ABC of Asthma E-Book

John Rees

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: ABC Series
• Sprache: Englisch

Seitenzahl: 236

Veröffentlichungsjahr: 2013

Beschreibung

Asthma is a common condition with increasing prevalence. This new edition of the highly regarded ABC of Asthma has been thoroughly revised with reference to the latest British Thoracic Society guidelines on the management of asthma in children and adults. It covers the advances in practice and methods, with a new emphasis on delivery systems, self-dose assessment and delivery of care with different pharmacological approaches.

The ABC of Asthma is a concise, up-to-date overview of all aspects of asthma and includes two new chapters focussing on GP practice issues including clinical management and organisation of asthma care. It is ideal for GPs, junior doctors and medical students, nurses, and anyone dealing with the treatment of asthma in children and adults.

Leseprobe

Contents

Preface

CHAPTER 1 Definition and Pathology

Labelling

Pathology

Types of asthma

CHAPTER 2 Prevalence

Genetics

Genetic studies

Future investigations

Early environment

Genetic factors and clinical course

Family history

Smoking in pregnancy

Weight control

Analgesics

Diagnostic criteria in epidemiological studies

Prevalence figures

Changes in prevalence

CHAPTER 3 Diagnostic Testing and Monitoring

Recording airflow obstruction

Use of diary cards

Written asthma action plans

Responsiveness to bronchodilators

Measuring reversibility

Further review

Peak flow variation

Diurnal variation

Nocturnal attacks

Exercise testing

Other types of challenge

Airway hyper-responsiveness

Degree of responsiveness

Specific airway challenge

Skin tests

Differential diagnosis in adults

Asthma and COPD

Non-asthmatic wheezing

Vocal cord dysfunction

Hyperventilation syndrome

Monitoring asthma control Peak expiratory flow

CHAPTER 4 Clinical Course

‘Growing out’ of asthma

Likelihood of remission

Adult height

Prognosis in adults

Deaths from asthma

Need for rapid response

Diurnal variation

Inpatient management

Morbidity

Patient education

CHAPTER 5 Precipitating Factors

Bronchial hyper-responsiveness

Exercise

Allergens at home

Cockroaches

Pollens and spores

Allergic bronchopulmonary aspergillosis

Occupational asthma

Drug-induced asthma

Emotional factors

Pollution

Asthma and pregnancy

CHAPTER 6 General Management of Chronic Asthma

Guidelines

General features

Asthma clinics

Aims of management

CHAPTER 7

β-agonists

Long-acting β-agonists

Anticholinergic bronchodilators

Methylxanthines

Mast cell stabilisers

Inhaled corticosteroids

Oral corticosteroids

Combined preparations

Leukotriene antagonists

Anti-IgE monoclonal antibody

Steroid-sparing agents

Future treatments

Immunotherapy

Alternative treatments

Chapter 8 General Management of Acute Asthma

Assessment of severity

Peak flow monitoring

Breathlessness

Seeking help

Examination

Chest sounds

Peak flow readings

Blood gases

Hypoxia and hypercapnia

Where to treat acute asthma

Initial treatment

Dangers of under-treatment

CHAPTER 9 Treatment of Acute Asthma

Introduction

Oxygen

β-agonists

Use and availability of nebulisers

Parenteral delivery

Anticholinergic agents

Methylxanthines

Corticosteroids

Oral delivery

Intravenous delivery

Length of steroid course

Magnesium

Fluid and electrolytes

Potassium supplements

Antibiotics

Controlled ventilation

Other factors

Discharge from hospital

Subsequent management

Hospital follow-up

CHAPTER 10 Methods of Delivering Drugs

Metered dose inhalers

Breath-actuated aerosol inhalers

Metered dose inhaler propellants

Spacer devices

Dry powder inhalers

Soft mist inhalers

Nebulisers

Tablets and syrups

Injections and infusions

CHAPTER 11 Definition, Prevalence and Prevention

Defining asthma in children

Public health issues

Reasons for the increasing global prevalence

The relevance of atopy

Lymphocytes

Early exposure to infections

Trigger factors in asthma

The domestic environment

Smoking

Air pollution

Intervention

Airway inflammation and hyper-responsiveness

CHAPTER 12 Patterns of Illness and Diagnosis

Wheezing in infancy

Respiratory tract infections

Progression of asthma from childhood to adolescence

Predictability

Results of studies

Teenagers with asthma

Sympathetic consultation

Diagnosis of asthma

Presentation

Hypersecretory asthma

Lung function and other tests

Labelling

Assessment of severity

Mild asthma

Moderate asthma

Severe asthma

CHAPTER 13 Treatment

Pharmacological management

Partnership in management

Changing the environment

House dust mite

CHAPTER 14 Pharmacological Therapies for Asthma

Inhaled short-acting β2-agomsts (bronchodilators)

Prophylactic agents

Inhaled corticosteroids

Dose

Methods of delivery

Adverse effects

Long-acting β2-agonists

Leukotriene receptor antagonists

Omalizumab

Magnesium

Theophyllines

Inhaler devices

Aerosols and powders

Spacers

Nebulisers

Choice of device

The future

CHAPTER 15 Acute Severe Asthma

Oxygen and dehydration

Steroids

Antibiotics

Stabilisation

Clinical signs to monitor severity and response to treatment

CHAPTER 16 Clinical Aspects of Managing Asthma in Primary Care

Background

Initial diagnosis

History

Examination

Diagnosis

Differential diagnosis

Management

Triggers

Referral to secondary care

Occupational asthma

Asthma, pregnancy and breastfeeding

Acute asthma

Life threatening

Severe attack

Moderate attack

Treatment of severe/moderate asthma

CHAPTER 17 Organisation of Asthma Care in Primary Care

The aim of asthma care

Asthma

Asthma register

Practice protocol

Initial assessment in asthma clinic

Personalised asthma plan

Review appointments

Compliance

Auditing asthma clinic

Criteria for referral to secondary care

Training and support

Index

This edition first published 2010, © 2010 byJohn Rees, Dipak Kanabar and Shriti PattaniPrevious editions: 1984, 1989, 1995, 2000, 2006

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Library of Congress Cataloging-in-Publication Data

Rees, John, 1949-

ABC of asthma/John Rees, Dipak Kanabar, Shriti Pattani. – 6th ed.

p.; cm.

Includes bibliographical references and index.ISBN 978-1-4051-8596-7

1. Asthma. I. Kanabar, Dipak. II. Pattani, Shriti. III. Title.[DNLM: 1. Asthma. WF 553R328a 2010]

RC591.R43 2006616.2'38 – dc22

2009029888

ISBN: 978-1-4051-8596-7

A catalogue record for this book is available from the British Library.

1 2010

Preface

The prevalence of asthma has increased over the past 20 years and it continues to be a common problem throughout the world. Considerable advances have been made in understanding the genetics, epidemiology and pathophysiology of asthma, new treatments have been devised and older treatments refined.

A small minority of patients have a form of asthma that is very difficult to control but the majority of patients can obtain very good control with standard medications. A number of studies have shown that many patients do not achieve this degree of control. Management of chronic conditions such as asthma is a partnership between patients, families and their doctors and nurses in primary care. This sixth edition of the ABC of Asthma deals with recent advances and also contains new chapters that deal with the management of asthma in general practice. We hope that it will help health professionals dealing with asthma and lead to real improvements in the lives of people with asthma.

John ReesDipak KanabarShriti Pattani

CHAPTER 1

Definition and Pathology

John Rees

Sherman Education Centre, Guy’s Hospital, London, UK

OVERVIEW

Asthma is an overall descriptive term but there are a number of more or less distinct phenotypes which may have different causes, clinical patterns and responses to treatmentThe clinical characteristic of asthma is airflow obstruction, which can be reversed over short periods of time or with treatmentIn the great majority of asthmatics, treatment is available to suppress asthma symptoms to allow normal activity without significant adverse effects