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Advance in asthma 2009 w.pongsak,MD
introduction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Obesity and asthma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
N0 ASSOCIATION POSITIVE CORRELATION INCREASE RISK ONLY IN FEMALE ONLY IN FEMALE INCREASE RISK INCREASE RISK INCREASE RISK
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
1.56
Conclusion =  failed to find an association between obesity and asthma control in an  urban population with asthma .
1.57 Conclusion = weight gain decrease in lung function in asthmatic patients N=638
1.58 Conclusion =  positive association between BMI and asthma risk that was similar in magnitude to those observed in longitudinal studies of white women
J Allergy Clin Immunol 2009;123:1328-34 . 1.59 N= 1,265
J Allergy Clin Immunol 2009;123:1328-34 . 1.59 Conclusions: Increased BMI is not associated with clinically significant worsening of impairment in subjects with mild to moderate persistent asthma.
Asthma and genetic Genetics
Asthma and genetic
 
 
Genetics ,[object Object],[object Object],[object Object],[object Object],[object Object]
1.14 J AllergyClin Immunol 2009;124:1188-94 N= 1,182
J AllergyClin Immunol 2009;124:1188-94 1.14 Conclusion: The Arg16 genotype of ADRB2 is associated with  exacerbations in asthmatic children and young adults exposed daily to b2-agonists
Biomarker for asthma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
1.19 N=73
Conclusion :  Targeting FENO on reference values is not justified.
1.20
 
 
Conclusion :  Conventional asthma management resulted in good control of symptoms in most participants. The  addition of fraction of exhaled NO as an indicator of control of asthma  resulted in higher doses of inhaled  corticosteroids, without clinically important improvements in symptomatic asthma control.
1.22
1.23 N=34
 
middleton   6   th edition
J Allergy Clin  Immunol 2009;124:928-32 . 1.25 N=238
J Allergy Clin  Immunol 2009;124:928-32 . 1.25 Area = 0.89 Conclusions : In an unselected sample of young adults, bronchial provocation with inhaled dry-powder mannitol had a high diagnostic specificity for the diagnosis of asthma .
Environment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
1.31
 
Conclusions: These findings suggest that subjects with mild allergic asthma and healthy subjects have similar cold symptoms and inflammatory and antiviral responses.
Therapeutics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
J Allergy Clin Immunol 2009;124:699-706 . 1.34
J Allergy ClinImmunol 2009;124:691-6 . 1.35
J Allergy ClinImmunol 2009;123:116-21 1.41
Conclusion: Although symptomatic control and rescue bronchodilator use may be improved by the addition of a LABA to ICS, there may  be a lower risk of severe exacerbations  and hospitalizations from ICS dose increase. Oral steroid use : lower in ICS group ( 22%vs 27%) Hospitalization  : lower in ICS group   ( 1.3% vs 1.7%) J Allergy ClinImmunol 2009;123:116-21
1.42
 
ns ns ns Conclusion : low dose fixed combination  and reliever therapy is associated with higher eosinophil counts, but these remain within the range associated with stable clinical control.
J Allergy Clin Immunol 2009;124:1180-5. 1.43
 
Conclusions:  relative mild asthmatic patients with delay ICS  Rx had elevate inflammatory markers but no clinical difference compare with early ICS Rx
Take home message ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Thank you  for  your attention

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Advance In Asthma 2009

  • 1. Advance in asthma 2009 w.pongsak,MD
  • 2.
  • 3.
  • 4.  
  • 5.  
  • 6.
  • 7.  
  • 8.  
  • 9. N0 ASSOCIATION POSITIVE CORRELATION INCREASE RISK ONLY IN FEMALE ONLY IN FEMALE INCREASE RISK INCREASE RISK INCREASE RISK
  • 10.
  • 11. 1.56
  • 12. Conclusion = failed to find an association between obesity and asthma control in an urban population with asthma .
  • 13. 1.57 Conclusion = weight gain decrease in lung function in asthmatic patients N=638
  • 14. 1.58 Conclusion = positive association between BMI and asthma risk that was similar in magnitude to those observed in longitudinal studies of white women
  • 15. J Allergy Clin Immunol 2009;123:1328-34 . 1.59 N= 1,265
  • 16. J Allergy Clin Immunol 2009;123:1328-34 . 1.59 Conclusions: Increased BMI is not associated with clinically significant worsening of impairment in subjects with mild to moderate persistent asthma.
  • 17. Asthma and genetic Genetics
  • 19.  
  • 20.  
  • 21.
  • 22. 1.14 J AllergyClin Immunol 2009;124:1188-94 N= 1,182
  • 23. J AllergyClin Immunol 2009;124:1188-94 1.14 Conclusion: The Arg16 genotype of ADRB2 is associated with exacerbations in asthmatic children and young adults exposed daily to b2-agonists
  • 24.
  • 26. Conclusion : Targeting FENO on reference values is not justified.
  • 27. 1.20
  • 28.  
  • 29.  
  • 30. Conclusion : Conventional asthma management resulted in good control of symptoms in most participants. The addition of fraction of exhaled NO as an indicator of control of asthma resulted in higher doses of inhaled corticosteroids, without clinically important improvements in symptomatic asthma control.
  • 31. 1.22
  • 33.  
  • 34. middleton 6 th edition
  • 35. J Allergy Clin Immunol 2009;124:928-32 . 1.25 N=238
  • 36. J Allergy Clin Immunol 2009;124:928-32 . 1.25 Area = 0.89 Conclusions : In an unselected sample of young adults, bronchial provocation with inhaled dry-powder mannitol had a high diagnostic specificity for the diagnosis of asthma .
  • 37.
  • 38. 1.31
  • 39.  
  • 40. Conclusions: These findings suggest that subjects with mild allergic asthma and healthy subjects have similar cold symptoms and inflammatory and antiviral responses.
  • 41.
  • 42. J Allergy Clin Immunol 2009;124:699-706 . 1.34
  • 43. J Allergy ClinImmunol 2009;124:691-6 . 1.35
  • 44. J Allergy ClinImmunol 2009;123:116-21 1.41
  • 45. Conclusion: Although symptomatic control and rescue bronchodilator use may be improved by the addition of a LABA to ICS, there may be a lower risk of severe exacerbations and hospitalizations from ICS dose increase. Oral steroid use : lower in ICS group ( 22%vs 27%) Hospitalization : lower in ICS group ( 1.3% vs 1.7%) J Allergy ClinImmunol 2009;123:116-21
  • 46. 1.42
  • 47.  
  • 48. ns ns ns Conclusion : low dose fixed combination and reliever therapy is associated with higher eosinophil counts, but these remain within the range associated with stable clinical control.
  • 49. J Allergy Clin Immunol 2009;124:1180-5. 1.43
  • 50.  
  • 51. Conclusions: relative mild asthmatic patients with delay ICS Rx had elevate inflammatory markers but no clinical difference compare with early ICS Rx
  • 52.
  • 53. Thank you for your attention