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Asthma Part 1 – A General Overview
Janet M. Beausoleil, MD, is an assistant professor of pediatrics at the University of Pennsylvania School of Medicine and attending physician at the Children’s Hospital of Philadelphia. Here, she discusses the epidemiology, pathophysiology, risk factors, and symptoms of asthma … the number one cause of hospitalization for children. Dr. Beausoleil wishes to disclosure that she has appeared as a speaker for GlaxoSmithKline and Merck. The pathophysiology of asthma is bronchoconstriction and mucosal inflammation and edema. Epidemiologically, its prevalence is increasing worldwide, says Dr Beausoleil, and it is the major cause of hospitalization for children. The chief risk factor, she says, is atopy, which can be demonstrated by elevated cord blood IgE, multiple positive skin tests, or a radioallergosorbent test. History taking includes asthma symptoms -- which can be perennial, seasonal, or perennial with seasonal exacerbation – and a family and social history; the latter being especially important in identifying such factors as tobacco smoke, presence of cockroaches and mice and domestic pets as asthma triggers. And viral respiratory infections are also common triggers. Differential diagnosis is extensive and may include respiratory syncytial virus, pertussis and mycoplasma. In an illustrated section on asthma management, the author cites the National Institutes of Health’s “Guidelines for the Diagnosis and management of Asthma” This classifies medications into those for quick relief as needed, and those for long-term control. Successful management includes an individualized self-monitoring plan involving when and how to take medications; and how to avoid allergens such as pets, pollen and molds. Therapeutic options include nebulizers, metered-dose inhalers, inhaled corticosteroids, and bronchodilators in asthma. The lecture concludes with advice on when to refer an asthmatic patient to an allergist or pulmonologist. |
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