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Asthma by Mind Map: Asthma
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Asthma

Asthma is a common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Common symptoms include wheezing, coughing, chest tightness, and shortness of breath. Asthma is thought to be caused by a combination of genetic and environmental factors. Its diagnosis is usually based on the pattern of symptoms, response to therapy over time, and spirometry. It is clinically classified according to the frequency of symptoms, forced expiratory volume in one second, and peak expiratory flow rate. Asthma may also be classified as atopic or non-atopic where atopy refers to a predisposition toward developing type 1 hypersensitivity reactions. Treatment of acute symptoms is usually with an inhaled short-acting beta-2 agonist and oral corticosteroids. In very severe cases, intravenous corticosteroids, magnesium sulfate, and hospitalization may be required. Symptoms can be prevented by avoiding triggers, such as allergens and irritants, and by the use of inhaled corticosteroids. Long-acting beta agonists or leukotriene antagonists may be used in addition to inhaled corticosteroids if asthma symptoms remain uncontrolled. The prevalence of asthma has increased significantly since the 1970s. In 2011, 235–300 million people globally have been diagnosed with asthma, and it caused 250,000 deaths.

Safety net practice-based research network

METHOD: asthma kits, educational materials, peak flow meters for patients, training for staff, templates for practice-level systems

Exposure

What exposure factors contribute to the prevalence of asthma?

Individual level

Proximity to central roads, proximity to truck traffic related to asthma prevalence

Season, Altitude, Temperature, humidity, weather, rainfall, most hospital admissions during WINTER

Exposure to farm milk and stables increases resistance to asthma, associated with hygiene hypothesis

Population level

Air Pollution, Nitrogen Dioxide (NO2), had been found to be the most associated, Sulphur Dioxide (SO2), Carbon monoxide (CO), particulate matter less than 2.5 microns in diameter, Ozone (O3)

Pollen

Intervention

Personal asthma management

self-monitoring, The Cochrane Central Register of Controlled Trials (CENTRAL) Issue 4, 2008, mobile phone self-monitoing yields same results as paper-based, and not effective

At school

Controling school bus operations

Increasing Compliance

Address reasons for noncompliance

Attitudes of mothers

Can be measured with a CHRONIC DISEASE COMPLIANCE INSTRUMENT

Media Alerts

The media engagement framework is a strategic construct used by marketing professionals to understand the behavior of social media marketing-based audiences. The media engagement framework consists of the definitions of personas (Individuals, Consumers and Influencers), referenced by the competitive set or constraint that applies to that persona and the measurement framework that might be applied to those personas. It is referenced first at the center of the marketing process diagram, surrounded by the marketing functions of strategy, tactics, metrics and ROI. The marketing process diagram describes how the media engagement framework can apply to any strategic marketing activity but was developed to establish a completely integrated framework describing how both traditional and social media marketing activities can be planned, executed, measured and improved. The media engagement framework provides a strategic planning construct in which measurements and metrics play a crucial role...

can be effective in changing activities outdoors

Hospital

The goal in this approach is to reduce hospital readmissions

Train asthma nurse specialists: socially appropriate asthma care (patient's education, motivation, cultural beliefs), MEASUREMENT: hospital re-admissions; absences from school/work

Establishment of individualized asthma self-management plans

Community

Compliance to National Asthma Education and Prevention Program guidelines for clinical care, MEASUREMENT: asthma severity in the community

Role of community health workers: fostering communication between patient and health team; educating patient and parent; conducting home visits

Asthma Resource Center, MEASUREMENT: Questionnaire, METHOD: Randomized Controlled Trial

"Asthma Control Test" created for non-asthma specialists to treat a wide variety of asthma cases. The guidelines are based on asthma situation is Saudi Arabia

Air Quality Health Index developed in China from an already existing Air Health Index in Canada based on WHO standards

intervention involving masters-level training, empowering families and equipping them with asthma-management skills, shown to be highly effective

Omalizumab

Study showed the drug improved asthma control

MEASUREMENT: Exacerbations, Need for other medications

METHOD: randomized double-blind, placebo-controlled, parallel-group trial

Microbial Manipulation

Inducing maturation of immune function to develop defense against viral infection and to prevent allergic sensitization

METHOD: feeding of probiotics

Educational Programmes

METHOD: controlled clinical trials

Showed improved lung function, reduced absence in school, reduce in number of hospital visits, reduced number of possible disturbed nights

12 week Disease Management Program

Treatment guidelines for long-term disease control; self-management education

Asthama Drug Fund

International Union Against Tuberculosis and Lung Disease: save governments millions in costs

High quality generic drugs

proper distribution, upgrading equipment and local levels, regular training and monitoring of performances of health workers

Indoor

Descriptive

Endotoxins and asthma in school children, Levels of endotoxins were inversely related to the occurrence of asthma in children., exposure to endotoxins may have crucial role in development of tolerance against asthma

Cockroach allergy and morbidity among inner-city children with asthma, exposure to cockroach allergen does not necessarily translate to a reaction in the patient, cockroach allergen is a marker for poor housekeeping, lowering exposure is very important in asthma management and control

Indoor air pollution and childhood asthma, Young children spend most of their time indoors, Children with parents who smoke indoors were more likely to develop pulmonary complications, Study design, 3 test groups, Polyurethane covered blankets and pillows / carpets were treated with tannic acid, Decrease in mite allergens, Significant decrease in bronchal hyperactivity, Group two treated with acaricide, benzyl benzoate, No significant decrease, Placebo, No significant decrease

Intervention

Breath-Easy Home, Strategies, moisture-reduction features, enhanced ventilation system, minimized dust and off-gassing, Conclusions, large increase of asthma-free days, emergency visits decreased from 62% to 21%, Exposure to mold, rodents and moisture were reduced significantly

Home-based environmental intervention, Strategy, Educaton, Remediation of exposure to allergens and tobacco smoke, Conclusions, Decrease in allergens, Reduced complications, Fewer days with symptoms in the intervention group as compared to the control group

Outdoor

Tools for Measurement

Geographical Information Systems

Adult asthma and traffic exposure at residential address, workplace address, and self-reported daily time outdoor in traffic: A two-stage case-control study., Roads (total time spent in traffic)

Use of a total traffic count metric to investigate the impact of roadways on asthma severity: a case-control study., Used to create models for cases(attended emergency departments more than once) and controls (Attended emergency departments only once) and was compared to the length of roads for each area

Examining associations between childhood asthma and traffic flow using a geographic information system., exposure to traffic and its density in different areas, Used census data to obtain unemployed, childhood poverty, urban/rural conditions for each “block” in the area based on GIS

Comparative effectiveness of asthma interventions within a practice based research network, housing density, neighborhood quality of life, pollution sources, transportation and built environment elements, race/ethnicity, and household income

Use of Spirometers and other equipments

Home environmental intervention in inner-city asthma: a randomized controlled clinical trial, Home environmental inspection (house hold dust samples through vacuuming, housing condition, water damage, evidence of infestation), Air pollution in children’s room was evaluated using equipment, Behavioral and physical interventions through using air filters, allergen-proof mattresses, and extermination of infestations, Pricking of skin for allergen testing, Spirometers were used to measure human lung capacity

Effect of urbanisation on asthma, allergy and airways inflammation in a developing country setting., NOx concentrations

Indoor air pollution on nurseries and primary schools: impact on childhood asthma-- study protocol.

Effects of an Ambient Air Pollution Intervention and Environmental Tobacco Smoke on Children's Respiratory Health in Hong Kong, SO2 using UV fluorescent analyzers, NO2 using dual channel chemiluminescent analyzers, Total suspended particles using high volume samplers

Temporal association between hospital admissions for asthma in Birmingham and ambient levels of sulphur dioxide and smoke, Used british standard black smoke method to calculate particulate pollution: The British Standard definition for black smoke (BS 1747) is based on a non-gravimetric reflectance method in which air is sampled through a filter and the resulting blackening measured. A conversion from black smoke to mass equivalent was established in the United Kingdom in the 1960s, based on domestic coal smoke emissions, as that was the main source of emissions at that time.

Policy and System Change and Community Coalitions: Outcomes From Allies Against Asthma, Data sources used to document changes included the online tracking system employed by coalitions to document their activities, published articles by coalition staff and conveners reporting their work,11 annual coalition reports to the national program office and the funder, key informant interviews with stakeholders (n = 97) in the coalitions' communities (conducted by a contract organization), and periodic group interviews with coalition staff, members, and leaders (n = 116).

Prevalence of asthma and other allergic conditions in Colombia 2009-2010: a cross-sectional study., Immunoglobin E (IgE) Serum samples were shipped following cold-chain standards to the Institute for Immunological Research at the University of Cartagena where all laboratory analyses took place. For each sample, total IgE (tIgE) and allergen-specific IgE antibody (sIgE) assays against Dermatophagoides pteronyssinus and Blomia tropicalis were performed using ImmunoCap system (Phadia) and following the technical instructions of the manufacturer.

Can Guideline-defined Asthma Control Be Achieved? The Gaining Optimal Asthma Control Study, Use of salmeterol/fluticasone propionate (salmeterol/fluticasone; Seretide/Advair; GlaxoSmithKline, Middlesex, UK) with fluticasone propionate (fluticasone; Flixotide/Flovent; GlaxoSmithKline) in making measures of asthma control, Measured through the following asthma outcomes: PEF, rescue medication use, symptoms, night-time awakenings, exacerbations, emergency visits, and adverse events

Quality of asthma management in an urban community in Delhi, India, Used spirometers to diagnose bronchial asthma based on the Global Initiative for Asthma (GINA)

Indoor air pollution on nurseries and primary schools: impact on childhood asthma-- study protocol., IgE serum samples, spirometry

Use of questionnaires, interviews, etc.

Adult asthma and traffic exposure at residential address, workplace address, and self-reported daily time outdoor in traffic: A two-stage case-control study.

Effects of an Ambient Air Pollution Intervention and Environmental Tobacco Smoke on Children's Respiratory Health in Hong Kong, self-completed questionnaire

Home environmental intervention in inner-city asthma: a randomized controlled clinical trial, - Questionnaires about demographic, medical, psychological, and environmental factors, - Outcomes measured through clinical visits and symptoms present

Asthma control in Latin America: the Asthma Insights and Reality in Latin America (AIRLA) survey, Interviews and survey

Policy and System Change and Community Coalitions: Outcomes From Allies Against Asthma, Questionnaires(symptoms) used to assess (face-to-face), Used cohort design to compare those exposed to coalition activities and those not exposed

High School Students with Asthma: Attitudes about School Health, Absenteeism, and Its Impact On Academic Achievement., Survey to assess health services in school, Survey to measure level of asthma sickness

Temporal changes in the prevalence of childhood asthma and allergies in urban and rural areas of Cyprus: results from two cross sectional studies, ISAAC Core questionnaire for assessing asthma and allergy symptoms

Prevalence of asthma and other allergic conditions in Colombia 2009-2010: a cross-sectional study., Cross-section population based study (survey)

Effect of urbanisation on asthma, allergy and airways inflammation in a developing country setting., Questionnaires on asthma and allergy symptoms

Evaluation of impairment of health related quality of life in asthma: development of a questionnaire for use in clinical trials, Structured interviews, Both physical and emotional health should be measured., Items must reflect areas of function that are important to patients with asthma., Summary scores amenable to statistical analysis must be provided., The questionnaire should be responsive to clinically important changes, even if the changes are small., The questionnaire should be valid-that is, measure subjective aspects of health state., Considerations of cost and efficiency dictate that the questionnaire be short., The questionnaire should be capable of being administered by an interviewer or being self administered.

Tailored interventions based on exhaled nitric oxide versus clinical symptoms for asthma in children and adults(reveiw), The Cochrane Airways Group Specialised Register of Trials, MEDLINE (1966 to February 2009). Topic search strategy combined with the RCT search filter as outlined in the Airways Group module., OLDMEDLINE (1950 to 65). Topic search strategy combined with the RCT search filter as outlined in the Airways Group module., EMBASE (1980 to February 2009). Topic search strategy combined with the RCT search filter as outlined in the Airways Group module., The list of references in relevant publications., Written communication with the authors of trials included in the review., Studies included in the review underwent quality assessment and entered into Risk of Bias table.Four components were assessed, Adequate sequence generation., Allocation concealment., Blinding. Classified, Free of other bias.

Development and validation of a questionnaire to measure asthma control, Asthma Control Questionnaire, Include symptoms that asthma clinicians consider to be most important for assessing adequacy of asthma control, Include a measure of a) short-acting b2-agonist use and b) airway calibre, Be applicable to all adults with asthma (17±70 yrs), Be reliable (give reproducible data when the clinical state is stable and be able to discriminate between patients with different levels of asthma control), Be responsive (be sensitive to small but clinically important changes in asthma control), Be valid (actually measure asthma control)., Be short and easy to complete

Asthma control in the Asia-Pacific region: The asthma insights and reality in Asia-Pacific study, Survey, Interviews of about 45-60 minutes in the participant’s homes, Questionnaire based on American Thoracic Society Questionnaire

Comparative effectiveness of asthma interventions within a practice based research network, Focus group discussions, Mini Asthma Quality of Life Questionnaire (Mini-AQLQ) or Mini Pediatric Asthma Quality of Life Questionnaire (Mini-PAQLQ), the Asthma Therapy Assessment Questionnaire (ATAQ) and 2 additional five-point scale questions added by the research team

Global asthma prevalence in adults: findings from the cross-sectional world health survey, World health survey through standardized questionnaires(similar to ISAAC and ECRHS surveys)

Quality of asthma management in an urban community in Delhi, India, Information on quality of prior treatment, patients’ knowledge about asthma and quality of life was obtained by using three questionnaires administered by one of the authors, The two questionnaires, Asthma Knowledge and Asthma Quality of Treatment were developed on the basis of the GINA guidelines

Indoor air pollution on nurseries and primary schools: impact on childhood asthma-- study protocol., Questionnaires, Data from hospitals

hospital admissions

Population

Decrease the burden of asthma at a wide level while minimizing cost

Legislation and Policy

participation of the local and national government

Social Practice

information dissemination

Education in level of the community

Education for health care providers

training for professional

asthma listed as a significant cause of death

obtained from Center of epidemiology for medical causes of death

Other factors affecting Asthma

Sex

women are more likely to develop asthma than men AFTER puberty. before puberty, it is otherwise

Age

most severe cases associated with aging

education

lowest level of education is related to most severa asthma

Recommendation Compliance

work absences related to asthma greatest in the philippines due to not following international recommendations

work absences lowest in south korea because they follow standards