Difference between revisions of "आज्मा"

robot Adding: bjn:Manggah; अंगराग परिवर्तन
m (robot Adding: bjn:Manggah; अंगराग परिवर्तन)
--><ref name=Lilly>Lilly CM. Diversity of asthma: Evolving concepts of pathophysiology and lessons from genetics. ''J Allergy Clin Immunol''. 2005;115 (4 Suppl):S526-31. PMID 15806035</ref>
== इतिहास ==
आज्मा धागु खंग्व [[प्राचीन युनान|युनानी]] खंग्व ''आजीन'' नं वगु ख,थ्व खंग्वयाग अर्थ "शार्प (sharp) सासः" ख। थ्व खँग्व दक्ले न्ह्य [[होमर]]यागु इलियाडय् च्वयातगु खने दु।<!--
--><ref name=Marketos>Marketos SG, Ballas CN. Bronchial asthma in the medical literature of Greek antiquity. ''J Asthma''. 1982;19(4):263-9. PMID 6757243</ref>
१७औं शताव्दीय् [[बर्नार्डिनो रामाजिनी]] नं अर्ग्यानिक धु व थ्व ल्वेयागु छुं सम्बन्ध दुगु खं सीका दिल। [[ब्रोंकोडाइलेटर]]यागु छ्येलेज्या १९०१ निसें न्ह्येथन तर १९६०यागु दशक तक्क नं थ्व ल्वेयागु इन्फ्लामेटरी भागयागु बारेय् चिकित्सकत अनभिज्ञ जुल। थ्व भाग सी धुंका [[एन्टि-इन्फ्लामेटरी]] वास नं थ्व ल्वेयागु रेजिमेनय् तेनिगु ज्या जुल।
== लक्षण ==
छुं मनुय् आज्मा क्रोनिक रेस्पिरेटरी इम्पेयरमेन्टयागु रुपे खने दै। मेमेपिंय् थ्व ल्वे इन्टर्मिटेन्ट ल्वेयागु रुपे खने दै व थ्व ल्वेयागु लक्षण इन्टरमिटेन्ट कथलं अपर रेस्पिरेटरी संक्रमण, तनाव, वायुय् दैगु एलर्जेन, वायु प्रदुषक (दसु कुं) वा व्यायामं याना जुइ।
some patients present primarily with [[cough]]ing, and in the late stages of an attack, air motion may be so impaired that no wheezing may be heard. When present the cough may sometimes produce clear [[sputum]]. The onset may be sudden, with a sense of constriction in the chest, breathing becomes difficult, and wheezing occurs (primarily upon expiration, but can be in both [[Respiration (physiology)|respiratory]] phases).
[[Sign (medicine)|Signs]] of an asthmatic episode include [[wheeze|wheezing]], rapid breathing ([[tachypnea]]), prolonged expiration, a rapid heart rate ([[tachycardia]]), [[rhonchus|rhonchous]] lung sounds (audible through a [[stethoscope]]), and over-inflation of the chest. During a serious asthma attack, the accessory [[muscle]]s of respiration (sternocleidomastoid and scalene muscles of the neck) may be used, shown as in-drawing of [[biological tissue|tissuetissues]]s between the ribs and above the [[sternum]] and [[clavicle]]s, and the presence of a [[paradoxical pulse]] (a pulse that is weaker during inhalation and stronger during exhalation).
During very severe attacks, an asthma sufferer can [[cyanosis|turn blue]] from lack of oxygen, and can experience [[chest pain]] or even loss of [[consciousness]]. Just before loss of consciousness, there is a chance that the patient will feel numbness in the limbs and palms may start to sweat. Feet may become icy cold. Severe asthma attacks may lead to respiratory arrest and death. Despite the severity of symptoms during an asthmatic episode, between attacks an asthmatic may show few signs of the disease.<ref>{{cite book |last=Longmore |first=Murray ''et al'' |title=Oxford Handbook of Clinical Medicine |publisher=Oxford University Press |location= |edition=7<sup>th</sup> ed.|year=2007 |pages= |isbn=978-0198568377 |oclc= |doi=}}</ref>
== डायाग्नोसिस ==
आज्मायात छगु रिभर्सिबल एअरवे अब्स्ट्रक्सनया कथं परिभाषित यानातगु दु। Reversibility थमंतुं (spontaneously) वा निदान (treatment) याना जुइ। थुकिया दक्ले आधारभूत [[पीक एक्स्पिरेटरी फ्लो रेट]]या लनेज्या व क्वय् बियातगु क्राइटेरियायात [[ब्रिटिस थोर्‍यासिक सोसाइटी]] नं आज्माया डायग्नोसिसया आधार कागु दु:<ref>{{cite journal |author=Pinnock H, Shah R|title=Asthma|journal=Br Med J|year=2007|volume=334|issue=7598|pages=847&ndash;50847–50|doi=10.1136/bmj.39140.634896.BE}}</ref>
* ≥२०% difference on at least three days in a week for at least two weeks;
* ≥२०% improvement of peak flow following treatment, दसु:
** १० मिनेट इन्हेल्ड &बेटा;-अगोनिस्ट (दसु., [[साल्ब्युतामोल]]);
** ६ (खु) वातक्क इन्हेल्ड [[कर्तिकोस्तेरोइद]] (दसु, [[बेक्लोमेथासोन]]);
** १४ न्हु ३०mg [[प्रेद्निसोलोन]].
* ≥२०% decrease in peak flow following exposure to a trigger (e.g., exercise).
In many cases, a physician can [[diagnosis|diagnose]] asthma on the basis of typical findings in a patient's clinical history and examination. Asthma is strongly suspected if a patient suffers from [[eczema]] or other [[allergy|allergic]] conditions—suggesting a general [[atopy|atopic constitution]]—or has a [[Family history (medicine)|family history]] of asthma. While measurement of airway function is possible for adults, most new cases are diagnosed in children who are unable to perform such tests. Diagnosis in children is based on a careful compilation and analysis of the patient's [[medical history]] and subsequent improvement with an inhaled [[bronchodilator]] medication. In adults, diagnosis can be made with a [[peak flow meter]] (which tests airway restriction), looking at both the diurnal [[Circadian rhythm|variation]] and any reversibility following inhaled [[bronchodilator]] [[Asthma#Rapid relief|medication]].
In the Emergency Department doctors may use a [[capnography]] PMID 16187465 which measures the amount of exhaled [[carbon dioxide]] along with [[pulse oximetry]] which shows the amount of oxygen dissolved in the blood, to determine the severity of an asthma attack as well as the response to treatment.
=== Differential diagnosis ===
Before diagnosing someone as asthmatic, [[differential diagnosis|alternative possibilities]] should be considered. A physician taking a history should check whether the patient is using any known bronchoconstrictors (substances that cause narrowing of the airways, e.g., certain [[anti-inflammatory]] agents or [[beta-blockers]]).
The majority of these triggers can often be identified from the history; for instance, asthmatics with [[hay fever]] or [[pollen]] allergy will have seasonal symptoms, those with allergies to [[pet]]s may experience an abatement of symptoms when away from home, and those with occupational asthma may improve during leave from work. Occasionally, [[allergy#Diagnosis|allergy tests]] are warranted and, if positive, may help in identifying avoidable symptom triggers.
After a [[Pulmonary_function_test|pulmonary function test]] has been carried out, radiological tests, such as a [[chest X-ray]] or [[computed tomography|CT scan]], may be required to exclude the possibility of other lung diseases. In some people, asthma may be triggered by [[gastroesophageal reflux disease]], which can be treated with suitable [[antacid]]s. Very occasionally, specialized tests after inhalation of [[methacholine challenge test|methacholine]] — or, even less commonly, [[histamine]] — may be performed.
Asthma is categorized by the United States [[National Heart, Lung and Blood Institute]] as falling into one of four categories: mild intermittent, mild persistent, moderate persistent and severe persistent. The diagnosis of "severe persistent asthma" occurs when symptoms are continual with frequent exacerbations and frequent nighttime symptoms, result in limited physical activity and when lung function as measured by PEV or FEV<sub>1</sub> tests is less than 60% predicted with PEF variability greater than 30%.
There is no cure for asthma. Doctors have only found ways to prevent attacks and relieve the symptoms such as tightness of the chest and trouble breathing.
== Pathophysiology ==
[[Imageकिपा:Asthma before-after.png|thumb|right|470px|'''Inflamed airways and bronchoconstriction in asthma'''. Airways narrowed as a result of the inflammatory response cause wheezing.]]
=== Bronchoconstriction ===
During an asthma episode, inflamed [[bronchiole|airways]] react to environmental triggers such as smoke, dust, or pollen. The airways narrow and produce excess [[mucus]], making it difficult to breathe.
In essence, asthma is the result of an [[immune response]] in the [[bronchial]] airways.<ref name=Maddox>Maddox L, Schwartz DA. The Pathophysiology of Asthma. ''Annu. Rev. Med.'' 2002, 53:477-98. PMID 11818486</ref>
The airways of asthmatics are "[[hypersensitivity|hypersensitive]]" to certain triggers, also known as ''stimuli'' (see below). In response to exposure to these triggers, the [[bronchi]] (large airways) contract into [[spasm]] (an "asthma attack"). [[Inflammation]] soon follows, leading to a further narrowing of the airways and excessive [[mucus]] production, which leads to coughing and other breathing difficulties.
=== Stimuli ===
There are many different categories of stimuli:
* [[Allergen]]ic [[Pollution|air pollution]], from nature, typically inhaled, which include waste from common household pests, such as the [[house dust mite]] and [[cockroach]], [[pollen|grass pollen]], [[mould]] spores, and pet [[epithelium|epithelial cells]];
* Indoor [[Allergen]]ic [[Pollution|air pollution]] from [[Volatile organic compound]]s, including [perfume]s and perfumed products. Examples include soap, dishwashing liquid, laundry detergent, fabric softener, paper tissues, paper towels, toilet paper, shampoo, hairspray, hair gel, cosmetics, facial cream, sun cream, deodorant, cologne, shaving cream, aftershave lotion, air freshener and candles, and products such as oil-based paint.
* [[Medication]]s, including [[aspirin]],<ref name=Jenkins>Jenkins C, Costello J, Hodge L. [[Systematic review]] of prevalence of aspirin induced asthma and its implications for clinical practice. ''[[British Medical Journal|BMJ]]'' 2004;328:434. PMID 14976098</ref> [[beta blocker|β-adrenergic antagonistantagonists]]s (beta blockers), and [[penicillin]].
* [[Food allergy|Food allergies]] such as [[milk]], [[peanut|peanuts]]s, and [[egg (food)|eggs]]. However, asthma is rarely the only symptom, and not all people with food or other allergies have asthma.
* Use of [[fossil fuel]] related [[allergen]]ic [[Pollution|air pollution]], such as [[ozone]], [[smog]], [[summer smog]], [[nitrogen dioxide]], and [[sulfur dioxide]], which is thought to be one of the major reasons for the high prevalence of asthma in [[Urban area|urban]] areas;
* Various industrial compounds and other chemicals, notably [[sulfites]]; [[chlorine|chlorinated]] swimming pools generate [[chloramine]]s—monochloramine (NH<sub>2</sub>Cl), dichloramine (NHCl<sub>2</sub>) and trichloramine (NCl<sub>3</sub>)—in the air around them, which are known to induce asthma.<ref name=Nemery>Nemery B, Hoet PH, Nowak D. Indoor swimming pools, water chlorination and respiratory health. ''Eur Respir J''. 2002;19(5):790-3. PMID 12030714</ref>
* Early childhood [[infection]]s, especially [[virus|viral]] [[URTI|respiratory infections]]. However, persons of any age can have asthma triggered by [[colds]] and other respiratory infections even though their normal stimuli might be from another category (e.g. pollen) and absent at the time of infection. 80% of asthma attacks in adults and 60% in children are caused by respiratory viruses.
* [[Exercise]], the effects of which differ somewhat from those of the other triggers;
* [[Allergen]]ic indoor [[Pollution|air pollution]] from [[newsprint]] & other literature such as, [[Direct marketing|junk mail]] leaflets & glossy [[magazine]]s (in some countries).
* [[Hormone|Hormonal]] changes in [[adolescent]] girls and adult women associated with their [[menstrual cycle]] can lead to a worsening of asthma. Some women also experience a worsening of their asthma during [[pregnancy]] whereas others find no significant changes, and in other women their asthma improves during their pregnancy.
* [[Stress (medicine)|Emotional stress]] which is poorly understood as a trigger.
=== Bronchial inflammation ===
The mechanisms behind allergic asthma—i.e., asthma resulting from an [[immune response]] to inhaled [[allergen]]s—are the best understood of the causal factors. In both asthmatics and non-asthmatics, inhaled allergens that find their way to the inner [[bronchiole|airways]] are [[phagocytosis|ingested]] by a type of cell known as [[antigen presenting cell]]s, or APCs. APCs then "present" pieces of the allergen to other [[immune system]] cells. In most people, these other immune cells ([[T helper cell|T<sub>H</sub>0 cells]]) "check" and usually ignore the allergen molecules. In asthmatics, however, these cells [[differentiation|transform]] into a different type of cell (T<sub>H</sub>2), for reasons that are not well understood. The resultant T<sub>H</sub>2 cells activate an important arm of the immune system, known as the [[humoral immunity|humoral immune system]]. The humoral immune system produces [[antibody|antibodies]] against the inhaled allergen. Later, when an asthmatic inhales the same allergen, these antibodies "recognize" it and activate a [[Humoral immune response|humoral response]]. [[Inflammation]] results: chemicals are produced that cause the airways to constrict and release more mucus, and the cell-mediated arm of the immune system is activated. The inflammatory response is responsible for the clinical manifestations of an asthma attack. The following section describes this complex series of events in more detail.
=== Pathogenesis ===
The fundamental problem in asthma appears to be [[immunology|immunological]]: young children in the early stages of asthma show signs of excessive inflammation in their airways. [[Epidemiology|Epidemiological findings]] give clues as to the [[pathogenesis]]: the incidence of asthma seems to be increasing worldwide, and asthma is now very much more common in affluent countries.
In 1995 Szentivanyi and colleagues demonstrated that IgE blocks beta-2 receptors.<!--
--><ref>{{cite journal | author=Szentivanyi A., Ali K., Calderon EG., Brooks SM., Coffey RG., Lockey RF. | title=The ''in vitro'' effect of Imunnoglobulin E {IgE} on cyclic AMP concentrations in A549 human pulmonary epithelial cells with or without beta adrenergic stimulation | journal=J. Allergy Clin Immunol. | volume=91 | pages=379 | year=1993}} - Part of Abstracts from:<br />
{{cite journal | author = | title = 50th Anniversary of the American Academy of Allergy and Immunology. 49th Annual Meeting. Chicago, Illinois, March 12–17, 1993. Abstracts. | journal = J Allergy Clin Immunol | volume = 91 | issue = 1 Pt 2 | pages = 141–379 | year = 1993 | id = PMID 8421135}}</ref>
Since overproduction of IgE is central to all atopic diseases, this was a watershed moment in the world of Allergy.<!--
The Beta-Adrenergic Theory has been cited in the scholarship of such noted investigators as [[Richard F. Lockey]] (former President of the American Academy of Allergy, Asthma, and Immunology),<ref name=Richard_F_Lockey>{{cite web | url = http://www.worldallergy.org/professional/allergic_diseases_center/anaphylaxis/anaphylaxissynopsis.shtml | title = Anaphylaxis: Synopsis | accessmonthday = September 23 | accessyear = 2006 | last = Lockey | first = Richard F. | date = 2006-04-28 | work = Allergic Diseases Resource Center | publisher = World Allergy Organization }}</ref> Charles Reed (Chief of Allergy at Mayo Medical School),<ref name=Charles_Reed>{{cite journal | first = J. J. | last = Ouellette | coauthors = C. E. Reed | year = 1967 | month = March | title = The effect of partial beta adrenergic blockade on the bronchial response of hay fever subjects to ragweed aerosol. | journal = Journal of Allergy | volume = 39 | issue = 3 | pages = 160-6 | id = {{PMID|5227155}}}}</ref> and Craig Venter (Human Genome Project).<ref name=Craig_Venter>{{cite journal | last = Fraser | first = Claire M. | coauthors = [[Craig Venter|J. Craig Venter]] | date = [[May 14]], [[1980]] | title = The synthesis of beta-adrenergic receptors in cultured human lung cells: induction by glucocorticoids. | journal = Biochemical and Biophysical Research Communications | volume = 94 | issue = 1 | pages = 390–397 | doi = 10.1016/S0006-291X(80)80233-6 | id = {{PMID|6248064}} | url = http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WBK-4G0VNMJ-S8&_coverDate=05%2F14%2F1980&_alid=454587819&_rdoc=1&_fmt=&_orig=search&_qd=1&_cdi=6713&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=f3bc10fca4f32364a318857c0262f252 | format = PDF | accessdate = 2006-09-23}}</ref><!--I know that this is A J. Craig Venter, but I do not know which one.-->
==== कारक ====
येक्व स्टडिज कथलं मस्तय् आज्मा, [[ब्रोंकाइटिस]], व एक्युट रेस्पिरेटरी ल्वेयात वायुयागु क्वालिटी नाप स्वापू दुगु खं क्यंगु दु।<ref name=asthma_air_quality>{{cite web | url = http://ewg.org/sites/asthmaindex/about/kidshealth.php | title = Asthma and Air Quality}}</ref> One of the largest of these studies is the California Children's Health Study.<ref name=childrens_health_study>{{cite web | url = http://www.arb.ca.gov/research/chs/chs.htm | title = California Children's Health Study}}</ref> From the press release [http://www.arb.ca.gov/newsrel/nr013102.htm]<blockquote>The study showed that children in the high ozone communities who played three or more sports developed asthma at a rate three times higher than those in the low ozone communities. Because participation in some sports can result in a child drawing up to 17 times the “normal” amount of air into the lungs, young athletes are more likely to develop asthma.</blockquote>
Note that concentrations of ozone have risen steadily in Europe since 1870. [http://www.eoearth.org/image/Histconc.gif]
--><ref name="Cochrane2005-Richeldi" />
=== Asthma and sleep apnea ===
{{main|sleep apnea}}
It is recognized with increasing frequency, that patients who have both obstructive sleep apnea (OSA) and bronchial asthma, often improve tremendously when the sleep apnea is diagnosed and treated.<ref name=sleep_anpea1>{{cite press release | title = Breathing disorders during sleep are common among asthmatics, may help predict severe asthma | publisher = University of Michigan Health System | date = May 25, 2005 | url = http://www.med.umich.edu/opm/newspage/2005/asthmasleep.htm | accessdate = 2006-09-23 }}</ref> [[CPAP]] is not effective in patients with nocturnal asthma only.<ref name=CPAP_not_an_anti-asthmatic>{{cite web | url = http://www.sleepapnea.org/resources/pubs/asthma-osa.html | title = Asthma and OSA | accessmonthday = September 23 | accessyear = 2006 | last = Basner | first = Robert C. | date = 2006-07-25 | work = ASAA Resources > Publications | publisher = American Sleep Apnea Association}}</ref>
=== Asthma and gastro-esophageal reflux disease ===
{{main|gastro-esophageal reflux disease}}
If gastro-esophageal reflux disease is present, the patient may have repetitive episodes of acid aspiration, which results in airway inflammation and "irritant-induced" asthma.{{Fact|date=February 2007}} GERD may be common in difficult-to-control asthma, but generally speaking, treating it does not seem to affect the asthma.<ref name=Leggett_et_al_2005>{{cite journal | last = Leggett | first = Julian J. | coauthors = Brian T. Johnston, Moyra Mills, Jackie Gamble, and Liam G. Heaney | year = 2005 | month = April | title = Prevalence of Gastroesophageal Reflux in Difficult Asthma | journal = Chest | volume = 127 | issue = 4 | pages = 1227–1231 | id = {{PMID|15821199}} | url = http://www.chestjournal.org/cgi/content/full/127/4/1227 | accessdate = 2006-09-23}}</ref>
== Treatment ==
The most effective treatment for asthma is identifying triggers, such as pets or aspirin, and limiting or eliminating exposure to them. [[Desensitization (medicine)|Desensitization]] to allergens has been shown to be a treatment option for certain patients.<ref>American Journal of Respiratory and Critical Care Medicine 1995;151:969–74.</ref>
A novel therapeutic target currently under investigation is the A<sub>2B</sub> receptor, a cell surface G-protein coupled receptor expressed in the lungs and in inflammatory cells expressed in asthma. Several animal models have confirmed the a critical role for A<sub>2B</sub> antagonists in pulmonary inflammation, fibrosis and airway remodelling.<ref> {{cite web | author=D. Zeng & R. Polosa |year=2006 | title=A Novel Therapeutic Target in Asthma - The A<sub>2B</sub> Adenosine Agonist|url=http://www.touchrespiratorydisease.com/articles.cfm?article_id=6169&level=2}}</ref>
=== Relief medication ===
Symptomatic control of episodes of wheezing and shortness of breath is generally achieved with fast-acting [[bronchodilator]]s. These are typically provided in pocket-sized, metered-dose [[inhaler]]s (MDIs). In young sufferers, who may have difficulty with the coordination necessary to use inhalers, or those with a poor ability to hold their breath for 10 seconds after inhaler use (generally the elderly), an [[asthma spacer]] (see top image) is used. The spacer is a plastic cylinder that mixes the medication with air in a simple tube, making it easier for patients to receive a full dose of the drug and allows for the active agent to be dispersed into smaller, more fully inhaled bits. A [[nebulizer]] which provides a larger, continuous dose can also be used. Nebulizers work by vaporizing a dose of medication in a saline solution into a steady stream of foggy vapour, which the patient inhales continuously until the full dosage is administered. There is no clear evidence, however, that they are more effective than inhalers used with a spacer. Nebulizers may be helpful to some patients experiencing a severe attack. Such patients may not be able to inhale deeply, so regular inhalers may not deliver medication deeply into the lungs, even on repeated attempts. Since a nebulizer delivers the medication continuously, it is thought that the first few inhalations may relax the airways enough to allow the following inhalations to draw in more medication.
Relievers include:
* Short-acting, selective [[Beta2-adrenergic receptor agonist|beta<sub>2</sub>-adrenoceptor agonists]], such as [[salbutamol]] (''albuterol'' [[United States Adopted Name|USAN]]), [[levalbuterol]], [[terbutaline]] and [[bitolterol]].<br />[[tremor|Tremors]], the major side effect, have been greatly reduced by inhaled delivery, which allows the drug to target the lungs specifically; oral and injected medications are delivered throughout the body. There may also be [[cardiac]] side effects at higher doses (due to Beta-1 agonist activity), such as elevated heart rate or blood pressure; with the advent of selective agents, these side effects have become less common. Patients must be cautioned against using these medicines too frequently, as with such use their efficacy may decline, producing [[desensitization]] resulting in an exacerbation of symptoms which may lead to refractory asthma and death.
* Older, less selective [[adrenergic receptor|adrenergic agonists]], such as inhaled [[epinephrine]] and [[ephedrine]] tablets, have also been used. Cardiac side effects occur with these agents at either similar or lesser rates to albuterol.<!--
--><ref name=Hendeles>Hendeles L, Marshik PL, ''et al.'' Response to nonprescription epinephrine inhaler during nocturnal asthma. ''Ann Allergy Asthma Immunol.'' 2005 Dec;95(6):530-4. PMID 16400891</ref> <!--
--><ref name=Rodrigo>Rodrigo GJ, Nannini LJ. Comparison between nebulized adrenaline and beta2 agonists for the treatment of acute asthma. A meta-analysis of randomized trials. ''Am J Emerg Med.'' 2006 Mar;24(2):217-22. PMID 16490653</ref> When used solely as a relief medication, inhaled epinephrine has been shown to be an effective agent to terminate an acute asthmatic exacerbation.<ref name="Hendeles" /> In emergencies, these drugs were sometimes administered by injection. Their use via injection has declined due to related adverse effects.
* [[Anticholinergic]] medications, such as [[ipratropium bromide]] may be used instead. They have no cardiac side effects and thus can be used in patients with heart disease; however, they take up to an hour to achieve their full effect and are not as powerful as the β<sub>2</sub>-adrenoreceptor agonists.
=== Prevention medication ===
Current treatment protocols recommend prevention medications such as an inhaled [[corticosteroid]], which helps to suppress [[inflammation]] and reduces the swelling of the lining of the airways, in anyone who has frequent (greater than twice a week) need of relievers or who has severe symptoms. If symptoms persist, additional preventive drugs are added until the asthma is controlled. With the proper use of prevention drugs, asthmatics can avoid the complications that result from overuse of relief medications.
Preventive agents include the following.
* Inhaled [[glucocorticoid]]s are the most widely used of the prevention medications and normally come as inhaler devices ([[ciclesonide]], [[beclomethasone]], [[budesonide]], [[flunisolide]], [[fluticasone]], [[mometasone furoate|mometasone]], and [[triamcinolone]]).<br />Long-term use of corticosteroids can have many side effects including a redistribution of fat, increased [[appetite]], blood [[glucose]] problems and weight gain. In particular high doses of steroids may cause [[osteoporosis]]. For this reasons inhaled steroids are generally used for prevention, as their smaller doses are targeted to the lungs unlike the higher doses of oral preparations. Nevertheless, patients on high doses of inhaled steroids may still require prophylactic treatment to prevent osteoporosis.<br />Deposition of steroids in the mouth may cause a [[dysphonia|hoarse voice]] or [[oral thrush]] (due to decreased immunity). This may be minimised by rinsing the mouth with water after inhaler use, as well as by using a [[spacer]] which increases the amount of drug that reaches the lungs.
* [[Leukotriene]] modifiers ([[montelukast]], [[zafirlukast]], [[pranlukast]], and [[zileuton]]).
* [[Mast cell]] stabilizers ([[cromoglicate]] (cromolyn), and [[nedocromil]]).
Additionally, the antidepressant [[tianeptine]] has shown significant efficacy in children with asthma.
=== Long-acting β<sub>2</sub>-agonists ===
[[Imageकिपा:AsthmaInhaler.jpg|thumb|180px|A typical [[inhaler]], of [[salmeterol|Serevent (salmeterol)]], a long-acting bronchodilator.]]
Long-acting bronchodilators (LABD) are similar in structure to short-acting selective beta<sub>2</sub>-adrenoceptor agonists, but have much longer sidechains resulting in a 12-hour effect, and are used to give a smoothed symptomatic relief (used morning and night). While patients report improved symptom control, these drugs do not replace the need for routine preventers, and their slow onset means the short-acting dilators may still be required. In November of 2005, the American [[Food and Drug Administration|FDA]] released a health advisory alerting the public to findings that show the use of long-acting β<sub>2</sub>-agonists could lead to a worsening of symptoms, and in some cases death.<!--
--><ref name=FDA"LABD">{{cite web | year=[[2006-03-03]] | title=Serevent Diskus, Advair Diskus, and Foradil Information (Long Acting Beta Agonists) - Drug information | publisher=FDA | url=http://www.fda.gov/cder/drug/infopage/LABA/default.htm}}</ref>
Currently available [[long acting beta-adrenoceptor agonist|long-acting beta<sub>2</sub>-adrenoceptor agonists]] include [[salmeterol]], [[formoterol]], [[bambuterol]], and sustained-release oral [[albuterol]]. Combinations of inhaled steroids and long-acting bronchodilators are becoming more widespread; the most common combination currently in use is fluticasone/salmeterol ([[Advair]] in the United States, and [[Seretide]] in the United Kingdom).
A recent meta-analysis of the roles of long-acting beta-agonists may indicate a danger to asthma patients. "These agents can improve symptoms through bronchodilation at the same time as increasing underlying inflammation and bronchial hyper-responsiveness, thus worsening asthma control without any warning of increased symptoms," said Shelley Salpeter in a Cornell study. The study goes on to say that "Three common asthma inhalers containing the drugs salmeterol or formoterol may be causing four out of five US asthma-related deaths per year and should be taken off the market".<ref name=Down_with_Serevent>{{cite web | first = Krishna | last = Ramanujan | title = Common asthma inhalers cause up to 80 percent of asthma-related deaths, Cornell and Stanford researchers assert | url = http://www.news.cornell.edu/stories/June06/AsthmaDeaths.kr.html | work = Cornell Chronicle Online | publisher = Cornell News Service | date = 2006-06-09 | accessdate = 2006-09-23}}</ref> This assertion has drawn criticism from many asthma specialists for being inaccurate. As Dr. Hal Nelson points out in a recent letter to the Annals of Internal Medicine,<br /><br /><i>''"Salpeter and colleagues also assert that salmeterol may be responsible for 4000 of the 5000 asthma-related deaths that occur in the United States annually. However, when salmeterol was introduced in 1994, more than 5000 asthma-related deaths occurred per year. Since the peak of asthma deaths in 1996, salmeterol sales have increased about 5-fold, while overall asthma mortality rates have decreased by about 25%, despite a continued increase in asthma diagnoses. In fact, according to the most recent data from the National Center for Health Statistics, U.S. asthma mortality rates peaked in 1996 (with 5667 deaths) and have decreased steadily since. The last available data, from 2004, indicate that 3780 deaths occurred. Thus, the suggestion that a vast majority of asthma deaths could be attributable to LABA use is inconsistent with the facts."</i>''<br /><br /> Dr. Salpeter has since tempered her comments regarding LABAs
=== Emergency treatment ===
When an asthma attack is unresponsive to a patient's usual medication, other treatments are available to the physician or hospital:<!--
--><ref name=rodrigo>Rodrigo GJ, Rodrigo C, Hall JB. Acute asthma in adults: a review. ''Chest''. 2004;125(3):1081-102. PMID 15006973</ref>
* Heliox, a mixture of helium and oxygen, may be used in a hospital setting. It has a more laminar flow than ambient air and moves more easily through constricted airways
=== Alternative and complementary medicine ===
Many asthmatics, like those who suffer from other chronic disorders, use alternative treatments; surveys show that roughly 50% of asthma patients use some form of unconventional therapy.<!--
--><ref name=blanc>Blanc PD, Trupin L, Earnest G, ''et al.'' Alternative therapies among adults with a reported diagnosis of asthma or rhinosinusitis: data from a population-based survey. ''Chest''. 2001;120(5):1461–7. PMID 11713120</ref><!--
See also ''[[Complementary and alternative medicine]]''.
== प्रोग्नोसिस ==
आज्माया प्रोग्नोसिस बांला, विशेषयाना माइल्ड ल्वय् दुगु मचातेत। मचाबिले डायग्नोसिस जुगु आज्माय् ५४%य् थ्व डायग्नोसिस १०दं धुंका दैमखु। आज्मातिक्सय् extent of permanent lung damage गुलि दु धका बांलाक्क जानकारी मदुनि। Airway remodelling खनेदै तर थुकिलिं म्हयात द्याइ वा त्याइ धका आतक्क धाय्‌ मछिं।<ref name=Maddox /> Although conclusions from studies are mixed, most studies show that early treatment with glucocorticoids prevents or ameliorates decline in lung function as measured by several parameters.<ref name=beckett>Beckett PA, Howarth PH. Pharmacotherapy and airway remodelling in asthma? ''Thorax''. 2003;58(2):163-74. PMID 12554904</ref>
For those who continue to suffer from mild symptoms, corticosteroids can help most to live their lives with few [[disabilities]]. The mortality rate for asthma is low, with around 6000 deaths per year in a population of some 10 million patients in the United States.<ref name=McFadden />
Better control of the condition may help prevent some of these deaths.
== Epidemiology ==
[[Imageकिपा:asthma_prevalence.png|thumb|right|350px|The [[prevalence]] of childhood asthma has increased since 1980, especially in younger children.]]
More than 6% of children in the United States have been diagnosed with asthma, a 75% increase in recent decades. The rate soars to 40% among some populations of urban children.
Asthma is usually diagnosed in childhood. The risk factors for asthma include:
* a personal or family [[history]] of asthma or [[atopy]];
* triggers (see ''[[Asthma#Pathophysiology|Pathophysiology]]'' above);
* premature birth or low birth weight;
* viral [[URTI|respiratory infection]] in early childhood;
* maternal smoking;
* being male, for asthma in prepubertal children; and
* being female, for persistence of asthma into adulthood.
There is a reduced occurrence of asthma in people who were breast-fed as babies. Current research suggests that the [[prevalence]] of childhood asthma has been increasing. According to the [[Centers for Disease Control and Prevention]]'s National Health Interview Surveys, some 9% of US children below 18 years of age had asthma in 2001, compared with just 3.6% in 1980 (see figure). The [[World Health Organization]] (WHO) reports that some 8% of the Swiss population suffers from asthma today, compared with just 2% some 25–30 years ago.<!--
On the remote South Atlantic island [[Tristan da Cunha]], 50% of the population are asthmatics due to heredity transmission of a mutation in the gene CC16.
=== Socioeconomic factors ===
The incidence of asthma is higher among low-income populations within a society (it is not more common in [[developed countries]] than [[developing countries]][http://www.who.int/mediacentre/factsheets/fs307/en/]), which in the western world are disproportionately minority, and more likely to live near industrial areas. Additionally, asthma has been strongly associated with the presence of cockroaches in living quarters, which is more likely in such neighborhoods.<!--
--><ref name="CDC2002">{{cite web | author=National Center for Health Statistics | title=Asthma Prevalence, Health Care Use and Mortality, 2002 | year=07 [[April 2006]] | publisher=Centers for Disease Control and Prevention | url=http://www.cdc.gov/nchs/products/pubs/pubd/hestats/asthma/asthma.htm}}</ref>
=== Asthma and athletics ===
Asthma appears to be more prevalent in athletes than in the general population. One survey of participants in the 1996 [[Summer Olympic Games]], in [[Atlanta, Georgia]], U.S., showed that 15% had been diagnosed with asthma, and that 10% were on asthma medication.<!--
--><ref name=olympics>Weiler JM, Layton T, Hunt M. Asthma in United States Olympic athletes who participated in the 1996 Summer Games. ''J Allergy Clin Immunol''. 1998;102(5):722-6. PMID 9819287</ref>
In addition, there exists a variant of asthma called [[exercise-induced asthma]] that shares many features with allergic asthma. It may occur either independently, or concurrent with the latter. Exercise studies may be helpful in diagnosing and assessing this condition.
== स्वया दिसँ ==
* [[रियाक्टिभ एअरवे ल्वे]]
* [[अटोपी]]
* [[हप्किन्स सिन्ड्रम]]
* [[हाइजिन हाइपोथेसिस]]
* [[इम्युन रेस्पोन्स]]
== References ==
== पिनेया स्वापूत ==
* [http://www.who.int/respiratory/asthma/en/ World Health Organization site on asthma]
* [http://www.who.int/mediacentre/factsheets/fs307/en/ World Health Organization fact sheet on asthma]
* [http://www.nhlbi.nih.gov/health/public/lung/index.htm#asthma National Heart, Lung, and Blood Institute — Asthma] – U.S. NHLBI Information for Patients and the Public page.
* [http://www.nhlbi.nih.gov/health/prof/lung/index.htm#asthma National Heart, Lung, and Blood Institute — Asthma] – U.S. NHLBI Information for Health Professionals page.
* [http://www.nlm.nih.gov/medlineplus/asthma.html MedLinePlus: Asthma] – a U.S. National Library of Medicine page.
* [http://www.aaaai.org American Academy of Allergy, Asthma, and Immunology] – a U.S. organization of medical professionals with a special interest in treating and researching conditions such as allergic rhinitis, asthma, atopic dermatitis/eczema, and anaphylaxis.
* [http://www.aafa.org Asthma and Allergy Foundation of America] – national nonprofit patient advocacy organization with information about asthma.
* [http://www.asthma.org.uk Asthma UK] – a patient-oriented site with information on asthma and ways that UK residents can help improve asthma-related policy.
* [http://www.asthmaqld.org.au Asthma Foundation of Queensland] Information and education for Australian asthma sufferers.
* [http://www.atsdr.cdc.gov/HEC/CSEM/asthma/ Case Studies in Environmental Medicine (CSEM): Environmental Triggers of Asthma] – Agency for Toxic Substances and Disease Registry, U.S. Department of Health and Human Services.
* [http://www.asthma.ge/links.htm Asthma as Neurogenic Inflammatory Disease] Neurogenic aspects of asthma. Pathophysiological links with other inflammatory disorders.
* [http://tauac.typepad.com/ac/2007/03/tau_researchers.html Asthma and Socio-economic Status]
* [http://www.asthmacure.com India Asthma Care Society] Easy to understand asthma information site for patients.
* [http://www.segal.org/asthma/ The Segal Guide to Asthma] by Michael Segal MD PhD.
* [http://www.fitness-and-nutrition-news.com/fish-and-pregnancy.html A New Found Advantage Between Apples, Fish And Pregnancy]
{{Respiratory pathology}}
[[az:Bronxial astma]]
[[bs:Bronhijalna astma]]