MLリソース：喘息リンク
このページには、[リンク＆リソース][主要サイト]を含む。
●リンク＆リソース
■喘息リンク～国内
●リンク集 喘息関連ホームページへのリンク from NIFTY-Serve すこやか村・喘息館(FSKYA) 喘息・アレルギーに関するリンク from 滋賀医大小児科アレルギー外来 Google Directory: 喘息 Google Directory: アレルギー
●学術団体～呼吸器 Respiratory Diseases ●日本気管食道科学会 - 日本気胸・嚢胞性肺疾患学会 -The Japan Society for Pneumothorax and Cystic Lung Diseases - [旧]日本気胸学会 - 自然気胸治療ガイドライン（案） - 「日本気胸・嚢胞性肺疾患学会雑誌」 - 「日本気胸・嚢胞性肺疾患学会総会」 ●日本胸部外科学会 -http://www.jpats.org/ - The Japanese Journal of THORACIC AND CARDIOVASCULAR SURGERY[年14回発行]～抄録公開・全文有料 - 第57回日本胸部外科学会定期学術集会[2004.10.20-22 札幌] - 第56回日本胸部外科学会総会[2003.11.19-21 東京]～プログラム公開 ●日本呼吸器学会 - [旧日本胸部疾患学会] 入会案内、専門医制度規則、市民公開講座の案内、臨床ガイドライン公開 - 日本呼吸器学会雑誌[月刊]ISSN1343-3490/ONLINE1345-9538～抄録公開・全文有償 - 学術講演会抄録検索～抄録公開 - ●日本呼吸器外科学会 - 第20回日本呼吸器外科学会総会[2003.5.8-9 東京] - 第21回日本呼吸器外科学会総会[2004.5.27-29 横浜] - 日本呼吸器内視鏡学会（旧 日本気管支学会） - 過去の学会プログラムの収録なし。 - 会誌「気管支学」[年６回]ISSN0287-2137～抄録公開(全文は有料) - 第27回日本呼吸器内視鏡学会総会[2004.6.2-3 大阪] - 日本呼吸療法医学会 - 日本小児呼吸器疾患学会 - 日本小児呼吸器疾患学会雑誌[年２回]～目次のみ -
●学術団体～肺 Lung 日本肺癌学会 - 過去の学会プログラムの収録なし。 会誌は、抄録公開 -
●主要サイト Japan Allergy and Asthma Network(JAA net) --- 東邦大学医学部付属佐倉病院内科の冨岡玖夫先生が提唱されているネットワーク オンラインぜんそく友の会 すこやか村・喘息館 on NIFTY SERVE - 喘息患者さんとそのご家族を対象としたフォーラムです。次の４つの掲示板から構成。 - 「ぜんそく最新情報」、「オンライン・ぜんそく友の会（フォーラム会員限定）」 、「喘息Ｑ＆Ａ（フォーラム会員限定）」、「自己紹介（フォーラム会員限定）」 日本喘息患者会連絡会[日喘連] - 現在３４都道府県４６喘息患者団体が加入 喘息を克服するためのホームページ - 「喘息ホットニュース」、「喘息とは」、「喘息大学」、「喘息治療の病院」 、「喘息デー」 滋賀医大小児科アレルギー外来 気管支喘息予防マニュアル Asthma Search in JAPAN = 日本語喘息全文検索エンジン = by 西藤こどもクリニック
■喘息リンク～海外
●リンク集 喘息関連ホームページへのリンク from NIFTY-Serve すこやか村・喘息館(FSKYA) 喘息・アレルギーに関するリンク from 滋賀医大小児科アレルギー外来 Google Directory: Asthma Google Directory: Allergy Google Directory: Rhinitis Google Directory: Bronchitis Yahoo! Health:Diseases and Conditions:Asthma --- Buteyko (3) --- Companies@ --- Organizations (11) Yahoo! Business and Economy:Companies:Health:Diseases and Conditions:Asthma --- Buteyko (5)
●学術団体～呼吸器 Respiratory Diseases ●行政機関 National Heart, Lung, and Blood Institute ●学会 International Association of Asthmology[INTERASMA] -http://www.interasma.org/ - by World Congress for Bronchology[WCB] [世界気管支学会議] - 13th World Congress for Bronchology[2004.6.20-23] -第13回世界気管支学会議 World Association for Bronchology [世界気管支学会] - Journal of Bronchology[季刊]ISSN1070-8030/Online ISSN1536-7959 ～抄録公開・全文有償 公式機関誌Edited by American Association for Bronchology[AAB] 公式機関誌Edited by [WAB] Published by Lippincott Williams and Wilkins American Academy of Allergy Asthma & Immunology[AAAAI] - http://www.aaaai.org/ ;米国アレルギー・喘息・免疫学会; 機関誌なし American College of Allergy, Asthma & Immunology[ACAAI] - Bulletins 機関誌 - "Annals of Allergy, Asthma & Immunology"[月刊]学術誌。 抄録・全文とも有料 American Association for Bronchology[AAB] - Journal of Bronchology[季刊]ISSN1070-8030/Online ISSN1536-7959 ～抄録公開・全文有償 公式機関誌Edited by American Association for Bronchology[AAB] 公式機関誌Edited by [WAB] Published by Lippincott Williams and Wilkins European Respiratory Society[ERS] -http://www.ersnet.org/ American Thoracic Society ●関連団体 Asthma and Allergy Foundation of America European Federation of Asthma and Allergy Associations[EFA] - http://www.efanet.org/ ; 欧州喘息・アレルギー学会連合; 23か国41学会参加 Asthma Society of Canada - 1974設立。 患者啓蒙・喘息研究
●[Lung] 肺 ●学会 American Lung Association Canadian Lung Association
●主要サイト World Network of Asthma Organizations（WNAO）
Global Initiative for Asthma（GINA）
National Asthma Campaign,UK --- イギリスのナショナル・アズマ・キャンペーンのホームページです。 National Asthma Campaign(NAC in Australia) --- オーストラリアのNACはイギリスのNACと並んで、世界でも指折りの団体。 International Asthma Council(IAC) Lung Line Allergy and Asthma Network / Mothers of Asthmatics［※←URL変更］ --- "Mothers of Asthmatics"はアメリカで喘息の子どもを持つ母親の会 alt.support.asthma FAQ: Asthma Medications --- 喘息の治療薬情報 Doctor's Guide to the Internet - Asthma - A guide to asthma-related information and resources
■アレルギーリンク～国内
●リンク集 Yahoo! - ホーム:健康と医学:病気、症状:アレルギー --- アトピー性皮膚炎(65) --- 化学物質過敏症@ --- 花粉症(51) --- 企業@ --- 研究機関(3) --- 食物アレルギー(2) --- 団体(3) --- ラテックスアレルギー@ アレルギー疾患 総合リンク集 - アトピー性皮膚炎、アレルギー性鼻炎、花粉症等、アレルギー疾患についての総合リンク集。 [健康新聞社]/改善へのヒント(癒し=ヒーリング、ハーブ、アロマテラピー) /関連の最新News Ｑ＆Ａ/基礎知識（総合情報） /アレルギー反応を起こす原因物質「アレルゲン」 改善へのヒント(食事) /改善へのヒント(住環境) /改善へのヒント(衣料・化粧品など) 症状・症例など /体験談 /治療法 /検査法 /医療関係者へ参考疫学 非常時におけるアレルギー医療体制 /治療病院情報 /医療相談コーナー /関連の患者団体・友の会
●学術団体～アレルギー Allergy ●日本アレルギー学会 - 過去の総会抄録検索可。 - ｢アレルギー｣[月刊]～抄録公開[2002-]、全文有償 - 総会抄録検索[発行から90日間までは、会員のみの閲覧] - 第53回日本アレルギー学会総会[秋季][2003.10.23-25] - 第15回日本アレルギー学会総会[春季][2003.5.12-14] 日本小児アレルギー学会 - 日本小児アレルギー学会誌」[年間５回]～WEB非公開 -
●主要サイト 日本アレルギー協会 Japan Allergy and Asthma Network(JAA net) --- 東邦大学医学部付属佐倉病院内科の冨岡玖夫先生が提唱されているネットワーク ★製薬会社 アスゲン製薬 - 同社の製品紹介とともに、ぜんそくや花粉症についてのQ&Aを掲載。 あなたを悩ますアレルギー その原因と対策 - 地域別、時期別花粉情報やアレルゲン一覧、アレルギー性結膜疾患の解説、各地の花粉情報へのリンク等。参天製薬による。 花粉症上手なつきあい方 - 原因とその治療法、予防、日常生活での留意点等、武田薬品工業による解説。 ★患者団体 希望の会（のぞみのかい）…国立小児病院アレルギー科受診中のアレルギーを持つ患児の親の会 化学物質過敏症患者の会 - 化学物質が原因と考えられる疾患に苦しむ人々の会。症例や対処の工夫点等も掲載。 食物アレルギーの子を持つ親の会 川崎病の子供をもつ親の会(臨時窓口) アトピーなんか飛んで行け！の会 アトピー・メイクフレンズの会 NPO日本アレルギー友の会 愛知ぜんそく大学 在宅酸素療法(HOT)患者会 オンラインぜんそく友の会 ★メーリングリスト 日本語アレルギーメーリングリスト - 参加、脱会方法等。 ★食物アレルギー 食物アレルギーの子を持つ親の会 -食物アレルギーやアナフィラキシーに関する情報。料理スタッフによる活動報告、レシピ一覧も。 ★花粉症 スギ花粉症のかたへ(川崎耳鼻咽喉科クリニックHomePage) 喘息・花粉症Ｑ＆Ａ(監修:医学博士・水野勝之氏、アスゲン製薬HomePage) 慈恵医大耳鼻科花粉症のページ [*] - 花粉症に対する適切な治療を行うことができるよう患者や医師、研究者に向けた情報を提供。 花粉症対策友の会 - 会報誌「ポラン」のページ。花粉症の予防、対策、花粉症グッズ等の紹介。 森の贈り物 花粉症特集 - 花粉症の原因から対処法までを専門家の意見も交えて紹介。 花粉症と上手につきあうためのＱ＆Ａ(参天製薬HomePage・監修：獨協医科大学眼科教授 小暮文雄氏) 花粉症(全薬工業株式会社) 花粉症のうんちく(情報提供：敬順堂薬局 杉本道信氏) スギ花粉症(かわい耳鼻咽喉科ホームページ) ★アトピー性皮膚炎 アトピー情報COSMOSネット
アトピー性皮膚炎の患者に中立の立場で情報を提供しようと作られたネットワークです。 非常時アトピー・アレルギー医療支援ネットワーク 震災などの際にアトピー性皮膚炎で困っているこども達に救援の手をさしのべようと企画されたネットワークです。 よしだこどもクリニック [*] - アトピー性皮膚炎の治療法や食生活に関連する情報、保険のきかない治療法等を詳しく解説。 A-Community - アトピー患者間の情報交換、交流の場。 ARK NET - 岡山から発信される健康と美容に関する情報。健康食品や基礎化粧品の案内とアトピーに関する一般的情報など。 atonet - 成人型アトピーとの闘病の体験記。ステロイドの罪について。 atopippi - アトピーに関する情報や食事献立つきの入院日記、コラム、関連リンク集、掲示板。 Atopy Drive with Keiichi Mizushima - アトピー性皮膚炎の治療講座を開いています。 BM企画 - アトピー肌とニキビ肌用「強酸性水」の紹介。 Dear Mam - 不妊症やアトピー性皮膚炎に関する情報やチャットルーム、漢方相談等を掲載。 Its ATPOS - ATPOS(アトピー患者と家族の会)のページ。アトピー性皮膚炎で悩んでいる人々との情報交換の場。 megu's homepage - 作者の体験を生かした女性のためのアトピー対策情報。 QP Net - アレルギー、アトピー皮膚炎情報のネットワーク。患者からの意見、情報をもとにアドバイス。 Sabbath - アトピーに関する情報交換。スキンケアについて等。 SHUMARI's Home Page - 体験的アトピー性皮膚炎治療の過程、アマチュア無線、自己紹介等。 アトピー/アトピー性皮膚炎 - ボランティアで指導しているアトピー性皮膚炎改善入浴液の作り方を紹介。 アトピー・ネットワーク・リボーン - 医師と患者のネットワーク。機関誌の発行、フォーラムの案内等。 アトピー・ステロイド情報センター - 活動内容の案内、機関誌の紹介等。 アトピー・ステロイドとの決別 - 希望の和 - ステロイドの薬害に苦しんで来た仲間の闘病記とカラー写真、アトピーと決別した体験談等を掲載。 アトピー患者交流メーリングリスト - 患者同志の交流を目指した情報交換が目的。 アトピー患者によるアトピー患者のためのページ - アトピー患者によるアトピー患者のためのページ。ステロイド外用剤に言及。 アトピー情報COSMOSネット - アトピー患者と医療機関とメーカーを結ぶ情報ネットワーク アトピー情報局 - 筆者の体験談。民間療法やアトピー対策について。 アトピースケッチ - 皮膚科医から見たアトピー性皮膚炎に関するエッセイ集。 アトピー性皮膚炎の新知見 - 皮膚に悪影響を与える因子、水道水中の塩素について皮膚科専門医が言及。 アトピー性皮膚炎の治し方 - アトピー性皮膚炎の温泉治療の紹介や、実例などを掲載。アトピーを防ぐためのアドバイスなども提供。 アトピー治療アシストシステム - 脱アトピー理論とそれに基づく治療法について。 アトピーとステロイドと裁判と - 筆者のアトピー歴、川崎ステロイド裁判、関連書籍や民間療法について。 アトピーなんか飛んで行け! の会 - アトピー経験者達が作ったボランティアの会。活動案内や治療情報等。 アトピー撲滅委員会 - 人間の体の仕組みとアトピーについて、関連ニュースや筆者の考え等。 アトピーマガジン - アトピーに苦しむ人のコミュニケーション、専門情報誌。アトピーの原因と対策、ステロイドからの脱却、アトピー体操などを紹介。 アトピーを治そう - 脱ステロイドを始めてからの経過、水治療の方法、リバウンドについて。 アレルギー自然療法研究所 - 水療法、自然療法によるアレルギー疾患治療を紹介。 アトピー改善情報LINK集 金太郎 - アトピー改善を目的にした治療施設や療養施設、体験談、対策食品、支援団体他のリンク集。プレゼントコーナーも。 木ノ花咲クヤヒメのスケッチブック - アトピーの子どもを持つ作者が発信する心と体の密接な関係、食の話題、専門家の情報等。 くらしの発明、電気と趣味、アトピーのｐａｇｅ - アトピーと仲良く暮らす方法を、体験に基づきアドバイス。 けむまき大学アトピー学科 - 学生によるアトピー闘病記。 脱ステロイド、温泉療法等について。 ケント倶楽部 - アトピーに関する情報及び対策方法について掲載。食物、スキンケア、ダニ/花粉/カビ対策等を掲載。 自然農法 - アトピーの子どもたちと自然農法による農業の話題。 芝皮フ科クリニック - アトピー性皮膚炎の治療法、医療レーザー治療、医院紹介等。 神経情報血液循環研究所 - 新聞掲載のクローン病の疾患原因の解明と治療法。 大ちゃんのお家 - アレルギー基礎知識や我が子のアトピー事情、掲示板、リンク集等。 高山家 - 成人アトピー性皮膚炎とステロイドのリバウンドで白内障を患い、現在医薬品副作用被害救済・研究振興調査機構に申請中 の作者が、アトピーに関する情報を提供。 たちかFamily - 娘のアトピー歴や日記、生活法、食事、書籍案内、リンク集等。 脱アトピー宣言 - 加世田皮膚科医院院長によるアトピーケア商品紹介、無料相談、Q&A掲示板等。 鶴町皮フ科クリニック - アトピー性皮膚炎専門のクリニック。非ステロイド剤や水道水の塩素等を除去する原因療法で治療。 泣き虫ママと呼ばせない! - 2人の子供を抱え悪戦苦闘する毎日の日記、エッセイ、こだわりの「アトピーっ子生活術」等。 西原ワールド - 東京大学医学博士・西原克成による、ガン、アトピー、難病の情報。医学生から医師、歯科医など 医療に携わる人、生物学や工学、進化論に関心のある学生に情報を提供。 典子ママのあとぴらんど - 生後1ヶ月からアトピーになった男の子とその家族の体験記。 非常時アトピー・アレルギー医療支援ネットワーク - 災害時にアレルギー患者を医療面で支援するボランティアネット。 僕のアトピーのはなし - アトピーになってからの症状や、パイロゲンを飲んで全快するまでの経過の報告。 まつのホームページ - 動物、ジャズ、演劇、ラジオ、パソコン、アトピーに関する話題。MIDIファイル、ムービーファイルあり。 まみちゃんのアトピーメール - 無料配信メールの案内、アトピーに関する掲示板、治療体験記。 ももたろう倶楽部 - 食物アレルギー、アトピー、ぜんそくの治療、体験、学習を掲載。 よくなったよ! 重症アトピー - 重症アトピー患者のSOD内服療法とその結果について。 わがままこざるのあとぴー奮戦記！ - アトピー歴30年の筆者の体験談、心境。 私のアトピー克服体験談 - 作者の経験に基づいた、アトピーの症状、治療法等の案内。 ～アトピー性皮膚炎の話～(札幌市でむら小児科クリニック 出村守氏) 小児期アトピー性疾患の考え方(アレルギー・マーチ、食物抗原など…すずき小児科内科クリニックHomePage) アトピー性皮膚炎治療の講義(水島圭一内科医院HomePage) アトピー治療情報(川村さん一家のホームページ)
■アレルギーリンク～海外
●リンク集 Yahoo! Home : Health : Diseases and Conditions :Allergies●［アレルギー］ --- Anaphylactic Shock@ --- Books@ --- Companies@ --- Food Allergies@ --- Institutes (3) --- Latex Allergies@ --- Multiple Chemical Sensitivity@ --- Organizations (9) --- Poison Ivy, Oak, and Sumac@
●学術団体～アレルギー Allergy ●行政機関 National Institute of Allergy and Infectious Diseases - http://www.niaid.nih.gov/; NIHのもう一つの喘息関連サイト ●学会 World Allergy Organisation[WAO-IAACI] -http://www.worldallergy.org/; 世界各国のアレルギー学会を傘下とする国際団体; 旧IAACI - Allergy & Clinical Immunology International[年６回]ISSN0838-1925～抄録公開・全文有償 - http://www.acii.net/ by Hogrefe & Huber Publishers - International Archives of Allergy and Immunology(Int Arch Allergy Immunol)[年12回]ISSN1018-2438/ISSN1423-0097 ～抄録公開・全文有償 published by Karger edited by World Allergy Organisation[WAO-IAACI] - The Asian Pacific Association of Allergology and Clinical Immunology[APAACI] - 総会。 機関誌なし European Academy of Allergology and Clinical Immunology[EAACI] -http://www.eaaci.org/ - Allergy -The European Journal of Allergy and Clinical Immunology[月刊]ISSN0105-4538/Online ISSN1398-9995～抄録公開・全文有償 by Blackwell Synergy - Pediatric Allergy and Immunology[隔月刊]ISSN0905-6157/Online ISSN1399-3038～抄録公開・全文有償 by Blackwell Synergy International Paediatric Respiratory Allergy and Immunology Congress American Academy of Allergy Asthma & Immunology[AAAAI] - http://www.aaaai.org/ ;米国アレルギー・喘息・免疫学会; 機関誌なし American College of Allergy, Asthma & Immunology[ACAAI] - Bulletins 機関誌 - "Annals of Allergy, Asthma & Immunology"[月刊]学術誌。 抄録・全文とも有料 Australasian Society of Clinical Immunology and Allergy[ASCIA] - Position papers British Society for Allergy and Clinical Immunology -http://www.bsaci.org/ - Clinical and Experimental Allergy[Clin Exp Allergy][月刊]ISSN0954-7894/Online ISSN1365-2222～抄録公開・全文有償 :Back issues |Reviews by Blackwell Synergy Canadian Society of Allergy and Clinical Immunology[CSACI] - Canadian Journal of Allergy and Clinical Immunology by Mediconcept Inc ●関連団体 Asthma and Allergy Foundation of America European Federation of Asthma and Allergy Associations[EFA] - http://www.efanet.org/ ; 欧州喘息・アレルギー学会連合; 23か国41学会参加 The British Allergy Foundation
●主要サイト Doctor's Guide to the Internet - Allergies - A guide to allergy-related information and resources
■MEDLINEplus: Asthma
Contents of this page: News From the NIH General/Overviews Clinical Trials Diagnosis/Symptoms Disease Management Prevention/Screening Research Specific Conditions/Aspects Treatment Dictionaries/Glossaries Directories Law and Policy Organizations Statistics Children Seniors Teenagers Search MEDLINE for recent research articles on Asthma: ・ General ・ Diagnosis ・ Exercise-induced ・ Therapy ●You may also be interested in these MEDLINEplus related pages: ・ Asthma in Children ・ Breathing Problems ・ Immune System/AIDS ・ Lungs and Breathing Latest News Air Filters Cut Asthma Symptoms (01/02/2003, Reuters Health) Nurses May Not Be Up on Latest Asthma Care (12/27/2002, Reuters Health) Eating Oily Fish May Reduce Risk of Asthma (12/18/2002, Reuters Health) From the National Institutes of Health Controlling Your Asthma (National Heart, Lung, and Blood Institute) Also available in: Spanish Focus On: Asthma (National Institute of Allergy and Infectious Diseases) ★General/Overviews Asthma (Mayo Foundation for Medical Education and Research) Asthma (Patient Education Institute) - requires Flash plug-in Also available in: Spanish Breath of Life (National Library of Medicine) ★Clinical Trials ClinicalTrials.gov: Asthma (National Institutes of Health) ★Diagnosis/Symptoms Spirometry (National Lung Health Education Program) ★Disease Management Asthma Action Plan (American Academy of Family Physicians) Asthma Flare-ups (American Academy of Family Physicians) Asthma: Questions to Ask When It Doesn't Get Better (American Academy of Family Physicians) Also available in: Spanish Asthma: Taking Medicines Safely (American Academy of Family Physicians) Also available in: Spanish Metered-Dose Inhaler: How to Use It Correctly (American Academy of Family Physicians) Also available in: Spanish Streamlining Allergy Control: Work Smart, Not Hard to Avoid Allergens in Your Home (American Lung Association) Update on National Asthma Guidelines Released (National Heart, Lung, and Blood Institute) What Is a Peak Flow Meter? (American Academy of Allergy, Asthma, and Immunology) Also available in: Spanish ★Prevention/Screening Asthma and Allergy Prevention (National Institute of Environmental Health Sciences) ★Research Asthma Research Centers Final Report 2001 (American Lung Association) CDC Study Links Improved Air Quality with Decreased Emergency Visits for Asthma (Centers for Disease Control and Prevention) Don't Get Rid of That Cat Yet, Say Asthma Researchers (National Institute of Allergy and Infectious Diseases) Groundbreaking Study Reveals That Flu Shots Are Safe for People With Asthma (American Lung Association) NHLBI Researchers Find Long-Acting Beta-Agonists Not as Effective as Inhaled Corticosteroids in Treating Persistent Asthma (National Heart, Lung, and Blood Institute) NHLBI Supported Study Finds Inhaled Steroids Accelerate Bone Loss in Women with Asthma (National Heart, Lung, and Blood Institute) Novel Anti-IgE Therapy Reduces Allergy Symptoms, Asthma Flare-ups and the Need to Use Some Medications (American College of Allergy, Asthma & Immunology) ★Specific Conditions/Aspects Asthma and Bone Health (Osteoporosis and Related Bone Diseases-National Resource Center) Asthma: A Concern for Minority Populations (National Institute of Allergy and Infectious Diseases) Asthma: Can Drinking Wine Trigger Symptoms? (Mayo Foundation for Medical Education and Research) Exercise-Induced Asthma (American Academy of Allergy, Asthma, and Immunology) Guide to Health Care Plans (American Academy of Allergy, Asthma, and Immunology) Also available in: Spanish Influenza: Serious Problem for People with Asthma (American Lung Association) Occupational Asthma: Wheezing at Work (Mayo Foundation for Medical Education and Research) Take an Asthma Quiz (Environmental Protection Agency) Traveling with Allergies and Asthma (American Academy of Allergy, Asthma, and Immunology) Also available in: Spanish Your Guide to Exercising with Asthma (McGraw-Hill Companies) ★Treatment Asthma and Allergy Medications (American Academy of Allergy, Asthma, and Immunology) Also available in: Spanish Asthma Inhalers (Mayo Foundation for Medical Education and Research) Asthma Medications (American Academy of Family Physicians) Asthma: Controller and Quick-Relief Medicine (American Academy of Family Physicians) ★Dictionaries/Glossaries Allergy-Immunology Glossary (American College of Allergy, Asthma & Immunology) Asthma Glossary (American Medical Association) ★Directories Find an Allergist: Search (American Academy of Allergy, Asthma, and Immunology) ★Law and Policy Metered-Dose Inhaler Information - Frequently Asked Questions (Food and Drug Administration) ★Organizations Allergy, Asthma and Immunology Online (American College of Allergy, Asthma & Immunology) American Academy of Allergy, Asthma & Immunology (American Academy of Allergy, Asthma, and Immunology) American Lung Association Asthma and Allergy Foundation of America EPA, Office of Indoor Air Quality (IAQ) (Environmental Protection Agency, Indoor Environments Division) National Heart, Lung, and Blood Institute National Institute of Allergy and Infectious Diseases ★Statistics Allergy Statistics (National Institute of Allergy and Infectious Diseases) FASTATS: Asthma (National Center for Health Statistics) Minority Lung Disease Data: Asthma (American Lung Association) New Estimates for Asthma Tracked (National Center for Health Statistics) ★Children Childhood Asthma: An Overview (American Lung Association) Jill's Asthma Story (Nemours Foundation) Also available in: Spanish ★Seniors Facing Asthma During the Golden Years (American Lung Association) Seniors and Asthma: Asthma Triggers in Seniors (American Academy of Allergy, Asthma, and Immunology) Seniors and Asthma: Be Prepared for an Asthma Emergency (American Academy of Allergy, Asthma, and Immunology) ★Teenagers How Can I Deal with My Asthma? (Nemours Foundation) Interactive Tutorial View slideshow on: Asthma Page last updated: 03 January 2003
●Allergy and Asthma Magazine: Fall 1998
Healthline オンライン雑誌
■MedWebPlus: Asthmaオンライン雑誌
GO AllAllergy.Net edited by Harris Steinman GO AllergieNet GO Allergy & Asthma Disease Management Center by the American Academy of Allergy, Asthma & Immunology GO Allergy & asthma magazine (tables of contents) GO Allergy and Asthma Network/Mothers of Asthmatics (AAN/MA) GO alt.support.asthma FAQ maintained by Marie Goldenberg GO American College of Allergy, Asthma & Immunology GO American College of Allergy, Asthma & Immunology Allergy, Asthma & Immunology Online (OMA) GO ANNALS OF ALLERGY, ASTHMA, AND IMMUNOLOGY (Vol. 82, 1999- ; requires registration) GO Asthma and Allergy Foundation of America (AAFA) GO Asthma Control from Glaxo Wellcome GO Asthma Learning Lab: asthma medication and treatment information GO Asthma Management: Guidelines for the Primary Care Physician by Miles Weinberger, University of Iowa College of Medicine Department of Pediatrics GO Asthma Society of Canada = Soci騁� Canadienne d'asthme GO Asthma, Allergy and Pulmonary News on the Net edited by Ronald J. Sherman GO Asthma-net (AsthmaNet.Org) GO Asthmaline History: Asthma through the ages GO AsthmaWeb: information resource for health professionals concerned with respiratory care (requires registration); sponsored by a educational grant from 3M Health Care GO Bodyware Asthmanager GO Breath of Life: an exhibition that examines the history of asthma, the experiences of people with asthma, and contemporary efforts to understand the disease. Created by the National Library of Medicine in collaboration with the National Heart, Lung, and Blood Institute, the National Institute of Allergy and Infectious Disease, and the National Institute of Environmental Health Sciences GO Bronx Asthma Project (Albert Einstein College of Medicine Division of Allergy and Immunology) GO Buteyko Institute of Breathing and Health (Manuka, Australian Capital Territory) GO Buteyko Online (Buteyko New Zealand) GO Canadian Asthma Consensus Conference Summary of recommendations (Canadian respiratory journal 1996;3(2):89-100) GO Capnography Research in Asthma (Nancy, France) GO Chronic Lung Disease Resource GO Dr Chhabra's Asthma Education Program GO Global Initiative for Asthma (GINA), a joint effort of the National Heart, Lung, and Blood Institute and the World Health Organizatio GO Global Initiative for Asthma. Asthma Management and Prevention: a Pocket Guide for Physicians and Nurses GO Global Initiative for Asthma: Global Strategy for Asthma Management and Prevention NHLBI/WHO Workshop Report GO Institute of Medicine. Committee on the Assessment of Asthma and Indoor Air Clearing the Air: Asthma and Indoor Air Exposures. -- Washington, DC: National Academy Press, 2000 GO International Conference on Paediatric Asthma (1998 March 3 and 4 : Maastricht, The Netherlands) GO International Food Information Council Food Allergy/Asthma GO Internet journal of asthma, allergy and immunology (Vol. 1, no. 1, Dec. 1997-June 1998- ) GO Iowa Health Book: Pediatrics Managing Asthma for Patients and Families by Miles Weinberger. 1999 GO JAMA Patient Page Asthma: Living with Asthma (JAMA 1999 June 9; 281 (22): 609) (Acrobat pdf files) GO Joint Council of Allergy, Asthma, and Immunology (formed as the socio-economic/political arm of the American Academy of Allergy, Asthma & Immunology and the American College of Allergy, Asthma & Immunology) GO JOURNAL OF ASTHMA (tables of contents and abstracts) GO Lung and Asthma Information Agency: an academic unit in the Department of Public Health Sciences at St George's Hospital Medical School GO MyAsthma provided by Protocol Driven Healthcare (free, but requires registration) GO National Asthma Campaign Asthma Management Handbook 1998 GO National Asthma Education and Prevention Program Expert Panel Report 2 Guidelines for the Diagnosis and Management of Asthma (NIH publication ; no. 97-4051) July 1997 (Acrobat .pdf file) GO National Heart, Lung, and Blood Institute Asthma Management Model System GO Pan American Aerobiology Associations (PAAA) GO Quack Asthma " Cure " Page maintained by Colin Campbell GO Teach Your Patients About Asthma: a clinician's guide from the National Asthma Education Program. October 1992 (NIH publication ; No. 92-2737) GO University of Newcastle Upon Tyne. Centre for Health Services Research. North of England Evidence Based Guideline Development Project. The primary care management of asthma in adults. 1997 GO Virtual Hospital Asthma Education: Interactive Guidelines: adapted in part from the National Asthma Education Program 2 Guidelines by Michael W. Peterson. 1998
●主要サイト
■Allergy, Asthma & Immunology Online[ACAAI]
- http://allergy.mcg.edu/ ; The American College of Allergy, Asthma & Immunology[ACAAI] 会員4000名 米国アレルギー・喘息・免疫学会 ACAAI Homepage Bulletins 機関誌 - "Annals of Allergy, Asthma & Immunology"[月刊]学術誌。 抄録・全文とも有料 Information for: Patients 患者向け解説 Physicians 明細別記 News Media
●ACAAI Information for Physicia ■[The American College of Allergy, Asthma & Immunology]
Online CME Course Explores Immunotherapy and Asthma 卒後研修：喘息と免疫療法 Insect Allergy (ALK Laboratories) 虫アレルギー Allergists Achieve Best Asthma Treatment Outcomes at Lower Costs - 低コストでの喘息治療：文献３０から臨床データ Allergy-Immunology Learning Objectives for Medical Students Latex Allergy Home Page ラテックス・アレルギー Allergy Practice Parameters from the JCAAI web site - 診療ガイドライン[明細別記] Expert Care and Immunotherapy for Asthma - Immunotherapy Fact Sheet - 免疫療法ファクトシート Administration of Immunotherapy Outside of the Prescribing Allergist Facility - Asthma Disease Management Resource Manual - 喘息管理マニュアル(1998.10) 患者向けガイドライン、チェックリスト、指導ガイドライン、家庭での管理など ●News Press releases
●Allergy Practice Parameters - 診療ガイドライン from JCAAI Practice Parameters for the Diagnosis and Treatment of Asthma Practice Parameters for Allergy Diagnostic Testing Practice Parameters for Diagnosis and Treatment of Immunodeficiency Practice Parameters for Immunotherapy
■American Academy of Allergy Asthma & Immunology (AAAAI)
- http://www.aaaai.org/ ;米国アレルギー・喘息・免疫学会 Patients & Consumers Center - Professionals Center - Members Center/a> - Media Center - Allergy Statistics アレルギー統計 - Asthma Statistics 喘息統計 - News Releases - AAAAI Statements 診療ガイドライン National Allergy Bureau - NAB: 2000 Pollen and Spore Report(花粉・胞子レポート)３週毎地区別情報など Physician Referral Directory - アレルギー専門医検索 Quick Find - リンク
●Professionals Center |Members Center
●Professionals Center Allergist Profiles Allergy & Asthma Disease Management Center(AADMC) Allergy/Immunology Workforce Needs Allergy Societies Careers in A/I Chrysalis Project Medical Residents Medical Students Membership Teaching Curriculum Teaching Slides Training Programs ●Members Center AAAAIStatements Academy News Allied Health Annual Meeting Associates to the AAAAI CME/CE Distinguished Lecture Series Education and Research Trust (ERT) Executive Office Staff Future Meetings Grants and Awards Health Related Web Sites Interest Sections and Committees Journal of Allergy & Clinical Immunology (JACI) Patient Update Handout Pediatric Asthma: Promoting Best Practice Practice Management Tips Prescription Assistance Program Speakers Bureau Teaching Slides Web Site Editors
■Practice Parameters for the Diagnosis and Treatment of Asthma
- http://www.jcaai.org/Param/Asthm.htm Asthma Practice Parameters Joint Council of Allergy, Asthma, and Immunology -http://www.jcaai.org/ Sponsored by the College and Academy Preface Introduction Diagnosis & Evaluation Specific diagnostic techniques A. Clinical evaluation of asthma B. Physiologic evaluation Management A. Classification of asthma severity B. Severe acute intractable asthma C. The fatality-prone asthmatic D. Environmental avoidance E.Pharmacotherapy F. Immunotherapy in the asthmatic patientG. Patient education H. Consultation with an asthma specialist Special Conditions A. CONCOMITANT CONDITIONS B. Asthma and anaphylaxis C. Management of asthma during pregnancy D. Nocturnal Asthma E. Exercise-induced asthma F. Nasal and sinus disease and asthma G. Gastroesophageal reflux ------------------------------------------------- ■Pharmacotherapy ●B-adrenergic agonist bronchodilators
Treatment of the asthmatic patient must be individualized.
B-agonist bronchodilators vary in their degree of selectivity and range from non-selective (e.g., isoproterenol) to relatively B-selective agonists (B2-agonists) (e-g., albuterol)
It is preferable to use a B2-agonist rather than a non-selective B- agonist because B2-agonists have a longer duration of action and are less likely to produce cardiovascular side effects.
The use of sustained release oral B2-agonists may be appropriate and indicated for some asthmatic patients, especially in situations in which a long duration of effect is desired or the patient does not tolerate inhaled B2-agonists. Otherwise, inhaled B2-agonists are preferable to oral drugs of this type in the treatment of chronic asthma because rapid onset of action, are generally more effective than other routes of administration, and infrequently produce adverse reactions.
Inhaled B2-agonists may be more effective when administered on an as needed basis rather than on a regular basis in the treatment of many patients with chronic asthma. If greater than eight inhalations per day (or approximately one canister per month) are needed, the addition of cromolyn, nedocromil, or inhaled cortosteroids should be considered.
Inhaled B2-agonists are generally the safest and most effective treatment for acute asthma. In general, oral B2-agonists should not be administered for the treatment of acute severe asthma.
The administration of B2-agonists in the treatment of acute or chronic asthma is not a substitute for the early use of anti-inflammatory drugs.
Patients must be carefully instructed, often more than once, in the use of inhaled B2-agonists because a large percentage of patients fail to use inhaler devices correctly. Spacers attached to inhaled B2-agonists improve drug delivery in patients who do not correctly use inhalers.
Inhaled B2-agonists, when administered 15 to 30 minutes before exercise, prevent exercise induced bronchospasm in many patients. Inhaled B2-agonists are generally considered the agent of choice for this purpose.
Tolerance to B2-agonists, which is usually reversible after the administration of corticosteroids, may develop after continued use of these drugs and may be associated with an unrecognized decrease in efficacy and delay in seeking medical attention.
Bronchial hyperresponsiveness may increase in patients who receive inhaled B2-agonists on a regular basis. This possibility should be considered in patients whose asthma is worsening on a regimen that includes the regular use of these drugs.
Tremor and central nervous system effects are minimized by inhalation of B2-agonists, although hypokalemia and significant cardiovascular effects can occur when these drugs are administered by this route.
Serious adverse effects from the administration of B2-agonists, when administered in recommended doses, are uncommon when given orally and extremely uncommon when administered by inhalation.
Both B2-agonists and non-selective B-agonists, when administered by inhalation, can produce a sudden paradoxical increase in bronchospasm, which may be life-threatening in some asthmatic patients.
Salmeterol is a long-acting, highly B2-selective B-agonist bronchodilator.
Well-controlled studies have shown that the duration of action of salmeterol is 12 hours or longer in most patients.
Pretreatment with single doses of salmeterol also prevents bronchospasm from histamine, methacholine, and cold air challenge.
Salmeterol can protect patients against exercise-induced bronchospasm for up to 12 hours after administration.
Because salmeterol is inherently different than short-acting inhaled B agonists, special recommendations must be considered when prescribing salmeterol for patients. In this regard salmeterol metered dose inhaler:
should not be initiated in patients with significantly worsening or acutely deteriorating asthma;
should not be used to treat acute symptoms; and
should not be considered a substitute for inhaled or oral corticosteroids.
●Theophylline
For the treatment of acute severe asthma, theophylline is less effective than inhaled or injected B2-selective agonists.
Maintenance therapy with theophylline is effective in reducing the frequency and severity of the symptoms of chronic asthma. It may be similar in effectiveness to cromolyn or B2-agonists, and long-acting preparations allow for effective control of nocturnal symptoms.
Patients with mild chronic asthma may be controlled at steady-state theophylline serum concentrations less than 10 ug/ml; patients with more severe disease may require concentrations greater than 10 ug/ml for effective control of symptoms. Although patients may experience significant adverse reactions at less than 10 ug/ml, as the serum concentration increases, the frequency and severity of toxicity increase. With levels less than 15 ug/ml severe adverse reactions are unlikely to occur.
The rate of theophylline metabolism varies greatly among patients in the same age group and is influenced by numerous medical conditions and pharmaceutical interventions.
The rate of theophylline metabolism is reduced, thereby leading to increased serum levels and increased potential for toxicity, in the presence of such conditions as cardiac decompensation, respiratory failure, hepatic cirrhosis, sustained high fever, viral infections, hypothyroidism, and after administration of cimetidine, oral contraceptives, troleandomycin, erythromycin, ciprofloxacin, and disulfiram. In contrast, factors such as cigarette or marijuana smoking, hyperthyroidism, rifampin, phenytoin, carbamazipine, and phenobarbital increase the rate of metabolism.
Oral slow-release formulations generally provide stable serum concentrations and favor patient compliance. However, the rate and extent of absorption vary between formulations, between individuals, and possibly in the same individual from time to time. Food ingestion may also affect the rate of absorption in different ways depending on the specific formulation.
Dosage for long-term therapy is based on the principle of slowly titrating the dose over several days to circumvent transient caffeine-like side effects. Final dosage is usually based on the peak serum concentration measurement obtained at steady state.
Elevated blood levels may produce neurologic, gastrointestinal (including gastroesophageal reflux [GER]), and/or cardiovascular side effects.
Orally administered activated charcoal or charcoal hemoperfusion dialysis should be considered at toxic theophylline concentrations. Intravenous phenobarbital should also be considered to prevent seizures; diazepam, but not phenytoin, should be used to terminate seizures.
● Anticholinergic agents
The regular use of anticholinergic bronchodilators appears to be most effective in patients with chronic obstructive pulmonary disease who have partially reversible airflow obstruction.
Inhaled anticholinergic medication is not sufficiently effective to be used as a single agent in the treatment of acute severe asthma but may provide benefit when combined with a B-agonist or other primary therapeutic agent.
Inhaled anticholinergic agents, such as ipratropium, appear to be more effective when used to treat patients with chronic mild to moderate degrees of airflow obstruction.
Inhaled anticholinergic medications, such as ipratropium, may be indicated in patients in whom alternative agents have not been sufficiently effective, are inappropriate because of other medical conditions, or have produced
unacceptable side effects.
● Antihistamines
Antihistamines can be safely used in most patients with asthma.
Antihistamines may be effective in the treatment of asthma because histamine, acting through H1 receptors, produces smooth muscle contraction, an increase in vascular permeability, and stimulation of parasympathetic nerves, all of which are pathophysiologic features of asthma.
Based on their ability to block late-phase responses to allergen exposure, newer antihistamines may play a greater role in the future treatment of asthma.
Antihistamines may alleviate asthma somewhat through their direct effect on the bronchial passageways.
There is a strong clinical impression that improvement of upper respiratory tract symptoms by antihistamines in patients who have concomitant allergic rhinitis and asthma may facilitate the treatment of lower respiratory tract symptoms.
Although antihistamines are not the treatment of choice for exercise-induced bronchospasm, pretreatment may attenuate exercise-induced bronchospasm in some patients.
Histamine is not the only mediator responsible for asthma symptoms, and therefore antihistamines, if used, should be considered adjunctive therapy in the treatment of asthma.
●Cromolyn and nedocromil
Cromolyn can be effective in many patients, alone or in conjunction with bronchodilators, in preventing the symptoms of mild-to-moderate asthma.
Cromolyn has been demonstrated to be extremely safe, although serious adverse effects, such as bronchospasm, have been reported.
Cromolyn can be effective in preventing or diminishing exercise-induced asthma when given 15 to 30 minutes before exercise.
Overall, there is similar effectiveness with use of the metered-dose inhaler, Spinhaler, and solution for nebulization, although individual response must be considered in the choice of the product.
Cromolyn has the ability to attenuate both early and late-phase IgE-mediated reactions.
Nedocromil sodium is a topically active anti-inflammatory, pyranoquinoline which has mast cell-stabilizing properties.
Nedocromil sodium has a number of putative mechanisms of action, as suggested by both animal in vivo experiments and in vitro effects on a variety of animal and human cell preparations.
Nedocromil sodium is primarily indicated as a preventive drug in the management of asthma-associated chronic inflammation. If used appropriately in this manner, it is effective in improving symptom scores, reducing use, and in some cases, other concomitant medications such as inhaled corticosteroids or cromolyn sodium.
Clinical dosing is based on its long-term preventive effects. Because it is not a bronchodilator, it is not indicated in the treatment of acute asthma.
Long-term use of nedocromil sodium is generally safe.
Nedocromil sodium is clinically useful in the preventive treatment of mild and moderate asthma.
●Corticosteroids
With renewed awareness of the importance of airway inflammation in the pathogenesis and chronicity of asthma, it is generally felt that inhaled corticosteroids should be used as primary therapy in patients with moderate and severe chronic asthma.
Systemic corticosteroids should be considered in the management of acute asthma when the patient does not respond readily to bronchodilators. Early use of corticosteroids shortens the course of asthma, prevents relapses, and reduces the need for hospitalization. The early use of corticosteroids is of particular importance in patients who have a history consistent with fatality-prone asthma.
Intravenous corticosteroids may be lifesaving in the treatment of severe intractable asthma. After episodes of severe intractable asthma, complete restoration of pulmonary function may require weeks of treatment. Therefore after such events, corticosteroids should be continued at least until symptoms are controlled and pulmonary function is restored.
Because of the potential for significant side effects from the prolonged use of systemic corticosteroids (and possibly high-dose inhaled corticosteroids), the need for oral corticosteroids should be monitored by pulmonary function tests, and inadequate control with maximal use of other treatment approaches should be a prerequisite for the long-term administration of systemic corticosteroids.
Patients receiving systemic corticosteroids on a chronic basis may need to be carefully monitored for changes in the hypothalamo-pituitary-adrenocortical axis, bone changes,glucose metabolism, hypertension, and other potential side effects of such therapy under certain circumstances.
●Hydration and pharmacomucolytic agents
Adequate hydration is recommended for patients with asthma, but overhydration should be prevented by careful monitoring of fluid and electrolyte balance, especially in infants, in severely ill patients, and in the elderly. Dehydration may occur with severe asthma and should be corrected. However, fluid overload may have adverse pulmonary and circulatory effects and must be prevented by careful monitoring of fluid and electrolyte balance.
Guaifenesin and potassium iodide may be worth a trial in some asthmatic patients, although the mechanisms of action are unclear.
●Other considerations
a. Alternative therapy
Whatever the reasons for failure to respond to corticosteroids, several treatment regimens for asthmatic patients who have not responded to systemic corticosteroids now exist.
Steroid-sparing regimens or alternatives to systemic corticosteroid therapy include troleandomycin, methotrexate, gold and intravenous y globulin therapy, which may be effective in some patients with asthma.
It should be recognized that certain of these regimens are contraindicated in some patients and/or may be associated with significant adverse effects.
b. Role of antibiotics/antivirals
Infections associated with asthma exacerbations are almost always viral in origin and do not require antibiotic therapy. Under these circumstances, however, reevaluation of the patient's treatment program, including bronchodilators and corticosteroids, may be important.
Bacterial infections, such as acute and chronic sinusitis, should be treated appropriately, including the prompt and adequate use of antibiotics.
Influenza can be associated with increased asthma. Therefore appropriate immunization is essential in patients with moderately severe or severe asthma.
Immunizations
Routine vaccinations are not contraindi-cated in patients with asthma or other allergic conditions.
Patients who have a history of egg sensitivity should be skin tested with the vaccination material. If results of the skin test are posi-tive, the patient may be immunized with small increasing doses with use of an estab-lished protocol.
Short-term, low-to-moderate dose systemic corticosteroids, alternate-day corticosteroids, or topical corticosteroids are not immunosuppressive and are not a contraindication for immunization.
Influenza vaccine and pneumococcal vaccine are recommended for patients with chronic pulmonary disease including asthma.
Comparability of therapeutic products
Comparability of inhaled products cannot be assumed because of potential differences in patient response to excipients or other inactive components in these products.
Substitution of a theophylline product different from the one the patient was previously receiving can produce decreased efficacy or toxicity in some patients.
Any adverse reaction that is temporally related to use of a drug product may be caused by the drug product even if the patient has tolerated the same drug in another product.
Polypharmacy
Polypharmacy may be necessary and indeed desirable in the management of patients with asthma. *The physician must guard against the unnecessary addition of medications that could increase morbidity and mortality in asthmatic patients.
Reprinted with permission from: The Journal of Allergy, and Clinical Immunology. Vol 96, No. 5, part 2. November, 1995.
Most recent update: March 11, 1996 Webbed by Joan Haskell, The Children's Mercy Hospital
●Links to Other Web Sites[ACAAI] Allergy and Asthma in the News
MSNBC HealthNews Page
Almost always has current news and interesting reading about asthma and other allergic diseases for patients, parents and physicians.
Other Allergy-Immunology Associations
American Academy of Allergy,Asthma, and Immunology A US organization dedicated to the needs of physicians and patients with allergic and immunologic diseases. European Academy of Allergology and Clinical Immunology Information for members of Europe's leadingprofessional society for allergists and immunologists Joint Council ofAllergy, Asthma, and Immunology. Sponsored by the College and Academy NationalHeart, Lung, and Blood Institute This link takes you to the new NAEPP asthma guidelines, written for physicians and other health care professionals,all 244 pages in Adobe PDF format and at times complicated medical terminology.Not a download for a slow ISP... National Institutes of Health-Institute of Allergy and Infectious Diseases The major governmental organization for sponsoring research in allergic andimmunologic diseases. Pan American AerobiologyAssociation An international organization dedicated to the needs of physicians and patients with allergic and immunologic diseases.
Allergy-Immunology Support Groups Allergy and AsthmaNetwork/Mothers of Asthmatics, Inc A national support group for parents of children with asthma. Asthma Society of Canada -A national volunteer organization devoted to enhancing the quality of lifeof people living with asthma and to eliminating this disorder. Allergy and Asthma Web Page Check this out, parents. Doctor's Guide to Allergies - Information and Resources
Local and Regional Asthma Consortiums Dallas Asthma ConsortiumInformation for patients and physicians.
Pharmaceutical Industry Home Pages ALK Laboratories Loads of info on bee, wasp, hornet and fire ant stings. Allerdays Web Site (Hoechst MarionRoussel) An interesting site with good patient information. Lotsof cool graphics, frames, etc. Astelin Home Page (Wallace Laboratories) Product information, "Strange But True" allergy cases, and other information. Allergy Relief Zone (Schering-Key)Lots of patient and physician information. Asthma Control Program(GlaxoWellcome) Loads of information on controlling your asthma.Lots of graphics. Flonase Web Site (GlaxoWellcome)Information on nasal allergy and its treatment. Zyrtec Home Page (Pfizer Labs)Product information and online allergy information. Pharmaceutical Industry Corporate Home Pages Astra Dura Pharmaceuticals, Inc. GlaxoWellcome Hoechst Marion Roussel Pfizer Labs Rhône-Poulenc Rorer, Inc. Sepracor Schering-Plough Zeneca
Other Allergy-Immunology Resources Immunology JournalIndex Somewhat esoteric for patients. JAMA Asthma InformationCenter A new, SIGNIFICANT source of information about asthma intendedmostly for health care professionals, but with some good patient informationas well. Online Mendelian Inheritancein Man An enormous, sophisticated database containing informationabout inherited diseases, including most causes of immunodeficiency. Intendedfor health care professionals.
Other Medical and General Resources American Lung Association American Medical Association Yucky BugWorld This is REALLY special! (Used to be Cockroach World) Medic Alert Special IDbracelets and necklaces for patients with certain chronic illnesses, medications,allergies, or implants Medical Matrix -Guide to Internet Clinical Medicine Resources MEDLINE Searchthe National Library of Medicine's medical literature database at no chargevia PubMed Grateful Med Another searchinterface for NLM's databases NewsFile: Health News Online Physicians Online (Stillwaiting for the new Mac client software...) Universityof Iowa Dermatology Your Money andYour Life: America's Managed Care Revolution. This site containsreal life stories, opinion pieces, a discussion group, etc.
Congress and Other Government Agencies Food and Drug Administration Health Care Financing Administration(HCFA) United States House of Representatives United States Senate Vote Smart WebThis lists how your representatives in congress voted on various issues. White House Web Page
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■Selected Articles From The Recent Literature
SELECTED ARTICLES FROM THE RECENT LITERATURE
Listed below are the Medical Editor's summaries and editorial comments about some recent articles about asthma and allergies in the medical literature which the Medical Editor felt to be of particular interest to those in clinical practice.Exposure to Environmental Tobacco Smoke (12/23/98) Asthma atopy linked to childhood infection (12/15/98)★ Childhood asthma and dampness in the home (12/15/98)--------------------------------------------------
Effects of lactose intolerance overestimated (12/10/98) Alendronate effective in steroid-induced osteoporosis (12/9/98) Decreased basophil counts and histamine release in chronic idiopathic urticaria (CIU) (12/9/98) Improving compliance in asthma management (12/2/98)★ Use of a portable spirometer in asthma (12/2/98) Reducing ongoing transmission of tuberculosis (12/2/98) Chlamydia penumoniae infections (11/20/98) Community Acquired Pneumonia (11/18/98) Viral infections predispose to bacterial pneumonias (11/16/98) Drugs in Pregnancy (11/13/98) Influenza in the elderly (11/13/98) Smoking and drug interactions (11/13/98) Hantavirus infection (11/13/98) Decreasing severity of allergic rhinitis with increasing age (11/11/98) Exacerbation of premenstrual asthma by an oral contraceptive (11/11/98) Mucosal immunity in the Eustachian tube (11/11/98) Is there cross-reacting adverse reaction to nimesulfides and aspirin or acetaminophen? (11/4/98) Does early anti-inflammatory therapy in asthma make a difference? (11/4/98)★ Effects of drugs on small airways (11/4/98)★ Are mite avoidance measures worthwhile in dust mite allergies? (10/27/98) HEPA filters ineffective in treatment of cat allergy (10/27/98) Photosensitive Drug Reactions (10/27/98)★ Lung function in asthmatics (10/27/98) Measures to reduce antibiotic in hospitalized patients (10/27/98) Hydrocortisone treatment of the chronic fatigue syndrome (10/26/98) Current transplanted organ survival (10/26/98) Misuse of epinephrine self-injectors (10/26/98) Asthma and Pregnancy (10/26/98)★ Less pain from lidocaine injection (10/20/98) Value of ipratropium in acute asthma (10/13/98)★ Salmeterol treatment incurs no increased risk in severe asthma (10/13/98)★ Tianeptine treatment for asthma (10/9/98)★ Anti-CD4 antibody treatment for asthma (10/9/98)★ Risk of antimicrobial resistance: Do antibiotic dose and duration matter? (10/9/98)★ Smoking and newborn lung function (10/9/98) Eastern alternative medicine approaches (10/6/98) Marker for TH2 cells? (10/6/98) Gas stoves bad for asthma? (10/6/98) Asthma during pregnancy (10/6/98) Asthma and mycoplasma pneumonia (10/2/98) Salmeterol treatment masks bronchial inflammation (10/2/98)★ C1 esterase concentrate therapy for acute flare-ups of hereditary angioedema (10/1/98)★ Bronchial hyper-reactivity and wheezing (10/1/98) More about Helicobacter infection and chronic idiopathic urticaria (CIU) (10/1/98) Delay in seeking treatment of acute asthma (10/1/98) Neutrophilic urticaria - A distant entity? (10/1/98) Loteprednol therapy for allergic conjunctivitis (9/23/98) Interferon-gamma therapy for atopic dermatitis (9/23/98) Diagnosis of penicillin, amoxicillin and cephalosporin allergy in children (9/23/98) Is fluticasone superior to other inhaled steroids? (9/22/98) Irritant contact dermatitis (9/22/98) Role of flavoring substances in food allergy and intolerance (9/18/98) Effects of orally-inhaled budesonide in seasonal allergic rhinitis (9/18/98) Comparison of effects of fluticasone nasal spray and oral steroids on the HPA (9/18/98) IgE-mediated allergy and desensitization to factor IX (9/18/98) Prevalence of allergies in different socio-economic groups (9/16/98) The role of IL-13 and its receptor in allergy and inflammatory responses (9/16/98) Prevalence of allergic rhinitis in asthma (9/16/98) Gastro-esophageal reflux (GER) and asthma (9/16/98) Elevated IgE levels and AIDS development (9/16/98) Best way to deliver chronic oxygen therapy (9/14/98) What is the best strategy for self-management of asthma? (9/11/98) Allergy to Ornamental Plants (9/2/98) Hydroxychloroquine therapy for asthma (9/2/98) Leukotriene antagonists for exercise-induced asthma (8/28/98) Does Influenza Immunization Worsen Asthma? (8/28/98) Adverse Drug Reactions (8/28/98) Increased association of cataracts with inhaled steroid use? (8/27/98) Modification of allergenicity linked to food technologies (8/27/98) Latex sensitivity in anesthesiologists (8/27/98) Theophylline treatment reduces bronchial hyper-reactivity (8/27/98) Identification of chronic fatigue subgroups on the basis of allergy and psychologic variables (8/27/98) Prevalence of Allergic Rhinitis (8/19/98) Subjective vs objective measures in asthma (8/19/98) Impact of chronic cough on quality of life (8/18/98) Another cause of obscure chronic cough (8/18/98) Atherosclerosis and the immune system (8/18/98) Skin test reactivity best predictor of allergic respiratory diseases (8/18/98) Liposome-encapsulated inhaled steroids (8/18/98) Nitric oxide may have no role in asthmatic responses to allergen (8/18/98) The newer inhaled steroids (7/29/98) Topical therapy for allergic conjunctivitis (7/29/98) Prevention of barotrauma during air travel (7/28/98) Investigation of mosquito allergy (7/28/98) ACE inhibitor(ACEI) - induced angioedema: Incidence, prevention and treatment (7/28/98) Restless Leg Syndrome (7/21/98) Vocal cord dysfunction associated with exercise (7/21/98) Out-patient treatment of pneumonia (7/21/98) Chronic urticaria and Helicobacter infection (7/21/98) Is the use of spacers for Metered Dose Inhalers(MDI) worthwhile? (7/21/98) C1-esterase inhibitor therapy in patients with hereditary angioedema (7/21/98) Treatment of Acute Asthma Exacerbation (7/21/98) Do nasal steroids relieve URI symptoms? (7/12/98) Anti-hypertension Treatment in Patients with Obstructive Airways Diseases (7/3/98) Metered Dose Inhalers: Past, Present and Future (6/30/98) Does MSG trigger asthma? (6/30/98) Discontinuing venom immunotherapy (6/29/98) Tolerance tests in multiple drug allergy (6/29/98) A strategy for evaluation and treatment of chronic cough (6/29/98) Etidronate therapy for corticosteroid-induced osteopenia (6/29/98) Ipratropium treatment of acute asthma (6/29/98) Asthma management to limit the risk for steroid-induced osteoporosis (6/29/98) Systemic side-effects from inhaled steroids - the debate continues (6/29/98) Steroid insensitive asthma (6/29/98) Improvement of childhood asthma after massage therapy (6/29/98) Hypertonic saline irrigation helps pediatric chronic sinusitis (6/15/98) Alternaria sensitivity as a risk factor in asthma (6/15/98) Is occupational asthma reversible? (5/23/98) Fenoterol use linked to asthma mortality in Japan (5/22/98) Theophylline revisited (5/13/98) Comparison of inhaled corticosteroids (5/13/98) Inhaled steroid effects on collagen synthesis (5/3/98) Does obesity predispose to asthma? (4/29/98) Regular use of salmeterol vs prn use of albuterol in childhood asthma (4/20/98) Magnesium therapy in status asthmaticus (4/20/98) Skin prick testing (4/9/98) Role of neutrophils in asthma (4/8/98) Preventable factors in hospital admissions for asthma (4/7/98) Food allergy in atopic dermatitis (4/2/98) Sublingual immunotherapy for allergies (4/9/98) No increased side-effects of theophylline or beclomethasone in children (4/9/98) Flunisolide aids in emergency asthma treatment (3/25/98) Early Childhood Wheezing Need Not Be Tied to Asthma (3/98) Bronchial responsiveness in asthma and allergic rhinitis (3/98) Comparison of budesonide by nebulizer and MDI (2/25/98) Zafirlukast benefits nasal congestion as well as asthma (2/25/98) Risk factors for recurrence of asthma flares after treatment in the Emergency Department (2/25/98) Sardine treatment of asthma (2/25/98) Effects of IL-5 on bronchial reactivity in asthmatics (2/25/98) What is the role of atopic family history and gender in the expression of adult-onset asthma Single daily inhaled steroid dose Initial inspiratory effect affects asthma powder inhaler efficacy What is the role of inhaled beta-2 agonists in the chronic treatment of asthma? A comparison of triamcinolone acetonide nasal aerosol spray and fluticasone propionate aqueous solution spray in the treatment of spring allergic rhinitis Cross sectional investigation of the effects of inhaled corticosteroids on bone density and bone metabolism in patients with asthma Latex Allergy In Children 1997 Archive
■Leukotriene antagonists for exercise-induced asthma (8/28/98)
8/28/98
Leukotriene antagonists for exercise-induced asthma
Summary
A number of control studies have shown the clinical effectiveness of leukotriene antagonists such as safirlukast (Accolate) and montelukast (Singulair) in mild to moderate asthma. A common problem for many asthmatics is exercise-induced bronchospasm, particularly with the recent emphasis on adequate exercise in the life style. Leff et al have recently reported that once-daily treatment with montelukast, 10 mg, significantly reduced exercise-induced decreases in FEV1 in a group of mild asthmatics (ages 15-45 years). Their overall asthmatic symptoms were also reduced significantly. No increased adverse effects were noted.
Reference New Eng. J. Med. 1998;339:147-52.
Editor's Comments The effects of leukotriene antagonists in mild to moderate asthmatics have been reivewed previously in this AADMC Web site. Montelukast has been marketed as a once-daily dosing preparation (the regimen used in this studay are reported above). What was striking to me is that the authors reported significant inhibition of airflow obstruction induced by an exercise challenge carried out 20-24 hours after the h.s. single daily dose of montelukast. This protective effect was observed in several exercise challenges carried out throughout the 12-week duration of the study. It should be emphasized that the patients in the study described had mild asthma. Therefore, it is not clear whether all patients with asthma of varying severity will experience such protection from exercise or LTD4 inhalational challenge for up to 24 hours after dosing. (Also see J Allergy Clin Immunol 1998;102:50-56).
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■What is the role of inhaled beta-2 agonists in the chronic treatment of asthma?
What is the role of inhaled beta-2 agonists in the chronic treatment of asthma?
Subject Summary
Many experts feel that first-line treatment of moderate to severe asthma should be with anti-inflammatory controlling therapy, particularly with inhaled steroids, and that inhaled beta-2 agonists should be reserved for PRN use to relieve acute asthmatic symptoms or used before exercise to prevent exercise-induced bronchospasm. These impressions are reflected in the recommendations of the expert panel of the National Asthma Education Panel (displayed elsewhere in this AADMC site). Some investigators have recommendations to chronic mild asthma, feeling that inhaled steroids may prevent long-term damage to the bronchial wall.
However, there is still controversy about the role of non-steroid therapeutic agents in chronic treatment of asthma. Examples of this debate come from four recent articles in the medical literature.
In a recent issue of the New England Journal of Medicine, Pauwels et al from Belgium reported that asthmatics receiving a combination of inhaled formoterol (a beta-2 agonist not yet available in the USA) plus low inhaled doses of budesonide (an inhaled steroid) did better overall after one year than the asthmatics treated with moderate doses of inhaled budesonide alone. Inhaled budesonide in high doses was more effective in preventing the most severe attacks but the combination of inhaled formoterol and moderate doses of budesonide was the most effective treatment of all. Dr. D'Alonzo, in an editorial comment, noted that similar efficacy had been reported with the combination of moderate doses of inhaled steroids and inhaled salmeterol, another long-acting beta-2 agonist which is available in the USA. The authors felt that potential for side effects of the inhaled steroids could be decreased by use of lower doses of inhaled steroids in combination with an agent like formoterol.
In the same issue of the NEJM, a group from the Imperial College of Medicine in London reported that asthmatics treated with a combination of moderate doses of inhaled steroids plus oral theophylline did as well as those treated with high doses of inhaled steroids alone. with considerable cost savings when the former regimen was used.
In a recent study, O'Byrne et al ,of McMaster University, Ontario, found that the eosinophil frequency in BAL fluids was increased in asthmatics receiving beta-2 agonists when compared to asthmatics being treated with inhaled steroids. The authors felt that these eosinophils could likely be the source of agents which damage the bronchial epithelium.They note that, while some in vitro studies suggest that beta-2 agonists may have anti-inflammatory properties in asthma, others show that regular use of these drugs increases asthmatic airway responsiveness and the allergen-induced late response. Further, regular albuterol use is also associated with increased levels of activated eosinophils in bronchial biopsies.
Beta 2 agonists may* also affect the function of eosinophils which do exude into the bronchial wall. Another recent study by Nielson and colleagues (Am. J. Respir. Crit. Care Med 1998;157:184-91) ,carried out in vitro, suggested that beta 2 agonists may inhibit eosinophil activation in acute exposure, but actually increase superoxide generation after continued exposure. They also found that the beta-2 agonist partially reduced the inhibitory effects on eosinophil activation of corticosteroids placed in the incubation medium.
Editor's Comments
These articles deal with one of the most debated questions in the therapy of chronic asthma. Before the availability of potent inhaled steroids with relatively little systemic absorption, inhaled beta-2 agonists and theophylline were the mainstays of chronic asthma treatment. However, large epidemiologic studies from Canada and New Zealand suggested that chronic use of inhaled beta-2 agents in asthma was associated with increased mortality, even when these agents were employed along with inhaled steroids.
Some investigators have felt that these potentially adverse effects of beta-2 agonists might be related to desensitization to this class of drugs with chronic use in some individuals. Although the mechanisms underlying such desensitization, a recent report in the journal Lancet suggests that a genetic predisposition may play a role.
These findings had considerable impact on asthma treatment strategies. Yet, some investigators felt that there was a role for chronic use of inhaled beta-2 agents in asthma treatment. One group reported that the use of long-acting beta-2 inhaled agents like salmeterol as monotherapy provided adequate control of chronic mild asthma. Many asthma specialists continued to use inhaled beta-2 agents along with inhaled steroids in chronic treatment. The two clinical reports described above tested this approach, finding a reduction in the dose of inhaled steroids needed for asthma control with equal or less major side-effects.
How does one resolve these somewhat contradictory findings? One has to know whether the asthma severity was similar in the different study groups. Compliance with the recommended treatment program and efficient use of metered-dose inhalers (both quite variable in asthma patients) may also be factors. However, the eosinophil findings described above raise concerns that chronic use of beta-2 agonists may thwart some of the anti-inflammatory effects of inhaled steroids.
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■Other Links of Interest[www.aadmc.org]
*Allergy and Asthma Network/Mothers of Asthmatics, Inc.
*American Academy of Dermatology
*American Academy of Ophthalmology
*American Association of Immunologists
*American College of Allergy, Asthma & Immunology
*American College of Chest Physicians
*American College of Physicians
*American College of Rheumatology
*American Medical Association
*AsmaNet: The International Association of Asthmology
*Clinical Immunology Society
*Community of Science
*The Food Allergy Network
*Immune Deficiency Foundation
*International Food Information Council
*Joint Council of Allergy, Asthma & Immunology
*Northwest Asthma & Allergy Center
*Pan American Aerobiology Association
*SciQuest
*Spanish Society of Allergy & Clinical Immunology's Aerobiology Committee (pollen counts)
*Texas Allergy and Immunology Society
Government agencies
*Centers for Disease Control
*Food and Drug Administration
*Health Care Financing Administration (Medicare/Medicaid)
*Health and Human Services
*National Institutes of Health
*National Library of Medicine
■European Federation of Asthma and Allergy Associations[EFA]
- http://www.efanet.org/ ; 欧州喘息・アレルギー学会連合; 14か国27学会参加
Links section - Our newly updated links section provides links to asthma and
allergy related Internet resources.
asthma info
An introduction to some of the issues surrounding asthma. Who gets it and why ? How to recognise the symptoms and get treatments. Frequently asked questions.
allergy info
What is allergy ? Who gets it ? What causes allergies ? How can allergy be treated. Frequently asked questions.
Contact information for members of the European Federation of Asthma and Allergy Association.
■National Institute of Allergy and Infectious Diseases(NIAID)
- http://www.niaid.nih.gov/ NIHのもう一つの喘息関連サイト
About NIAID Director's page | Institute Facts | Key Contacts INFORMATION News Rerease | Calendar of events | Publications | NIAID Council News | Links to other sites RESEARCH ACTIVITIES AIDS | Allergy, Immunology, Transplantation | Microbiology, Infectious disease | Laboratories OPPOTUNITIES Reagents programs and repositories | Clinical Trials | Contracts | Employment | Grants | Tech Transfer ------------------------------------------------ ■Publications at the National Institute of Allergies and Infectious Diseases (NIAID) Allergies | Asthma ------------------------------------------------ ■Allergy Publications at the National Institute of Allergies and Infectious Diseases (NIAID) Allergies Fact Sheets and Brochures Allergies: Living with Allergies Asthma and Allergy Statistics Food Allergy and Intolerances How to Create a Dust-Free Bedroom Poison Ivy Resources to Fight Indoor Pollution Something in the Air: Airborne Allergens ------------------------------------------------ ■Asthma Publications at the National Institute of Allergies and Infectious Diseases (NIAID) Asthma Fact Sheets and Brochures Asthma: A Concern for Minority Populations