1. plan
1.1. objectives briefly
1.2. introduction, definition, mechanism and history
1.2.1. definition
1.2.1.1. chronic disorder of the airways, characterized by variable reversible and recurring symptoms related to airflow obstruction, bronchial hyperresponsiveness, and an underlying inflammation
1.2.1.2. Asthma is a complex syndrome characterized by a state of airways hyperresponsiveness (AH) and caused by a multi-cellular inflammatory reaction that leads to airway obstruction
1.2.2. mechanisim
1.2.2.1. Recruitment and activation of mast cells, macrophages, antigen-presenting dendritic cells, neutrophils, eosinophils, and T lymphocytes result in an inflammatory and cellular infiltration of the airways
1.2.2.2. Type 2 T-helper cells (Th2) have a major role in the activation of the immune cascade that leads to the release of many mediators such as interleukins (IL)-3, IL-4, IL-5, IL-13,
1.2.2.2.1. early
1.2.2.2.2. late
1.2.3. history
1.2.3.1. 1- The Corpus Hippocraticum, by Hippocrates, is the earliest text where the word asthma is found as a medical term. We are not sure whether Hippocrates (460-360 BC) meant asthma as a clinical entity or as merely a symptom
1.2.3.2. 3- Galen (130-200 AD), an ancient Greek physician, wrote several mentions of asthma --He described asthma as bronchial obstructions and treated it with owl's blood in wine.
1.2.3.3. 7-At the beginning of the 20th century asthma was seen as a psychosomatic disease . During the 1930s to 1950s, asthma was known as one of the holy seven psychosomatic illnesses.
1.2.3.4. 8-Asthma, as an inflammatory disease, was not really recognized until the 1960s when anti-inflammatory medications started being used.
1.3. distributions
1.3.1. How common is the problem in the total population and in different sub-groups?
1.3.1.1. Nearly 8% of the US population suffers from asthma
1.3.2. prevalence of asthma
1.3.2.1. The prevalence of asthma has increased both in the United States and globally during the past 4 decades.
1.3.2.2. methadology
1.3.2.2.1. The most comprehensive data on asthma prevalence in the United States come from the National Health Interview Survey (NHIS), an ongoing US population- based disease-surveillance study conducted by the US Centers for Disease Control and Prevention National Center for Health Statistics. NHIS data are drawn from household interviews of a nationally representative sample of the civilian noninstitutionalized popula- tion. Information on asthma status in the NHIS was self-reported by individuals ages 18 years or older or collected from an adult family member for children younger than 18 years old. Data from the NHIS survey conducted from January to September 2005, the most recent time period for which data are available
1.3.2.3. asthma
1.3.2.3.1. at any age
1.3.2.3.2. male
1.3.2.3.3. female
1.3.2.4. asthma attack
1.3.2.4.1. defined as the proportion of indi- viduals with at least 1 asthma episode during the 12 1 months before the survey
1.3.2.4.2. Asthma-attack prevalence provides a crude gauge of the number of individuals who have uncontrolled asthma and are therefore at risk for poor outcomes, ex hospitalization
1.3.2.4.3. Overall, 4.2% of individuals of any age experienced at least 1 asthma episode during the 12 months before the sur- vey (Figure 2
1.3.2.5. prevalence in saudi arabia
1.3.2.5.1. Prevalence of allergic disorders among primary school-aged children in Madinah, Saudi Arabia: two-stage cross-sectional survey.
1.3.2.5.2. Asthma prevalence among 16- to 18-year-old adolescents in Saudi Arabia using the ISAAC questionnaire
1.3.2.5.3. Predictors of asthma severity during the pilgrimage to Mecca (Hajj).
1.3.2.5.4. The prevalence of aspirin-induced asthma in Saudian asthmatic patients.
1.3.2.5.5. The Saudi Initiative for asthma.
1.3.2.5.6. Pattern and risk factors associated with hospital emergency visits among schoolboys with bronchial asthma in Al-Khobar.
1.3.2.5.7. Schoolboys with bronchial asthma in Al-Khobar City, Saudi Arabia: are they at increased risk of school absenteeism?
1.3.2.5.8. Epidemiology of bronchial asthma among schoolboys in Al-Khobar city, Saudi Arabia: cross-sectional study.
1.3.2.6. globaly
1.3.3. statistics
1.3.3.1. Asthma was the reason for 13.9 million outpa- tient visits, or 492 outpatient visits per 10 000 people
1.3.3.2. Asthma was responsible for 1.9 million emer- gency department visits, or 67 per 10 000 peo- ple
1.3.3.3. Asthma was the reason for 484 000 hospitaliza- tions, or 17 per 10 000 people.
1.3.3.4. consider different gatagories
1.3.4. mortality
1.3.4.1. Asthma mortality has increased in the past 2 decades in western countries, including the United States.
1.3.4.2. 2002
1.3.4.3. asthma was the cause of 1.5 per 100 000 deaths in the United States
1.3.4.4. -differences in categories
1.3.5. childhood asthma
1.3.5.1. asthma is the most common chronic disease of childhood and the leading cause of hospitalizations in children.9,12
1.3.5.2. The peak incidence of asthma occurs during the first year of life, and 8 of 10 children who develop asthma expe- rience their first episode of wheezing before their third birthday
1.4. causes
1.4.1. What causes the problem?
1.5. prevention
1.5.1. How can the problem be prevented?
1.5.2. primary
1.5.3. secondry
1.5.4. tertiry
1.5.4.1. obesity and asthma prevention cohort study southren brazil
1.5.4.2. EDUCATIONAL INTERVENTIONS IN SCHOOL SETTINGS B
1.5.4.2.1. school-based asthma education programs can improve health and quality of life in students who have persistent asthma. Five controlled trials of education in schools for children who have asthma have shown reduced symptoms for children receiving asthma education
1.5.4.3. Home-Based Allergen-Control Interventions A
1.5.4.3.1. Eight controlled trials have evaluated allergen-control interventions that combined education for families about implementing allergen-control strategies with provision of tools and supplies needed to carry them out
1.6. management
1.6.1. What is the most appropriate management of the problem at individual system & population levels, and how can systems be continually improved?
1.7. evidnce based
1.7.1. How strong is the evidence about the distribution and cause of the problem, its prevention and its management?
1.8. societal effects or family
1.8.1. What are the effects of the problem (and its management) on, and in, society?
1.8.2. family
1.8.2.1. Asthma also affects the lives of family members who provide care for patients with asthma
1.8.2.2. In a study of children with persistent asthma and their caregivers, approximately 33% of caregivers missed work during the 12-month study because of their child’s asthma.6
1.8.2.2.1. The amount of work lost was strongly and negatively cor- related with the degree of asthma control as assessed by use of rescue medication, nocturnal symptoms, impairment of activities, and asthma crises. Caregivers of children with poorly controlled asthma were 8 times more likely to lose more than 5 days of work during the study period than caregivers of children with well-controlled asthma
1.8.3. economic cost of asthma
1.8.3.1. The annual economic cost of asthma in the United States is estimated at $14 billion, a value that includes both direct and indirect costs
1.8.3.2. Direct costs, or those associated with the delivery of healthcare
1.8.3.2.1. include com- ponents such as the cost of medications, hospitaliza- tions, emergency department visits, office visits, and medical tests and procedures
1.8.3.3. Indirect costs are those associated with illness-attributed lost or reduced pro- ductivity
1.8.3.4. Data from a cross-sectional survey of 401 adults with asthma drawn from a random samples of northern California pulmonologists, allergist-immu- nologists, and family practitioners suggest that lost workplace productivity and pharmaceuticals account for the majority of the economic costs of asthma.9 The total average annual cost of asthma per person was $4912
1.8.3.4.1. consider categories
1.9. personal effects
1.9.1. What are the personal effects of having the problem?
1.9.2. personal
1.9.2.1. Consistent with its chronicity and its manifesta- tions, including pulmonary-function impairment and symptoms of wheezing, cough, dyspnea, and chest tightness, asthma impairs patients’ well-being and can significantly interfere with the ability to undertake normal daily activities
1.9.2.2. Among those with at least 1 asthma attack in the previous year in the 2002 NHIS, asthma was responsible for 14.7 million missed school days in children 5 to 17 years old and 11.8 million missed workdays in adults 18 years and older
1.9.2.2.1. These data do not take into account the larger burden of presenteeism (ie, showing up for work but being unable to perform to standards
1.9.2.3. In 2003 to 2004, limitation of activity because of chronic health conditions was reported for 7% of children younger than 18 years in the United States.1 Among preschool children, asthma was a leading cause of activity limitation
1.9.2.3.1. Only speech problems and mental retardation were associated with greater activity limitation than asthma in this age group (Table 1).1
1.9.3. personal in childhood
1.9.3.1. Poorly controlled asthma is partic- ularly of concern in the growing child because it may impact emotional, intellectual, and physical develop- ment (eg, restricting children’s activities, such as run- ning, walking, and vocalizing, impairing children’s emotional health, and causing children to miss school or other intellectual or social activities).13,16-18 Poorly controlled asthma in childhood is also of concern because it may lead to more rapid progression of dis- ease and deterioration of pulmonary function than well-controlled asthma.13
1.9.4. in saudi
1.9.4.1. Socioclinical profile of children with asthma in Al-Majmaah Health Province.
1.9.4.1.1. aim
1.9.4.1.2. methodology
1.9.4.1.3. resualt
1.10. societal response
1.10.1. How does (and could) society respond to the problem?
1.11. take home massege and summry
1.12. resources
1.12.1. http://www.jhasim.com/files/articlefiles/pdf/GELFAND-%20Article1.pdf
1.13. DONT FORGET
1.13.1. scenario and areas of improvement
1.13.2. RESOURCES
2. others
2.1. assessment of the severity
3. distributions
3.1. How common is the problem in the total population and in different sub-groups?
3.1.1. Nearly 8% of the US population suffers from asthma
3.2. prevalence of asthma
3.2.1. globaly
3.2.1.1. There has been a sharp increase in the global prevalence, morbidity, mortality, and economic burden associated with asthma over the last 40 years, particularly in children.
3.2.1.2. Approximately 300 million people worldwide currently have asthma, and its prevalence increases by 50% every decade
3.2.1.3. The prevalence of asthma has increased both in the United States and globally during the past 4 decades.
3.2.2. methadology
3.2.2.1. Information on asthma status in the NHIS was self-reported by individuals ages 18 years or older or collected from an adult family member for children younger than 18 years old. Data from the NHIS survey conducted from January to September 2005, the most recent time period for which data are available
3.2.2.2. National Health Interview Survey (NHIS)
3.2.2.3. an ongoing US population- based disease-surveillance study conducted by the US Centers for Disease Control and Prevention National Center for Health Statistics.
3.2.3. asthma
3.2.3.1. at any age
3.2.3.1.1. show that 7.7% of individuals of any age in the United States currently have asthma (Figure 1).1 This prevalence rate exceeds that in the 2 preceding years (2003, 7.1%; 2004, 7.3%).
3.2.3.2. male
3.2.3.2.1. males, asthma prevalence was approximately twice as high in those 14 years old or younger (10.7%) than in patients 15 to 34 years old (5.2%) or those at least 35 years old (5.0%; Figure 1
3.2.3.3. female
3.2.3.3.1. females, asthma prevalence did not significant- ly vary by age (7.5% in patients 0–14 years old; 9.6% in patients 15–34 years old; 9.3% in those at least 35 years old; Figure 1)
3.2.4. prevalence in saudi arabia
3.2.4.1. Prevalence of allergic disorders among primary school-aged children in Madinah, Saudi Arabia: two-stage cross-sectional survey.
3.2.4.1.1. aim
3.2.4.1.2. methodology
3.2.4.1.3. resualt
3.2.4.2. Asthma prevalence among 16- to 18-year-old adolescents in Saudi Arabia using the ISAAC questionnaire
3.2.4.2.1. College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
3.2.4.2.2. aim
3.2.4.2.3. methodology
3.2.4.2.4. resualt
3.2.4.3. Epidemiology of bronchial asthma among schoolboys in Al-Khobar city, Saudi Arabia: cross-sectional study.
3.2.4.3.1. Department of Family & Community Medicine, King Faisal University
3.2.4.3.2. aim
3.2.4.3.3. methodology
3.2.4.3.4. conclusion
4. introduction, definition, mechanism and history
4.1. definition
4.1.1. chronic disorder of the airways, characterized by variable reversible and recurring symptoms related to airflow obstruction, bronchial hyperresponsiveness, and an underlying inflammation
4.1.2. Asthma is a complex syndrome characterized by a state of airways hyperresponsiveness (AH) and caused by a multi-cellular inflammatory reaction that leads to airway obstruction
4.2. history
4.2.1. 1- The Corpus Hippocraticum, by Hippocrates, is the earliest text where the word asthma is found as a medical term. We are not sure whether Hippocrates (460-360 BC) meant asthma as a clinical entity or as merely a symptom
4.2.2. 3- Galen (130-200 AD), an ancient Greek physician, wrote several mentions of asthma --He described asthma as bronchial obstructions and treated it with owl's blood in wine.
4.2.3. 7-At the beginning of the 20th century asthma was seen as a psychosomatic disease . During the 1930s to 1950s, asthma was known as one of the holy seven psychosomatic illnesses.
4.2.4. 8-Asthma, as an inflammatory disease, was not really recognized until the 1960s when anti-inflammatory medications started being used.
4.3. mechanisim
4.3.1. Recruitment and activation of mast cells, macrophages, antigen-presenting dendritic cells, neutrophils, eosinophils, and T lymphocytes result in an inflammatory and cellular infiltration of the airways
4.3.2. Type 2 T-helper cells (Th2) have a major role in the activation of the immune cascade that leads to the release of many mediators such as interleukins (IL)-3, IL-4, IL-5, IL-13,
4.3.2.1. early
4.3.2.1.1. MAST CELLS
4.3.2.2. late
4.3.2.2.1. eaosinophills