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Related Concept Videos

Asthma-I: Introduction01:29

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Asthma is a chronic respiratory ailment that requires careful management due to its varying symptoms and influencing factors. It is characterized by airway inflammation, bronchial hyperresponsiveness, and reversible airflow obstruction, leading to symptoms like wheezing, shortness of breath, chest tightness, and coughing. The symptom frequency and intensity may vary considerably over time. It is also linked to immune system responses to allergens and irritants, highlighting the complex...
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Asthma-III: Symptoms and Complications01:24

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Asthma, a common chronic respiratory condition, is classified considering the frequency and severity of symptoms alongside lung function impairment. Understanding this classification is essential for appropriate treatment and management. Here's a detailed look at the classification of asthma and its clinical features and complications:
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Asthma-IV: Diagnostic and Management01:30

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Asthma: Pathogenesis and Management01:20

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Asthma is a chronic pulmonary condition involving inflammation of the airways, hyper-reactivity, and reversible obstruction of the airways. This condition can significantly impact a person's quality of life, making breathing difficult and leading to distressing symptoms.
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Asthma-II: Pathophysiology and Classification01:26

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Asthma is a prevalent chronic respiratory condition marked by inflammation and hyperresponsiveness of the airways. Its pathophysiology involves complex interactions among inflammatory pathways, immune responses, and neural mechanisms.
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Asthma-IV: Nursing Management01:30

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The nursing management of asthma is a comprehensive approach that relies heavily on the expertise and dedication of healthcare professionals. It involves thorough assessment, accurate diagnosis, strategic planning, effective implementation, and diligent evaluation. By meticulously following this step-by-step process, healthcare professionals play a crucial role in providing the best possible care and treatment for patients with asthma, enhancing their overall health and well-being.
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A Traditional Chinese Medicine Characteristic Therapy for Bronchial Asthma: Moxibustion
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Controller therapy in Asians and whites with persistent Asthma.

Wansu Chen1, Michael Schatz2, Zhi Liang1

  • 1Departments of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.

Asian Pacific Journal of Allergy and Immunology
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Summary

Montelukast monotherapy showed similar asthma exacerbation rates compared to low-dose inhaled corticosteroids (ICS) in white adults. No significant differences were found in Asian patients or white children, indicating comparable effectiveness for alternative controller regimens.

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Area of Science:

  • Pulmonology
  • Pharmacology
  • Real-world evidence

Background:

  • Limited data exists on the comparative effectiveness of leukotriene receptor antagonists (LTRAs) versus inhaled corticosteroids (ICS) as monotherapy, or long-acting beta-agonists (LABA) as add-on therapy, specifically within Asian populations.
  • Persistent asthma management often involves multiple controller medications, necessitating real-world comparative data.

Purpose of the Study:

  • To compare the effectiveness of montelukast (an LTRA) versus ICS as a first-line monotherapy for persistent asthma.
  • To evaluate montelukast as an add-on therapy in comparison with LABA, when added to ICS, for managing asthma exacerbations.
  • To assess these comparative treatment strategies in both Asian and non-Hispanic white patients within a large managed care setting.

Main Methods:

  • A retrospective cohort study design was employed, identifying patients using ICD-9 codes and pharmacy dispensing data.
  • Asthma exacerbations were defined by emergency department visits, hospitalizations, or outpatient visits requiring systemic corticosteroids.
  • Inverse probability treatment weighting (IPTW) was used to balance patient characteristics, and multivariable robust Poisson and Cox-proportional hazards regression models analyzed outcomes.

Main Results:

  • Montelukast monotherapy demonstrated a statistically significant lower incidence rate of asthma exacerbations compared to low-dose ICS monotherapy in white patients aged 12 years and older (RR 0.89, p=0.03).
  • However, no significant difference in the hazard rate of exacerbations was observed between these groups (HR 0.96, p=0.43).
  • No significant differences in exacerbation rates were found in Asian patients or in white children aged 4-11 years. Other add-on therapy comparisons also showed no statistically significant differences.

Conclusions:

  • In real-world clinical practice, asthma exacerbation rates were found to be similar between guideline-alternative controller regimens, including montelukast and ICS, in both Asian and white populations.
  • These findings suggest that montelukast can be a viable alternative controller medication for certain asthma patient groups, with comparable effectiveness to ICS in managing exacerbations.