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Asthma and rhinitis during pregnancy.

Asthma and rhinitis during pregnancy.

Mt Sinai J Med. 2011 Sep;78(5):661-70

Authors: Namazy JA, Schatz M

Abstract
Pregnancy may be complicated by new-onset or preexisting rhinitis, or asthma. This article reviews the recognition and management of rhinitis and asthma during pregnancy, as well as general principles of medication use during pregnancy. Asthma is one of the most common potentially serious medical problems to complicate pregnancy, and chronic rhinitis is even more common in pregnant women. Both conditions may substantially affect maternal quality of life and directly or indirectly affect the pregnancy. Optimal management of asthma and rhinitis during pregnancy is thus important for both mother and baby. This article reviews the assessment and management of rhinitis and asthma in pregnant women. Mt Sinai J Med 78:661-670, 2011. © 2011 Mount Sinai School of Medicine.

PMID: 21913197 [PubMed - in process]

Ocular allergy.

Ocular allergy.

Mt Sinai J Med. 2011 Sep;78(5):740-58

Authors: Bielory L

Abstract
The eye is probably the most common site for the development of allergic inflammatory disorders, because it has no mechanical barrier to prevent the impact of allergens such as pollen on its surface. Physicians in various specialties and subspecialties who provide some form of primary care frequently encounter various forms of inflammation of the anterior surface of the eye that present as "red eye." However, the eye is rarely the only target for an immediate allergic-type response. Typically, many patients have other combinations of allergic disorders, such as rhinoconjunctivitis, rhinosinusitis, asthma, urticaria, or eczema. Even so, ocular signs and symptoms can frequently be the most prominent features of the entire allergic response for which a patient visits his or her physician. An improved differential diagnosis provides the basis for improved treatment algorithms. Over the past 20 years, we have witnessed an astonishing growth in therapeutic advances, ranging essentially from derivatives of simple aspirin to various newly developed biologic immunomodulatory agents, utilizing implantable drug-delivery devices that exceed the safety and efficacy of those available for other organ systems, and resorting to advanced surgical techniques for the correction of sight-threatening, disease-related complications. Overall, with the expanding knowledge base, the intricacy of ocular inflammation appears to be becoming ever more manageable and, with the team approach between the primary care physician, the ophthalmologist, and the clinical allergist/immunologist, the new "immuno-ophthalmology" approach improves patient outcomes. Mt Sinai J Med 78:740-758, 2011. © 2011 Mount Sinai School of Medicine.

PMID: 21913203 [PubMed - in process]

Role of Beta2 Agonists in Respiratory Medicine with Particular Attention to Novel Patents and Effects on Endocrine System and Immune Response.

Beta adrenergic receptors are very important in respiratory medicine. Traditionally, the stimulation of beta adrenergic receptors by beta2-agonists is commonly used for giving bronchodilation in chronic airflow obstruction However; the wide distribution of these receptors in cells and tissues other than airway smooth muscle suggests that beta agonists should offer other beneficial effects in respiratory disease.

Recent studies have shown the importance of these receptors in the modulation of endocrine and immune system that affect respiratory function and may decrease therapy effectiveness in asthma and chronic obstructive pulmonary disease.

New patented compound and uses have provided new insights in future therapeutics of respiratory diseases in which genetic, endocrine and immune response should be considered.

Leukotriene receptor antagonists as first line or add-on treatment for asthma.

Asthma is one of the most prevalent chronic diseases in children and adults. Despite effective drugs and evidence based guidelines, most people with asthma have suboptimal control, even in countries with free access to medical care and drugs. Several reasons may be at play.

To control asthma, a sequence of events must be successfully accomplished by patients and doctors, including patient awareness that symptoms are bad enough to seek medical care; adequate diagnosis and recognition of poor control by the doctor; accurate identification of the source of poor control (environmental triggers, adherence, inhalation technique, comorbidity, suboptimal treatment, or combinations thereof); appropriate adjustment of treatment if indicated; and sufficient patient adherence to both drug based and non-drug based recommendations. Any break in the sequence can lead to poor control.

Consequently, to assess the benefit of a drug, efficacy trials call for objective confirmation of the diagnosis, careful patient selection with regard to control and comorbidities, rigorous drug prescribing, and close monitoring of subjects, all of which result in higher drug use than typically seen in clinical practice.

Meta-analyses of efficacy trials have clearly confirmed the superiority of low dose inhaled corticosteroids over leukotriene receptor antagonists (LTRAs) given as monotherapy and of long acting β2 agonists over LTRAs as adjuncts to inhaled corticosteroids. 

Diagnostic Exercise Challenge Testing.

This article reviews the diagnostic challenge methods-both exercise and surrogate-for diagnosis of exercise-induced bronchoconstriction (EIB) and EIB with known asthma.

Indirect challenges that release the entire repertoire of mediators representative of EIB and asthma are more specific for diagnosis and are recommended over direct challenges such as methacholine challenge, which are sensitive but nonspecific. Self-reported history and empiric therapeutic trials are not adequate for diagnosis of EIB with or without known asthma. Objective pulmonary function documentation with bronchodilator reversibility or exercise or surrogate challenge are optimal for diagnosis of EIB or EIB with known asthma.

Such objective pulmonary function documentation is optimal for the proper management and healthy lifestyle of the exercising athlete or individual.

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