlm.nih.gov/pubmed. Type the periodical’s name into the search box to find the latest studies published. If you want complete details about the historical contents of a periodical, you can also visit the site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/ you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.” The following is a sample of periodicals which publish articles on asthma: ·
American Journal of Public Health. (Am J Public Health) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=A merican+Journal+of+Public+Health&dispmax=20&dispstart=0
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Archives of Disease in Childhood. (Arch Dis Child) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ar chives+of+Disease+in+Childhood&dispmax=20&dispstart=0
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Behavior Modification. (Behav Modif) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Be havior+Modification&dispmax=20&dispstart=0
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Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie. (Biomed Pharmacother) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Bi omedicine+&+Pharmacotherapy+=+Biomedecine+&+Pharmacotherapie &dispmax=20&dispstart=0
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Bmj (Clinical Research Ed. . (BMJ) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=B mj+(Clinical+Research+Ed.+&dispmax=20&dispstart=0
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Heart & Lung : the Journal of Critical Care. (Heart Lung) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=He art+&+Lung+:+the+Journal+of+Critical+Care&dispmax=20&dispstart=0
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Journal of Alternative and Complementary Medicine (New York, N. . . (J Altern Complement Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Alternative+and+Complementary+Medicine+(New+York,+N. +.+&dispmax=20&dispstart=0
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Journal of Clinical Pharmacology. (J Clin Pharmacol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Clinical+Pharmacology&dispmax=20&dispstart=0
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Pediatric Pulmonology. (Pediatr Pulmonol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Pe diatric+Pulmonology&dispmax=20&dispstart=0
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Psychosomatic Medicine. (Psychosom Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ps ychosomatic+Medicine&dispmax=20&dispstart=0
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Respirology (Carlton, Vic. . (Respirology) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Re spirology+(Carlton,+Vic.+&dispmax=20&dispstart=0
Vocabulary Builder Otitis: Inflammation of the ear, which may be marked by pain, fever, abnormalities of hearing, hearing loss, tinnitus, and vertigo. [EU] Pharmacotherapy: A regimen of using appetite suppressant medications to manage obesity by decreasing appetite or increasing the feeling of satiety. These medications decrease appetite by increasing serotonin or catecholamine—two brain chemicals that affect mood and appetite. [NIH] Phenytoin: An anticonvulsant that is used in a wide variety of seizures. It is also an anti-arrhythmic and a muscle relaxant. The mechanism of therapeutic action is not clear, although several cellular actions have been described including effects on ion channels, active transport, and general membrane stabilization. The mechanism of its muscle relaxant effect appears to involve a reduction in the sensitivity of muscle spindles to stretch. Phenytoin has been proposed for several other therapeutic uses, but its use has been limited by its many adverse effects and interactions with other drugs. [NIH] Tacrolimus: A macrolide isolated from the culture broth of a strain of Streptomyces tsukubaensis that has strong immunosuppressive activity in vivo and prevents the activation of T-lymphocytes in response to antigenic or mitogenic stimulation in vitro. [NIH] Warfarin: An anticoagulant that acts by inhibiting the synthesis of vitamin K-dependent coagulation factors. Warfarin is indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, pulmonary embolism, and atrial fibrillation with embolization. It is also used as an adjunct in the prophylaxis of systemic embolism after myocardial infarction. Warfarin is also used as a rodenticide. [NIH]
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CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.
NIH Guidelines For the more common diseases, The National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm
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The NHLBI recently recommended the following guidelines and references to physicians treating patients with lung conditions: Asthma General: ·
National Asthma Education and Prevention Program Slide Sets: http://hin.nhlbi.nih.gov/naepp_slds/menu.htm
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Action Against Asthma: A Strategic Plan for the Department of Health and Human Services: http://aspe.hhs.gov/sp/asthma
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Asthma Management Model System (Web Site): http://www.nhlbisupport.com/asthma/index.html
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Asthma Management in Minority Children: http://www.nhlbi.nih.gov/health/prof/lung/asthma/ast_chil.htm
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AsthmaMemo: http://www.nhlbi.nih.gov/health/prof/lung/asthma/asth_mem.htm
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Data Fact Sheet: Asthma Statistics: http://www.nhlbi.nih.gov/health/prof/lung/asthma/asthstat.htm
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Diagnosing and Managing Asthma in the Elderly: http://www.nhlbi.nih.gov/health/prof/lung/asthma/as_elder.htm
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Guidelines for the Diagnosis and Management of Asthma: NAEPP Expert Panel Report 2: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm
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NAEPP Task Force on the Cost Effectiveness, Quality of Care, and Financing of Asthma Care: http://www.nhlbi.nih.gov/health/prof/lung/asthma/ast_cost.htm
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Nurses: Partners in Asthma Care: http://www.nhlbi.nih.gov/health/prof/lung/asthma/nurs_gde.htm
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Practical Guide for the Diagnosis and Management of Asthma: http://www.nhlbi.nih.gov/health/prof/lung/asthma/practgde.htm
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Report of the Working Group on Asthma and Pregnancy: http://www.nhlbi.nih.gov/health/prof/lung/asthma/astpreg.txt
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The Role of the Pharmacist in Improving Asthma Care: http://www.nhlbi.nih.gov/health/prof/lung/asthma/asmapmcy.htm
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World Asthma Day 2001 (May 3, 2001): http://www.nhlbi.nih.gov/health/prof/lung/asthma/wad_2/index.htm
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Schools/child care centers: ·
NAEPP Resolution on Asthma Management at School: http://www.nhlbi.nih.gov/health/public/lung/asthma/resolut.htm
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Asthma and Physical Activity in the School: http://www.nhlbi.nih.gov/health/public/lung/asthma/phy_asth.htm
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Asthma Awareness Curriculum for the Elementary Classroom: http://www.nhlbi.nih.gov/health/prof/lung/asthma/school/index.htm
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How Asthma-Friendly Is Your School? (¿Su escuela tiene en cuenta a los niños con asma?): http://www.nhlbi.nih.gov/health/public/lung/asthma/friendhi.htm
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How Asthma-Friendly Is Your Child-Care Setting? (¿Su guardería infantil tiene en cuenta a los niños con asma?): http://www.nhlbi.nih.gov/health/public/lung/asthma/child_ca.htm
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School Asthma Education Slide Set: http://hin.nhlbi.nih.gov/naepp_slds/menu.htm
See also: ·
Asthma Clinical Research Network (ACRN): http://www.acrn.org/28
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Global Initiative for Asthma: http://www.nhlbi.nih.gov/health/prof/lung/gina.htm
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National Asthma Education and Prevention Program: http://www.nhlbi.nih.gov/about/naepp/index.htm National Emphysema Treatment Trial (NETT)
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News Release: NHLBI-Funded Emphysema Study Finds Certain Patients at High Risk for Death Following Lung Surgery, August 14, 2001: http://www.nhlbi.nih.gov/new/press/01-08-14.htm
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News Release: NHLBI/HCFA Lung Volume Reduction Surgery Study Participants Announced, December 20, 1996: http://www.nhlbi.nih.gov/health/prof/lung/nett/lvrspr.htm
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Background and Study Information: http://www.nhlbi.nih.gov/health/prof/lung/nett/lvrsweb.htm
Please note: This link, which goes outside the NHLBI Web site, will open a new browser window; to return to this document, either close the new window, or toggle back (ALT-TAB for Windows users, Apple-TAB for Macintosh users).
28
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·
Participating Centers: http://www.nhlbi.nih.gov/health/prof/lung/nett/lvrsctr.htm Other Pulmonary Information
Global Initiative for Chronic Obstructive Lung Disease (GOLD): ·
COPD Guideline Tool for Palm OS: http://hin.nhlbi.nih.gov/copd.htm
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Workshop Report: http://www.nhlbi.nih.gov/health/prof/lung/gold.htm
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Tuberculosis Academic Awards: http://www.nhlbi.nih.gov/funding/training/tbaa/index.htm
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Acute Respiratory Distress Syndrome Clinical Network (ARDSNet): http://hedwig.mgh.harvard.edu/ardsnet/
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Pulmonary Immunobiology and Inflammation in Pulmonary Diseases NHLBI, Workshop Summary: http://www.nhlbi.nih.gov/meetings/workshops/pul_inflam.htm
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Pharmacological Therapy for Idiopathic Pulmonary Fibrosis: Past, Present, and Future, NHLBI Workshop Summary: http://www.nhlbi.nih.gov/meetings/workshops/ipf-sum.htm
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Nurses: Help Your Patients Stop Smoking: http://www.nhlbi.nih.gov/health/prof/lung/other/nurssmok.txt
See also: ·
List of Publications: http://www.nhlbi.nih.gov/health/pubs/pub_prof.htm
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Information Center: http://www.nhlbi.nih.gov/health/infoctr/index.htm
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Lung Information for Patients/Public: http://www.nhlbi.nih.gov/health/public/lung/index.htm
NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.29 Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html).
29
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Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:30 ·
Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
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Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
30
See http://www.nlm.nih.gov/databases/databases.html.
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·
Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
While all of the above references may be of interest to physicians who study and treat asthma, the following are particularly noteworthy.
The Combined Health Information Database A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information Package” and asthma using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years,” select your preferred language, and the format option “Fact Sheet.” By making these selections and typing “asthma” (or synonyms) into the “For these words:” box above, you will only receive results on fact sheets dealing with asthma. The following is a sample result: ·
Managing Asthma: A Guide for Schools Source: Bethesda, MD, US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute, National Asthma Education Program, 17 p., September 1991. Contact: National Asthma Education Program Information Center, 4733 Bethesda Avenue, Suite 530, Bethesda, MD 20814. (301) 951-3260. Summary: Managing Asthma: A Guide for Schools is a booklet for school personnel that provides practical ways to help students with asthma
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participate fully in all school activities. It specifies roles and actions that various staff should perform for asthma management. The booklet is the first in a series of collaborative projects between the National Heart, Lung, and Blood Institute (NHLBI), National Asthma Education Program (NAEP), National Institutes of Health (NIH), U.S. Department of Health and Human Services (HHS), and the Fund for the Improvement and Reform of Schools and Teaching, Office of Educational Research and Improvement (OERI), U.S. Department of Education (DOE). Along with a description of asthma and asthma management, the booklet presents actions for school staff including the principal, school nurses or other health personnel, classroom teachers, physical education instructors and coaches, and guidance counselors. Included are a list of common triggers or stimuli that cause asthma episodes, and reproducible actions sheets for school staff. Other practical information on asthma includes early signs of an asthma episode, simple use of the asthma action plan, use of a metered dose inhaler and of a peak flow meter, and resources available to schools to help manage asthma. A poster presents asthma basics for school personnel. ·
Short of breath: Our lack of response to the growing asthma epidemic and the need for nationwide tracking Source: Washington, DC: Trust for America's Health. 2001. 34 pp. Contact: Available from Trust for America's Health, 1101 Vermont Avenue, N.W., Suite 501, Washington, DC 22205. Telephone: (202) 5890940 / fax: (202) 589-0945 / e-mail:
[email protected] / Web site: http://healthyamericans.org. Available from the Web site at no charge. Summary: This document outlines the Trust for America's Health's proposed three-year action plan for the federal government to create the Nationwide Health Tracking Network to track chronic illnesses at the community level. The report gives an overview of the need for tracking illnesses, such as asthma, nationwide through the development and funding of regional laboratories and agency support mechanisms to create the network; funding a state-level chronic disease investigator to survey and ascertain chronic disease hot spots and pursue potential environmental relationships; and following baseline standards for collecting consistent, comparable data tied to a common definition of asthma, other targeted chronic diseases, and relevant environmental factors. Statistical data and program specifics are provided in many charts and graphs. The appendices describe the current states practicing surveillance of environmental factors; asthma basics; details of state programs for asthma tracking; and an overview of the New England
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Tracking Initiative. Reading references and report contributors are included. ·
Attack asthma: Why America needs a public health defense system to battle environmental threats Source: Baltimore, MD: Pew Environmental Health Commission. 2000. 19 pp. Contact: Available from Pew Environmental Health Commission, Johns Hopkins University School of Public Health, 111 Market Street, Suite 850, Baltimore, MD 21202. Telephone: (410) 659-2690 / fax: (410) 659-2699 / Web site: http://pewenvirohealth.jhsph.edu/html/home/home.html. Available from the Web site at no charge. Summary: This report provides information and statistics on the growing epidemic of asthma and discusses the federal plans to respond, as well as the Pew Environmental Health Commission recommendations for investments in building the public health infrastructure to implement the federal plan. Topics discussed are an overview of the epidemic and the climbing rates of asthma; troubling predictors; an analysis of the federal Healthy People 2010 program regarding asthma, a review of grants awarded by the National Institutes of Health for asthma research; and the need for a national health defense system. Statistical data is presented in charts, tables, and graphs throughout the report.
·
A self-management educational program for severe asthmatic children: Evaluation of rural medical, educational and service delivery outcomes Source: Albuquerque, NM: New Mexico Asthma Project, University of New Mexico School of Medicine. 1995. 124 pp. Contact: Available from New Mexico Asthma Project, University of New Mexico School of Medicine, Department of Pediatrics, Albuquerque, NM 87131. Telephone: (505) 277-3072 or (800) 439-3916. Summary: This report details a study to determine if a comprehensive medical and educational self management program for children with severe asthma in rural New Mexico would affect morbidity, costs of medical care, and parental stress. Two groups of children were studied. One group received comprehensive medical care and the other received both comprehensive medical care and a structured self management education program. The report includes the initial premise, study design, findings, statistics, forms, and recommendations. [Funded by the Maternal and Child Health Bureau].
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·
Management of asthma during pregnancy Source: Bethesda, MD: Working Group on Asthma and Pregnancy, U.S. Department of Health and Human Services. 1993. 74 pp., exec. summ. (20 pp.). Contact: Available from National Asthma Education Program, National Heart, Lung, and Blood Institute, National Institutes of Health, P.O. Box 30105, Bethesda, MD 20824-0105. Telephone: (301) 951-3260. (DHHS (NIH) 93-3279). Summary: This report is designed to provide clinicians who care for pregnant women with new insights into asthma management. The Working Group on Asthma and Pregnancy strongly recommends that asthma should be treated as aggressively in pregnant women as it is in nonpregnant patients, as the risks of uncontrolled asthma are more dangerous to the pregnant patient and her fetus than the risks from the medications used to control asthma. The report is designed to enable clinicians to use therapy appropriately for chronic control as well as for symptomatic relief of asthma in pregnant women. An executive summary is also available.
·
Guidelines for the diagnosis and management of asthma Source: Bethesda, MD: National Asthma Education Program, U.S. Department of Health and Human Services. 1991. 136 pp. Contact: Available from National Asthma Education Program, Office of Prevention, Education, and Control, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892. (DHHS 913042). Summary: This report is the result of an expert panel convened by the Coordinating Committee of the National Asthma Education Program, in response to the increasing prevalence rate of asthma in the U.S., and as a means of bridging the gap between research and practice. The report reflects the current state of knowledge about the underlying causes of asthma and presents detailed recommendations to guide the diagnosis and management of asthma. Topic sections are: definition and diagnosis; objective measures of lung function; asthma mortality; overview of approaches to asthma therapy; patient education; managing allergy in the asthma patient; management of exacerbations of asthma; exerciseinduced asthma; and special considerations, including pregnancy and asthma.
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The NLM Gateway31 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for many of NLM’s information resources or databases.32 One target audience for the Gateway is the Internet user who is new to NLM’s online resources and does not know what information is available or how best to search for it. This audience may include physicians and other healthcare providers, researchers, librarians, students, and, increasingly, patients, their families, and the public.33 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “asthma” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Items Found Journal Articles 71317 Books / Periodicals / Audio Visual 1643 Consumer Health 523 Meeting Abstracts 215 Other Collections 112 Total 73810
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 33 Other users may find the Gateway useful for an overall search of NLM’s information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 31 32
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HSTAT34 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.35 HSTAT’s audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.36 Simply search by “asthma” (or synonyms) at the following Web site: http://text.nlm.nih.gov.
Coffee Break: Tutorials for Biologists37 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. To this end, we recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.38 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.39 This site has new Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. The HSTAT URL is http://hstat.nlm.nih.gov/. 36 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force’s Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 37 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 38 The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 39 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 34 35
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articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access the Coffee Break Web site at http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
·
Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center’s MARS electronic medical record system; see the following Web site: http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.
·
Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
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MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical literature, and to explore relevant Web sites; see http://www.med.virginia.edu/~wmd4n/medweaver.html.
·
Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language generally used by caregivers into terms from formal, controlled vocabularies; see the following Web site: http://www.lexical.com/Metaphrase.html.
The Genome Project and Asthma With all the discussion in the press about the Human Genome Project, it is only natural that physicians, researchers, and patients want to know about how human genes relate to asthma. In the following section, we will discuss databases and references used by physicians and scientists who work in this area.
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Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).40 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. Go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html to search the MEDLINE database. Type “asthma” (or synonyms) in the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. By following these links, especially the link titled “Database Links,” you will be exposed to numerous specialized databases that are largely used by the scientific community. These databases are overly technical and seldom used by the general public, but offer an abundance of information. The following is an example of the results you can obtain from the OMIM for asthma: ·
Asthma Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?600807
·
Asthma, Nasal Polyps, Aspirin Intolerance Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?208550
·
Asthma, Short Stature, and Elevated Iga Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?208600 Genes and Disease (NCBI - Map)
The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. Go to http://www.ncbi.nlm.nih.gov/disease/, 40 Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.
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and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to re-visit it from time to time. The following systems and associated disorders are addressed: ·
Metabolism: Food and energy. Examples: Adreno-leukodystrophy, Atherosclerosis, Best disease, Gaucher disease, Glucose galactose malabsorption, Gyrate atrophy, Juvenile onset diabetes, Obesity, Paroxysmal nocturnal hemoglobinuria, Phenylketonuria, Refsum disease, Tangier disease, Tay-Sachs disease. Web site: http://www.ncbi.nlm.nih.gov/disease/Metabolism.html
·
Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html
·
Nervous System: Mind and body. Examples: Alzheimer disease, Amyotrophic lateral sclerosis, Angelman syndrome, Charcot-Marie-Tooth disease, epilepsy, essential tremor, Fragile X syndrome, Friedreich’s ataxia, Huntington disease, NiemannPick disease, Parkinson disease, Prader-Willi syndrome, Rett syndrome, Spinocerebellar atrophy, Williams syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Brain.html
·
Signals: Cellular messages. Examples: Ataxia telangiectasia, Baldness, Cockayne syndrome, Glaucoma, SRY: sex determination, Tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html
·
Transporters: Pumps and channels. Examples: Cystic Fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html
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Entrez Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·
PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
·
Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide
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Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein
·
Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure
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Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome
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PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset
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OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM
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Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy
·
Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books
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ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
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3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/
To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=genome, and then select the database that you would like to search. The databases
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available are listed in the drop box next to “Search.” In the box next to “for,” enter “asthma” (or synonyms) and click “Go.”
Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database41 This online resource can be quite useful. It has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html you can also search across syndromes using an alphabetical index:. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html you can search by keywords. The Genome Database42 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html. 42 Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html#mission. 41
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“asthma” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms). This database is extremely technical as it was created for specialists. The articles are the results which are the most accessible to non-professionals and often listed under the heading “Citations.” The contact names are also accessible to non-professionals.
Specialized References The following books are specialized references written for professionals interested in asthma (sorted alphabetically by title, hyperlinks provide rankings, information, and reviews at Amazon.com): · Foundations of Respiratory Care by Kenneth A. Wyka, William F. Clark, Paul J. Mathews; Hardcover - 1032 pages, 1st edition (January 15, 2002), Delmar Learning; ISBN: 0766808939; http://www.amazon.com/exec/obidos/ASIN/0766808939/icongroupinterna · Lung Disorders Sourcebook by Dawn D. Matthews; Hardcover, 1st edition (March 2002), Omnigraphics, Inc.; ISBN: 0780803396; http://www.amazon.com/exec/obidos/ASIN/0780803396/icongroupinterna · Pulmonary Diseases and Disorders Companion Handbook by Alfred P. Fishman; Paperback, 3rd edition (April 15, 2002), McGraw-Hill; ISBN: 0070220026; http://www.amazon.com/exec/obidos/ASIN/0070220026/icongroupinterna · Textbook of Respiratory Medicine (Two-Volume Set) by John F. Murray, Jay A. Nadel; Hardcover - 2562 pages, 3rd edition (May 15, 2000), W B Saunders Co; ISBN: 0721677118; http://www.amazon.com/exec/obidos/ASIN/0721677118/icongroupinterna
Dissertations 205
CHAPTER 10. DISSERTATIONS ON ASTHMA Overview University researchers are active in studying almost all known diseases. The result of research is often published in the form of Doctoral or Master’s dissertations. You should understand, therefore, that applied diagnostic procedures and/or therapies can take many years to develop after the thesis that proposed the new technique or approach was written. In this chapter, we will give you a bibliography on recent dissertations relating to asthma. You can read about these in more detail using the Internet or your local medical library. We will also provide you with information on how to use the Internet to stay current on dissertations.
Dissertations on Asthma ProQuest Digital Dissertations is the largest archive of academic dissertations available. From this archive, we have compiled the following list covering dissertations devoted to asthma. You will see that the information provided includes the dissertation’s title, its author, and the author’s institution. To read more about the following, simply use the Internet address indicated. The following covers recent dissertations dealing with asthma: ·
A Prospective Cohort Study of Maternal Factors in Childhood Asthma: Parity, Obesity, Fetal Growth, and Social Stressors by Held, Kathryn B.; Phd from The University of Oklahoma, 2000, 312 pages http://wwwlib.umi.com/dissertations/fullcit/9985574
206 Asthma
·
A Randomized Placebo Controlled Trial to Evaluate the Efficacy of a Second Generation Antihistamine (h1), Cetirizine, in Addition to Standard Therapy of High Dose Albuterol in Acute Asthmatics Presenting to an Urban Emergency Department by Engelberg, Stacey Leigh; Pharmd from Long Island University, the Brooklyn Center, 2001, 93 pages http://wwwlib.umi.com/dissertations/fullcit/3026513
·
A Study of Airway Inflammation in Childhood Asthma by Fitch, Patrick Stephen; Md from Queen's University of Belfast (northern Ireland), 2000 http://wwwlib.umi.com/dissertations/fullcit/f785009
·
A Study of Environmental and Genetic Risk Factors for Asthma in Hong Kong by Chan, Hiu Shuen; Phd from Chinese University of Hong Kong (people's Republic of China), 2001, 135 pages http://wwwlib.umi.com/dissertations/fullcit/3025885
·
Academic Achievement in Children with New-onset Seizures or Asthma by Mcnelis, Angela Marie; Phd from Indiana University, 2000, 236 pages http://wwwlib.umi.com/dissertations/fullcit/9981074
·
An Analysis of an Intervention to Increase and Assess the Role of Parental Self-efficacy in Pediatric Asthma by Hanson, Jean Elizabeth, Phd from The University of New Mexico, 1997, 153 pages http://wwwlib.umi.com/dissertations/fullcit/9727488
·
An Evaluation of Community Pharmacists Applying the Patient Centered Care Approach to Ambulatory Oregon Health Plan Asthmatics in a Managed Care Setting by Crowder, Terry J.; Phd from Oregon State University, 2000, 428 pages http://wwwlib.umi.com/dissertations/fullcit/9961450
·
An Evaluation of the Relationships between Health-related Quality of Life, Disease Severity, Healthcare Utilization, and Willingness to Give Time to an Asthma Self-management Program by Dupclay, Leon, Jr.; Phd from Purdue University, 2000, 257 pages http://wwwlib.umi.com/dissertations/fullcit/3033084
·
An Exploratory Study of the Educational Process of Parents of Chronically Ill Children: Diabetes and Asthma by Young, Alma T., Edd from Columbia University Teachers College, 1980, 115 pages http://wwwlib.umi.com/dissertations/fullcit/8022187
Dissertations 207
·
An Exploratory Study of Urban Air Pollution, Childhood Asthma and Landscape Planning (ontario, Saskatchewan) by Wilton, Bronwynne Leigh; Msc from University of Guelph (canada), 2001, 88 pages http://wwwlib.umi.com/dissertations/fullcit/MQ61958
Keeping Current As previously mentioned, an effective way to stay current on dissertations dedicated to asthma is to use the database called ProQuest Digital Dissertations via the Internet, located at the following Web address: http://wwwlib.umi.com/dissertations. The site allows you to freely access the last two years of citations and abstracts. Ask your medical librarian if the library has full and unlimited access to this database. From the library, you should be able to do more complete searches than with the limited 2-year access available to the general public.
Vocabulary Builder Cetirizine: A potent second-generation histamine H1 antagonist that is effective in the treatment of allergic rhinitis, chronic urticaria, and polleninduced asthma. Unlike many traditional antihistamines, it does not cause drowsiness or anticholinergic side effects. [NIH] Parity: The number of offspring a female has borne. It is contrasted with gravidity, which refers to the number of pregnancies, regardless of outcome. [NIH]
Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH]
209
PART III. APPENDICES
ABOUT PART III Part III is a collection of appendices on general medical topics which may be of interest to patients with asthma and related conditions.
Researching Your Medications 211
APPENDIX A. RESEARCHING YOUR MEDICATIONS Overview There are a number of sources available on new or existing medications which could be prescribed to patients with asthma. While a number of hard copy or CD-Rom resources are available to patients and physicians for research purposes, a more flexible method is to use Internet-based databases. In this chapter, we will begin with a general overview of medications. We will then proceed to outline official recommendations on how you should view your medications. You may also want to research medications that you are currently taking for other conditions as they may interact with medications for asthma. Research can give you information on the side effects, interactions, and limitations of prescription drugs used in the treatment of asthma. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
212 Asthma
Your Medications: The Basics43 The Agency for Health Care Research and Quality has published extremely useful guidelines on how you can best participate in the medication aspects of asthma. Taking medicines is not always as simple as swallowing a pill. It can involve many steps and decisions each day. The AHCRQ recommends that patients with asthma take part in treatment decisions. Do not be afraid to ask questions and talk about your concerns. By taking a moment to ask questions early, you may avoid problems later. Here are some points to cover each time a new medicine is prescribed: ·
Ask about all parts of your treatment, including diet changes, exercise, and medicines.
·
Ask about the risks and benefits of each medicine or other treatment you might receive.
·
Ask how often you or your doctor will check for side effects from a given medication.
Do not hesitate to ask what is important to you about your medicines. You may want a medicine with the fewest side effects, or the fewest doses to take each day. You may care most about cost, or how the medicine might affect how you live or work. Or, you may want the medicine your doctor believes will work the best. Telling your doctor will help him or her select the best treatment for you. Do not be afraid to “bother” your doctor with your concerns and questions about medications for asthma. You can also talk to a nurse or a pharmacist. They can help you better understand your treatment plan. Feel free to bring a friend or family member with you when you visit your doctor. Talking over your options with someone you trust can help you make better choices, especially if you are not feeling well. Specifically, ask your doctor the following: ·
The name of the medicine and what it is supposed to do.
·
How and when to take the medicine, how much to take, and for how long.
·
What food, drinks, other medicines, or activities you should avoid while taking the medicine.
·
What side effects the medicine may have, and what to do if they occur.
·
If you can get a refill, and how often.
43
This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.
Researching Your Medications 213
·
About any terms or directions you do not understand.
·
What to do if you miss a dose.
·
If there is written information you can take home (most pharmacies have information sheets on your prescription medicines; some even offer large-print or Spanish versions).
Do not forget to tell your doctor about all the medicines you are currently taking (not just those for asthma). This includes prescription medicines and the medicines that you buy over the counter. Then your doctor can avoid giving you a new medicine that may not work well with the medications you take now. When talking to your doctor, you may wish to prepare a list of medicines you currently take, the reason you take them, and how you take them. Be sure to include the following information for each: ·
Name of medicine
·
Reason taken
·
Dosage
·
Time(s) of day
Also include any over-the-counter medicines, such as: ·
Laxatives
·
Diet pills
·
Vitamins
·
Cold medicine
·
Aspirin or other pain, headache, or fever medicine
·
Cough medicine
·
Allergy relief medicine
·
Antacids
·
Sleeping pills
·
Others (include names)
Learning More about Your Medications Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications your doctor has recommended for asthma. One such source is
214 Asthma
the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the “U.S. Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at www.usp.org. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database.44 While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopoeia (USP). It is important to read the disclaimer by the United States Pharmacopoeia (http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using the information provided. Of course, we as editors cannot be certain as to what medications you are taking. Therefore, we have compiled a list of medications associated with the treatment of asthma. Once again, due to space limitations, we only list a sample of medications and provide hyperlinks to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to asthma:
Though cumbersome, the FDA database can be freely browsed at the following site: www.fda.gov/cder/da/da.htm.
44
Researching Your Medications 215
Anticholinergics/Antispasmodics ·
Systemic - U.S. Brands: Anaspaz; A-Spas S/L; Banthine; Bentyl; Cantil; Cystospaz; Cystospaz-M; Donnamar; ED-SPAZ; Gastrosed; Homapin; Levbid; Levsin; Levsin/SL; Levsinex Timecaps; ProBanthine; Quarzan; Robinul; Robinul Forte; Symax SL; TransdermScop http://www.nlm.nih.gov/medlineplus/druginfo/anticholinergics antispasmodics202049.html
Antihistamines ·
Systemic - U.S. Brands: Aller-Chlor; AllerMax Caplets; Aller-med; Atarax; Banophen; Banophen Caplets; Benadryl; Benadryl Allergy; Bromphen; Calm X; Chlo-Amine; Chlorate; Chlor-Trimeton; ChlorTrimeton Allergy; Chlor-Trimeton Repetabs; Claritin; Claritin Reditabs; Compoz; Conta http://www.nlm.nih.gov/medlineplus/druginfo/antihistaminess ystemic202060.html
Ascorbic Acid (Vitamin C) ·
Systemic - U.S. Brands: Ascorbicap; Cecon; Cee-500; Cemill; Cenolate; Cetane; Cevi-Bid; Flavorcee; Ortho/CS; Sunkist http://www.nlm.nih.gov/medlineplus/druginfo/ascorbicacidvita mincsystemic202071.html Aspirin, Sodium Bicarbonate, and Citric Acid- U.S. Brands:
Benzonatate ·
Systemic - U.S. Brands: Tessalon http://www.nlm.nih.gov/medlineplus/druginfo/benzonatatesyst emic202085.html
Bronchodilators, Adrenergic ·
Inhalation - U.S. Brands: Adrenalin Chloride; Airet; Alupent; Arm-a-Med Isoetharine; Arm-a-Med Metaproterenol; Asthmahaler Mist; AsthmaNefrin; Beta-2; Brethaire; Bronkaid Mist; Bronkaid Suspension Mist; Bronkometer; Bronkosol; Dey-Lute Isoetharine; Dey-Lute Metaproterenol; Isupr http://www.nlm.nih.gov/medlineplus/druginfo/bronchodilators adrenergicinhal202095.html
216 Asthma
·
Oral/Injection - U.S. Brands: Adrenalin; Alupent; Ana-Guard; Brethine; Bricanyl; EpiPen Auto-Injector; EpiPen Jr. Auto-Injector; Isuprel; Proventil; Proventil Repetabs; Ventolin; Volmax http://www.nlm.nih.gov/medlineplus/druginfo/bronchodilators adrenergicorali202096.html
Bronchodilators, Theophylline ·
Systemic - U.S. Brands: Aerolate Sr; Asmalix; Choledyl; Choledyl SA; Elixophyllin; Lanophyllin; Phyllocontin; Quibron-T Dividose; Quibron-T/SR Dividose; Respbid; Slo-Bid Gyrocaps; Slo-Phyllin; Theo-24; Theobid Duracaps; Theochron; Theo-Dur; Theolair; Theolair-SR; Theo-Time; Th http://www.nlm.nih.gov/medlineplus/druginfo/bronchodilators theophyllinesys201945.html
Corticosteroids ·
Dental - U.S. Brands: Kenalog in Orabase; Orabase-HCA; Oracort; Oralone http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidsd ental202010.html
·
Inhalation - U.S. Brands: AeroBid; AeroBid-M; Azmacort; Beclovent; Decadron Respihaler; Pulmicort Respules; Pulmicort Turbuhaler; Vanceril; Vanceril 84 mcg Double Strength http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidsi nhalation202011.html
·
Nasal - U.S. Brands: Beconase; Beconase AQ; Dexacort Turbinaire; Flonase; Nasacort; Nasacort AQ; Nasalide; Nasarel; Nasonex; Rhinocort; Vancenase; Vancenase AQ 84 mcg; Vancenase pockethaler http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidsn asal202012.html
·
Ophthalmic - U.S. Brands: AK-Dex; AK-Pred; AK-Tate; Baldex; Decadron; Dexair; Dexotic; Econopred; Econopred Plus; Eflone; Flarex; Fluor-Op; FML Forte; FML Liquifilm; FML S.O.P.; HMS Liquifilm; Inflamase Forte; Inflamase Mild; I-Pred; Lite Pred; Maxidex; Ocu-Dex; Ocu-Pred; Ocu-Pr http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidso phthalmic202013.html
·
Otic - U.S. Brands: Decadron http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidso tic202014.html
Researching Your Medications 217
·
Rectal - U.S. Brands: Anucort-HC; Anu-Med HC; Anuprep HC; Anusol-HC; Anutone-HC; Anuzone-HC; Cort-Dome; Cortenema; Cortifoam; Hemorrhoidal HC; Hemril-HC Uniserts; Proctocort; Proctosol-HC; Rectosol-HC http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidsr ectal203366.html
Corticosteroids Glucocorticoid Effects ·
Systemic - U.S. Brands: Acetocot; A-hydroCort; Amcort; AMethaPred; Aristocort; Aristocort Forte; Aristopak; Aristospan; Articulose-50; Articulose-L.A.; Celestone; Celestone Phosphate; Celestone Soluspan; Cinalone 40; Cinonide 40; Clinacort; Clinalog; Cordrol; Cortastat; Corta http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidsg lucocorticoide202018.html
Cromolyn ·
Inhalation - U.S. Brands: Intal http://www.nlm.nih.gov/medlineplus/druginfo/cromolyninhala tion202166.html
·
Nasal - U.S. Brands: Nasalcrom http://www.nlm.nih.gov/medlineplus/druginfo/cromolynnasal2 02167.html
·
Ophthalmic - U.S. Brands: Crolom http://www.nlm.nih.gov/medlineplus/druginfo/cromolynophth almic202168.html
·
Oral - U.S. Brands: Gastrocrom http://www.nlm.nih.gov/medlineplus/druginfo/cromolynoral20 2169.html
Dextromethorphan ·
Systemic - U.S. Brands: Cough-X; Creo-Terpin; Trocal http://www.nlm.nih.gov/medlineplus/druginfo/dextromethorph ansystemic202187.html Dyphylline ·
Systemic - U.S. Brands: Dilor; Dilor-400; Lufyllin; Lufyllin-400 http://www.nlm.nih.gov/medlineplus/druginfo/dyphyllinesyste mic202752.html
218 Asthma
Epinephrine ·
Ophthalmic - U.S. Brands: Epifrin; Epinal; Eppy/N; Glaucon http://www.nlm.nih.gov/medlineplus/druginfo/epinephrineoph thalmic202213.html
Fluticasone ·
Inhalation-Local - U.S. Brands: Flovent http://www.nlm.nih.gov/medlineplus/druginfo/fluticasoneinhal ationlocal203649.html
·
Nasal - U.S. Brands: Flonase http://www.nlm.nih.gov/medlineplus/druginfo/fluticasonenasal 203588.html
Ipratropium ·
Inhalation - U.S. Brands: Atrovent http://www.nlm.nih.gov/medlineplus/druginfo/ipratropiuminh alation202304.html
·
Nasal - U.S. Brands: Atrovent http://www.nlm.nih.gov/medlineplus/druginfo/ipratropiumnas al202713.html
Ipratropium and Albuterol ·
Inhalation-Local - U.S. Brands: Combivent; DuoNeb http://www.nlm.nih.gov/medlineplus/druginfo/ipratropiumand albuterolinhalat203487.html
Isoxsuprine ·
Systemic - U.S. Brands: Vasodilan http://www.nlm.nih.gov/medlineplus/druginfo/isoxsuprinesyst emic202310.html
Ketotifen ·
Ophthalmic - U.S. Brands: http://www.nlm.nih.gov/medlineplus/druginfo/ketotifenophtha lmic500012.html
·
Ophthalmic - U.S. Brands: Zaditor http://www.nlm.nih.gov/medlineplus/druginfo/ketotifenophtha lmic500012.html
Researching Your Medications 219
Levalbuterol ·
Inhalation-Local - U.S. Brands: Xopenex http://www.nlm.nih.gov/medlineplus/druginfo/levalbuterolinha lationlocal203784.html
Methotrexate for Cancer ·
Ophthalmic - U.S. Brands: http://www.nlm.nih.gov/medlineplus/druginfo/ketotifenophtha lmic500012.html
Methotrexate for Noncancerous Conditions ·
Systemic - U.S. Brands: Folex; Rheumatrex http://www.nlm.nih.gov/medlineplus/druginfo/methotrexatefor noncancerouscon202356.html
Montelukast ·
Systemic - U.S. Brands: Singulair http://www.nlm.nih.gov/medlineplus/druginfo/montelukastsyst emic203613.html
Nedocromil ·
Inhalation - U.S. Brands: Tilade http://www.nlm.nih.gov/medlineplus/druginfo/nedocromilinha lation202681.html
·
Ophthalmic - U.S. Brands: Alocril http://www.nlm.nih.gov/medlineplus/druginfo/nedocromilopht halmic500105.html
Oxtriphylline and Guaifenesin ·
Systemic - U.S. Brands: Brondelate http://www.nlm.nih.gov/medlineplus/druginfo/oxtriphyllinean dguaifenesinsys202430.html
Pyridoxine (Vitamin B 6 ) ·
Systemic - U.S. Brands: Beesix; Doxine; Nestrex; Pyri; Rodex http://www.nlm.nih.gov/medlineplus/druginfo/pyridoxinevita minb6systemic202493.html
220 Asthma
Salicylates ·
Systemic - U.S. Brands: Acuprin 81; Amigesic; Anacin Caplets; Anacin Maximum Strength; Anacin Tablets; Anaflex 750; Arthritis Pain Ascriptin; Arthritis Pain Formula; Arthritis Strength Bufferin; Arthropan; Aspergum; Aspirin Regimen Bayer Adult Low Dose; Aspirin Regimen Bayer R http://www.nlm.nih.gov/medlineplus/druginfo/salicylatessyste mic202515.html
Theophylline and Guaifenesin ·
Systemic - U.S. Brands: Bronchial; Elixophyllin-GG; Glyceryl-T; Quibron; Quibron-300; Theocon; Theolate http://www.nlm.nih.gov/medlineplus/druginfo/theophyllineand guaifenesinsyst202557.html
Theophylline, Ephedrine, and Hydroxyzine ·
Systemic - U.S. Brands: Marax; Marax-DF http://www.nlm.nih.gov/medlineplus/druginfo/theophyllineeph edrineandhydrox202555.html
Zafirlukast ·
Systemic - U.S. Brands: Accolate http://www.nlm.nih.gov/medlineplus/druginfo/zafirlukastsyste mic202917.html
Zanamivir ·
Inhalation--Systemic - U.S. Brands: Relenza http://www.nlm.nih.gov/medlineplus/druginfo/zanamivirinhala tionsystemic500004.html
Zileuton ·
Systemic - U.S. Brands: Zyflo http://www.nlm.nih.gov/medlineplus/druginfo/zileutonsystemi c203040.html
Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their
Researching Your Medications 221
institutions. You may be able to access these sources from your local medical library or your doctor’s office.
Reuters Health Drug Database The Reuters Health Drug Database can be searched by keyword at the hyperlink: http://www.reutershealth.com/frame2/drug.html. The following medications are listed in the Reuters’ database as associated with asthma (including those with contraindications):45 ·
Acebutolol HCl http://www.reutershealth.com/atoz/html/Acebutolol_HCl.htm
·
Acetylcysteine http://www.reutershealth.com/atoz/html/Acetylcysteine.htm
·
Acetylcysteine(N-Acetylcysteine) http://www.reutershealth.com/atoz/html/Acetylcysteine(NAcetylcysteine).htm
·
Adenosine http://www.reutershealth.com/atoz/html/Adenosine.htm
·
Albuterol http://www.reutershealth.com/atoz/html/Albuterol.htm
·
Alfentanil HCl http://www.reutershealth.com/atoz/html/Alfentanil_HCl.htm
·
Aminophylline http://www.reutershealth.com/atoz/html/Aminophylline.htm
·
Aminophylline(Theophylline Ethylenediamine) http://www.reutershealth.com/atoz/html/Aminophylline(Theophyllin e_Ethylenediamine).htm
·
Amobarbital Secobarbital http://www.reutershealth.com/atoz/html/Amobarbital_Secobarbital.ht m
·
Amobarbital Sodium http://www.reutershealth.com/atoz/html/Amobarbital_Sodium.htm
·
Amphotericin B Cholesteryl Sulfate Complex http://www.reutershealth.com/atoz/html/Amphotericin_B_Cholestery l_Sulfate_Complex.htm
45
Adapted from A to Z Drug Facts by Facts and Comparisons.
222 Asthma
·
Anistreplase http://www.reutershealth.com/atoz/html/Anistreplase.htm
·
Ascorbic Acid http://www.reutershealth.com/atoz/html/Ascorbic_Acid.htm
·
Ascorbic Acid(Vitamin C) http://www.reutershealth.com/atoz/html/Ascorbic_Acid(Vitamin_C).htm
·
Aspirin http://www.reutershealth.com/atoz/html/Aspirin.htm
·
Aspirin (Acetylsalicylic Acid; ASA) http://www.reutershealth.com/atoz/html/Aspirin_(Acetylsalicylic_Aci d;_ASA).htm
·
Atenolol http://www.reutershealth.com/atoz/html/Atenolol.htm
·
Atenolol Chlorthalidone http://www.reutershealth.com/atoz/html/Atenolol_Chlorthalidone.htm
·
Atropine http://www.reutershealth.com/atoz/html/Atropine.htm
·
Azelastine http://www.reutershealth.com/atoz/html/Azelastine.htm
·
Basiliximab http://www.reutershealth.com/atoz/html/Basiliximab.htm
·
Beclomethasone Dipropionate http://www.reutershealth.com/atoz/html/Beclomethasone_Dipropiona te.htm
·
Betaxolol HCl http://www.reutershealth.com/atoz/html/Betaxolol_HCl.htm
·
Bethanechol Chloride http://www.reutershealth.com/atoz/html/Bethanechol_Chloride.htm
·
Bisoprolol Fumarate http://www.reutershealth.com/atoz/html/Bisoprolol_Fumarate.htm
·
Bitolterol Mesylate http://www.reutershealth.com/atoz/html/Bitolterol_Mesylate.htm
·
Brompheniramine Maleate http://www.reutershealth.com/atoz/html/Brompheniramine_Maleate. htm
Researching Your Medications 223
·
Budesonide http://www.reutershealth.com/atoz/html/Budesonide.htm
·
Carbenicillin Indanyl Sodium http://www.reutershealth.com/atoz/html/Carbenicillin_Indanyl_Sodiu m.htm
·
Carisoprodol http://www.reutershealth.com/atoz/html/Carisoprodol.htm
·
Carteolol HCl http://www.reutershealth.com/atoz/html/Carteolol_HCl.htm
·
Celecoxib http://www.reutershealth.com/atoz/html/Celecoxib.htm
·
Cetirizine http://www.reutershealth.com/atoz/html/Cetirizine.htm
·
Chlorhexidine Gluconate http://www.reutershealth.com/atoz/html/Chlorhexidine_Gluconate.htm
·
Chlorpheniramine Maleate http://www.reutershealth.com/atoz/html/Chlorpheniramine_Maleate. htm
·
Chlorpromazine HCI http://www.reutershealth.com/atoz/html/Chlorpromazine_HCI.htm
·
Chlorthalidone http://www.reutershealth.com/atoz/html/Chlorthalidone.htm
·
Cidofovir http://www.reutershealth.com/atoz/html/Cidofovir.htm
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Cimetidine http://www.reutershealth.com/atoz/html/Cimetidine.htm
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Clemastine Fumarate http://www.reutershealth.com/atoz/html/Clemastine_Fumarate.htm
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Clindamycin http://www.reutershealth.com/atoz/html/Clindamycin.htm
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Clonidine HCl http://www.reutershealth.com/atoz/html/Clonidine_HCl.htm
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Codeine http://www.reutershealth.com/atoz/html/Codeine.htm
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Cromolyn Sodium http://www.reutershealth.com/atoz/html/Cromolyn_Sodium.htm
224 Asthma
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Cromolyn Sodium (Disodium Cromoglycate) http://www.reutershealth.com/atoz/html/Cromolyn_Sodium_(Disodi um_Cromoglycate).htm
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Cyproheptadine HCl http://www.reutershealth.com/atoz/html/Cyproheptadine_HCl.htm
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Desipramine HCl http://www.reutershealth.com/atoz/html/Desipramine_HCl.htm
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Dexamethasone http://www.reutershealth.com/atoz/html/Dexamethasone.htm
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Dextromethorphan Hydrobromide http://www.reutershealth.com/atoz/html/Dextromethorphan_Hydrob romide.htm
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Diclofenac Sodium Misoprostol http://www.reutershealth.com/atoz/html/Diclofenac_Sodium_Misopr ostol.htm
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Diflunisal http://www.reutershealth.com/atoz/html/Diflunisal.htm
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Dimenhydrinate http://www.reutershealth.com/atoz/html/Dimenhydrinate.htm
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Dinoprostone(PGE2; Prostaglandin E2) http://www.reutershealth.com/atoz/html/Dinoprostone(PGE2;_Prosta glandin_E2).htm
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Diphenhydramine HCl http://www.reutershealth.com/atoz/html/Diphenhydramine_HCl.htm
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Dipyridamole Aspirin http://www.reutershealth.com/atoz/html/Dipyridamole_Aspirin.htm
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Doxapram HCl http://www.reutershealth.com/atoz/html/Doxapram_HCl.htm
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Droperidol http://www.reutershealth.com/atoz/html/Droperidol.htm
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Edrophonium Chloride http://www.reutershealth.com/atoz/html/Edrophonium_Chloride.htm
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Efavirenz http://www.reutershealth.com/atoz/html/Efavirenz.htm
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Ephedrine http://www.reutershealth.com/atoz/html/Ephedrine.htm
Researching Your Medications 225
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Epinephrine http://www.reutershealth.com/atoz/html/Epinephrine.htm
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Erythromycin Ethylsuccinate Sulfisoxazole http://www.reutershealth.com/atoz/html/Erythromycin_Ethylsuccinat e_Sulfisoxazole.htm
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Esmolol HCl http://www.reutershealth.com/atoz/html/Esmolol_HCl.htm
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Estradiol http://www.reutershealth.com/atoz/html/Estradiol.htm
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Estrogens Conjugated http://www.reutershealth.com/atoz/html/Estrogens_Conjugated.htm
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Estropipate http://www.reutershealth.com/atoz/html/Estropipate.htm
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Estropipate (Piperazine Estrone Sulfate) http://www.reutershealth.com/atoz/html/Estropipate_(Piperazine_Est rone_Sulfate).htm
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Etodolac http://www.reutershealth.com/atoz/html/Etodolac.htm
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Famotidine http://www.reutershealth.com/atoz/html/Famotidine.htm
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Fenoprofen Calcium http://www.reutershealth.com/atoz/html/Fenoprofen_Calcium.htm
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Flunisolide http://www.reutershealth.com/atoz/html/Flunisolide.htm
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Fluoxetine HCl http://www.reutershealth.com/atoz/html/Fluoxetine_HCl.htm
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Fluphenazine http://www.reutershealth.com/atoz/html/Fluphenazine.htm
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Flurbiprofen http://www.reutershealth.com/atoz/html/Flurbiprofen.htm
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Fluticasone Propionate http://www.reutershealth.com/atoz/html/Fluticasone_Propionate.htm
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Formoterol Fumarate http://www.reutershealth.com/atoz/html/Formoterol_Fumarate.htm
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Foscarnet Sodium http://www.reutershealth.com/atoz/html/Foscarnet_Sodium.htm
226 Asthma
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Foscarnet Sodium (Phosphonoformic Acid) http://www.reutershealth.com/atoz/html/Foscarnet_Sodium_(Phosph onoformic_Acid).htm
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Guaifenesin http://www.reutershealth.com/atoz/html/Guaifenesin.htm
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Guaifenesin(Glyceryl Guaiacolate) http://www.reutershealth.com/atoz/html/Guaifenesin(Glyceryl_Guaia colate).htm
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Guanadrel http://www.reutershealth.com/atoz/html/Guanadrel.htm
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Guanethidine Monosulfate http://www.reutershealth.com/atoz/html/Guanethidine_Monosulfate. htm
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Haloperidol http://www.reutershealth.com/atoz/html/Haloperidol.htm
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Heparin http://www.reutershealth.com/atoz/html/Heparin.htm
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Hydrochlorothiazide Triamterene(HCTZ Triamterene) http://www.reutershealth.com/atoz/html/Hydrochlorothiazide_Triamt erene(HCTZ_Triamterene).htm
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Hydrochlorothiazide(HCTZ) http://www.reutershealth.com/atoz/html/Hydrochlorothiazide(HCTZ) .htm
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Hydromorphone HCl http://www.reutershealth.com/atoz/html/Hydromorphone_HCl.htm
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Hydroxyzine HCl http://www.reutershealth.com/atoz/html/Hydroxyzine_HCl.htm
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Inamrinone http://www.reutershealth.com/atoz/html/Inamrinone.htm
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Indapamide http://www.reutershealth.com/atoz/html/Indapamide.htm
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Indomethacin http://www.reutershealth.com/atoz/html/Indomethacin.htm
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Influenza Virus Vaccine 2000 http://www.reutershealth.com/atoz/html/Influenza_Virus_Vaccine_20 00.htm
Researching Your Medications 227
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Influenza Virus Vaccine 2001 http://www.reutershealth.com/atoz/html/Influenza_Virus_Vaccine_20 01.htm
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Interferon Gamma-1b http://www.reutershealth.com/atoz/html/Interferon_Gamma-1b.htm
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Iodine http://www.reutershealth.com/atoz/html/Iodine.htm
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Ipratropium Bromide http://www.reutershealth.com/atoz/html/Ipratropium_Bromide.htm
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Ipratropium Bromide Albuterol Sulfate http://www.reutershealth.com/atoz/html/Ipratropium_Bromide_Albu terol_Sulfate.htm
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Iron Dextran http://www.reutershealth.com/atoz/html/Iron_Dextran.htm
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Isoetharine http://www.reutershealth.com/atoz/html/Isoetharine.htm
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Isoproterenol http://www.reutershealth.com/atoz/html/Isoproterenol.htm
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Ketoprofen http://www.reutershealth.com/atoz/html/Ketoprofen.htm
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Ketorolac Tromethamine http://www.reutershealth.com/atoz/html/Ketorolac_Tromethamine.htm
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Labetalol HCL http://www.reutershealth.com/atoz/html/Labetalol_HCL.htm
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Levobunolol http://www.reutershealth.com/atoz/html/Levobunolol.htm
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Levodopa Carbidopa http://www.reutershealth.com/atoz/html/Levodopa_Carbidopa.htm
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Loratadine http://www.reutershealth.com/atoz/html/Loratadine.htm
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Meclizine http://www.reutershealth.com/atoz/html/Meclizine.htm
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Medroxyprogesterone Acetate http://www.reutershealth.com/atoz/html/Medroxyprogesterone_Acet ate.htm
228 Asthma
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Mefenamic Acid http://www.reutershealth.com/atoz/html/Mefenamic_Acid.htm
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Megestrol Acetate http://www.reutershealth.com/atoz/html/Megestrol_Acetate.htm
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Meloxicam http://www.reutershealth.com/atoz/html/Meloxicam.htm
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Meperidine HCl http://www.reutershealth.com/atoz/html/Meperidine_HCl.htm
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Meprobamate http://www.reutershealth.com/atoz/html/Meprobamate.htm
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Metaproterenol Sulfate http://www.reutershealth.com/atoz/html/Metaproterenol_Sulfate.htm
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Methenamine and Methenamine Salts http://www.reutershealth.com/atoz/html/Methenamine_and_Methena mine_Salts.htm
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Methenamine Hippurate http://www.reutershealth.com/atoz/html/Methenamine_Hippurate.htm
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Methotrexate http://www.reutershealth.com/atoz/html/Methotrexate.htm
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Metolazone http://www.reutershealth.com/atoz/html/Metolazone.htm
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Metoprolol http://www.reutershealth.com/atoz/html/Metoprolol.htm
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Midazolam HCl http://www.reutershealth.com/atoz/html/Midazolam_HCl.htm
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Mivacurium Chloride http://www.reutershealth.com/atoz/html/Mivacurium_Chloride.htm
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Montelukast Sodium http://www.reutershealth.com/atoz/html/Montelukast_Sodium.htm
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Morphine Sulfate http://www.reutershealth.com/atoz/html/Morphine_Sulfate.htm
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Muromonab–CD3 http://www.reutershealth.com/atoz/html/Muromonab–CD3.htm
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Mycophenolate Mofetil http://www.reutershealth.com/atoz/html/Mycophenolate_Mofetil.htm
Researching Your Medications 229
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Nabumetone http://www.reutershealth.com/atoz/html/Nabumetone.htm
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Nadolol http://www.reutershealth.com/atoz/html/Nadolol.htm
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Nalbuphine HCl http://www.reutershealth.com/atoz/html/Nalbuphine_HCl.htm
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Naproxen http://www.reutershealth.com/atoz/html/Naproxen.htm
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Nedocromil Sodium http://www.reutershealth.com/atoz/html/Nedocromil_Sodium.htm
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Neostigmine http://www.reutershealth.com/atoz/html/Neostigmine.htm
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Niacin http://www.reutershealth.com/atoz/html/Niacin.htm
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Nitrofurantoin http://www.reutershealth.com/atoz/html/Nitrofurantoin.htm
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Ondansetron HCl http://www.reutershealth.com/atoz/html/Ondansetron_HCl.htm
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Oral Contraceptives Combination Products http://www.reutershealth.com/atoz/html/Oral_Contraceptives_Combi nation_Products.htm
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Oral Contraceptives Progestin-only Products http://www.reutershealth.com/atoz/html/Oral_Contraceptives_Proges tin-only_Products.htm
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Oxycodone HCl http://www.reutershealth.com/atoz/html/Oxycodone_HCl.htm
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Pancrelipase http://www.reutershealth.com/atoz/html/Pancrelipase.htm
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Pancuronium Bromide http://www.reutershealth.com/atoz/html/Pancuronium_Bromide.htm
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Penbutolol Sulfate http://www.reutershealth.com/atoz/html/Penbutolol_Sulfate.htm
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Penicillin G http://www.reutershealth.com/atoz/html/Penicillin_G.htm
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Penicillin V http://www.reutershealth.com/atoz/html/Penicillin_V.htm
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Pentamidine Isethionate http://www.reutershealth.com/atoz/html/Pentamidine_Isethionate.htm
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Pentazocine http://www.reutershealth.com/atoz/html/Pentazocine.htm
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Pentobarbital Sodium http://www.reutershealth.com/atoz/html/Pentobarbital_Sodium.htm
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Perphenazine http://www.reutershealth.com/atoz/html/Perphenazine.htm
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Perphenazine Amitriptyline http://www.reutershealth.com/atoz/html/Perphenazine_Amitriptyline .htm
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Phenobarbital http://www.reutershealth.com/atoz/html/Phenobarbital.htm
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Phenylpropanolamine HCl Guaifenesin http://www.reutershealth.com/atoz/html/Phenylpropanolamine_HCl_ Guaifenesin.htm
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Pilocarpine http://www.reutershealth.com/atoz/html/Pilocarpine.htm
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Pindolol http://www.reutershealth.com/atoz/html/Pindolol.htm
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Piperacillin Sodium http://www.reutershealth.com/atoz/html/Piperacillin_Sodium.htm
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Pirbuterol Acetate http://www.reutershealth.com/atoz/html/Pirbuterol_Acetate.htm
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Piroxicam http://www.reutershealth.com/atoz/html/Piroxicam.htm
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Prochlorperazine http://www.reutershealth.com/atoz/html/Prochlorperazine.htm
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Progesterone http://www.reutershealth.com/atoz/html/Progesterone.htm
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Promethazine HCl http://www.reutershealth.com/atoz/html/Promethazine_HCl.htm
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Propoxyphene http://www.reutershealth.com/atoz/html/Propoxyphene.htm
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Propranolol HCl http://www.reutershealth.com/atoz/html/Propranolol_HCl.htm
Researching Your Medications 231
·
Quinapril HCl http://www.reutershealth.com/atoz/html/Quinapril_HCl.htm
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Ramipril http://www.reutershealth.com/atoz/html/Ramipril.htm
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Rapacuronium Bromide http://www.reutershealth.com/atoz/html/Rapacuronium_Bromide.htm
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Rofecoxib http://www.reutershealth.com/atoz/html/Rofecoxib.htm
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Salicylate Combination http://www.reutershealth.com/atoz/html/Salicylate_Combination.htm
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Salmeterol http://www.reutershealth.com/atoz/html/Salmeterol.htm
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Secobarbital Sodium http://www.reutershealth.com/atoz/html/Secobarbital_Sodium.htm
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Sildenafil http://www.reutershealth.com/atoz/html/Sildenafil.htm
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Sirolimus http://www.reutershealth.com/atoz/html/Sirolimus.htm
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Sotalol HCl http://www.reutershealth.com/atoz/html/Sotalol_HCl.htm
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Sufentanil Citrate http://www.reutershealth.com/atoz/html/Sufentanil_Citrate.htm
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Sulfasalazine http://www.reutershealth.com/atoz/html/Sulfasalazine.htm
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Sulfisoxazole http://www.reutershealth.com/atoz/html/Sulfisoxazole.htm
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Sulindac http://www.reutershealth.com/atoz/html/Sulindac.htm
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Tacrolimus http://www.reutershealth.com/atoz/html/Tacrolimus.htm
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Terazosin http://www.reutershealth.com/atoz/html/Terazosin.htm
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Terbutaline Sulfate http://www.reutershealth.com/atoz/html/Terbutaline_Sulfate.htm
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Testosterone http://www.reutershealth.com/atoz/html/Testosterone.htm
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Theophylline http://www.reutershealth.com/atoz/html/Theophylline.htm
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Thiopental Sodium http://www.reutershealth.com/atoz/html/Thiopental_Sodium.htm
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Thioridazine HCl http://www.reutershealth.com/atoz/html/Thioridazine_HCl.htm
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Thiothixene http://www.reutershealth.com/atoz/html/Thiothixene.htm
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Timolol Maleate http://www.reutershealth.com/atoz/html/Timolol_Maleate.htm
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Tolmetin Sodium http://www.reutershealth.com/atoz/html/Tolmetin_Sodium.htm
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Triamcinolone http://www.reutershealth.com/atoz/html/Triamcinolone.htm
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Trifluoperazine HCl http://www.reutershealth.com/atoz/html/Trifluoperazine_HCl.htm
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Trimethoprim Sulfamethoxazole http://www.reutershealth.com/atoz/html/Trimethoprim_Sulfamethox azole.htm
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Triprolidine HCl http://www.reutershealth.com/atoz/html/Triprolidine_HCl.htm
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Urokinase http://www.reutershealth.com/atoz/html/Urokinase.htm
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Vasopressin http://www.reutershealth.com/atoz/html/Vasopressin.htm
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Vecuronium Bromide http://www.reutershealth.com/atoz/html/Vecuronium_Bromide.htm
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Zafirlukast http://www.reutershealth.com/atoz/html/Zafirlukast.htm
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Zileuton http://www.reutershealth.com/atoz/html/Zileuton.htm
Mosby’s GenRx Mosby’s GenRx database (also available on CD-Rom and book format) covers 45,000 drug products including generics and international brands. It
Researching Your Medications 233
provides prescribing information, drug interactions, and patient information. Information on Mosby’s Gen Rx can be obtained at the following hyperlink: http://www.genrx.com/Mosby/PhyGenRx/group.html. Physicians Desk Reference The Physicians Desk Reference database (also available in CD-Rom and book format) is a full-text drug database. The database is searchable by brand name, generic name or by indication. It features multiple drug interactions reports. Information can be obtained at the following hyperlink: http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm.
Other Web Sites A number of additional Web sites discuss drug information. As an example, you may like to look at www.drugs.com which reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. which allows users to download articles on various drugs and therapeutics for a nominal fee: http://www.medletter.com/.
Contraindications and Interactions (Hidden Dangers) Some of the medications mentioned in the previous discussions can be problematic for patients with asthma--not because they are used in the treatment process, but because of contraindications, or side effects. Medications with contraindications are those that could react with drugs used to treat asthma or potentially create deleterious side effects in patients with asthma. You should ask your physician about any contraindications, especially as these might apply to other medications that you may be taking for common ailments. Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect. Drug interactions may make your medications less effective, cause unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you.
234 Asthma
Be sure to read the label every time you use a nonprescription or prescription drug, and take the time to learn about drug interactions. These precautions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense. Drug labels contain important information about ingredients, uses, warnings, and directions which you should take the time to read and understand. Labels also include warnings about possible drug interactions. Further, drug labels may change as new information becomes available. This is why it’s especially important to read the label every time you use a medication. When your doctor prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins, botanicals, minerals and herbals you take as well as the foods you eat. Ask your pharmacist for the package insert for each prescription drug you take. The package insert provides more information about potential drug interactions.
A Final Warning At some point, you may hear of alternative medications from friends, relatives, or in the news media. Advertisements may suggest that certain alternative drugs can produce positive results for patients with asthma. Exercise caution--some of these drugs may have fraudulent claims, and others may actually hurt you. The Food and Drug Administration (FDA) is the official U.S. agency charged with discovering which medications are likely to improve the health of patients with asthma. The FDA warns patients to watch out for46: ·
Secret formulas (real scientists share what they know)
·
Amazing breakthroughs or miracle cures (real breakthroughs don’t happen very often; when they do, real scientists do not call them amazing or miracles)
·
Quick, painless, or guaranteed cures
·
If it sounds too good to be true, it probably isn’t true.
If you have any questions about any kind of medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 146
This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.
Researching Your Medications 235
888-INFO-FDA www.fda.gov.
(1-888-463-6332),
or
on
the
World
Wide
Web
at
General References In addition to the resources provided earlier in this chapter, the following general references describe medications (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Delmar’s Respiratory Care Drug Reference by Fred Hill; Paperback - 575 pages, 1st edition (January 15, 1999), Delmar Learning; ISBN: 0827390661; http://www.amazon.com/exec/obidos/ASIN/0827390661/icongroupinterna
·
Mosby’s Respiratory Care Drug Reference by Joseph L., Jr. Rau; Paperback - 352 pages, 1st edition (January 15, 1997), Mosby-Year Book; ISBN: 0815184565; http://www.amazon.com/exec/obidos/ASIN/0815184565/icongroupinterna
·
Pharmacology in Respiratory Care by Stuart R. Levine, Henry Hitner, Arthur J. McLaughlin, Jr.; Hardcover - 386 pages (May 11, 2001), Appleton & Lange; ISBN: 0071347275; http://www.amazon.com/exec/obidos/ASIN/0071347275/icongroupinterna
·
Respiratory Care Drug Reference by Arthur McLaughlin; Paperback - 383 pages, 2 edition (March 1997), Unknown; ISBN: 0834207885; http://www.amazon.com/exec/obidos/ASIN/0834207885/icongroupinterna
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Acetylcysteine: The N-acetyl derivative of cysteine. It is used as a mucolytic agent to reduce the viscosity of mucous secretions. It has also been shown to have antiviral effects in patients with HIV due to inhibition of viral stimulation by reactive oxygen intermediates. [NIH] Aminophylline: A drug combination that contains theophylline and ethylenediamine. It is more soluble in water than theophylline but has similar pharmacologic actions. It's most common use is in bronchial asthma, but it has been investigated for several other applications. [NIH] Atropine: A toxic alkaloid, originally from Atropa belladonna, but found in other plants, mainly Solanaceae. [NIH]
236 Asthma
Cimetidine: A weight loss drug that is thought to work by suppression of gastric acid or suppression of hunger by blocking histamine H2 receptors. It is not approved by the FDA. [NIH] Clindamycin: An antibacterial agent that is a semisynthetic analog of lincomycin. [NIH] Codeine: An opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough. [NIH] Contraceptive: conception. [EU]
An agent that diminishes the likelihood of or prevents
Diflunisal: A salicylate derivative and anti-inflammatory analgesic with actions and side effects similar to those of aspirin. [NIH] Dimenhydrinate: A drug combination that contains diphenhydramine and theophylline. It is used for treating vertigo, motion sickness, and nausea associated with pregnancy. It is not effective in the treatment of nausea associated with cancer chemotherapy. [NIH] Dyphylline: A theophylline derivative with broncho- and vasodilator properties. It is used in the treatment of asthma, cardiac dyspnea, and bronchitis. [NIH] Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Etodolac: A nonsteroidal anti-inflammatory agent with potent analgesic and antiarthritic properties. It has been shown to be effective in the treatment of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and in the alleviation of postoperative pain. [NIH] Famotidine: A competitive histamine H2-receptor antagonist. Its main pharmacodynamic effect is the inhibition of gastric secretion. [NIH] Fluphenazine: A phenothiazine used in the treatment of psychoses. Its properties and uses are generally similar to those of chlorpromazine. [NIH] Flurbiprofen: An anti-inflammatory analgesic and antipyretic of the phenylalkynoic acid series. It has been shown to reduce bone resorption in periodontal disease by inhibiting carbonic anhydrase. [NIH] Indapamide: A sulfamyl diuretic with about 16x the effect of furosemide. It has also been shown to be an effective antihypertensive agent in the clinic. [NIH]
Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Researching Your Medications 237
Ipratropium: A muscarinic antagonist structurally related to atropine but often considered safer and more effective for inhalation use. It is used for various bronchial disorders, in rhinitis, and as an antiarrhythmic. [NIH] Isoetharine: Adrenergic beta-2 agonist used as bronchodilator for emphysema, bronchitis and asthma. [NIH] Isoproterenol: Isopropyl analog of epinephrine; beta-sympathomimetic that acts on the heart, bronchi, skeletal muscle, alimentary tract, etc. It is used mainly as bronchodilator and heart stimulant. [NIH] Isoxsuprine: A beta-adrenergic agonist that causes direct relaxation of uterine and vascular smooth muscle. Its vasodilating actions are greater on the arteries supplying skeletal muscle than on those supplying skin. It is used in the treatment of peripheral vascular disease and in premature labor. [NIH]
Ketoprofen: An ibuprofen-type anti-inflammatory analgesic and antipyretic. It is used in the treatment of rheumatoid arthritis and osteoarthritis. [NIH] Ketorolac Tromethamine: A pyrrolizine carboxylic acid derivative structurally related to indomethacin. It is a non-steroidal anti-inflammatory agent used for analgesia for postoperative pain and inhibits cyclooxygenase activity. [NIH] Ketotifen: A cycloheptathiophene that interferes with the release of inflammatory mediators and blocks histamine H1 receptors. It has been proposed as an anti-asthmatic and for the treatment of rhinitis, skin allergies, and anaphylaxis. [NIH] Levobunolol: A nonselective beta-adrenoceptor antagonist used in the treatment of glaucoma. [NIH] Liquifilm: A thin liquid layer of coating. [EU] Meclizine: A histamine H1 antagonist used in the treatment of motion sickness, vertigo, and nausea during pregnancy and radiation sickness. [NIH] Mefenamic Acid: A non-steroidal anti-inflammatory agent with analgesic, anti-inflammatory, and antipyretic properties. It is an inhibitor of cyclooxygenase. [NIH] Metolazone: A potent, long acting diuretic useful in chronic renal disease. It also tends to lower blood pressure and increase potassium loss. [NIH] Metoprolol: Adrenergic beta-1-blocking agent with no stimulatory action. It is less bound to plasma albumin than alprenolol and may be useful in angina pectoris, hypertension, or cardiac arrhythmias. [NIH] Nadolol: A non-selective beta-adrenergic antagonist with a long half-life, used in cardiovascular disease to treat arrhythmias, angina pectoris, and hypertension. Nadolol is also used for migraine and for tremor. [NIH]
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Naproxen: An anti-inflammatory agent with analgesic and antipyretic properties. Both the acid and its sodium salt are used in the treatment of rheumatoid arthritis and other rheumatic or musculoskeletal disorders, dysmenorrhea, and acute gout. [NIH] Neostigmine: A cholinesterase inhibitor used in the treatment of myasthenia gravis and to reverse the effects of muscle relaxants such as gallamine and tubocurarine. Neostigmine, unlike physostigmine, does not cross the blood-brain barrier. [NIH] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nitrofurantoin: A urinary anti-infective agent effective against most grampositive and gram-negative organisms. Although sulfonamides and antibiotics are usually the agents of choice for urinary tract infections, nitrofurantoin is widely used for prophylaxis and long-term suppression. [NIH]
Ophthalmic: Pertaining to the eye. [EU] Pancrelipase: A preparation of hog pancreatic enzymes standardized for lipase content. [NIH] Penicillin G: A penicillin derivative commonly used in the form of its sodium or potassium salts in the treatment of a variety of infections. It is effective against most gram-positive bacteria and against gram-negative cocci. It has also been used as an experimental convulsant because of its actions on GABA mediated synaptic transmission. [NIH] Penicillin V: A broad-spectrum penicillin antibiotic used orally in the treatment of mild to moderate infections by susceptible gram-positive organisms. [NIH] Perphenazine: An antipsychotic phenothiazine derivative with actions and uses similar to those of chlorpromazine. [NIH] Phenobarbital: A barbituric acid derivative that acts as a nonselective central nervous system depressant. It promotes binding to inhibitory gaba subtype receptors, and modulates chloride currents through receptor channels. It also inhibits glutamate induced depolarizations. [NIH] Pilocarpine: A slowly hydrolyzed muscarinic agonist with no nicotinic effects. Pilocarpine is used as a miotic and in the treatment of glaucoma. [NIH] Propoxyphene: A narcotic analgesic structurally related to methadone. Only the dextro-isomer has an analgesic effect; the levo-isomer appears to exert an antitussive effect. [NIH] Ramipril: A long-acting angiotensin-converting enzyme inhibitor. It is a
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prodrug that is transformed in the liver to its active metabolite ramiprilat. [NIH]
Sirolimus: A macrolide compound obtained from Streptomyces hygroscopicus that acts by selectively blocking the transcriptional activation of cytokines thereby inhibiting cytokine production. It is bioactive only when bound to immunophilins. Sirolimus is a potent immunosuppressant and possesses both antifungal and antineoplastic properties. [NIH] Sulindac: A sulfinylindene derivative whose sulfinyl moiety is converted in vivo to an active anti-inflammatory analgesic that undergoes enterohepatic circulation to maintain constant blood levels without causing gastrointestinal side effects. [NIH] Thiothixene: A thioxanthine used as an antipsychotic agent. Its effects are similar to the phenothiazine antipsychotics. [NIH] Triamterene: A pteridine that is used as a mild diuretic. [NIH] Vecuronium Bromide: Monoquaternary homolog of pancuronium. A nondepolarizing neuromuscular blocking agent with shorter duration of action than pancuronium. Its lack of significant cardiovascular effects and lack of dependence on good kidney function for elimination as well as its short duration of action and easy reversibility provide advantages over, or alternatives to, other established neuromuscular blocking agents. [NIH]
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APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your friends or doctor have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to asthma. Finally, at the conclusion of this chapter, we will provide a list of readings on asthma from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine’s (NCCAM) overview of complementary and alternative medicine.
What Is CAM?47 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and 47
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.
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treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.
What Are the Domains of Alternative Medicine?48 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are
48
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.
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practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India’s traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body’s defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.
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Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind’s capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.
Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine’s use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.
Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body’s systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues.
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Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient’s recovery and that healing is promoted when the body’s energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.
Can Alternatives Affect My Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your medical treatment. It becomes all the more important to speak with your doctor who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for patients of both genders and all ages.49
49
Adapted from http://www.4woman.gov/faq/alternative.htm.
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Is It Okay to Want Both Traditional and Alternative Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.
Finding CAM References on Asthma Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for asthma. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required.
The Combined Health Information Database For a targeted search, The Combined Health Information Database is a bibliographic database produced by health-related agencies of the Federal Government (mostly from the National Institutes of Health). This database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “asthma” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: ·
Immunomodulatory Effects of Acupuncture in the Treatment of Allergic Asthma: A Randomized Controlled Study Source: Journal of Alternative and Complementary Medicine: Research on Paradigm, Practice and Policy. 6(6): 519-525. December 2000.
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Summary: This journal article examines the immunomodulatory effects of acupuncture in patients with allergic asthma. Thirty-eight patients were enrolled in a single-blind, randomized, controlled study. Twenty patients were treated with acupuncture according to the principles of traditional Chinese medicine (TCM group), and 18 were treated using acupuncture points not specific for asthma (control group). All patients received 12 30-minute treatments over 4 weeks. After treatment, significantly more TCM patients (79 percent) than controls (47 percent) reported an improvement in general well-being. The TCM group also showed significant changes in several peripheral blood parameters. Within lymphocyte subpopulations, CD3+ cells and CD4+ cells increased significantly. Values for cytokine concentrations showed decreases in interleukin (IL)-6 and IL-10 and an increase in IL-8. In addition, the 'in vitro' lymphocyte proliferation rate increased while the number of eosinophils decreased. The only change observed in the control group was an increase in CD4+ cells. The results suggest that asthma patients may benefit from acupuncture treatment given as an adjunct to conventional therapy. Furthermore, acupuncture given according to TCM principles produces significant immune-modulating effects. The article has 2 figures, 3 tables, and 27 references. ·
Comprehensive Approach to Controlling Allergies and Asthma Source: Alternative and Complementary Therapies. 5(5): 254-265. October 1999. Summary: This journal article describes an alternative approach to controlling allergies and asthma. The first part reviews the epidemiology of allergies and asthma and examines the current medical treatment for these conditions. The second part describes a comprehensive protocol for preventing and treating allergies and asthma. This approach has five main components: 1) strengthening the immune system by eliminating avoidable allergens; 2) correcting digestive problems and prostaglandin imbalances with essential fatty acids and their cofactors via proper diet; 3) chiropractic adjustment; 4) healing affirmations and stress reduction; and 5) nutritional supplementation with antioxidants, bioflavonoids, and herbs. The article has 1 table and 60 references.
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Prevention of Atopic Asthma Source: Positive Health. Number 25: 23-26. February 1998. Summary: This journal article examines a possible correlation between the increase in house dust mite (HDM) infestation and the increase in asthma throughout the world in recent years. It provides statistics for increased asthma rates; describes current asthma treatments that do not
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appear to be effective in halting the incidence or treatment of this disease; and suggests that environmental elements, including reduced ventilation, laundry detergents, and carpeting, are providing good conditions in which HDM breed and cause asthma. The article reports that children are especially susceptible to HDM. It suggests ways to prevent infestation, such as lowering humidity levels, frequent vacuum cleaning and dusting, and replacing old mattresses and pillows. The article also advises doctors to alert their patients about HDM prevention, especially for those suffering from asthma. The article includes 35 references. ·
Asthma and Its Aromatherapy Management Source: Positive Health. Number 25: 28-29. February 1998. Summary: This article describes asthma and treatments for it, including general measures and aromatherapy. It defines the difference between acute and chronic asthma, and lists asthma symptoms. The author describes sudden life-threatening asthmatic reactions and factors that can bring on attacks, such as humidity and estrogen. Recommendations for general treatments include avoiding certain foods, household allergens, and tobacco smoke; and frequently cleaning ones's house. Aromatherapy is recommended to produce relaxation, dilate the breathing tubes, and encourage emotional balance. The author suggests particular oils that may produce these effects when applied directly to the skin or diffused in the air. This journal article contains 9 references and lists a referral organization to contact for more information.
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Asthma - Breathe Easily Again Source: Alternative Medicine. 2560-67. August-September 1998. Summary: This journal article discusses the long-term benefits of herbs and nutrients, chiropractic, homeopathic remedies, hypnosis, and new breathing techniques in patients with asthma. The author suggests that such therapies offer the possibility of a lasting remission from this respiratory disorder. The author presents several case examples illustrating the success of these therapies: (1) the use of nutrients and herbs in a 15-year-old girl with asthma associated with excess copper and deficiencies in magnesium, selenium, manganese, and molybdenum; (2) the use of acupuncture and Chinese herbal medicine to treat a 35-yearold woman with asthma associated with dysfunction of the spleen; (3) the use of chiropractic and homeopathic remedies to treat a 10-year-old boy with asthma associated with a vertebral misalignment resulting from a fall from a tree; (4) the use of hypnosis to treat a 28-year-old woman with asthma associated with anxiety; and (5) the use of breathing exercises
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emphasizing shallow breath cycles. The article includes a list of resources. ·
Beyond Steroids: New Developments for the Treatment of Asthma Source: Alternative and Complementary Therapies. 4(4): 298-308. October 1998. Summary: This article highlights alternative and complementary approaches to the treatment of asthma. Some treatments focus on allergies as the primary cause of asthma. These treatments include vitamin B12, vitamin B6, and magnesium supplementation, and emphasize the importance of removing allergens from the patient's environment. Some practitioners also advocate the use of 'Coleus forskholii,' 'Ginkgo biloba,' vitamin C, the natural antihistamine quercetin, and a combination of omega-3 and omega-6 fatty acids. Other practitioners use homeopathy as the primary approach, sometimes in conjunction with craniosacral manipulation. Environmental medicine specialists consider asthma to be an environmental illness. Their treatments focus on desensitizing the patient to the environmental triggers, and may include heat depuration treatment for asthma resulting from exposure to a toxic chemical. In Chinese medicine, different kinds of asthma are differentiated by their signs and symptoms. However, all cases are treated with acupuncture and a combination of herbs. Other alternative approaches include mind-body techniques, chiropractic, massage, breath training, yoga, and diet. The article has 20 references.
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Comparison of Active and Simulated Chiropractic Manipulation as Adjunctive Treatment for Childhood Asthma Source: New England Journal of Medicine. 339(15): 1013-1020. October 8, 1998. Summary: This journal article describes a randomized, controlled trial of chiropractic spinal manipulation for children with mild to moderate asthma. The participants were 91 children, aged 7 to 16 years, who had had asthma for more than 1 year and whose symptoms required the use of a bronchodilator at least 3 times weekly. All participants had evidence of vertebral subluxation on palpation, but none had previously received chiropractic care. The patients were randomly assigned to receive 20 to 36 active or simulated chiropractic manipulation treatments in addition to regular medical care during a 4-month period. The primary outcome measure was the change in peak expiratory flow from baseline to 2 and 4 months. Eighty patients (38 active treatment, 42 simulated treatment) had outcome data that could be evaluated. There were small increases in peak expiratory flow in the morning and evening in both groups, with no
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significant differences in change from baseline values between groups. Asthma symptoms and use of beta-agonists decreased and quality of life increased in both groups, with no significant differences between groups. There were no significant changes in spirometric measurements or airway responsiveness. The authors conclude that the addition of chiropractic spinal manipulation to usual medical care was of no benefit in these children with asthma. The article has 2 figures, 3 tables, and 45 references. ·
Acupuncture in the Treatment of Asthma: A Critical Review Source: Allergologia et Immunopathologia. 26(6): 263-271. 1998. Summary: This journal article presents a review of the literature on the use and utility of acupuncture in the treatment of asthma. This work was supported by the Office of Alternative Medicine. The first section reviews the basic principles of traditional Chinese medicine and acupuncture. The second section provides an overview of the epidemiology of asthma and its conventional treatment. The third section reviews data concerning the extent to which acupuncture is used for the treatment of asthma. One study found that 33 percent of nonphysician health care providers and 14 percent of physicians used acupuncture for the treatment of asthma. Another study reported that 31 percent of children seen at a pediatric outpatient clinic had received complementary and alternative medicine (CAM); these children were most commonly seen for complaints of allergy and asthma. The final section reviews evidence of the efficacy of acupuncture in the treatment of asthma. Relevant reports were identified using the National Library of Medicine, the Office of Alternative Medicine's database, and other databases on CAM. The authors conclude that existing data do not provide sufficient support for a useful role of acupuncture in asthma management, and that well-designed clinical trials addressing this issue are urgently needed. The article has 3 tables and 185 references.
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Use of Alternative Therapies By Children With Asthma: A Brief Report Source: Journal of Paediatrics and Child Health. 34: 131-134. 1998. Summary: This journal article reports the use of alternative therapies in a consecutive series of 51 children with asthma, aged 1-6 years, attending the Women's and Children's Hospital in South Australia. Parents completed a questionnaire on their children's use of 29 different alternative therapies, the severity of their asthma, and demographic characteristics. Results indicate that approximately 55 percent of the children used at least one alternative therapy for the management of their asthma. The therapies most commonly used were massage, relaxation
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exercises, diet therapy, and vitamins. There were no significant differences in age, asthma severity, time since diagnosis, or comorbidity between children who did and did not use alternative therapies. The authors conclude that pediatricians should be prepared to discuss the use of alternative therapies with the parents of their asthma patients. The article has 1 figure, 3 tables, and 15 references. ·
Alleviating Asthma With Mental Imagery: A Phenomenological Approach Source: Alternative and Complementary Therapies. 3(1): 42-52. February 1997. Summary: This journal article presents a study, funded by the Office of Alternative Medicine, into phenomenological analysis of mental imagery in patients with asthma. Participants were 17 subjects who had completed the imagery arm of a study, funded by the National Institutes of Health, of the effects of guided imagery on asthma. The participants provided written responses to three statements designed to provide raw material for phenomenological analysis of three research questions: (1) What are the common elements in experiencing the meaning of mental imagery as a treatment for disease? (2) How and why is mental imagery experienced as valuable in the treatment for disease? and (3) If mental imagery facilitates the experience of power, what are common elements of power experienced in relation to imagery? The subjects reported that the use of mental imagery deepened their understanding of asthma and increased their ability to be active participants in its treatment. In addition, several subjects reported that use of imagery led to an awareness of a variety of previously unappreciated conflicts that were salient to their illness. The authors conclude that improvement in quality of life and personal power in asthma patients practicing imagery may occur independently of symptomatic change or changes in medication. This journal article contains 3 tables and 17 references.
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Acupuncture and Chinese Herbal Medicine Versus Conventional Treatments for Asthma Source: Alternative and Complementary Therapies. 3(6): 451-454. December 1997. Summary: This journal article discusses the efficacy and safety of traditional Chinese medicine (TCM) and conventional treatments for asthma. The first section reviews evidence from studies of various Chinese herbal treatments, including ma huang ('Ephedra herba'), Wen Yang, Kan-Lin, 'Ginkgo biloba,' and Saiboku-to (a Japanese herbal mixture with origins in TCM). The second section reviews studies of the
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acute and long-term benefits of acupuncture for asthma. The author notes that, unfortunately, the available literature uses small sample sizes, lacks adequate control groups, and is comprised of similar studies with contradictory results. The third section discusses the relative lack of side effects with TCM, and how potential adverse effects can be avoided. The final section describes the standard pharmaceutical approaches used to treat asthma in Western medicine. The author suggests that an integrative approach may work best. Such an approach would involve the continued use of fast-acting pharmaceuticals while using TCM as a complementary treatment to reduce drug dosages and potential side effects of the pharmaceuticals. The article has 24 references. ·
Unconventional Therapies in Asthma: An Overview Source: Allergy. 51(11): 761-769. November 1996. Summary: This journal article reviews the evidence base for the use of several unconventional or complementary therapies in the treatment of asthma. These treatments include acupuncture; homeopathy; mind/body therapies, such as hypnotherapy and yoga; and nutritional, herbal, and environmental medicine. The author notes that although there are few large, randomized controlled trials in this area, there is evidence to suggest that many of these therapies may produce objective and subjective benefits in selected groups of asthma patients. The author recommends that given the increasing popularity of complementary medicine among patients and general practitioners, high-quality research is needed to determine how, or whether, these therapies may be interwoven with the more orthodox treatments currently available. This journal article contains 105 references.
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Reflexology and Bronchial Asthma Source: Respiratory Medicine. 95: 173-179. 2001. Summary: This journal article examines the efficacy of reflexology as a treatment for bronchial asthma. Forty asthma patients, aged 18 to 60 years, were enrolled in a 10-week, randomized, controlled trial. Only patients with a forced expiratory volume in 1 second (FEV1) greater than 60 percent of the predicted value were included. Patients were randomly assigned to treatment with active or simulated (placebo) reflexology, which consists of one 45-minute session weekly for 10 weeks. All treatments were given by the same experienced reflexologist. Objective lung function tests (patient-measured peak flow morning and evening, and weekly spirometry at the clinic) did not change in either group. Subjective scores for symptoms, beta2-inhalations, and quality of life and bronchial sensitivity to histamine improved in both groups, with no
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difference between the active and placebo treatments. Although a trend favoring active reflexology was evident in a supplementary analysis of the symptom diaries, this was accompanied by a tendency for patients to correctly guess which treatment they had been receiving. The authors conclude that reflexology appears to have no specific effect on asthma beyond that of placebo. The article has 4 figures, 1 table, and 13 references. ·
Occupational Asthma and Rhinitis Caused by Multiple Herbal Agents in a Pharmacist Source: Annals of Allergy, Asthma and Immunology. 86(4): 469-474. April 2001. Summary: This journal article reports a case of occupational asthma and rhinitis in a pharmacist caused by exposure to multiple herbal agents. The patient was a 35 year old male pharmacist whose responsibilities included chopping different kinds of herbal materials in preparation for sale. He had experienced profuse rhinorrhea and sneezing for 10 years, and cough and shortness of breath for 7 years. He had strong positive responses on skin prick tests to extracts of six herbal materials: Chunkung ('Cnidii rhizoma'), Banha ('Pinellia ternata'), Sanyak ('Dioscorea radix'), Kangwhal ('Ostericum koreanum'), Danggui ('Angelica radix'), and Kunkang ('Zingiberis rhizoma'). Bronchoprovocation tests showed an early asthmatic response to Danggui extract. Serum specific IgE antibodies to Chunkung, Banha, and Sanyak were detected by ELISA, whereas no specific IgE bindings to Kangwhal, Danggui, and Kunkang extracts were found. There was one IgE binding component in Chunkung extract, two in Banha, and four in Sanyak. In a basophil histamine release test, Danggui extract induced a greater histamine release in the patient than in a healthy control. The article has 3 figures, 3 tables, and 16 references. (AA-M).
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Use of Complementary Therapies in Childhood Asthma Source: Pediatric Asthma, Allergy and Immunology. 12(1): 29-32. 1998. Summary: This journal article reports a study of the use of complementary therapies in childhood asthma. A questionnaire was mailed to 17,000 members of the National Asthma Campaign, United Kingdom; an estimated 4,000 of these members had children under age 16 years. Of the 1,471 respondents, 33 percent reported they had tried some form of complementary medicine for their children. The most popular therapies were homeopathy (15 percent), breathing techniques (15 percent), herbalism (6 percent), and osteopathy (2 percent). Twentysix percent of respondents felt that the complementary therapies had
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improved their children's symptoms to some or a great extent, 34 percent felt that symptoms had improved slightly or not at all, and the rest did not answer this question. The amount of money spent on complementary therapies generally was modest. The author concludes that complementary medicine frequently is used for childhood asthma, and that these therapies generally are perceived as being moderately helpful. The article has 1 table and 15 references. National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine’s databases to allow patients to search for articles that specifically relate to asthma and complementary medicine. To search the database, go to the following Web site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “asthma” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine (CAM) that are related to asthma: ·
"Alternative" therapies for asthma : reason for concern? Author(s): Ernst E. Source: Chest. 2001 November; 120(5): 1433-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11713112&dopt=Abstract
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14 cases of child bronchial asthma treated by auricular plaster and meridian instrument. Author(s): Yan S. Source: J Tradit Chin Med. 1998 September; 18(3): 202-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10453615&dopt=Abstract
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A brief introduction to researches on treatment of hormone-dependent asthma with traditional Chinese medicine. Author(s): Cui H, Wu W. Source: J Tradit Chin Med. 2001 June; 21(2): 153-9. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11498908&dopt=Abstract
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A case series of 71 patients referred to a hospital-based occupational and environmental medicine clinic for occupational asthma. Author(s): Wheeler S, Rosenstock L, Barnhart S. Source: The Western Journal of Medicine. 1998 February; 168(2): 98-104. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9499743&dopt=Abstract
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A clinical trial of the Buteyko Breathing Technique in asthma as taught by a video. Author(s): Opat AJ, Cohen MM, Bailey MJ, Abramson MJ. Source: The Journal of Asthma : Official Journal of the Association for the Care of Asthma. 2000; 37(7): 557-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11059522&dopt=Abstract
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A comparison of active and simulated chiropractic manipulation as adjunctive treatment for childhood asthma. Author(s): Balon J, Aker PD, Crowther ER, Danielson C, Cox PG, O'Shaughnessy D, Walker C, Goldsmith CH, Duku E, Sears MR. Source: The New England Journal of Medicine. 1998 October 8; 339(15): 1013-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9761802&dopt=Abstract
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A pilot study on the clinical efficacy of Solanum xanthocarpum and Solanum trilobatum in bronchial asthma. Author(s): Govindan S, Viswanathan S, Vijayasekaran V, Alagappan R. Source: Journal of Ethnopharmacology. 1999 August; 66(2): 205-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10433479&dopt=Abstract
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A report for the therapeutic effects of asthma plaster in the treatment of 139 asthmatic children. Author(s): Liu G, Xiang H, Mi R, Huang L, Wang Q. Source: J Tradit Chin Med. 2001 December; 21(4): 261-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12014124&dopt=Abstract
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A survey of research on the treatment of asthma by invigorating blood circulation to remove blood stasis. Author(s): Wang Z.
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Source: J Tradit Chin Med. 1997 December; 17(4): 304-10. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10437218&dopt=Abstract ·
Acupuncture for asthma: fact or fiction? Author(s): Varon J, Fromm RE Jr, Marik PE. Source: Chest. 2002 May; 121(5): 1387-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12006413&dopt=Abstract
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Acupuncture for chronic asthma. Author(s): Linde K, Jobst K, Panton J. Source: Cochrane Database Syst Rev. 2000; (2): Cd000008. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10796465&dopt=Abstract
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Acupuncture in asthma and pulmonary disease: an analysis of efficacy and safety. Author(s): Jobst KA. Source: Journal of Alternative and Complementary Medicine (New York, N.Y.). 1996 Spring; 2(1): 179-206; Discussion 207-10. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9395653&dopt=Abstract
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Acupuncture in the treatment of asthma: a critical review. Author(s): Davis PA, Chang C, Hackman RM, Stern JS, Gershwin ME. Source: Allergologia Et Immunopathologia. 1998 November-December; 26(6): 263-71. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9934404&dopt=Abstract
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Acupuncture in treatment of stable asthma. Author(s): Biernacki W, Peake MD. Source: Respiratory Medicine. 1998 September; 92(9): 1143-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9926170&dopt=Abstract
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Adults' experience with asthma and their reported uncertainty and coping strategies. Author(s): Sexton DL, Stephanie RN, Calcasola SL, Bottomley SR, Funk M.
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Source: Clin Nurse Spec. 1999 January; 13(1): 8-14; Quiz 15-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10335144&dopt=Abstract ·
Alexander technique for chronic asthma. Author(s): Dennis J. Source: Cochrane Database Syst Rev. 2000; (2): Cd000995. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10796574&dopt=Abstract
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Alternative and complementary medicine: a source of improved therapies for asthma? A challenge for redefining the specialty? Author(s): Engler RJ. Source: The Journal of Allergy and Clinical Immunology. 2000 October; 106(4): 627-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11031331&dopt=Abstract
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Alternative medicine for allergy and asthma. Author(s): Ziment I, Tashkin DP. Source: The Journal of Allergy and Clinical Immunology. 2000 October; 106(4): 603-14. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11031328&dopt=Abstract
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Alternative strategies in the treatment of bronchial asthma. Author(s): In 't Veen JC, Sterk PJ, Bel EH. Source: Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology. 2000 January; 30(1): 16-33. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10606927&dopt=Abstract
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Alternative therapies among adults with a reported diagnosis of asthma or rhinosinusitis : data from a population-based survey. Author(s): Blanc PD, Trupin L, Earnest G, Katz PP, Yelin EH, Eisner MD. Source: Chest. 2001 November; 120(5): 1461-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11713120&dopt=Abstract
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Alternative therapies for asthma. Author(s): Ziment I.
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Source: Current Opinion in Pulmonary Medicine. 1997 January; 3(1): 6171. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9139775&dopt=Abstract ·
An analysis of therapeutic effect of drug acupoint application in 209 cases of allergic asthma. Author(s): Lai X, Li Y, Fan Z, Zhang J, Liu B. Source: J Tradit Chin Med. 2001 June; 21(2): 122-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11498901&dopt=Abstract
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An osteopathic approach to asthma. Author(s): Rowane WA, Rowane MP. Source: J Am Osteopath Assoc. 1999 May; 99(5): 259-64. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10370278&dopt=Abstract
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Analysis of induced sputum for studying allergen-specific IgE antibodies in airway secretion from asthmatic patients. Author(s): Nahm DH, Park HS. Source: Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology. 1998 June; 28(6): 686-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9677132&dopt=Abstract
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Antiresorptive therapy in asthmatic patients receiving high-dose inhaled steroids: a prospective study for 18 months. Author(s): Wang WQ, Ip MS, Tsang KW, Lam KS. Source: The Journal of Allergy and Clinical Immunology. 1998 April; 101(4 Pt 1): 445-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9564795&dopt=Abstract
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Applying hypnosis in a preschool family asthma education program: uses of storytelling, imagery, and relaxation. Author(s): Kohen DP, Wynne E. Source: Am J Clin Hypn. 1997 January; 39(3): 169-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9037794&dopt=Abstract
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Asthma and Latino cultures: different prevalence reported among groups sharing the same environment. Author(s): Ledogar RJ, Penchaszadeh A, Garden CC, Iglesias Garden. Source: American Journal of Public Health. 2000 June; 90(6): 929-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10846511&dopt=Abstract
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Asthma and rhinitis induced by exposure to raw green beans and chards. Author(s): Daroca P, Crespo JF, Reano M, James JM, Lopez-Rubio A, Rodriguez J. Source: Ann Allergy Asthma Immunol. 2000 September; 85(3): 215-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11030276&dopt=Abstract
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Asthma and the Buteyko breathing method. Author(s): Birch M. Source: Australian Nursing Journal (July 1993). 2001 March; 8(8): 35. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11894574&dopt=Abstract
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Asthma education: creating a partnership. Author(s): Reinke LF, Hoffman L. Source: Heart & Lung : the Journal of Critical Care. 2000 May-June; 29(3): 225-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10819804&dopt=Abstract
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Asthma severity, psychophysiological indicators of arousal, and immune function in asthma patients undergoing biofeedback-assisted relaxation. Author(s): Kern-Buell CL, McGrady AV, Conran PB, Nelson LA. Source: Applied Psychophysiology and Biofeedback. 2000 June; 25(2): 7991. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10932333&dopt=Abstract
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Asthma to tetramethrin. Author(s): Vandenplas O, Delwiche JP, Auverdin J, Caroyer UM, Cangh FB.
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Source: Allergy. 2000 April; 55(4): 417-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10782541&dopt=Abstract ·
Asthma. Author(s): Ziment I. Source: Current Opinion in Pulmonary Medicine. 1997 January; 3(1): 1-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9139766&dopt=Abstract
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Biofeedback-induced voluntary reduction of respiratory resistance in severe bronchial asthma. Author(s): Mass R, Richter R, Dahme B. Source: Behaviour Research and Therapy. 1996 October; 34(10): 815-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8952124&dopt=Abstract
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Breathing exercises for asthma. Author(s): Holloway E, Ram FS. Source: Cochrane Database Syst Rev. 2000; (3): Cd001277. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10908489&dopt=Abstract
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Breathing techniques--adjunctive treatment modalities for asthma? A systematic review. Author(s): Ernst E. Source: The European Respiratory Journal : Official Journal of the European Society for Clinical Respiratory Physiology. 2000 May; 15(5): 969-72. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10853868&dopt=Abstract
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Bronchial asthma: information on phytotherapy with essential fatty acids. Interactions between essential fatty acids and steroid hormones. Author(s): Hassig A, Liang WX, Stampfli K. Source: Medical Hypotheses. 2000 January; 54(1): 72-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10790728&dopt=Abstract
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Cardiovascular effects of tricyclic antidepressants in childhood asthma: a case series and review. Author(s): Wamboldt MZ, Yancey AG Jr, Roesler TA. Source: Journal of Child and Adolescent Psychopharmacology. 1997 Spring; 7(1): 45-64. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9192541&dopt=Abstract
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Characteristics of rural dust events shown to impact on asthma severity in Brisbane, Australia. Author(s): Rutherford S, Clark E, McTainsh G, Simpson R, Mitchell C. Source: International Journal of Biometeorology. 1999 April; 42(4): 217-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10232058&dopt=Abstract
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Childhood asthma in the United States: urban issues. Author(s): Shapiro GG, Stout JW. Source: Pediatric Pulmonology. 2002 January; 33(1): 47-55. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11747260&dopt=Abstract
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Children with asthma have improved pulmonary functions after massage therapy. Author(s): Field T, Henteleff T, Hernandez-Reif M, Martinez E, Mavunda K, Kuhn C, Schanberg S. Source: The Journal of Pediatrics. 1998 May; 132(5): 854-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9602199&dopt=Abstract
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Chiropractic manipulation for childhood asthma. Author(s): Richards DG, Mein EA, Nelson CD. Source: The New England Journal of Medicine. 1999 February 4; 340(5): 391-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9988611&dopt=Abstract
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Chiropractic manipulation for childhood asthma. Author(s): Jongeward BV.
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Source: The New England Journal of Medicine. 1999 February 4; 340(5): 391; Discussion 392. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9988610&dopt=Abstract ·
Chronic pediatric asthma and chiropractic spinal manipulation: a prospective clinical series and randomized clinical pilot study. Author(s): Bronfort G, Evans RL, Kubic P, Filkin P. Source: Journal of Manipulative and Physiological Therapeutics. 2001 July-August; 24(6): 369-77. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11514813&dopt=Abstract
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Chronobiology of asthma. Author(s): Martin RJ, Banks-Schlegel S. Source: American Journal of Respiratory and Critical Care Medicine. 1998 September; 158(3): 1002-7. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9731039&dopt=Abstract
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Circadian rhythm in peak expiratory flow: alteration with nocturnal asthma and theophylline chronotherapy. Author(s): Burioka N, Suyama H, Sako T, Shimizu E. Source: Chronobiology International. 2000 July; 17(4): 513-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10908127&dopt=Abstract
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Circadian rhythms in the pharmacokinetics and clinical effects of betaagonist, theophylline, and anticholinergic medications in the treatment of nocturnal asthma. Author(s): D'Alonzo GE, Crocetti JG, Smolensky MH. Source: Chronobiology International. 1999 September; 16(5): 663-82. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10513888&dopt=Abstract
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Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Open Directory Project: http://dmoz.org/Health/Alternative/
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TPN.com: http://www.tnp.com/
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs
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WellNet: http://www.wellnet.ca/herbsa-c.htm
The following is a specific Web list relating to asthma; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
General Overview Asthma Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Asthma Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsLookups/Uses/ast hma.html Asthma Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Asthm acc.html Asthma Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html ·
Alternative Therapy Acupuncture Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Therapy/Acupuncture.htm Acupuncture Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Acupu ncturecm.html Acupuncture Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,663, 00.html Apitherapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,669, 00.html Aromatherapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,664, 00.html Ayurveda Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Ayurve dacm.html Chiropractic Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Therapy/Chiropractic.htm Chiropractic Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Chiropr acticcm.html Colon therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,682, 00.html Color therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,683, 00.html Craniosacral therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,685, 00.html Feldenkrais Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,695, 00.html Five Minute Massage Alternative names: Five Minute Massages Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D.
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Hyperlink: http://www.canoe.ca/AltmedDictionary/f.html Guided imagery Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,699, 00.html Homeopathy Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Homeo pathycm.html Homeopathy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,703, 00.html Hypnotherapy Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Hypnot herapycm.html Hypnotherapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,706, 00.html Ionized Air (Negative Ions) Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Therapy/Ionized_Air.htm Mind&Body Medicine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/MindB odyMedicinecm.html
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Native American medicine Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,721, 00.html Osteopathy Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Osteop athycm.html Osteopathy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,724, 00.html Qigong Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,729, 00.html Reflexology Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,730, 00.html Rolfing Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,732, 00.html Shiatsu Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,733, 00.html Tai Chi
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Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/TaiChic m.html Traditional Chinese Medicine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Traditi onalChineseMedicinecm.html Traditional Chinese medicine Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 85,00.html Urine therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,744, 00.html Writing therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,745, 00.html Yoga Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Yogac m.html Yoga Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,746, 00.html
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Chinese Medicine Baiguo Alternative names: Ginkgo Seed; Semen Ginkgo Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Banxia Alternative names: Pinellia Tuber; Rhizoma Pinelliae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Baokening Keli Alternative names: Baokening Granules Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Baokening%20Keli &mh=10&sb=---&view_records=View+Records Beiling Jiaonang Alternative names: Beiling Capsules Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Beiling%20Jiaonan g&mh=10&sb=---&view_records=View+Records Chenxiang Alternative names: Chinese Eaglewood Wood; Lignum Aquilariae Resinatum Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Chuanbei Xueli Alternative names: Chuanbei Xueli Concentrated Decoction; Chuanbei Xueli Gao Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Chuanbei%20Xueli &mh=10&sb=---&view_records=View+Records
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Daqingye Alternative names: Dyers Woad Leaf; Folium Isatidis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Dilong Alternative names: Earthworm; Pheretima Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Dongchongxiacao Alternative names: Chinese Caterpillar Fungus; Cordyceps Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Fabanxia Alternative names: Prepared Pinellia Tuber; Rhizoma Pinelliae Preparata Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Gancao Jingao Alternative names: Liquorice Extract; Gancao JingaoExtractum Glycyrrhizae Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Gancao%20Jingao& mh=10&sb=---&view_records=View+Records Geiie Dingchuan Wan Alternative names: Gejie Dingchuan Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Geiie%20Dingchua n%20Wan&mh=10&sb=---&view_records=View+Records Gejie Alternative names: Tokay Gecko; Gecko Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Hetaoren
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Alternative names: English Walnut Seed; Semen Juglandis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Huashanshen Alternative names: Funneled Physochlaina Root; Radix Physochlainae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Jiezi Alternative names: Mustard Seed; Semen Sinapis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Kuxingren Alternative names: Bitter Apricot Seed; Semen Armeniacae Amarum Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Liaodaqingye Alternative names: Indigoplant Leaf; Folium Polygoni Tinctorii Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Liuhuang Alternative names: Sulfur; Sulfur Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Madouling Alternative names: Dutohmanspipe Fruit; Fructus Aristolochiae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Mahuang Alternative names: Ephedra; Herba EphedraeHerba Ephedrae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Mujingye Alternative names: Hempleaf Negundo Chastetree Leaf; Folium Viticis Negundo Source: Chinese Materia Medica
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Hyperlink: http://www.newcenturynutrition.com/ Mujingyou Alternative names: Negundo Chastetree Oil; Oleum Viticis Negundo Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Qiwei Duqi Wan Alternative names: Qiwei Duqi Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Qiwei%20Duqi%20 Wan&mh=10&sb=---&view_records=View+Records Sangbaipi Alternative names: White Mulberry Root-bark; Cortex Mori Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Shigao Alternative names: Gypsum; Gypsum Fibrosum Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Shiwei Alternative names: Shearer's Pyrrosia Leaf; Folium Pyrrosiae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Taoren Alternative names: English Walnut Seed; Hetaoren; Semen Juglandis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Tianxianzi Alternative names: Henbane Seed; Semen Hyoscyami Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Wuweizi Alternative names: Chinese Magnoliavine Fruit; Fructus Schisandrae Source: Chinese Materia Medica
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Hyperlink: http://www.newcenturynutrition.com/ Yangjinhua Alternative names: Datura Flower; Flos Daturae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Zhongrushi Alternative names: Stalactite; Stalactitum Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Zishiyin Alternative names: Fluorite; Fluoritum Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Ziwan Alternative names: Tatarian Aster Root; Radix Asteris Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ ·
Homeopathy Arsenicum album Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Arsenicum_ album.htm Carbo vegetabilis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Carbo_vege tabilis.htm Chamomilla Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Chamomilla .htm
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Ipecac Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Ipecac.htm Natrum sulfuricum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Natrum_sul phuricum.htm Nux vomica Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Nux_vomic a.htm Pulsatilla Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Pulsatilla.htm Spongia tosta Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Spongia_tos ta.htm ·
Herbs and Supplements 5-Hydroxytryptophan Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html Adrenal Extract Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Adrenal_Extract.htm Albuterol Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Drug/Albuterol.htm Aloe Alternative names: Aloe vera, Aloe barbadensis, Aloe ferox , Aloe Vera Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Aloech.html Aloe Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000091.html Aloe Vera Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Aloech.html Alpha-Linolenic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Bronchitis.htm Amino Acid K Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Lysi necs.html Ananas comosus Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Brom elaincs.html Anise Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Bronchitis.htm Anise Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Concern/COPD.htm Anise Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Antibiotics Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Antibiotics Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Bronchitis.htm Antioxidants Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Ascorbate Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Aspirin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Aspirin Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Barbiturates Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html
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Bee products Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,756, 00.html Benzodiazepines Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html Beta-Blockers Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html Beta-Carotene Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Beta_Carotene.htm Beta-Carotene Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Beta-Carotene Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/COPD.htm Beta-Carotene Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Bronchitis.htm Beta-Carotene Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html
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Beta-Carotene Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000104.html Betaine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Black Haw Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsa-c.htm Blood Root Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsa-c.htm Bloodroot Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000112.html Blue Flag Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Boswellia Alternative names: Frankincense; Boswellia serrata Roxb. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Boswellia Alternative names: Boswellia serrata Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Boswellia.htm Boswellia Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Bromelain Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Bromelain.htm Bromelain Alternative names: Ananas comosus, Bromelainum Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Brom elaincs.html Bromelainum Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Brom elaincs.html Caffeine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html Capsaicin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Cayennech. html Capsaicin Alternative names: Cayenne Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsHerbs/Interactions /Cayennech.html Capsicum frutescens Alternative names: Cayenne Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsHerbs/Interactions /Cayennech.html Capsicum frutescens Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Cayennech. html Cardiac Glycosides Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Bronchitis.htm Cayenne Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Cayenne Alternative names: Capsaicin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsHerbs/Interactions /Cayennech.html Cayenne Alternative names: Capsicum frutescens, Capsicum spp., Capsaicin, Chili Pepper, Red Pepper Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Cayennech. html Chamomile Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html
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Chamomile Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000124.html Cherry fruit extract Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 15,00.html Chickweed Alternative names: Stellaria media Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Chickweed.htm Chili Pepper Alternative names: Cayenne Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsHerbs/Interactions /Cayennech.html Chili Pepper Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Cayennech. html Cinnamomum Alternative names: Cinnamon; Cinnamomum zeylanicum Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Coenzyme Q10 Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/COPD.htm Coleus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm
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Coleus Alternative names: Coleus forskohlii Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Coleus.htm Coleus Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Coleus forskohlii Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Coleus forskohlii Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000136.html Coltsfoot Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Asthm acc.html CoQ10 Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/COPD.htm Corticosteroids Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Corticosteroids.htm Cyanocobalamin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Cysteine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/COPD.htm
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Cysteine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Cysteine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Asthm acc.html Damiana Alternative names: Turnera diffusa Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Damiana.htm Damiana Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000142.html Dandelion Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Dehydroepiandrosterone (DHEA) Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/DHEA.htm Dexamethasone Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Diazepam Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html
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Echinacea Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Bronchitis.htm Elecampane Alternative names: Inula helenium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Elecampane.htm Elecampane Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Bronchitis.htm Elecampane Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Asthm acc.html Elecampane Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Elecampane Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000152.html Elecampane Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsd-f.htm Ephedra Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Ephedra.htm Ephedra Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Ephedra Alternative names: Ephedra sinensis, Ma huang Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Ephedrach. html Ephedra Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Ephedra Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000154.html Ephedra (Ma huang) Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,777, 00.html Ephedra sinensis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Ephedrach. html Ephedrine and Pseudoephedrine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Ephedrine.htm Ephedrine and Pseudoephedrine Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Epinephrine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Epinephrine.htm
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Eucalyptus Alternative names: Eucalyptus globulus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Eucalyptus.htm Eucalyptus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Bronchitis.htm Eucalyptus Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,778, 00.html Evening Primrose Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Fennel Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Fennel.htm Flavonoids Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Flavonoids Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,782, 00.html Forskolin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm
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Forskolin Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Forskolin Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 25,00.html Ginkgo Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Ginkgo Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000167.html Ginkgo biloba Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Ginkgo_Biloba.htm Ginkgo biloba Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,788, 00.html Ginseng Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Bronchitis.htm GLA (Gamma-Linolenic Acid) Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000111.html Glutathione Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm
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Glycyrrhiza1 Alternative names: Licorice; Glycyrrhiza glabra L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Goldenseal Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Green-Lipped Mussel Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Green_Lipped_Mussel.h tm Grindelia Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Grindelia Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsg-i.htm Herbal Medicine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Bronchitis.htm Herbal Medicine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Herbal Medicine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html
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Herbal Medicine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Asthm acc.html Hops Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html Horehound Alternative names: Marrubium vulgare Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Horehound.htm Horehound Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsg-i.htm Horseradish Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Huperzine A Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 38,00.html Hypericum perforatum Alternative names: St. John's Wort Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsHerbs/Interactions /StJohnsWortch.html
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Hypericum perforatum Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/StJohnsWor tch.html Hyssop Alternative names: Hyssopus officinalis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Hyssop.htm Hyssop Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Indian Tobacco Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Indian Tobacco Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Lobeliach.html Inhaled Corticosteroids Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Corticosteroids_Inhaled. htm Insulin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/SleepA pneacc.html Ipriflavone Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000189.html
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Ipriflavone Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 39,00.html Ivy Leaf Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Bronchitis.htm Ivy Leaf Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Ivy Leaf Alternative names: Hedera helix Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Ivy_Leaf.htm Kava Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html Kava Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,798, 00.html Kava Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html Klamathweed Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/StJohnsWor tch.html Klamathweed Alternative names: St. John's Wort Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsHerbs/Interactions /StJohnsWortch.html Kola Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html Lavender Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html Lemon Balm Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html Licorice Alternative names: Glycyrrhiza glabra, Glycyrrhiza uralensis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Licorice.htm Licorice Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Licorice Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Asthm acc.html Licorice Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000144.html Licorice Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,801, 00.html Lipase Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html L-Lysine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Lysi necs.html Lobelia Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Bronchitis.htm Lobelia Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Lobelia Alternative names: Lobelia inflata Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Lobelia.htm Lobelia Alternative names: Lobelia inflata, Indian Tobacco
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Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Lobeliach.ht ml Lobelia Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Lobelia Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsj-l.htm Lobelia inflata Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Lobeliach.html Lobelia inflata Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Lycopene Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Lycopene.htm Lycopene Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Lysine Alternative names: Amino Acid K, L-Lysine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Lysi necs.html Ma huang Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Ephedrach. html Ma huang Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Ma Huang Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsm-o.htm Marshmallow Alternative names: Althea officinalis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Marshmallow.htm Marshmallow Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000205.html Melatonin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html Mentha Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html Montelukast Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Montelukast.htm Mullein Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Concern/Bronchitis.htm Mullein Alternative names: Verbascum thapsus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Mullein.htm Mullein Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/COPD.htm Mullein Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000210.html Mullein flower Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,865, 00.html Musa Banana Alternative names: Plantain, Banana; Musa sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ NAC (N-acetylcysteine) Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,809, 00.html N-acetylcysteine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Bronchitis.htm NADH Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/NADH.htm
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Nadolol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Nadolol.htm Nettle Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 48,00.html Omnipen Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Bronchitis.htm Oral Corticosteroids Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Corticosteroids_Oral.htm Parsley Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Passiflora incarnata Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Passionflow erch.html Passionflower Alternative names: Passiflora incarnata Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Passionflow erch.html Peppermint Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com
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Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,812, 00.html Picrorhiza Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Picrorhiza Alternative names: Picrorhiza kurroa Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Picrorhiza.htm Pimpinella Alternative names: Anise; Pimpinella anisum (L) Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Piper Alternative names: Kava; Piper methysticum Forst.f Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Plantago major Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Bronchitis.htm Plantago psyllium Alternative names: Psyllium, Ispaghula; Plantago psyllium/ovata Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Pleurisy Root Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Bronchitis.htm Pollen Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Concern/COPD.htm Pollen Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Pollen.htm Prednisone Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Principen Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Bronchitis.htm Pyridoxal-5-Phosphate Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Asthm acc.html Red Clover Alternative names: Trifolium pratense , beebread, cow clover, cow grass, meadow clover, purple clover Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/RedCloverc h.html Red Pepper Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Cayennech. html Red Pepper Alternative names: Cayenne Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsHerbs/Interactions /Cayennech.html
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Reishi Alternative names: Ganoderma lucidum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Reishi.htm Reishi Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000229.html Rosemary Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Rosmarinus Alternative names: Rosemary; Rosmarinus officinalis L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Royal Jelly Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Royal_Jelly.htm Sage Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Asthm acc.html Salicylates Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Salicylic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Salmeterol Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Drug/Salmeterol.htm Selective Serotonin Reuptake Inhibitors Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html Selenite Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Skullcap Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Asthm acc.html Skunk Cabbage Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbss-v.htm Slo-bid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Smilax Alternative names: Sarsaparilla; Smilax glabra Roxb. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ St. John's Wort Alternative names: Hypericum perforatum, Klamathweed Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/StJohnsWor tch.html
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St. John's Wort Alternative names: Hypericum perforatum Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsHerbs/Interactions /StJohnsWortch.html St. John's Wort Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000237.html Suma Alternative names: Pfaffia paniculata , Hebanthe paniculata Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Suma.htm Theolair Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Theophylline Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Theophylline Alternative names: Accurbron, Aerolate, Aquaphyllin, Asmalix, Elixomin, Elixophyllin, Lanophyllin, Quibron-T, Quibron-T-SR, Slo-bid, Slo-Phyllin, T-Phyl, Theo-24, Theo-Dur, Theo-Sav, Theo-X, Theobid, Theochron, Theoclear L.A., Theoclear-80, Theolair, Theolair-SR, Theospan-SR, Theostat 80, Theovent, Uni-Dur, Uniphyl Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000306.html Theophylline Derivatives Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Asthm aMedicationscl.html Theophylline/Aminophylline Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Drug/Theophylline.htm Thuja occid Alternative names: Arbor Vitae; Thuja occidentalis Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Thuja plicata Alternative names: Western Red Cedar Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Thyme Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Bronchitis.htm Thyme Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Thyme Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbss-v.htm Thymus Alternative names: Thyme; Thymus vulgaris Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Thymus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Bronchitis.htm Thymus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm
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Thymus Extracts Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Thymus_Extracts.htm Triazolam Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html Trigonella Alternative names: Fenugreek; Trigonella foenum graecum L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Tylophora Alternative names: Tylophora indica, Tylophora asthmatica Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Tylophora.htm Tylophora Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Tylophora Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Valerian Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html Wild Cherry Bark Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsw-z.htm
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Wild Indigo Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Willow Bark Alternative names: There are several species of willow includingSalix alba, Salix nigra, Salix fragilis, Salix purpurea, Salix babylonica, White Willow, European Willow, Black Willow, Pussy Willow, Crack Willow, Purple Willow, Weeping Willow, Liu-zhi Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/WillowBark ch.html Yerba Santa Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/COPD.htm Yerba Santa Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000250.html Zafirlukast Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Zafirlukast.htm Zingiber Alternative names: Ginger; Zingiber officinale Roscoe Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Zizyphus Alternative names: Jujube; Ziziphus sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/
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Related Conditions Allergic Reaction, Anaphylaxis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Anaph ylaxiscc.html Allergies Alternative names: Hay Fever Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000258.html Allergies and Sensitivities Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Allergies.htm Allergy, Food Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodA llergycc.html Alzheimer's Disease, Non-Alzheimer's Dementia, and Normal AgeRelated Memory Loss Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000259.html Anaphylaxis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Anaph ylaxiscc.html Bronchitis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Bronchitis.htm Chronic Fatigue Syndrome Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Concern/Chronic_Fatigue_Syn drome.htm Chronic Obstructive Pulmonary Disease Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/COPD.htm Colic, Infantile Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Infantil eColiccc.html Cough Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Cough.htm Cough Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Cough cc.html Cystic Fibrosis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Depression (Mild to Moderate) Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000280.html Eczema Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Eczema.htm Eczema Source: Prima Communications, Inc.
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Hyperlink: http://www.personalhealthzone.com/pg000267.html Epilepsy Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Epilepsy.htm Food Allergy Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodA llergycc.html Hay Fever Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hayfever.htm Indigestion, Heartburn, and Low Stomach Acidity Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Indigestion.htm Infantile Colic Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Infantil eColiccc.html Infection Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Infection.htm Insomnia Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html Menopause Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Menop ausecc.html Migraine Headaches Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Migraine.htm Osteoporosis Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000270.html Pulmonary Edema Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pulmo naryEdemacc.html Rubella Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Rubell acc.html Sinus Congestion Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Sinus_Congestion.htm Sleep Apnea Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/SleepA pneacc.html Sleeplessness Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html Systemic Lupus Erythematosus Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Concern/Lupus.htm Urinary Tract Infection Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/UTI.htm
General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Alternative Medicine for Dummies by James Dillard (Author); Audio Cassette, Abridged edition (1998), Harper Audio; ISBN: 0694520659; http://www.amazon.com/exec/obidos/ASIN/0694520659/icongroupinterna ·
Complementary and Alternative Medicine Secrets by W. Kohatsu (Editor); Hardcover (2001), Hanley & Belfus; ISBN: 1560534400; http://www.amazon.com/exec/obidos/ASIN/1560534400/icongroupinterna
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Dictionary of Alternative Medicine by J. C. Segen; Paperback-2nd edition (2001), Appleton & Lange; ISBN: 0838516211; http://www.amazon.com/exec/obidos/ASIN/0838516211/icongroupinterna
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Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating by Walter C. Willett, MD, et al; Hardcover - 352 pages (2001), Simon & Schuster; ISBN: 0684863375; http://www.amazon.com/exec/obidos/ASIN/0684863375/icongroupinterna
· Encyclopedia of Natural Medicine, Revised 2nd Edition by Michael T. Murray, Joseph E. Pizzorno; Paperback - 960 pages, 2nd Rev edition (1997), Prima Publishing; ISBN: 0761511571; http://www.amazon.com/exec/obidos/ASIN/0761511571/icongroupinterna ·
Integrative Medicine: An Introduction to the Art & Science of Healing by Andrew Weil (Author); Audio Cassette, Unabridged edition (2001), Sounds True; ISBN: 1564558541; http://www.amazon.com/exec/obidos/ASIN/1564558541/icongroupinterna
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New Encyclopedia of Herbs & Their Uses by Deni Bown; Hardcover - 448 pages, Revised edition (2001), DK Publishing; ISBN: 078948031X; http://www.amazon.com/exec/obidos/ASIN/078948031X/icongroupinterna
· Textbook of Complementary and Alternative Medicine by Wayne B. Jonas; Hardcover (2003), Lippincott, Williams & Wilkins; ISBN: 0683044370; http://www.amazon.com/exec/obidos/ASIN/0683044370/icongroupinterna For additional information on complementary and alternative medicine, ask your doctor or write to: National Institutes of Health National Center for Complementary and Alternative Medicine Clearinghouse P. O. Box 8218 Silver Spring, MD 20907-8218
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APPENDIX C. RESEARCHING NUTRITION Overview Since the time of Hippocrates, doctors have understood the importance of diet and nutrition to patients’ health and well-being. Since then, they have accumulated an impressive archive of studies and knowledge dedicated to this subject. Based on their experience, doctors and healthcare providers may recommend particular dietary supplements to patients with asthma. Any dietary recommendation is based on a patient’s age, body mass, gender, lifestyle, eating habits, food preferences, and health condition. It is therefore likely that different patients with asthma may be given different recommendations. Some recommendations may be directly related to asthma, while others may be more related to the patient’s general health. These recommendations, themselves, may differ from what official sources recommend for the average person. In this chapter we will begin by briefly reviewing the essentials of diet and nutrition that will broadly frame more detailed discussions of asthma. We will then show you how to find studies dedicated specifically to nutrition and asthma.
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Food and Nutrition: General Principles What Are Essential Foods? Food is generally viewed by official sources as consisting of six basic elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and (6) minerals. Consuming a combination of these elements is considered to be a healthy diet: ·
Fluids are essential to human life as 80-percent of the body is composed of water. Water is lost via urination, sweating, diarrhea, vomiting, diuretics (drugs that increase urination), caffeine, and physical exertion.
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Carbohydrates are the main source for human energy (thermoregulation) and the bulk of typical diets. They are mostly classified as being either simple or complex. Simple carbohydrates include sugars which are often consumed in the form of cookies, candies, or cakes. Complex carbohydrates consist of starches and dietary fibers. Starches are consumed in the form of pastas, breads, potatoes, rice, and other foods. Soluble fibers can be eaten in the form of certain vegetables, fruits, oats, and legumes. Insoluble fibers include brown rice, whole grains, certain fruits, wheat bran and legumes.
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Proteins are eaten to build and repair human tissues. Some foods that are high in protein are also high in fat and calories. Food sources for protein include nuts, meat, fish, cheese, and other dairy products.
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Fats are consumed for both energy and the absorption of certain vitamins. There are many types of fats, with many general publications recommending the intake of unsaturated fats or those low in cholesterol.
Vitamins and minerals are fundamental to human health, growth, and, in some cases, disease prevention. Most are consumed in your diet (exceptions being vitamins K and D which are produced by intestinal bacteria and sunlight on the skin, respectively). Each vitamin and mineral plays a different role in health. The following outlines essential vitamins: ·
Vitamin A is important to the health of your eyes, hair, bones, and skin; sources of vitamin A include foods such as eggs, carrots, and cantaloupe.
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Vitamin B1, also known as thiamine, is important for your nervous system and energy production; food sources for thiamine include meat, peas, fortified cereals, bread, and whole grains.
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Vitamin B2, also known as riboflavin, is important for your nervous system and muscles, but is also involved in the release of proteins from
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nutrients; food sources for riboflavin include dairy products, leafy vegetables, meat, and eggs. ·
Vitamin B3, also known as niacin, is important for healthy skin and helps the body use energy; food sources for niacin include peas, peanuts, fish, and whole grains
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Vitamin B6, also known as pyridoxine, is important for the regulation of cells in the nervous system and is vital for blood formation; food sources for pyridoxine include bananas, whole grains, meat, and fish.
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Vitamin B12 is vital for a healthy nervous system and for the growth of red blood cells in bone marrow; food sources for vitamin B12 include yeast, milk, fish, eggs, and meat.
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Vitamin C allows the body’s immune system to fight various diseases, strengthens body tissue, and improves the body’s use of iron; food sources for vitamin C include a wide variety of fruits and vegetables.
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Vitamin D helps the body absorb calcium which strengthens bones and teeth; food sources for vitamin D include oily fish and dairy products.
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Vitamin E can help protect certain organs and tissues from various degenerative diseases; food sources for vitamin E include margarine, vegetables, eggs, and fish.
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Vitamin K is essential for bone formation and blood clotting; common food sources for vitamin K include leafy green vegetables.
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Folic Acid maintains healthy cells and blood and, when taken by a pregnant woman, can prevent her fetus from developing neural tube defects; food sources for folic acid include nuts, fortified breads, leafy green vegetables, and whole grains.
It should be noted that one can overdose on certain vitamins which become toxic if consumed in excess (e.g. vitamin A, D, E and K). Like vitamins, minerals are chemicals that are required by the body to remain in good health. Because the human body does not manufacture these chemicals internally, we obtain them from food and other dietary sources. The more important minerals include: ·
Calcium is needed for healthy bones, teeth, and muscles, but also helps the nervous system function; food sources for calcium include dry beans, peas, eggs, and dairy products.
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Chromium is helpful in regulating sugar levels in blood; food sources for chromium include egg yolks, raw sugar, cheese, nuts, beets, whole grains, and meat.
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·
Fluoride is used by the body to help prevent tooth decay and to reinforce bone strength; sources of fluoride include drinking water and certain brands of toothpaste.
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Iodine helps regulate the body’s use of energy by synthesizing into the hormone thyroxine; food sources include leafy green vegetables, nuts, egg yolks, and red meat.
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Iron helps maintain muscles and the formation of red blood cells and certain proteins; food sources for iron include meat, dairy products, eggs, and leafy green vegetables.
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Magnesium is important for the production of DNA, as well as for healthy teeth, bones, muscles, and nerves; food sources for magnesium include dried fruit, dark green vegetables, nuts, and seafood.
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Phosphorous is used by the body to work with calcium to form bones and teeth; food sources for phosphorous include eggs, meat, cereals, and dairy products.
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Selenium primarily helps maintain normal heart and liver functions; food sources for selenium include wholegrain cereals, fish, meat, and dairy products.
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Zinc helps wounds heal, the formation of sperm, and encourage rapid growth and energy; food sources include dried beans, shellfish, eggs, and nuts.
The United States government periodically publishes recommended diets and consumption levels of the various elements of food. Again, your doctor may encourage deviations from the average official recommendation based on your specific condition. To learn more about basic dietary guidelines, visit the Web site: http://www.health.gov/dietaryguidelines/. Based on these guidelines, many foods are required to list the nutrition levels on the food’s packaging. Labeling Requirements are listed at the following site maintained by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government recommends that consumers become familiar with the following abbreviations before reading FDA literature:50 ·
DVs (Daily Values): A new dietary reference term that will appear on the food label. It is made up of two sets of references, DRVs and RDIs.
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DRVs (Daily Reference Values): A set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium.
50
Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.
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·
RDIs (Reference Daily Intakes): A set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. The name “RDI” replaces the term “U.S. RDA.”
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RDAs (Recommended Dietary Allowances): A set of estimated nutrient allowances established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge. What Are Dietary Supplements?51
Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail. Dietary supplements are provided in many forms including tablets, capsules, powders, gel-tabs, extracts, and liquids. Historically in the United States, the most prevalent type of dietary supplement was a multivitamin/mineral tablet or capsule that was available in pharmacies, either by prescription or “over the counter.” Supplements containing strictly herbal preparations were less widely available. Currently in the United States, a wide array of supplement products are available, including vitamin, mineral, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin. The Office of Dietary Supplements (ODS) of the National Institutes of Health is the official agency of the United States which has the expressed goal of acquiring “new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.”52 According to the ODS, dietary supplements can have an important impact on the prevention and management of disease and on the maintenance of health.53 The ODS notes that considerable research on the effects of dietary supplements has been conducted in Asia and Europe where the use of plant products, in particular, has a long tradition. However, the This discussion has been adapted from the NIH: http://ods.od.nih.gov/whatare/whatare.html. 52 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920, Fax: (301) 480-1845, E-mail:
[email protected]. 53 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health and Education Act defines dietary supplements as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” 51
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overwhelming majority of supplements have not been studied scientifically. To explore the role of dietary supplements in the improvement of health care, the ODS plans, organizes, and supports conferences, workshops, and symposia on scientific topics related to dietary supplements. The ODS often works in conjunction with other NIH Institutes and Centers, other government agencies, professional organizations, and public advocacy groups. To learn more about official information on dietary supplements, visit the ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact: The Office of Dietary Supplements National Institutes of Health Building 31, Room 1B29 31 Center Drive, MSC 2086 Bethesda, Maryland 20892-2086 Tel: (301) 435-2920 Fax: (301) 480-1845 E-mail:
[email protected] Finding Studies on Asthma The NIH maintains an office dedicated to patient nutrition and diet. The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.54 IBIDS is available to the public free of charge through the ODS Internet page: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We recommend that you start with the Consumer Database. While you may not find references for the topics that are of most interest to you, check back periodically as this database is frequently updated. More studies can be Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
54
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found by searching the Full IBIDS Database. Healthcare professionals and researchers generally use the third option, which lists peer-reviewed citations. In all cases, we suggest that you take advantage of the “Advanced Search” option that allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “asthma” (or synonyms) into the search box. To narrow the search, you can also select the “Title” field. The following is a typical result when searching for recently indexed consumer information on asthma: ·
Asthma and food allergy. Source: Rumsaeng, V Metcalfe, D D Nutr-Revolume 1998 January; 56(1 Pt 2): S153-60 0029-6643
The following information is typical of that found when using the “Full IBIDS Database” when searching using “asthma” (or a synonym): ·
Antenatal interventions in childhood asthma. Author(s): Channing Laboratory, Brigham and Women's Hospital, Boston, MA 02115, USA. Source: Hanrahan, J P Halonen, M Eur-Respir-J-Suppl. 1998 July; 2746s51s 0904-1850
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Asthma therapy: present trends and future prospects. Author(s): University of Miami School of Medicine, FL 33101. Source: Mintzer, M J Compr-Ther. 1990 March; 16(3): 12-6 0098-8243
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Asthma with sulfite intolerance in children: a blocking study with cyanocobalamin. Author(s): Allergology Service, La Paz Hospital, Madrid, Spain. Source: Anibarro, B Caballero, T Garcia Ara, C Diaz Pena, J M Ojeda, J A J-Allergy-Clin-Immunol. 1992 July; 90(1): 103-9 0091-6749
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Bradykinin-induced bronchospasm in the rat in vivo: a role for nitric oxide modulation. Author(s): Division of Respiratory Disease, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan. Source: Homma, T Irvin, C G Eur-Respir-J. 1999 February; 13(2): 313-20 0903-1936
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Breastfeeding and asthma in children: findings from a West Australian study. Author(s): TVW Telethon Institute for Child Health Research, West Perth, Western Australia.
[email protected] Source: Oddy, W H Breastfeed-Revolume 2000 March; 8(1): 5-11 07292759
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Controlled trial of a home and ambulatory program for asthmatic children. Author(s): Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada. Source: Hughes, D M McLeod, M Garner, B Goldbloom, R B Pediatrics. 1991 January; 87(1): 54-61 0031-4005
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Effect of Aloe extract on peripheral phagocytosis in adult bronchial asthma. Source: Shida, T. Yagi, A. Nishimura, H. Nishioka, I. Plant-Med-J-MedPlant-Res. Stuttgart, W. Ger. : Thieme-Stratton. June 1985. (3) page 273275. 0032-0943
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Effects of BCG on ovalbumin-induced bronchial hyperreactivity in a guinea pig asthma model. Author(s): Institute of Microbiology and Immunology, National YangMing University, Section of Allergy and Immunology, Cathay General Hospital, Taipei, Taiwan, ROC. Source: Su, Y C Peng, H J Wang, S R Han, S H Tsai, J J J-MicrobiolImmunol-Infect. 2001 March; 34(1): 25-34
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Eosinophils in bronchial asthma. Author(s): Department of Pneumonology and Allergology, Medical Academy of Lodz, Poland. Source: Gorski, P Palczynski, C Allergol-Immunopathol-(Madr). 1989 Mar-April; 17(2): 113-6 0301-0546
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Exercise-induced urinary excretion of leukotriene E4 in children with atopic asthma. Author(s): Department of Pediatrics, Fukui Medical School, Japan. Source: Kikawa, Y Hosoi, S Inoue, Y Saito, M Nakai, A Shigematsu, Y Hirao, T Sudo, M Pediatr-Res. 1991 May; 29(5): 455-9 0031-3998
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Factors associated with pediatric asthma readmissions. Author(s): Pediatric Outcomes Research Team, Hospital for Sick Children, Toronto, Ontario, Canada. Source: Macarthur, C Calpin, C Parkin, P C Feldman, W J-Allergy-ClinImmunol. 1996 November; 98(5 Pt 1): 992-3 0091-6749
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Increased excretion of leukotriene E4 during aspirin-induced asthma. Author(s): Division of Clinical Pharmacology, Vanderbilt University, Nashville. Source: Knapp, H R Sladek, K Fitzgerald, G A J-Lab-Clin-Med. 1992 January; 119(1): 48-51 0022-2143
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Ipecacuanha asthma: an old lesson. Author(s): Department of Environmental and Occupational Medicine, University of Aberdeen Medical School.
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Source: Seaton, A Thorax. 1990 December; 45(12): 974 0040-6376 ·
Magnesium attenuates methacholine-induced bronchoconstriction in asthmatics. Author(s): Clinica Medica I dell'Universita, Torino, Italia. Source: Rolla, G Bucca, C Arossa, W Bugiani, M Magnesium. 1987; 6(4): 201-4 0252-1156
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Management and treatment of pediatric asthma: update. Author(s): Pediatrics and Otolaryngology, University of Pittsburgh School of Medicine, Chief, Allergy and Immunology, Children's Hospital of Pittsburgh, 3705 Fifth Ave., Pittsburgh, PA 15213, USA. Source: Skoner, D P Allergy-Asthma-Proc. 2001 Mar-April; 22(2): 71-4 1088-5412
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Nasal response in subjects undergoing challenges by inhaling occupational agents causing asthma through the nose and mouth. Author(s): Department of Otorhinolaryngology, Centre hospitalier universitaire de Montreal (CHUM), Montreal, Canada. Source: Desrosiers, M Nguyen, B Ghezzo, H Leblanc, C Malo, J L Allergy. 1998 September; 53(9): 840-8 0105-4538
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National guidelines for the management of asthma in adults. Author(s): UMDNJ-Robert Wood Johnson Medical School, New Brunswick. Source: Podell, R N Am-Fam-Physician. 1992 October; 46(4): 1189-96 0002-838X
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Occupational asthma caused by exposure to ash wood dust (Fraxinus americana). Author(s): Dept of Chest Medicine, Hopital du Sacre-Coeur, Montreal, Canada. Source: Malo, J L Cartier, A Eur-Respir-J. 1989 April; 2(4): 385-7 0903-1936
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Occupational asthma caused by soybean flour in bakers--differences with soybean-induced epidemic asthma. Author(s): Fundacion Jimenez Diaz, Servicio de Alergologia, Universidad Autonoma de Madrid, Spain. Source: Quirce, S Polo, F Figueredo, E Gonzalez, R Sastre, J Clin-ExpAllergy. 2000 June; 30(6): 839-46 0954-7894
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Occupational asthma caused by sunflower-seed dust. Author(s): Department of Chest Medicine, University Hospital of MontGodinne, Yvoir, Belgium. Source: Vandenplas, O Vander Borght, T Delwiche, J P Allergy. 1998 September; 53(9): 907-8 0105-4538
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Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&pag e=0
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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
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Google: http://directory.google.com/Top/Health/Nutrition/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Nutrition/
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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
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WebMDÒHealth: http://my.webmd.com/nutrition
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to asthma; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
Vitamins Ascorbic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Ascorbic Acid Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minCAscorbicAcidcs.html Niacin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minB3Niacincs.html Pantothenic Acid Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minB5PantothenicAcidcs.html Pantothenic acid Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com
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Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,882, 00.html Pyridoxine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Pyridoxine Alternative names: Vitamin B6 (Pyridoxine) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/Inter actions/VitaminB6Pyridoxinecs.html Pyridoxine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minB6Pyridoxinecs.html Pyridoxine Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Vitamin A Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_A.htm Vitamin B Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 67,00.html Vitamin B12 Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_B12.htm
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Vitamin B12 Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000134.html Vitamin B3 (Niacin) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minB3Niacincs.html Vitamin B5 (Pantothenic Acid) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minB5PantothenicAcidcs.html Vitamin B6 Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_B6.htm Vitamin B6 Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000225.html Vitamin B6 (Pyridoxine) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minB6Pyridoxinecs.html Vitamin B6 (Pyridoxine) Alternative names: Pyridoxine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/Inter actions/VitaminB6Pyridoxinecs.html Vitamin C Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_C.htm
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Vitamin C Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000098.html Vitamin C Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,904, 00.html Vitamin C (Ascorbic Acid) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minCAscorbicAcidcs.html Vitamin E Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000092.html ·
Minerals Alpha-Tocopherol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/COPD.htm Alpha-Tocopherol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Bronchitis.htm Betaine Hydrochloride Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Betaine_HCl.htm Betaine Hydrochloride Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000106.html Calcium Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Calcium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Calci umcs.html Copper Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Cromolyn Sodium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Cromolyn_Sodium.htm L-Carnitine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/COPD.htm Magnesium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/COPD.htm Magnesium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Magnesium.htm Magnesium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Magnesium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Mag nesiumcs.html
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Magnesium Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000202.html Magnesium Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Magnesium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,890, 00.html Molybdenum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Molybdenum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Molybdenum.htm Quercetin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Quercetin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Quercetin.htm Quercetin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Quer cetincs.html Quercetin Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html
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Quercetin Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000226.html Quercetin Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 53,00.html Selenium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Selenium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Selenium.htm Selenium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Selenium Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000233.html Sulfur Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Sulfu rcs.html Sulfur Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Asthm acc.html
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·
Food and Diet Artichoke Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Artichoke.htm Asparagus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Asparagus.htm Avocado Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Avocado.htm Bananas Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Barley Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Beets Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Beets.htm Broccoflower Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Broccoflower.htm Broccoli Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Broccoli.htm
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Brussels Sprouts Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Brussels_Sprouts. htm Buffalo Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/SleepA pneacc.html Cabbage Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Cabbage.htm Cauliflower Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Cauliflower.htm Celery Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Cheese Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Chicory Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Chicory.htm Coffee Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html Collards Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Collards.htm Corn Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Asthm acc.html Corn-Free Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Corn_Free_Diet.htm Crackers Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html Dandelion Greens Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Dandelion_Green s.htm Egg-Free Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Egg_Free_Diet.htm Eggs Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html
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Fats Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Fish Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/COPD.htm Fish Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Fish Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Asthm acc.html Fish Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Flour Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Fruit Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Garlic Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html
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Garlic Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000164.html Grains Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Asthm acc.html Jerusalem Artichoke Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Jerusalem_Artich oke.htm Jicama Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Jicama.htm Kale Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Kale.htm Kohlrabi Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Kohlrabi.htm Leeks Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Leeks.htm Legumes Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Asthm acc.html
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Low-Allergen Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Low_Allergen_Diet.htm Low-Salt Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Low_Salt_Diet.htm Magnesium Sulfate Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/COPD.htm Magnesium Sulfate Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Meat Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Milk Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Bronchitis.htm Milk Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html Milk Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html
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Mustard Greens Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Mustard_Greens. htm Nuts Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Asthm acc.html Oats Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Obesity Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/SleepA pneacc.html Okra Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Okra.htm Omega-3 Fatty Acids Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/COPD.htm Onions Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Onions.htm Onions Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Asthm acc.html Onions Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Oranges Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Parsnips Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Parsnips.htm Peanuts Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Peanuts Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Asthm acc.html Pickles Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Plums Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Poultry Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Asthm acc.html Radishes Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Radishes.htm Romaine Lettuce Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Romaine_Lettuce .htm Rutabagas Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Rutabagas.htm Rye Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Saturated Fats Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Seeds Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html
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Snow Peas Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Snow_Peas.htm Soy Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Asthm acc.html Soy-Free Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Soy_Free_Diet.htm Sugar Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/SleepA pneacc.html Sugar Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Sugar Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Asthm acc.html Summer Squash Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Summer_Squash. htm Sweet Peppers Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Sweet_Peppers.htm Sweet Potatoes Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Sweet_Potatoes.h tm Tea Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Bronchitis.htm Tea Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Asthm acc.html Tea Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Tea Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Tomatoes Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Tomatoes.htm Turnips Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Turnips.htm Vegetables Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Asthm acc.html Water Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Water Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Asthm acc.html Water Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/SleepA pneacc.html Weight Loss Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Asthma.htm Weight Loss Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/SleepA pneacc.html Wheat Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Asthm acc.html Wheat Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/CysticF ibrosiscc.html Wheat-Free Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Wheat_Free_Diet.htm Winter Squash Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Winter_Squash.h tm Yams Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Yams.htm Zucchini Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Zucchini.htm
Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU]
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Otorhinolaryngology: That branch of medicine concerned with medical and surgical treatment of the head and neck, including the ears, nose and throat. [EU]
Ovalbumin: An albumin obtained from the white of eggs. It is a member of the serpin superfamily. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Phagocytosis: Endocytosis of particulate material, such as microorganisms or cell fragments. The material is taken into the cell in membrane-bound vesicles (phagosomes) that originate as pinched off invaginations of the plasma membrane. Phagosomes fuse with lysosomes, forming phagolysosomes in which the engulfed material is killed and digested. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Thermoregulation: Heat regulation. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH]
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APPENDIX D. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM’s interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.55
55
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
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Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):56 ·
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
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Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM
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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
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California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html
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California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html
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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
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California: Gateway Health Library (Sutter Gould Medical Foundation)
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California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/
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Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
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California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
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California: San José PlaneTree Health Library, http://planetreesanjose.org/
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California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html
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California: University of California, Davis. Health Sciences Libraries
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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html
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California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/
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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm
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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
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Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
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Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml
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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm
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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html
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Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp
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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/
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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm
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Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html
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Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/
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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm
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Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/
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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/
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Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/
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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm
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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html
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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm
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Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/
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Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library
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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10
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Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html
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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml
Finding Medical Libraries 349
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Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html
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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp
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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital), http://www.southcoast.org/library/
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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/
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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm
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Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html
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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41
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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
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National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
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Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm
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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
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New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm
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New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/
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New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
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New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/
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New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html
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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
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Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp
Finding Medical Libraries 351
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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/
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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/
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Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html
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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp
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Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm
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Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/
·
South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm
·
Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
·
Texas: Matustik Family Resource Center (Cook Children’s Health Care System), http://www.cookchildrens.com/Matustik_Library.html
·
Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
·
Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/
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APPENDIX E. YOUR RIGHTS AND INSURANCE Overview Any patient with asthma faces a series of issues related more to the healthcare industry than to the medical condition itself. This appendix covers two important topics in this regard: your rights and responsibilities as a patient, and how to get the most out of your medical insurance plan.
Your Rights as a Patient The President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has created the following summary of your rights as a patient.57 Information Disclosure Consumers have the right to receive accurate, easily understood information. Some consumers require assistance in making informed decisions about health plans, health professionals, and healthcare facilities. Such information includes: ·
Health plans. Covered benefits, cost-sharing, and procedures for resolving complaints, licensure, certification, and accreditation status, comparable measures of quality and consumer satisfaction, provider network composition, the procedures that govern access to specialists and emergency services, and care management information.
57Adapted
from Consumer Bill of Rights and Responsibilities: http://www.hcqualitycommission.gov/press/cbor.html#head1.
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·
Health professionals. Education, board certification, and recertification, years of practice, experience performing certain procedures, and comparable measures of quality and consumer satisfaction.
·
Healthcare facilities. Experience in performing certain procedures and services, accreditation status, comparable measures of quality, worker, and consumer satisfaction, and procedures for resolving complaints.
·
Consumer assistance programs. Programs must be carefully structured to promote consumer confidence and to work cooperatively with health plans, providers, payers, and regulators. Desirable characteristics of such programs are sponsorship that ensures accountability to the interests of consumers and stable, adequate funding.
Choice of Providers and Plans Consumers have the right to a choice of healthcare providers that is sufficient to ensure access to appropriate high-quality healthcare. To ensure such choice, the Commission recommends the following: ·
Provider network adequacy. All health plan networks should provide access to sufficient numbers and types of providers to assure that all covered services will be accessible without unreasonable delay -including access to emergency services 24 hours a day and 7 days a week. If a health plan has an insufficient number or type of providers to provide a covered benefit with the appropriate degree of specialization, the plan should ensure that the consumer obtains the benefit outside the network at no greater cost than if the benefit were obtained from participating providers.
·
Women’s health services. Women should be able to choose a qualified provider offered by a plan -- such as gynecologists, certified nurse midwives, and other qualified healthcare providers -- for the provision of covered care necessary to provide routine and preventative women’s healthcare services.
·
Access to specialists. Consumers with complex or serious medical conditions who require frequent specialty care should have direct access to a qualified specialist of their choice within a plan’s network of providers. Authorizations, when required, should be for an adequate number of direct access visits under an approved treatment plan.
·
Transitional care. Consumers who are undergoing a course of treatment for a chronic or disabling condition (or who are in the second or third trimester of a pregnancy) at the time they involuntarily change health
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plans or at a time when a provider is terminated by a plan for other than cause should be able to continue seeing their current specialty providers for up to 90 days (or through completion of postpartum care) to allow for transition of care. ·
Choice of health plans. Public and private group purchasers should, wherever feasible, offer consumers a choice of high-quality health insurance plans.
Access to Emergency Services Consumers have the right to access emergency healthcare services when and where the need arises. Health plans should provide payment when a consumer presents to an emergency department with acute symptoms of sufficient severity--including severe pain--such that a “prudent layperson” could reasonably expect the absence of medical attention to result in placing that consumer’s health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.
Participation in Treatment Decisions Consumers have the right and responsibility to fully participate in all decisions related to their healthcare. Consumers who are unable to fully participate in treatment decisions have the right to be represented by parents, guardians, family members, or other conservators. Physicians and other health professionals should: ·
Provide patients with sufficient information and opportunity to decide among treatment options consistent with the informed consent process.
·
Discuss all treatment options with a patient in a culturally competent manner, including the option of no treatment at all.
·
Ensure that persons with disabilities have effective communications with members of the health system in making such decisions.
·
Discuss all current treatments a consumer may be undergoing.
·
Discuss all risks, nontreatment.
·
Give patients the opportunity to refuse treatment and to express preferences about future treatment decisions.
benefits,
and
consequences
to
treatment
or
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·
Discuss the use of advance directives -- both living wills and durable powers of attorney for healthcare -- with patients and their designated family members.
·
Abide by the decisions made by their patients and/or their designated representatives consistent with the informed consent process.
Health plans, health providers, and healthcare facilities should: ·
Disclose to consumers factors -- such as methods of compensation, ownership of or interest in healthcare facilities, or matters of conscience -that could influence advice or treatment decisions.
·
Assure that provider contracts do not contain any so-called “gag clauses” or other contractual mechanisms that restrict healthcare providers’ ability to communicate with and advise patients about medically necessary treatment options.
·
Be prohibited from penalizing or seeking retribution against healthcare professionals or other health workers for advocating on behalf of their patients.
Respect and Nondiscrimination Consumers have the right to considerate, respectful care from all members of the healthcare industry at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality healthcare system. To assure that right, the Commission recommends the following: ·
Consumers must not be discriminated against in the delivery of healthcare services consistent with the benefits covered in their policy, or as required by law, based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.
·
Consumers eligible for coverage under the terms and conditions of a health plan or program, or as required by law, must not be discriminated against in marketing and enrollment practices based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment. Confidentiality of Health Information
Consumers have the right to communicate with healthcare providers in confidence and to have the confidentiality of their individually identifiable
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healthcare information protected. Consumers also have the right to review and copy their own medical records and request amendments to their records. Complaints and Appeals Consumers have the right to a fair and efficient process for resolving differences with their health plans, healthcare providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review. A free copy of the Patient’s Bill of Rights is available from the American Hospital Association.58
Patient Responsibilities Treatment is a two-way street between you and your healthcare providers. To underscore the importance of finance in modern healthcare as well as your responsibility for the financial aspects of your care, the President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has proposed that patients understand the following “Consumer Responsibilities.”59 In a healthcare system that protects consumers’ rights, it is reasonable to expect and encourage consumers to assume certain responsibilities. Greater individual involvement by the consumer in his or her care increases the likelihood of achieving the best outcome and helps support a quality-oriented, cost-conscious environment. Such responsibilities include: ·
Take responsibility for maximizing healthy habits such as exercising, not smoking, and eating a healthy diet.
·
Work collaboratively with healthcare providers in developing and carrying out agreed-upon treatment plans.
·
Disclose relevant information and clearly communicate wants and needs.
·
Use your health insurance plan’s internal complaint and appeal processes to address your concerns.
·
Avoid knowingly spreading disease.
58 To order your free copy of the Patient’s Bill of Rights, telephone 312-422-3000 or visit the American Hospital Association’s Web site: http://www.aha.org. Click on “Resource Center,” go to “Search” at bottom of page, and then type in “Patient’s Bill of Rights.” The Patient’s Bill of Rights is also available from Fax on Demand, at 312-422-2020, document number 471124. 59 Adapted from http://www.hcqualitycommission.gov/press/cbor.html#head1.
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·
Recognize the reality of risks, the limits of the medical science, and the human fallibility of the healthcare professional.
·
Be aware of a healthcare provider’s obligation to be reasonably efficient and equitable in providing care to other patients and the community.
·
Become knowledgeable about your health plan’s coverage and options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions.
·
Show respect for other patients and health workers.
·
Make a good-faith effort to meet financial obligations.
·
Abide by administrative and operational procedures of health plans, healthcare providers, and Government health benefit programs.
Choosing an Insurance Plan There are a number of official government agencies that help consumers understand their healthcare insurance choices.60 The U.S. Department of Labor, in particular, recommends ten ways to make your health benefits choices work best for you.61 1. Your options are important. There are many different types of health benefit plans. Find out which one your employer offers, then check out the plan, or plans, offered. Your employer’s human resource office, the health plan administrator, or your union can provide information to help you match your needs and preferences with the available plans. The more information you have, the better your healthcare decisions will be. 2. Reviewing the benefits available. Do the plans offered cover preventive care, well-baby care, vision or dental care? Are there deductibles? Answers to these questions can help determine the out-of-pocket expenses you may face. Matching your needs and those of your family members will result in the best possible benefits. Cheapest may not always be best. Your goal is high quality health benefits.
More information about quality across programs is provided at the following AHRQ Web site: http://www.ahrq.gov/consumer/qntascii/qnthplan.htm. 61 Adapted from the Department of Labor: http://www.dol.gov/dol/pwba/public/pubs/health/top10-text.html. 60
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3. Look for quality. The quality of healthcare services varies, but quality can be measured. You should consider the quality of healthcare in deciding among the healthcare plans or options available to you. Not all health plans, doctors, hospitals and other providers give the highest quality care. Fortunately, there is quality information you can use right now to help you compare your healthcare choices. Find out how you can measure quality. Consult the U.S. Department of Health and Human Services publication “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer. 4. Your plan’s summary plan description (SPD) provides a wealth of information. Your health plan administrator can provide you with a copy of your plan’s SPD. It outlines your benefits and your legal rights under the Employee Retirement Income Security Act (ERISA), the federal law that protects your health benefits. It should contain information about the coverage of dependents, what services will require a co-pay, and the circumstances under which your employer can change or terminate a health benefits plan. Save the SPD and all other health plan brochures and documents, along with memos or correspondence from your employer relating to health benefits. 5. Assess your benefit coverage as your family status changes. Marriage, divorce, childbirth or adoption, and the death of a spouse are all life events that may signal a need to change your health benefits. You, your spouse and dependent children may be eligible for a special enrollment period under provisions of the Health Insurance Portability and Accountability Act (HIPAA). Even without life-changing events, the information provided by your employer should tell you how you can change benefits or switch plans, if more than one plan is offered. If your spouse’s employer also offers a health benefits package, consider coordinating both plans for maximum coverage. 6. Changing jobs and other life events can affect your health benefits. Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), you, your covered spouse, and your dependent children may be eligible to purchase extended health coverage under your employer’s plan if you lose your job, change employers, get divorced, or upon occurrence of certain other events. Coverage can range from 18 to 36 months depending on your situation. COBRA applies to most employers with 20 or more workers and requires your plan to notify you of your rights. Most plans require eligible individuals to make their COBRA election within 60 days of the plan’s notice. Be sure to follow up with your plan sponsor if you don’t receive notice, and make sure you respond within the allotted time.
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7. HIPAA can also help if you are changing jobs, particularly if you have a medical condition. HIPAA generally limits pre-existing condition exclusions to a maximum of 12 months (18 months for late enrollees). HIPAA also requires this maximum period to be reduced by the length of time you had prior “creditable coverage.” You should receive a certificate documenting your prior creditable coverage from your old plan when coverage ends. 8. Plan for retirement. Before you retire, find out what health benefits, if any, extend to you and your spouse during your retirement years. Consult with your employer’s human resources office, your union, the plan administrator, and check your SPD. Make sure there is no conflicting information among these sources about the benefits you will receive or the circumstances under which they can change or be eliminated. With this information in hand, you can make other important choices, like finding out if you are eligible for Medicare and Medigap insurance coverage. 9. Know how to file an appeal if your health benefits claim is denied. Understand how your plan handles grievances and where to make appeals of the plan’s decisions. Keep records and copies of correspondence. Check your health benefits package and your SPD to determine who is responsible for handling problems with benefit claims. Contact PWBA for customer service assistance if you are unable to obtain a response to your complaint. 10. You can take steps to improve the quality of the healthcare and the health benefits you receive. Look for and use things like Quality Reports and Accreditation Reports whenever you can. Quality reports may contain consumer ratings -- how satisfied consumers are with the doctors in their plan, for instance-- and clinical performance measures -- how well a healthcare organization prevents and treats illness. Accreditation reports provide information on how accredited organizations meet national standards, and often include clinical performance measures. Look for these quality measures whenever possible. Consult “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer.
Medicare and Medicaid Illness strikes both rich and poor families. For low-income families, Medicaid is available to defer the costs of treatment. The Health Care Financing Administration (HCFA) administers Medicare, the nation’s largest health insurance program, which covers 39 million Americans. In the following pages, you will learn the basics about Medicare insurance as well as useful
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contact information on how to find more in-depth information about Medicaid.62
Who is Eligible for Medicare? Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. You might also qualify for coverage if you are under age 65 but have a disability or EndStage Renal disease (permanent kidney failure requiring dialysis or transplant). Here are some simple guidelines: You can get Part A at age 65 without having to pay premiums if: ·
You are already receiving retirement benefits from Social Security or the Railroad Retirement Board.
·
You are eligible to receive Social Security or Railroad benefits but have not yet filed for them.
·
You or your spouse had Medicare-covered government employment.
If you are under 65, you can get Part A without having to pay premiums if: ·
You have received Social Security or Railroad Retirement Board disability benefit for 24 months.
·
You are a kidney dialysis or kidney transplant patient.
Medicare has two parts: ·
Part A (Hospital Insurance). Most people do not have to pay for Part A.
·
Part B (Medical Insurance). Most people pay monthly for Part B. Part A (Hospital Insurance)
Helps Pay For: Inpatient hospital care, care in critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas) and skilled nursing facilities, hospice care, and some home healthcare.
This section has been adapted from the Official U.S. Site for Medicare Information: http://www.medicare.gov/Basics/Overview.asp.
62
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Cost: Most people get Part A automatically when they turn age 65. You do not have to pay a monthly payment called a premium for Part A because you or a spouse paid Medicare taxes while you were working. If you (or your spouse) did not pay Medicare taxes while you were working and you are age 65 or older, you still may be able to buy Part A. If you are not sure you have Part A, look on your red, white, and blue Medicare card. It will show “Hospital Part A” on the lower left corner of the card. You can also call the Social Security Administration toll free at 1-800-772-1213 or call your local Social Security office for more information about buying Part A. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Fiscal Intermediary about Part A bills and services. The phone number for the Fiscal Intermediary office in your area can be obtained from the following Web site: http://www.medicare.gov/Contacts/home.asp. Part B (Medical Insurance) Helps Pay For: Doctors, services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home healthcare. Part B helps pay for covered services and supplies when they are medically necessary. Cost: As of 2001, you pay the Medicare Part B premium of $50.00 per month. In some cases this amount may be higher if you did not choose Part B when you first became eligible at age 65. The cost of Part B may go up 10% for each 12-month period that you were eligible for Part B but declined coverage, except in special cases. You will have to pay the extra 10% cost for the rest of your life. Enrolling in Part B is your choice. You can sign up for Part B anytime during a 7-month period that begins 3 months before you turn 65. Visit your local Social Security office, or call the Social Security Administration at 1-800-7721213 to sign up. If you choose to enroll in Part B, the premium is usually taken out of your monthly Social Security, Railroad Retirement, or Civil Service Retirement payment. If you do not receive any of the above payments, Medicare sends you a bill for your part B premium every 3 months. You should receive your Medicare premium bill in the mail by the 10th of the month. If you do not, call the Social Security Administration at 1800-772-1213, or your local Social Security office. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Medicare carrier about bills and services. The
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phone number for the Medicare carrier in your area can be found at the following Web site: http://www.medicare.gov/Contacts/home.asp. You may have choices in how you get your healthcare including the Original Medicare Plan, Medicare Managed Care Plans (like HMOs), and Medicare Private Fee-for-Service Plans.
Medicaid Medicaid is a joint federal and state program that helps pay medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state. People on Medicaid may also get coverage for nursing home care and outpatient prescription drugs which are not covered by Medicare. You can find more information about Medicaid on the HCFA.gov Web site at http://www.hcfa.gov/medicaid/medicaid.htm. States also have programs that pay some or all of Medicare’s premiums and may also pay Medicare deductibles and coinsurance for certain people who have Medicare and a low income. To qualify, you must have: ·
Part A (Hospital Insurance),
·
Assets, such as bank accounts, stocks, and bonds that are not more than $4,000 for a single person, or $6,000 for a couple, and
·
A monthly income that is below certain limits.
For more information on these programs, look at the Medicare Savings Programs brochure, http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Langua ge=English&Type=Pub&PubID=10126. There are also Prescription Drug Assistance Programs available. Find information on these programs which offer discounts or free medications to individuals in need at http://www.medicare.gov/Prescription/Home.asp.
NORD’s Medication Assistance Programs Finally, the National Organization for Rare Disorders, Inc. (NORD) administers medication programs sponsored by humanitarian-minded pharmaceutical and biotechnology companies to help uninsured or underinsured individuals secure life-saving or life-sustaining drugs.63 NORD Adapted from NORD: http://www.rarediseases.org/cgibin/nord/progserv#patient?id=rPIzL9oD&mv_pc=30.
63
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programs ensure that certain vital drugs are available “to those individuals whose income is too high to qualify for Medicaid but too low to pay for their prescribed medications.” The program has standards for fairness, equity, and unbiased eligibility. It currently covers some 14 programs for nine pharmaceutical companies. NORD also offers early access programs for investigational new drugs (IND) under the approved “Treatment INDs” programs of the Food and Drug Administration (FDA). In these programs, a limited number of individuals can receive investigational drugs that have yet to be approved by the FDA. These programs are generally designed for rare diseases or disorders. For more information, visit www.rarediseases.org.
Additional Resources In addition to the references already listed in this chapter, you may need more information on health insurance, hospitals, or the healthcare system in general. The NIH has set up an excellent guidance Web site that addresses these and other issues. Topics include:64 ·
Health Insurance: http://www.nlm.nih.gov/medlineplus/healthinsurance.html
·
Health Statistics: http://www.nlm.nih.gov/medlineplus/healthstatistics.html
·
HMO and Managed Care: http://www.nlm.nih.gov/medlineplus/managedcare.html
·
Hospice Care: http://www.nlm.nih.gov/medlineplus/hospicecare.html
·
Medicaid: http://www.nlm.nih.gov/medlineplus/medicaid.html
·
Medicare: http://www.nlm.nih.gov/medlineplus/medicare.html
·
Nursing Homes and Long-term Care: http://www.nlm.nih.gov/medlineplus/nursinghomes.html
·
Patient’s Rights, Confidentiality, Informed Consent, Ombudsman Programs, Privacy and Patient Issues: http://www.nlm.nih.gov/medlineplus/patientissues.html
·
Veteran’s Health, Persian Gulf War, Gulf War Syndrome, Agent Orange: http://www.nlm.nih.gov/medlineplus/veteranshealth.html
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
64
Your Rights and Insurance 365
Vocabulary Builder Auscultation: The act of listening for sounds within the body, chiefly for ascertaining the condition of the lungs, heart, pleura, abdomen and other organs, and for the detection of pregnancy. [EU] Cyanosis: Bluish color of the skin due to insufficient oxygen in the blood. [NIH]
ECG: Measurement of electrical activity during heartbeats. [NIH] Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU] Paralysis: Loss or impairment of motor function in a part due to lesion of the neural or muscular mechanism; also by analogy, impairment of sensory function (sensory paralysis). In addition to the types named below, paralysis is further distinguished as traumatic, syphilitic, toxic, etc., according to its cause; or as obturator, ulnar, etc., according to the nerve part, or muscle specially affected. [EU]
Online Glossaries 367
ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
·
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
·
Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
·
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
·
On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/
·
Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
·
Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html
Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia Web site address is http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a) and drkoop.com (http://www.drkoop.com/). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to asthma and keep them on file. The NIH, in particular, suggests that patients with asthma visit the following Web sites in the ADAM Medical Encyclopedia:
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·
Basic Guidelines for Asthma Asthma and allergy - resources Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002190.htm Bronchial asthma Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000141.htm Occupational asthma Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000110.htm Pediatric asthma Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000990.htm Pneumonia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000145.htm
·
Signs & Symptoms for Asthma Anxiety Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Bluish color Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003215.htm Breath sounds Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003323.htm Breathing difficulty Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003075.htm
Online Glossaries 369
Chest pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003079.htm Cough Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003072.htm Coughing up blood Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003073.htm Cyanosis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003215.htm Difficulty breathing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003075.htm Edema Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003103.htm Fatigue Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Intercostal retractions Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003322.htm Nasal flaring Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003055.htm Paralysis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003190.htm
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Rapid pulse Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003077.htm Shortness of breath Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003075.htm Stress Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Sweating Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003218.htm Tachycardia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003077.htm Tachypnea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003071.htm Wheezing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003070.htm ·
Diagnostics and Tests for Asthma Allergy testing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003519.htm ANA Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003535.htm Arterial blood gas Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003855.htm
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AST Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003472.htm Blood gases Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003855.htm BUN Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003474.htm CBC Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003642.htm Chest radiography Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003804.htm Chest X-ray Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003804.htm ECG Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003868.htm Eosinophils Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003649.htm Hyperplasia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003441.htm Pulmonary function Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003443.htm
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Pulmonary function tests Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003853.htm Radiography Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003337.htm X-ray Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003337.htm ·
Nutrition for Asthma Proteins Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002467.htm
·
Background Topics for Asthma Acute Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002215.htm Aggravated by Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002227.htm Allergen Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002229.htm Asthma and allergy - support group Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002190.htm Auscultation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002226.htm
Online Glossaries 373
Exercise Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001941.htm Incidence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002387.htm Intravenous Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002383.htm Respiratory Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002290.htm Support group Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002150.htm
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
·
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
·
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
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Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
Glossary 375
ASTHMA GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. Abdominal: Pertaining to the abdomen. [EU] Abortion: 1. the premature expulsion from the uterus of the products of conception - of the embryo, or of a nonviable fetus. The four classic symptoms, usually present in each type of abortion, are uterine contractions, uterine haemorrhage, softening and dilatation of the cervix, and presentation or expulsion of all or part of the products of conception. 2. premature stoppage of a natural or a pathological process. [EU] Absenteeism: Chronic absence from work or other duty. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acetylcysteine: The N-acetyl derivative of cysteine. It is used as a mucolytic agent to reduce the viscosity of mucous secretions. It has also been shown to have antiviral effects in patients with HIV due to inhibition of viral stimulation by reactive oxygen intermediates. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH]
Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has
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affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Airways: Tubes that carry air into and out of the lungs. [NIH] Albuterol: A racemic mixture with a 1:1 ratio of the r-isomer, levalbuterol, and s-albuterol. It is a short-acting beta2-adrenergic agonist with its main clinical use in asthma. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH] Allergen: A antigenic substance capable of producing immediate-type hypersensitivity (allergy). [EU] Alveoli: Tiny sac-like air spaces in the lungs where transfer of carbon dioxide from blood into the lungs and oxygen from air into blood takes place. [NIH] Aminophylline: A drug combination that contains theophylline and ethylenediamine. It is more soluble in water than theophylline but has similar pharmacologic actions. It's most common use is in bronchial asthma, but it has been investigated for several other applications. [NIH] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Anaphylactic: Pertaining to anaphylaxis. [EU] Anaphylaxis: An acute hypersensitivity reaction due to exposure to a previously encountered antigen. The reaction may include rapidly progressing urticaria, respiratory distress, vascular collapse, systemic shock, and death. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH] Anorexia: Lack or loss of the appetite for food. [EU] Anthropometry: The technique that deals with the measurement of the size, weight, and proportions of the human or other primate body. [NIH]
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Antiarrhythmic: An agent that prevents or alleviates cardiac arrhythmia. [EU]
Antibiotic: A drug that kills or inhibits the growth of bacteria. [NIH] Antibodies: Specific proteins produced by the body's immune system that bind with foreign proteins (antigens). [NIH] Anticholinergic: An agent that blocks the parasympathetic nerves. Called also parasympatholytic. [EU] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Antifungal: Destructive to fungi, or suppressing their reproduction or growth; effective against fungal infections. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antihistamine: A drug that counteracts the action of histamine. The antihistamines are of two types. The conventional ones, as those used in allergies, block the H1 histamine receptors, whereas the others block the H2 receptors. Called also antihistaminic. [EU] Antioxidant: One of many widely used synthetic or natural substances added to a product to prevent or delay its deterioration by action of oxygen in the air. Rubber, paints, vegetable oils, and prepared foods commonly contain antioxidants. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Anxiolytic: An anxiolytic or antianxiety agent. [EU] Apnea: A transient absence of spontaneous respiration. [NIH] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Arrhythmia: An irregular heartbeat. [NIH]
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Arrhythmogenic: Producing or promoting arrhythmia. [EU] Arterial: Pertaining to an artery or to the arteries. [EU] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH]
Ascites: Effusion and accumulation of serous fluid in the abdominal cavity; called also abdominal or peritoneal dropsy, hydroperitonia, and hydrops abdominis. [EU] Aspergillosis: Infections with fungi of the genus aspergillus. [NIH] Aspiration: The act of inhaling. [EU] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asthenia: Lack or loss of strength and energy, weakness. [EU] Asymptomatic: Showing or causing no symptoms. [EU] Atenolol: A cardioselective beta-adrenergic blocker possessing properties and potency similar to propranolol, but without a negative inotropic effect. [NIH]
Atopic: Pertaining to an atopen or to atopy; allergic. [EU] Atropine: A toxic alkaloid, originally from Atropa belladonna, but found in other plants, mainly Solanaceae. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Auricular: Pertaining to an auricle or to the ear, and, formerly, to an atrium of the heart. [EU] Auscultation: The act of listening for sounds within the body, chiefly for ascertaining the condition of the lungs, heart, pleura, abdomen and other organs, and for the detection of pregnancy. [EU] Autonomic: Self-controlling; functionally independent. [EU] Barium: An element of the alkaline earth group of metals. It has an atomic symbol Ba, atomic number 56, and atomic weight 138. All of its acid-soluble salts are poisonous. [NIH] Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH] Beclomethasone: An anti-inflammatory, synthetic glucocorticoid. It is used topically as an anti-inflammatory agent and in aerosol form for the treatment of asthma. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released
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from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchiectasis: Chronic dilatation of the bronchi marked by fetid breath and paroxysmal coughing, with the expectoration of mucopurulent matter. It may effect the tube uniformly (cylindric b.), or occur in irregular pockets (sacculated b.) or the dilated tubes may have terminal bulbous enlargements (fusiform b.). [EU] Bronchiole: The smaller airways of the lungs. [NIH] Bronchiolitis: Inflammation of the bronchioles, usually caused by a viral infection. [NIH] Bronchitis: Inflammation of one or more bronchi. [EU] Bronchoconstriction: Tightening of the muscles surrounding the bronchi, the tubes that branch from the windpipe. [NIH] Bronchodilator: A drug that relaxes the smooth muscles in the constricted airway. [NIH] Bronchopulmonary: Pertaining to the lungs and air passages. [NIH] Bronchoscope: A long, narrow tube with a light at the end that is used by the doctor for direct observation of the airways, as well as for suction of tissue and other materials. [NIH] Bronchoscopy: A technique for visualizing the interior of bronchi and instilling or removing fluid or tissue samples by passing a lighted tube (bronchoscope) through the nose or mouth into the bronchi. [NIH] Bronchospasm: Spasmodic contraction of the smooth muscle of the bronchi, as occurs in asthma. [EU] Budesonide: A glucocorticoid used in the management of asthma, the treatment of various skin disorders, and allergic rhinitis. [NIH] Calcitonin: A peptide hormone that lowers calcium concentration in the blood. In humans, it is released by thyroid cells and acts to decrease the formation and absorptive activity of osteoclasts. Its role in regulating plasma calcium is much greater in children and in certain diseases than in normal adults. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrates: A nutrient that supplies simple or complex. Simple carbohydrates carbohydrates are called starch and compound—containing carbon, hydrogen,
4 calories/gram. They may be are called sugars, and complex fiber (cellulose). An organic and oxygen—that is formed by
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photosynthesis in plants. Carbohydrates are heat producing and are classified as monosaccharides, disaccharides, or polysaccharides. [NIH] Carcinoma: A malignant new growth made up of epithelial cells tending to infiltrate the surrounding tissues and give rise to metastases. [EU] Cardiac: Pertaining to the heart. [EU] Cardiopulmonary: Pertaining to the heart and lungs. [EU] Cardiovascular: Pertaining to the heart and blood vessels. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Cell: Basic subunit of every living organism; the simplest unit that can exist as an independent living system. [NIH] Cetirizine: A potent second-generation histamine H1 antagonist that is effective in the treatment of allergic rhinitis, chronic urticaria, and polleninduced asthma. Unlike many traditional antihistamines, it does not cause drowsiness or anticholinergic side effects. [NIH] Cholestasis: Impairment of biliary flow at any level from the hepatocyte to Vater's ampulla. [NIH] Cholesterol: A soft, waxy substance manufactured by the body and used in the production of hormones, bile acid, and vitamin D and present in all parts of the body, including the nervous system, muscle, skin, liver, intestines, and heart. Blood cholesterol circulates in the bloodstream. Dietary cholesterol is found in foods of animal origin. [NIH] Chromans: Benzopyrans saturated in the 2 and 3 positions. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chronic: Of long duration; frequently recurring. [NIH] Chronotherapy: The adaptation of the administration of drugs to circadian rhythms. The concept is based on the response of biological functions to time-related events, such as the low point in epinephrine levels between 10 p.m. and 4 a.m. or the elevated histamine levels between midnight and 4 a.m. The treatment is aimed at supporting normal rhythms or modifying therapy based on known variations in body rhythms. While chronotherapy is commonly used in cancer chemotherapy, it is not restricted to cancer therapy or to chemotherapy. [NIH] Cimetidine: A weight loss drug that is thought to work by suppression of gastric acid or suppression of hunger by blocking histamine H2 receptors. It is not approved by the FDA. [NIH] Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU]
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Clindamycin: An antibacterial agent that is a semisynthetic analog of lincomycin. [NIH] Codeine: An opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough. [NIH] Colic: Paroxysms of pain. This condition usually occurs in the abdominal region but may occur in other body regions as well. [NIH] Collapse: 1. a state of extreme prostration and depression, with failure of circulation. 2. abnormal falling in of the walls of any part of organ. [EU] Colorectal: Pertaining to or affecting the colon and rectum. [EU] Comorbidity: Two or more diseases or conditions existing together in an individual. [NIH] Concomitant: Accompanying; accessory; joined with another. [EU] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Confusion: Disturbed orientation in regard to time, place, or person, sometimes accompanied by disordered consciousness. [EU] Congestion: Abnormal fluid accumulation in the body, especially the lungs. [NIH]
Constipation: Infrequent or difficult evacuation of the faeces. [EU] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Contraceptive: conception. [EU] Contractility: stimulus. [EU]
An agent that diminishes the likelihood of or prevents Capacity for becoming short in response to a suitable
Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Corticosteroids: Drugs that mimic the action of a group of hormones produced by adrenal glands; they are anti-inflammatory and act as bronchodilators. [NIH] Croup: A condition characterized by resonant barking cough, hoarseness and persistant stridor and caused by allergy, foreign body, infection, or neoplasm. It occurs chiefly in infants and children. [NIH] Cryptococcosis:
Infection with a fungus of the species cryptococcus
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neoformans. [NIH] Cues: Signals for an action; that specific portion of a perceptual field or pattern of stimuli to which a subject has learned to respond. [NIH] Cyanosis: Bluish color of the skin due to insufficient oxygen in the blood. [NIH]
Cystitis: Inflammation of the urinary bladder. [EU] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Decompensation: Failure of compensation; cardiac decompensation is marked by dyspnea, venous engorgement, and edema. [EU] Decongestant: An agent that reduces congestion or swelling. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dermatitis: Inflammation of the skin. [EU] Dermatology: A medical specialty concerned with the skin, its structure, functions, diseases, and treatment. [NIH] Dermatomycoses: Superficial infections of the skin or its appendages by any of various fungi. [NIH] Desensitization: The prevention or reduction of immediate hypersensitivity reactions by administration of graded doses of allergen; called also hyposensitization and immunotherapy. [EU] Desquamation: The shedding of epithelial elements, chiefly of the skin, in scales or small sheets; exfoliation. [EU] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diflunisal: A salicylate derivative and anti-inflammatory analgesic with actions and side effects similar to those of ASPIRIN. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Dilate: Relax; expand. [NIH] Dimenhydrinate: A drug combination that contains diphenhydramine and theophylline. It is used for treating vertigo, motion sickness, and nausea associated with pregnancy. It is not effective in the treatment of nausea associated with cancer chemotherapy. [NIH] Diurnal: Occurring during the day. [EU]
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Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dyphylline: A theophylline derivative with broncho- and vasodilator properties. It is used in the treatment of asthma, cardiac dyspnea, and bronchitis. [NIH] Dyslipidemia: Disorders in the lipoprotein metabolism; classified as hypercholesterolemia, hypertriglyceridemia, combined hyperlipidemia, and low levels of high-density lipoprotein (HDL) cholesterol. All of the dyslipidemias can be primary or secondary. Both elevated levels of lowdensity lipoprotein (LDL) cholesterol and low levels of HDL cholesterol predispose to premature atherosclerosis. [NIH] Dyspepsia: Impairment of the power of function of digestion; usually applied to epigastric discomfort following meals. [EU] Dysplasia: Abnormal development or growth. [NIH] Dyspnea: Shortness of breath; difficult or labored breathing. [NIH] ECG: Measurement of electrical activity during heartbeats. [NIH] Eclampsia: Convulsions and coma occurring in a pregnant or puerperal woman, associated with preeclampsia, i.e., with hypertension, edema, and/or proteinuria. [EU] Eczema: A pruritic papulovesicular dermatitis occurring as a reaction to many endogenous and exogenous agents, characterized in the acute stage by erythema, edema associated with a serous exudate between the cells of the epidermis (spongiosis) and an inflammatory infiltrate in the dermis, oozing and vesiculation, and crusting and scaling; and in the more chronic stages by lichenification or thickening or both, signs of excoriations, and hyperpigmentation or hypopigmentation or both. Atopic dermatitis is the most common type of dermatitis. Called also eczematous dermatitis. [EU] Edema: Abnormal fluid accumulation in body tissues. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Effusion: The escape of fluid into a part or tissue, as an exudation or a transudation. [EU] EKG: Measurement of electrical activity during heartbeats. [NIH] Electrocardiogram:
Measurement of electrical activity during heartbeats.
[NIH]
Emphysema: Chronic lung disease in which there is permanent destruction of alveoli. [NIH]
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Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endogenous: Developing or originating within the organisms or arising from causes within the organism. [EU] Endometriosis: A condition in which tissue more or less perfectly resembling the uterine mucous membrane (the endometrium) and containing typical endometrial granular and stromal elements occurs aberrantly in various locations in the pelvic cavity; called also adenomyosis externa and endometriosis externa. [EU] Endoscopy: Visual inspection of any cavity of the body by means of an endoscope. [EU] Endotoxin: Toxin from cell walls of bacteria. [NIH] Enterocolitis: Inflammation involving both the small intestine and the colon; see also enteritis. [EU] Enzyme: Substance, made by living cells, that causes specific chemical changes. [NIH] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other health-related event occurring in such outbreaks. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithelium: The covering of internal and external surfaces of the body, including the lining of vessels and other small cavities. It consists of cells joined by small amounts of cementing substances. Epithelium is classified into types on the basis of the number of layers deep and the shape of the superficial cells. [EU]
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Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Ethnopharmacology: The study of the actions and properties of drugs, usually derived from medicinal plants, indigenous to a population or ethnic group. [NIH] Etodolac: A nonsteroidal anti-inflammatory agent with potent analgesic and antiarthritic properties. It has been shown to be effective in the treatment of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and in the alleviation of postoperative pain. [NIH] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Extracellular: Outside a cell or cells. [EU] Extracorporeal: Situated or occurring outside the body. [EU] Extravasation: A discharge or escape, as of blood, from a vessel into the tissues. [EU] Extravascular: Situated or occurring outside a vessel or the vessels. [EU] Famotidine: A competitive histamine H2-receptor antagonist. Its main pharmacodynamic effect is the inhibition of gastric secretion. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Fetus: Unborn offspring from 7 or 8 weeks after conception until birth. [NIH] Fibrosis: Process by which inflamed tissue becomes scarred. [NIH] Fluphenazine: A phenothiazine used in the treatment of psychoses. Its properties and uses are generally similar to those of chlorpromaazine. [NIH] Flurbiprofen: An anti-inflammatory analgesic and antipyretic of the phenylalkynoic acid series. It has been shown to reduce bone resorption in periodontal disease by inhibiting carbonic anhydrase. [NIH] Folklore: The common orally transmitted traditions, myths, festivals, songs, superstitions, and stories of all peoples. [NIH] GABA: The most common inhibitory neurotransmitter in the central nervous system. [NIH] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Gastroscopy: Endoscopic examination, therapy or surgery of the interior of the stomach. [NIH] Gels: Colloids with a solid continuous phase and liquid as the dispersed
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phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting colloid is called a sol. [NIH] Genotype: The entire genetic makeup of an individual. The fundamental constitution of an organism in terms of its hereditary factors. A group of organisms in which each has the same hereditary characteristics. [NIH] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Glutamine: A non-essential amino acid present abundantly throught the body and is involved in many metabolic processes. It is synthesized from glutamic acid and ammonia. It is the principal carrier of nitrogen in the body and is an important energy source for many cells. [NIH] Gluten: The protein of wheat and other grains which gives to the dough its tough elastic character. [EU] Granuloma: A relatively small nodular inflammatory lesion containing grouped mononuclear phagocytes, caused by infectious and noninfectious agents. [NIH] Haplotypes: The genetic constitution of individuals with respect to one member of a pair of allelic genes, or sets of genes that are closely linked and tend to be inherited together such as those of the major histocompatibility complex. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts. [NIH] Hepatic: Pertaining to the liver. [EU] Hepatitis: Inflammation of the liver. [EU] Hepatocellular: Pertaining to or affecting liver cells. [EU] Hernia: (he protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [EU]
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Hoarseness: An unnaturally deep or rough quality of voice. [NIH] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hydration: The condition of being combined with water. [EU] Hyperbaric: Characterized by greater than normal pressure or weight; applied to gases under greater than atmospheric pressure, as hyperbaric oxygen, or to a solution of greater specific gravity than another taken as a standard of reference. [EU] Hyperkinesia: Abnormally hyperactivity. [EU]
increased
motor
function
or
activity;
Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU] Hypersecretion: Excessive secretion. [EU] Hypersensitivity: A state of altered reactivity in which the body reacts with an exaggerated immune response to a foreign substance. Hypersensitivity reactions are classified as immediate or delayed, types I and IV, respectively, in the Gell and Coombs classification (q.v.) of immune responses. [EU] Hypertension: High blood pressure (i.e., abnormally high blood pressure tension involving systolic and/or diastolic levels). The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure defines hypertension as a systolic blood pressure of 140 mm Hg or greater, a diastolic blood pressure of 90 mm Hg or greater, or taking hypertensive medication. The cause may be adrenal, benign, essential, Goldblatt's, idiopathic, malignant PATE, portal, postpartum, primary, pulmonary, renal or renovascular. [NIH] Hypodermic: Applied or administered beneath the skin. [EU] Hysterectomy: The operation of excising the uterus, performed either through the abdominal wall (abdominal h.) or through the vagina (vaginal h.) [EU] Idiopathic: Results from an unknown cause. [NIH] Idiosyncrasy: An abnormal susceptibility to some drug, protein, or other agent which is peculiar to the individual. [EU] Immunity: The condition of being immune; the protection against infectious disease conferred either by the immune response generated by immunization or previous infection or by other nonimmunologic factors
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(innate i.). [EU] Immunization: Protection from disease by administering vaccines that induce the body to form antibodies against infectious agents. [NIH] Immunogenetics: A branch of genetics which deals with the genetic basis of the immune response. [NIH] Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection. [NIH] Incontinence: Inability to control excretory functions, as defecation (faecal i.) or urination (urinary i.). [EU] Indapamide: A sulfamyl diuretic with about 16x the effect of furosemide. It has also been shown to be an effective antihypertensive agent in the clinic. [NIH]
Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infarction: 1. the formation of an infarct. 2. an infarct. [EU] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: Response of the body tissues to injury; typical signs are swelling, redness, and pain. [NIH] Infusion: The therapeutic introduction of a fluid other than blood, as saline solution, solution, into a vein. [EU] Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]
Inhalation: The drawing of air or other substances into the lungs. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Interferons: Proteins secreted by vertebrate cells in response to a wide variety of inducers. They confer resistance against many different viruses, inhibit proliferation of normal and malignant cells, impede multiplication of intracellular parasites, enhance macrophage and granulocyte phagocytosis, augment natural killer cell activity, and show several other
Glossary 389
immunomodulatory functions. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intramuscular: Within the substance of a muscle. [EU] Intravascular: Within a vessel or vessels. [EU] Intravenous: Within a vein or veins. [EU] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Ipratropium: A muscarinic antagonist structurally related to ATROPINE but often considered safer and more effective for inhalation use. It is used for various bronchial disorders, in rhinitis, and as an antiarrhythmic. [NIH] Irritants: Drugs that act locally on cutaneous or mucosal surfaces to produce inflammation; those that cause redness due to hyperemia are rubefacients; those that raise blisters are vesicants and those that penetrate sebaceous glands and cause abscesses are pustulants; tear gases and mustard gases are also irritants. [NIH] Isoetharine: Adrenergic beta-2 agonist used as bronchodilator for emphysema, bronchitis and asthma. [NIH] Isoproterenol: Isopropyl analog of epinephrine; beta-sympathomimetic that acts on the heart, bronchi, skeletal muscle, alimentary tract, etc. It is used mainly as bronchodilator and heart stimulant. [NIH] Isoxsuprine: A beta-adrenergic agonist that causes direct relaxation of uterine and vascular smooth muscle. Its vasodilating actions are greater on the arteries supplying skeletal muscle than on those supplying skin. It is used in the treatment of peripheral vascular disease and in premature labor. [NIH]
Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH] Kava: Dried rhizome and roots of Piper methysticum, a shrub native to Oceania and known for its anti-anxiety and sedative properties. Heavy usage results in some adverse effects. It contains alkaloids, lactones, kawain, methysticin, mucilage, starch, and yangonin. Kava is also the name of the pungent beverage prepared from the plant's roots. [NIH]
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Kerosene: A refined petroleum fraction used as a fuel as well as a solvent. [NIH]
Ketoprofen: An ibuprofen-type anti-inflammatory analgesic and antipyretic. It is used in the treatment of rheumatoid arthritis and osteoarthritis. [NIH] Ketorolac Tromethamine: A pyrrolizine carboxylic acid derivative structurally related to indomethacin. It is a non-steroidal anti-inflammatory agent used for analgesia for postoperative pain and inhibits cyclooxygenase activity. [NIH] Ketotifen: A cycloheptathiophene that interferes with the release of inflammatory mediators and blocks histamine H1 receptors. It has been proposed as an anti-asthmatic and for the treatment of rhinitis, skin allergies, and anaphylaxis. [NIH] Laryngectomy: Total or partial excision of the larynx. [NIH] Laryngitis: Inflammation of the larynx, a condition attended with dryness and soreness of the throat, hoarseness, cough and dysphagia. [EU] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Lavage: To wash the interior of a body organ. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Leukotrienes: A family of biologically active compounds derived from arachidonic acid by oxidative metabolism through the 5-lipoxygenase pathway. They participate in host defense reactions and pathophysiological conditions such as immediate hypersensitivity and inflammation. They have potent actions on many essential organs and systems, including the cardiovascular, pulmonary, and central nervous system as well as the gastrointestinal tract and the immune system. [NIH] Levobunolol: A nonselective beta-adrenoceptor antagonist used in the treatment of glaucoma. [NIH] Lip: Either of the two fleshy, full-blooded margins of the mouth. [NIH] Lipoxygenase: An enzyme of the oxidoreductase class that catalyzes reactions between linoleate and other fatty acids and oxygen to form hydroperoxy-fatty acid derivatives. Related enzymes in this class include the arachidonate lipoxygenases, arachidonate 5-lipoxygenase, arachidonate 12lipoxygenase, and arachidonate 15-lipoxygenase. ec 1.13.11.12. [NIH] Liquifilm: A thin liquid layer of coating. [EU]
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Lithotripsy: The destruction of a calculus of the kidney, ureter, bladder, or gallbladder by physical forces, including crushing with a lithotriptor through a catheter. Focused percutaneous ultrasound and focused hydraulic shock waves may be used without surgery. Lithotripsy does not include the dissolving of stones by acids or litholysis. Lithotripsy by laser is lithotripsy, laser. [NIH] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH]
Malaise: A vague feeling of bodily discomfort. [EU] Meclizine: A histamine H1 antagonist used in the treatment of motion sickness, vertigo, and nausea during pregnancy and radiation sickness. [NIH] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medicament: A medicinal substance or agent. [EU] MEDLARS: A computerized biomedical bibliographic storage and retrieval system operated by the National Library of Medicine. From it a monthly and cumulated Index Medicus is generated and through it the online system, MEDLINE, as well as many other databases, is operated. [NIH] Mefenamic Acid: A non-steroidal anti-inflammatory agent with analgesic, anti-inflammatory, and antipyretic properties. It is an inhibitor of cyclooxygenase. [NIH] Membrane: Thin, flexible film of proteins and lipids that encloses the contents of a cell; it controls the substances that go into and come out of the cell. Also, a thin layer of tissue that covers the surface or lines the cavity of an organ. [NIH] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Menopause: The cessation of menstruation in the human female, which begins at about the age of 50. [NIH] Metabolite: process. [EU]
Any substance produced by metabolism or by a metabolic
Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Metolazone: A potent, long acting diuretic useful in chronic renal disease. It
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also tends to lower blood pressure and increase potassium loss. [NIH] Metoprolol: Adrenergic beta-1-blocking agent with no stimulatory action. It is less bound to plasma albumin than alprenolol and may be useful in angina pectoris, hypertension, or cardiac arrhythmias. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microorganism: A microscopic organism; those of medical interest include bacteria, viruses, fungi and protozoa. [EU] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Motility: The ability to move spontaneously. [EU] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucus: A thick fluid produced by the lining of some organs of the body. [NIH]
Myalgia: Pain in a muscle or muscles. [EU] Nadolol: A non-selective beta-adrenergic antagonist with a long half-life, used in cardiovascular disease to treat arrhythmias, angina pectoris, and hypertension. Nadolol is also used for migraine and for tremor. [NIH] Naproxen: An anti-inflammatory agent with analgesic and antipyretic properties. Both the acid and its sodium salt are used in the treatment of rheumatoid arthritis and other rheumatic or musculoskeletal disorders, dysmenorrhea, and acute gout. [NIH] Nasal: Pertaining to the nose. [EU] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Necrosis: The sum of the morphological changes indicative of cell death and caused by the progressive degradative action of enzymes; it may affect groups of cells or part of a structure or an organ. [EU] Neostigmine: A cholinesterase inhibitor used in the treatment of myasthenia gravis and to reverse the effects of muscle relaxants such as gallamine and tubocurarine. Neostigmine, unlike physostigmine, does not cross the blood-brain barrier. [NIH] Nervousness: Excessive excitability and irritability, with mental and physical unrest. [EU] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Neuroleptic: A term coined to refer to the effects on cognition and behaviour of antipsychotic drugs, which produce a state of apathy, lack of initiative, and limited range of emotion and in psychotic patients cause a
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reduction in confusion and agitation and normalization of psychomotor activity. [EU] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrophil: Having an affinity for neutral dyes. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nickel: Nickel. A trace element with the atomic symbol Ni, atomic number 28, and atomic weight 58.69. It is a cofactor of the enzyme urease. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nitrofurantoin: A urinary anti-infective agent effective against most grampositive and gram-negative organisms. Although sulfonamides and antibiotics are usually the agents of choice for urinary tract infections, nitrofurantoin is widely used for prophylaxis and long-term suppression. [NIH]
Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Oedema: The presence of abnormally large amounts of fluid in the intercellular tissue spaces of the body; usually applied to demonstrable accumulation of excessive fluid in the subcutaneous tissues. Edema may be localized, due to venous or lymphatic obstruction or to increased vascular permeability, or it may be systemic due to heart failure or renal disease. Collections of edema fluid are designated according to the site, e.g. ascites (peritoneal cavity), hydrothorax (pleural cavity), and hydropericardium (pericardial sac). Massive generalized edema is called anasarca. [EU] Ophthalmic: Pertaining to the eye. [EU] Osteoarthritis:
Noninflammatory degenerative joint disease occurring
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chiefly in older persons, characterized by degeneration of the articular cartilage, hypertrophy of bone at the margins, and changes in the synovial membrane. It is accompanied by pain and stiffness. [NIH] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Otitis: Inflammation of the ear, which may be marked by pain, fever, abnormalities of hearing, hearing loss, tinnitus, and vertigo. [EU] Otolaryngology: A surgical specialty concerned with the study and treatment of disorders of the ear, nose, and throat. [NIH] Otorhinolaryngology: That branch of medicine concerned with medical and surgical treatment of the head and neck, including the ears, nose and throat. [EU]
Outpatients: Persons who receive ambulatory care at an outpatient department or clinic without room and board being provided. [NIH] Ovalbumin: An albumin obtained from the white of eggs. It is a member of the serpin superfamily. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU] Oxygenation: To provide with oxygen. [NIH] Pacemaker: An object or substance that influences the rate at which a certain phenomenon occurs; often used alone to indicate the natural cardiac pacemaker or an artificial cardiac pacemaker. In biochemistry, a substance whose rate of reaction sets the pace for a series of interrelated reactions. [EU] Paediatric: Of or relating to the care and medical treatment of children; belonging to or concerned with paediatrics. [EU] Palpation: Application of fingers with light pressure to the surface of the body to determine consistence of parts beneath in physical diagnosis; includes palpation for determining the outlines of organs. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the islets of langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH]
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Pancrelipase: A preparation of hog pancreatic enzymes standardized for lipase content. [NIH] Panniculitis: An inflammatory reaction of the subcutaneous fat, which may involve the connective tissue septa between the fat lobes, the septa lobules and vessels, or the fat lobules, characterized by the development of single or multiple cutaneous nodules. [EU] Paralysis: Loss or impairment of motor function in a part due to lesion of the neural or muscular mechanism; also by analogy, impairment of sensory function (sensory paralysis). In addition to the types named below, paralysis is further distinguished as traumatic, syphilitic, toxic, etc., according to its cause; or as obturator, ulnar, etc., according to the nerve part, or muscle specially affected. [EU] Parity: The number of offspring a female has borne. It is contrasted with gravidity, which refers to the number of pregnancies, regardless of outcome. [NIH]
Particle: A tiny mass of material. [EU] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Pelvic: Pertaining to the pelvis. [EU] Penicillin G: A penicillin derivative commonly used in the form of its sodium or potassium salts in the treatment of a variety of infections. It is effective against most gram-positive bacteria and against gram-negative cocci. It has also been used as an experimental convulsant because of its actions on GABA mediated synaptic transmission. [NIH] Penicillin V: A broad-spectrum penicillin antibiotic used orally in the treatment of mild to moderate infections by susceptible gram-positive organisms. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perennial: Lasting through the year of for several years. [EU] Perfusion: The passage of fluid through an organ. [NIH] Perinatal: Pertaining to or occurring in the period shortly before and after
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birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Perphenazine: An antipsychotic phenothiazine derivative with actions and uses similar to those of chlorpromazine. [NIH] Phagocytosis: Endocytosis of particulate material, such as microorganisms or cell fragments. The material is taken into the cell in membrane-bound vesicles (phagosomes) that originate as pinched off invaginations of the plasma membrane. Phagosomes fuse with lysosomes, forming phagolysosomes in which the engulfed material is killed and digested. [EU] Pharmacists: Those persons legally qualified by education and training to engage in the practice of pharmacy. [NIH] Pharmacokinetics: The action of drugs in the body over a period of time, including the processes of absorption, distribution, localization in tissues, biotransformation, and excretion. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharmacotherapy: A regimen of using appetite suppressant medications to manage obesity by decreasing appetite or increasing the feeling of satiety. These medications decrease appetite by increasing serotonin or catecholamine—two brain chemicals that affect mood and appetite. [NIH] Phenobarbital: A barbituric acid derivative that acts as a nonselective central nervous system depressant. It promotes binding to inhibitory gaba subtype receptors, and modulates chloride currents through receptor channels. It also inhibits glutamate induced depolarizations. [NIH] Phenotype: The entire physical, biochemical, and physiological makeup of an individual as determined by his or her genes and by the environment in the broad sense. [NIH] Phenytoin: An anticonvulsant that is used in a wide variety of seizures. It is also an anti-arrhythmic and a muscle relaxant. The mechanism of therapeutic action is not clear, although several cellular actions have been described including effects on ion channels, active transport, and general membrane stabilization. The mechanism of its muscle relaxant effect appears to involve a reduction in the sensitivity of muscle spindles to stretch. Phenytoin has been proposed for several other therapeutic uses, but its use has been limited by its many adverse effects and interactions with other drugs. [NIH] Phonation: The process of producing vocal sounds by means of vocal cords vibrating in an expiratory blast of air. [NIH] Pilocarpine: A slowly hydrolyzed muscarinic agonist with no nicotinic effects. Pilocarpine is used as a miotic and in the treatment of glaucoma. [NIH]
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Piroxicam: 4-Hydroxy-2-methyl-N-2-pyridyl-2H-1,2-benzothiazine-3carboxamide 1,1-dioxide. A non-steroidal anti-inflammatory agent that is well established in the treatment of rheumatoid arthritis and osteoarthritis. Its usefulness has also been demonstrated in the treatment of musculoskeletal disorders, dysmenorrhea, and postoperative pain. Its long half-life enables it to be administered once daily. The drug has also been shown to be effective if administered rectally. Gastrointestinal complaints are the most frequently reported side effects. [NIH] Plague: An acute infectious disease caused by yersinia pestis that affects humans, wild rodents, and their ectoparasites. This condition persists due to its firm entrenchment in sylvatic rodent-flea ecosystems throughout the world. Bubonic plague is the most common form. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Postnatal: Occurring after birth, with reference to the newborn. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Prenatal: Occurring before birth. [NIH] Preoperative: Preceding an operation. [EU] Prevalence: The number of events, e.g., instances of a given disease or other condition, in a given population at a designated time. When used without qualification, the term usually refers to the situation at specific point in time (point prevalence). Prevalence is a number, not a rate. [NIH] Progressive: Increasing in severity. [NIH] Prophylaxis: The prevention of disease; preventive treatment. [EU] Propoxyphene: A narcotic analgesic structurally related to methadone. Only the dextro-isomer has an analgesic effect; the levo-isomer appears to exert an antitussive effect. [NIH] Propranolol: A widely used non-cardioselective beta-adrenergic antagonist. Propranolol is used in the treatment or prevention of many disorders including acute myocardial infarction, arrhythmias, angina pectoris, hypertension, hypertensive emergencies, hyperthyroidism, migraine, pheochromocytoma, menopause, and anxiety. [NIH]
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Prostaglandins: A group of compounds derived from unsaturated 20carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Pruritus: 1. itching; an unpleasant cutaneous sensation that provokes the desire to rub or scratch the skin to obtain relief. 2. any of various conditions marked by itching, the specific site or type being indicated by a modifying term. [EU] Psoriasis: A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis. [NIH] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Psychopharmacology: The study of the effects of drugs on mental and behavioral activity. [NIH] Psychophysiology: The study of the physiological basis of human and animal behavior. [NIH] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]
Pulmonary: Relating to the lungs. [NIH] Quackery: The fraudulent misrepresentation of the diagnosis and treatment of disease. [NIH] Quercetin: Aglucon of quercetrin, rutin, and other glycosides. It is widely distributed in the plant kingdom, especially in rinds and barks, clover blossoms, and ragweed pollen. [NIH] Radiotherapy: The treatment of disease by ionizing radiation. [EU] Radon: Radon. A naturally radioactive element with atomic symbol Rn, atomic number 86, and atomic weight 222. It is a member of the noble gas
Glossary 399
family and released during the decay of radium and found in soil. There is a link between exposure to radon and lung cancer. [NIH] Ramipril: A long-acting angiotensin-converting enzyme inhibitor. It is a prodrug that is transformed in the liver to its active metabolite ramiprilat. [NIH]
Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Recombinant: 1. a cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Reflux: A backward or return flow. [EU] Refractory: Not readily yielding to treatment. [EU] Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] Remission: A diminution or abatement of the symptoms of a disease; also the period during which such diminution occurs. [EU] Respiration: Process of exchanging oxygen from the air for carbon dioxide from the body; includes the mechanical process of breathing, gas exchange, and oxygen and carbon dioxide transport to and from the cells. [NIH] Respiratory: Pertaining to respiration. [EU] Rheumatoid: Resembling rheumatism. [EU] Rheumatology: A subspecialty of internal medicine concerned with the study of inflammatory or degenerative processes and metabolic derangement of connective tissue structures which pertain to a variety of musculoskeletal disorders, such as arthritis. [NIH] Rhinitis: Inflammation of the mucous membrane of the nose. [EU] Rhinorrhea: The free discharge of a thin nasal mucus. [EU] Rhinovirus: A genus of picornaviridae inhabiting primarily the respiratory tract of mammalian hosts. It includes the human strains associated with common colds. [NIH] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It
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occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Salicylates: The salts, esters of salicylic acids, or salicylate esters of an organic acid. Some of these have analgesic, antipyretic, and antiinflammatory activities by inhibiting prostaglandin synthesis. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Sarcoidosis: An idiopathic systemic inflammatory granulomatous disorder comprised of epithelioid and multinucleated giant cells with little necrosis. It usually invades the lungs with fibrosis and may also involve lymph nodes, skin, liver, spleen, eyes, phalangeal bones, and parotid glands. [NIH] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Sedative: 1. allaying activity and excitement. 2. an agent that allays excitement. [EU] Sedentary: 1. sitting habitually; of inactive habits. 2. pertaining to a sitting posture. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Sensitization: 1. administration of antigen to induce a primary immune response; priming; immunization. 2. exposure to allergen that results in the development of hypersensitivity. 3. the coating of erythrocytes with antibody so that they are subject to lysis by complement in the presence of homologous antigen, the first stage of a complement fixation test. [EU] Sertraline: A selective serotonin uptake inhibitor that is used in the treatment of depression. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU]
Glossary 401
Sirolimus: A macrolide compound obtained from Streptomyces hygroscopicus that acts by selectively blocking the transcriptional activation of cytokines thereby inhibiting cytokine production. It is bioactive only when bound to immunophilins. Sirolimus is a potent immunosuppressant and possesses both antifungal and antineoplastic properties. [NIH] Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spices: The dried seeds, bark, root, stems, buds, leaves, or fruit of aromatic plants used to season food. [NIH] Spirometry: Measurement of volume of air inhaled or exhaled by the lung. [NIH]
Sputum: Matter ejected from the lungs, bronchi, and trachea, through the mouth. [EU] Stasis: A word termination indicating the maintenance of (or maintaining) a constant level; preventing increase or multiplication. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulant: 1. producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. an agent or remedy that produces stimulation. [EU] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood
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flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Sublingual: Located beneath the tongue. [EU] Sulfites: Inorganic salts of sulfurous acid. [NIH] Sulindac: A sulfinylindene derivative whose sulfinyl moiety is converted in vivo to an active anti-inflammatory analgesic that undergoes enterohepatic circulation to maintain constant blood levels without causing gastrointestinal side effects. [NIH] Sunburn: An injury to the skin causing erythema, tenderness, and sometimes blistering and resulting from excessive exposure to the sun. The reaction is produced by the ultraviolet radiation in sunlight. [NIH] Surfactant: A fat-containing protein in the respiratory passages which reduces the surface tension of pulmonary fluids and contributes to the elastic properties of pulmonary tissue. [NIH] Surgical: Of, pertaining to, or correctable by surgery. [EU] Sympathetic: 1. pertaining to, caused by, or exhibiting sympathy. 2. a sympathetic nerve or the sympathetic nervous system. [EU] Symptomatic: 1. pertaining to or of the nature of a symptom. 2. indicative (of a particular disease or disorder). 3. exhibiting the symptoms of a particular disease but having a different cause. 4. directed at the allying of symptoms, as symptomatic treatment. [EU] Symptomatology: 1. that branch of medicine with treats of symptoms; the systematic discussion of symptoms. 2. the combined symptoms of a disease. [EU]
Syphilis: A contagious venereal disease caused by the spirochete treponema pallidum. [NIH] Systemic: Relating to a process that affects the body generally; in this instance, the way in which blood is supplied through the aorta to all body organs except the lungs. [NIH] Tachycardia: Excessive rapidity in the action of the heart; the term is usually applied to a heart rate above 100 per minute and may be qualified as atrial, junctional (nodal), or ventricular, and as paroxysmal. [EU] Tachyphylaxis: 1. rapid immunization against the effect of toxic doses of an extract or serum by previous injection of small doses. 2. rapidly decreasing response to a drug or physiologically active agent after administration of a few doses. [EU] Tacrolimus: A macrolide isolated from the culture broth of a strain of Streptomyces tsukubaensis that has strong immunosuppressive activity in vivo and prevents the activation of T-lymphocytes in response to antigenic or mitogenic stimulation in vitro. [NIH]
Glossary 403
Terbutaline: A selective beta-2 adrenergic agonist used as a bronchodilator and tocolytic. [NIH] Thermoregulation: Heat regulation. [EU] Thiothixene: A thioxanthine used as an antipsychotic agent. Its effects are similar to the phenothiazine antipsychotics. [NIH] Thoracic: Pertaining to or affecting the chest. [EU] Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [NIH]
Thromboxanes: Physiologically active compounds found in many organs of the body. They are formed in vivo from the prostaglandin endoperoxides and cause platelet aggregation, contraction of arteries, and other biological effects. Thromboxanes are important mediators of the actions of polyunsaturated fatty acids transformed by cyclooxygenase. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tonsillitis: Inflammation of the tonsils, especially the palatine tonsils. [EU] Topical: Pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. [EU] Toxic: Pertaining to, due to, or of the nature of a poison or toxin; manifesting the symptoms of severe infection. [EU] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Tremor: An involuntary trembling or quivering. [EU] Triamterene: A pteridine that is used as a mild diuretic. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Trustees: Board members of an institution or organization who are entrusted with the administering of funds and the directing of policy. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of mycobacterium. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ubiquinone: A lipid-soluble benzoquinone which is involved in electron
404 Asthma
transport in mitochondrial preparations. The compound occurs in the majority of aerobic organisms, from bacteria to higher plants and animals. [NIH]
Ulcer: A local defect, or excavation, of the surface of an organ or tissue; which is produced by the sloughing of inflammatory necrotic tissue. [EU] Ulceration: 1. the formation or development of an ulcer. 2. an ulcer. [EU] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Urinary: Pertaining to the urine; containing or secreting urine. [EU] Urticaria: Pathology: a transient condition of the skin, usually caused by an allergic reaction, characterized by pale or reddened irregular, elevated patches and severe itching; hives. [EU] Uveitis: An inflammation of part or all of the uvea, the middle (vascular) tunic of the eye, and commonly involving the other tunics (the sclera and cornea, and the retina). [EU] Vaccine: A suspension of attenuated or killed microorganisms (bacteria, viruses, or rickettsiae), administered for the prevention, amelioration or treatment of infectious diseases. [EU] Vasculitis: Inflammation of a vessel, angiitis. [EU] Vecuronium Bromide: Monoquaternary homolog of pancuronium. A nondepolarizing neuromuscular blocking agent with shorter duration of action than pancuronium. Its lack of significant cardiovascular effects and lack of dependence on good kidney function for elimination as well as its short duration of action and easy reversibility provide advantages over, or alternatives to, other established neuromuscular blocking agents. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Ventilation: The process of exchange of air between the lungs and the atmosphere leading to exchange of gases in the blood. [NIH] Ventricular: Pertaining to a ventricle. [EU] Vertebral: Of or pertaining to a vertebra. [EU] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH] Warfarin: An anticoagulant that acts by inhibiting the synthesis of vitamin K-dependent coagulation factors. Warfarin is indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, pulmonary
Glossary 405
embolism, and atrial fibrillation with embolization. It is also used as an adjunct in the prophylaxis of systemic embolism after myocardial infarction. Warfarin is also used as a rodenticide. [NIH] Wheezing: Breathing with a rasp or whistling sound; a sign of airway constriction or obstruction. [NIH] Xanthines: Purine bases found in body tissues and fluids and in some plants. [NIH]
General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna
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Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg, M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna
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A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinterna
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Dorland’s Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna
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Dorland’s Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna
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Dorland’s Pocket Medical Dictionary (Dorland’s Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna /103-4193558-7304618
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Melloni’s Illustrated Medical Dictionary (Melloni’s Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna
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Stedman’s Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna
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Stedman’s Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN: 068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupinterna
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Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co, ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna
Index 407
INDEX A Abdominal.......58, 59, 130, 162, 168, 378, 381, 387, 394 Abortion .......................................101, 375 Absenteeism..........................................96 Acetylcholine .......................140, 149, 393 Adenosine....................115, 139, 179, 375 Adolescence ....38, 87, 106, 154, 375, 395 Adrenergic ......37, 96, 116, 119, 123, 125, 127, 135, 149, 237, 376, 378, 384, 389, 392, 397, 403 Agonist....16, 95, 116, 119, 161, 237, 238, 262, 376, 389, 393, 396, 403 Airways .....11, 14, 15, 50, 69, 87, 97, 125, 129, 133, 135, 137, 138, 146, 181, 379 Albuterol ................................96, 116, 376 Alimentary....................................237, 389 Alleles ..........................................128, 132 Allergen ....67, 70, 73, 108, 111, 112, 119, 144, 147, 258, 382, 400 Alveoli ......................................50, 58, 383 Analogous............................................136 Anaphylaxis .................168, 237, 376, 390 Anemia ..........................................68, 200 Antiarrhythmic......................140, 237, 389 Antibiotic ................70, 150, 238, 395, 401 Antibodies..............38, 128, 253, 258, 388 Anticholinergic .....127, 136, 207, 262, 380 Anticonvulsant .....................140, 186, 396 Antifungal.....................................239, 401 Antigen .36, 106, 119, 123, 128, 148, 376, 391, 400 Antihistamine .......................................249 Antioxidant...................................111, 144 Antiviral ........................................235, 375 Anxiety.........118, 132, 149, 248, 389, 397 Apnea ....................................................47 Appendicitis .........................................164 Arrhythmia ...........................146, 377, 378 Arrhythmogenic ...................................140 Artery .............................57, 160, 376, 378 Ascites .........................................149, 393 Assay...................................................136 Asthenia...............................................130 Atopic.....................70, 111, 122, 128, 320 Auricular ..............................................254 Autonomic............140, 146, 149, 375, 393 B Basophils .............................................129 Beclomethasone....................................80 Bronchiolitis .........................................133
Bronchitis ... 125, 133, 154, 166, 236, 237, 383, 389 Bronchoconstriction ............ 125, 139, 321 Bronchodilator...... 71, 119, 237, 249, 389, 403 Bronchoscope ......................... 69, 87, 379 Bronchoscopy ....................................... 69 Bronchospasm .... 113, 125, 128, 142, 319 Budesonide ......................................... 175 C Capsules ............................................. 317 Carbohydrates .................... 160, 314, 379 Cardiac..... 37, 39, 59, 117, 146, 149, 236, 237, 377, 382, 383, 384, 392, 394, 401 Cardiovascular ... 118, 127, 237, 239, 390, 392, 404 Causal................................................... 79 Cell....... 36, 47, 67, 88, 89, 111, 117, 118, 133, 149, 161, 165, 200, 343, 376, 382, 384, 385, 388, 391, 392, 393, 396, 399 Cholesterol....... 39, 50, 58, 160, 314, 316, 380, 383, 401 Chromans ........................................... 130 Chromosomal ............................... 97, 123 Chronotherapy ............ 114, 116, 262, 380 Collapse ................................ 37, 125, 376 Comorbidity......................................... 251 Concomitant........................ 100, 137, 144 Conduction.......................................... 140 Confounding ....................................... 101 Confusion.............................. 60, 133, 393 Congestion.................. 144, 147, 178, 382 Constipation ........................................ 164 Contractility ......................................... 134 Corticosteroids ...... 96, 107, 135, 176, 181 Croup .................................................. 164 Cytokines ............................ 111, 239, 401 D Decompensation ................... 96, 117, 382 Decongestant.............................. 129, 137 Degenerative ...... 150, 161, 315, 393, 399 Dermatitis.............................. 37, 111, 383 Desquamation..................................... 135 Diarrhea ...................... 130, 144, 164, 314 Digestion 36, 39, 147, 162, 376, 383, 395, 401 Dilate................................................... 248 Dizziness..................................... 130, 144 Dyspepsia ................................... 130, 144 Dysplasia ............................................ 200 Dyspnea.............. 117, 139, 236, 382, 383
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E Eclampsia ............................................101 Edema .......37, 117, 128, 135, 142, 149, 382, 383, 393 Efficacy .......76, 87, 95, 97, 114, 129, 141, 206, 250, 251, 252, 255, 256, 383 Effusion................................................138 Electrocardiogram .................................68 Emphysema....46, 49, 125, 133, 154, 166, 237, 389 Endometriosis......................................384 Endotoxin...............................................73 Enzyme ......118, 130, 148, 238, 390, 393, 399 Eosinophils ..........129, 130, 136, 138, 247 Epidemic..............106, 156, 193, 194, 321 Epinephrine .........116, 149, 375, 380, 393 Epithelium............................133, 135, 143 Expiration.............................................125 Extracellular...........................................70 Extravasation.......................................134 F Fatigue...................................58, 144, 377 Fetus....................................195, 315, 375 Fibrosis ..........61, 114, 165, 168, 380, 400 G Gastrointestinal.......37, 38, 118, 130, 239, 342, 379, 384, 385, 390, 402 Gels .........................................21, 38, 386 Glucose .......................155, 161, 386, 388 H Heparin ..................................................68 Hoarseness ...................38, 168, 381, 390 Hormones ...37, 39, 58, 89, 117, 260, 380, 381, 382, 399, 401 Hyperbaric .....................................59, 387 Hypersecretion ....................................138 Hypersensitivity ....36, 118, 119, 133, 147, 376, 382, 390, 400 Hypertension ....... 59, 101, 117, 149, 237, 383, 387, 392, 397 I Idiopathic .........................59, 61, 387, 400 Immunity ..............................................133 Immunization .......59, 119, 148, 150, 387, 388, 400, 402 Immunotherapy....................134, 147, 382 Indicative .........88, 89, 126, 132, 392, 402 Induction ..............................................140 Infarction..............130, 149, 186, 397, 405 Infiltration .....................................135, 143 Ingestion ......60, 125, 128, 131, 133, 317, 397 Inhalation .......60, 68, 125, 128, 133, 138, 237, 389, 397 Insulin ..........................155, 161, 386, 388
Intermittent .................................. 122, 129 Interstitial............................. 134, 168, 380 Intrinsic............................ 4, 125, 131, 141 Irritants .............. 34, 38, 72, 125, 132, 389 K Kerosene............................................... 22 L Larynx ................................... 38, 161, 390 Lavage .................................................. 69 Lesion ........................... 59, 365, 386, 395 Leukotrienes ....... 112, 129, 131, 141, 145 Lipoxygenase...... 118, 130, 138, 144, 390 Lupus .................................................. 154 M Mediator .............................................. 131 Membrane.... 61, 148, 161, 162, 186, 343, 384, 390, 392, 394, 396, 399 Meningitis.................................... 161, 391 Menopause ................................. 149, 397 Metabolite ........................... 239, 317, 399 Methionine .......................................... 128 Microbiology................................ 160, 378 Molecular 72, 88, 120, 191, 197, 199, 386, 399, 403 Mucosa 38, 128, 135, 137, 142, 148, 391, 392 Mucus ..... 107, 119, 128, 135, 137, 138, 399 Myalgia................................................ 130 N Nasal..... 38, 119, 137, 144, 178, 391, 399 Nausea........ 130, 144, 236, 237, 382, 391 Necrosis .................................. 61, 70, 400 Neural ................................. 315, 365, 395 Neuronal ............................................. 140 Neurotransmitter ...... 115, 138, 146, 147, 149, 342, 375, 379, 385, 393 Niacin .................................................. 315 Nitrofurantoin .............................. 238, 393 Norepinephrine ... 116, 127, 149, 375, 393 O Oedema .............................................. 138 Osteoarthritis ...... 236, 237, 385, 390, 397 Ovalbumin........................................... 320 Overdose ............................................ 315 Oxidation............................................. 131 Oxygenation........................................ 137 P Pacemaker.......................... 140, 149, 394 Palpation ............................. 118, 249, 394 Pancreas..................................... 161, 388 Paralysis ..................................... 365, 395 Particle .................................................. 71 Pathogenesis .......... 71, 81, 123, 137, 158 Pathophysiology ........... 47, 108, 129, 175 Pelvic .................................... 61, 384, 398
Index 409
Percutaneous ................................60, 391 Perennial .....................................129, 137 Perinatal ................................................80 Phagocytosis .......................161, 320, 388 Pharmacokinetics ................................262 Pharmacologic.......................76, 235, 376 Plague .................................................397 Pneumonia ............................................47 Potassium............237, 238, 316, 392, 395 Predisposition ......................................122 Prevalence....... 35, 38, 95, 97, 100, 105, 106, 129, 135, 140, 195, 259, 397 Progressive....................................88, 392 Prophylaxis ..................186, 238, 393, 404 Propranolol ..........................................142 Prostaglandins.............................130, 140 Psoriasis ......................130, 144, 150, 398 Psychology ..........................................112 Q Quercetin .............................................249 R Radon ............................................61, 399 Reagent ...............................................136 Receptor .......70, 96, 107, 116, 123, 128, 129, 139, 236, 238, 377, 385, 396 Reflux ..................................................177 Regurgitation .................................38, 386 Remission............................................248 Respiration ......................39, 58, 377, 399 Rheumatoid .......144, 154, 236, 237, 238, 385, 390, 392, 397 Rhinitis .......102, 137, 144, 146, 178, 207, 237, 253, 259, 379, 380, 389, 390 Rhinorrhea...........................................253 Riboflavin.............................................314 S Saliva .....................................................21 Sarcoidosis ..........................................184 Secretion ....... 89, 95, 122, 128, 135, 139, 147, 236, 258, 385, 387, 400 Sedative...............118, 127, 236, 381, 389 Seizures.......................186, 207, 396, 400 Selenium..............................111, 248, 316 Sertraline .............................................127 Serum ............98, 119, 128, 150, 400, 402 Sneezing..............................................253 Species .....37, 58, 61, 136, 138, 150, 381, 384, 401, 403 Spectrum .....................133, 145, 238, 395 Sphincter .......................39, 161, 390, 401 Spirometry .............................97, 101, 252
Sputum........................................ 133, 258 Stasis .................................................. 255 Steroid............. 15, 89, 106, 180, 260, 399 Stimulant ..................................... 237, 389 Stomach............................ 13, 37, 59, 385 Sulfites ................................................ 125 Surfactant............................................ 108 Surgical ................................. 38, 343, 394 Sympathetic ... 43, 61, 116, 146, 149, 375, 393, 402 Symptomatic ..... 89, 106, 125, 195, 251, 402 Symptomatology ................................. 100 Systemic .... 37, 61, 70, 96, 141, 149, 186, 376, 384, 393, 400, 405 T Tachycardia ........................................ 140 Thermoregulation................................ 314 Thoracic ................................................ 46 Threonine............................................ 128 Thromboxanes .................................... 130 Thyroxine ............................................ 316 Tonsillitis ............................................. 164 Topical ........................................ 162, 403 Toxic .. 119, 129, 150, 151, 161, 235, 249, 315, 365, 378, 393, 395, 400, 402, 403 Transplantation ..................................... 51 Tremor ................................ 200, 237, 392 Tricyclic ............................... 116, 261, 377 Tuberculosis...................... 38, 46, 47, 391 Tyrosine .............................................. 136 U Ubiquinone.......................................... 139 Ulcer............................................ 169, 404 Urinary ........ 160, 238, 320, 382, 388, 393 Urticaria................. 37, 137, 207, 376, 380 Uveitis ................................................. 140 V Vaginal .......................................... 59, 387 Vein....................... 68, 148, 169, 388, 389 Ventilation ................................... 139, 248 Ventricular........................... 140, 150, 402 Vertebral ..................................... 248, 249 Viral............. 123, 125, 146, 235, 375, 379 Viruses ... 39, 60, 107, 160, 161, 377, 388, 392, 404 W Wheezing ..... 15, 50, 131, 133, 136, 139, 172 X Xanthines ............................................ 141
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