The emergency visit and management of asthma

Article Abstract:

The advice given to a patient about managing asthma should focus on achieving a particular outcome, and should be based on an understanding of the mechanisms underlying the disease process. Asthma is characterized by: desquamation, or shedding, of the epithelial cells lining the respiratory tract; blockage of the airways by a mucus-like secretion; and accumulation of various types of immune and inflammatory cells, including lymphocytes, eosinophils, basophils, and mast cells. Current treatment of asthma is focused on preventing bronchospasm, or contraction of the bronchi, by decreasing inflammation. In severe cases, the objective is to maintain anti-inflammatory treatment until the desquamated epithelium can regenerate itself. Although bronchodilators, which dilate the airways, have been used for 30 years to relieve symptoms, these agents do not prevent inflammation or decrease the rate of hospitalization. Corticosteroids are the most effective anti-inflammatory agents used to treat asthma. A recent study described a preventive approach using techniques of outpatient asthma management. This approach consists of intensive patient education, instruction on inhaler usage, self-management skills (particularly for the use of corticosteroids), and development of a crisis plan. This strategy of outpatient asthma management has reduced the rate of hospitalization but its effect on rate of death is not clear. Severe psychologic disorders were shown to increase the risk of death from asthma. The degree of bronchial inflammation associated with desquamation may be the main determinant of hospital admission after a sudden asthma attack. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Evaluation, Corticosteroids, Adrenocortical hormones, Antiasthmatic agents, editorial

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Gamma-delta T cells in asthma

Article Abstract:

Gamma-delta T cells may be central in the regulation of asthma, for good or bad. The finding of elevated levels of gamma-delta T cells in the lung fluid of asthma patients may lead to further study of their role in asthma and inflammation. T cells have two types of antigen receptors, of which gamma-delta is one. The gamma-delta T cells identify antigens differently than does the other T cell receptor. How the antigens activate gamma-delta T cells is unknown. Gamma-delta T cells have been found to be integral to ridding animals of infections, suggesting that their presence is needed for the immune system to work properly. Elevated levels of gamma-delta T cells in the lungs are unusual, so their role in asthma is unclear.

Editorial, Physiological aspects, T cells

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Observations on asthma mortality

Article Abstract:

Death from asthma is relatively rare, but a large percentage of those deaths might have been avoided with proper diagnosis and treatment. The primary cause of death seems related to the patient or doctor or both failing to recognize the severity of the attack or to treat it properly. Nearly half of deaths occurred in hospitals, but measurement of blood gases or lung function is infrequently done. In about 85% of all deaths, the illness lasts 12 hours or more, allowing time for treatment.

Services, Patient outcomes, Mortality, Hospitals, Asthmatics

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