ASTHMA AND ALLERGY

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0 height="100%"><tr> <td valign="top" width=210 BGCOLOR="#99CC99" TEXT="#080000" bgproperties="fixed" background="112f2f02esnpct.jpg"> <div> <A HREF="index.htm" TARGET="_top" TITLE="_"><U><B><U>HOME</U></B></U></A></div> <div> <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="149" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP BGCOLOR=#66FFFF HEIGHT= 23 ><NOBR><div> <A HREF="id91.htm" TARGET="_top" TITLE="BRUCE ROSEMAN, M.D. 140 WEST 86th Stree"><U>CONTACT ME</U></A></div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFCC99 HEIGHT= 23 ><NOBR><div> <A HREF="id17.htm" TARGET="_top" TITLE="office info"><U>OFFICE INFO</U></A></div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFF99 HEIGHT= 23 WIDTH="149"><div> <A HREF="http://www.nlm.nih.gov/medlineplus/druginformation.html" TARGET="_top" 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WIDTH="123"><bR> <div> <A HREF="#asthma_medications" TITLE="ASTHMA AND ALLERGY"><U><B>ASTHMA MEDICATIONS:</B></U></A></div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFF99 WIDTH="117"><bR> <div> <A HREF="#asthma_websites" TITLE="ASTHMA AND ALLERGY"><U><B>ASTHMA WEBSITES</B></U></A></div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFCC WIDTH="113"><bR> <div> <A HREF="#asthma_general_information" TITLE="ASTHMA AND ALLERGY"><U><B>ASTHMA GENERAL INFORMATION</B></U></A></div> <bR> </tD> <tD VALIGN=TOP BGCOLOR=#CCFFCC WIDTH="96"><bR> <div> <A HREF="#pollen_count" TITLE="ASTHMA AND ALLERGY"><U><B>POLLEN</B></U></A></div> <div> <A HREF="#pollen_count" TITLE="ASTHMA AND ALLERGY"><U><B>COUNT</B></U></A></div> <bR> </tD> </tR> </TABLE></div> <div> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" WIDTH="1060" BORDERCOLORLIGHT="#660099" BORDERCOLORDARK="#660099" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 651 WIDTH="465"><div> <B><U><IMG BORDER="0" SRC="Symb075c00b700dcff000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><A NAME="asthma_explanation"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></U></B><B><U>ASTHMA EXPLANATIONS</U></B></div> <div> <A HREF="#mechanism_of_asthma" TITLE="ASTHMA AND ALLERGY"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">WHAT IS ASTHMA</U></A></div> <div> <A HREF="#lung_anatomy" TITLE="ASTHMA AND ALLERGY"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">LUNG ANATOMY</U></A></div> <div> <A HREF="id134.htm" TARGET="_top" TITLE="oxygen availability curve"><U><IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">oxygen availability curve</U></A></div> <div> <A HREF="id136.htm" TARGET="_top" TITLE="SMALL AIRWAY DISEASE"><U><IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">SMALL AIRWAY DISEASE DIAGRAM</U></A></div> <div> <A HREF="id53_respiratory_system_basci_function.htm" TARGET="_top" TITLE=" ANATOMY"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">RESPIRATORY SYSTEM:BASIC FUNCTION</U></A></div> <div> <A HREF="#respiratory_system_glossary" TITLE="ASTHMA AND ALLERGY"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">RESPIRATORY SYSTEM:GLOSSARY</U></A></div> <div> <A HREF="#what_is_a_peak_flow_meter__" TITLE="ASTHMA AND ALLERGY"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">PEAK FLOW METER</U></A></div> <div> <A HREF="#sample_peak_flow_chart" TITLE="ASTHMA AND ALLERGY"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">SAMPLE PEAK FLOW CHART</U></A></div> <div> <A HREF="#nebulizers" TITLE="ASTHMA AND ALLERGY"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">NEBULIZERS</U></A></div> <div> <B><U> <A NAME="asthma_medications"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></U></B><B><U>ASTHMA MEDICATIONS:</U></B></div> <div> <A HREF="#singulair" TITLE="ASTHMA AND ALLERGY"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">SINGULAIR-HOW IT WORKS</U></A></div> <div> <A HREF="http://www.anaphylaxis.com/pro/6_6_2.cfm?continue=1" TARGET="_top" TITLE="http://www.anaphylaxis.com/pro/6_6_2.cfm"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">EPIPEN</U></A></div> <div> <A HREF="#advair_diskus" TITLE="ASTHMA AND ALLERGY"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">ADVAIR</U></A></div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">XOLAIR</div> <div> <A HREF="#xolair" TITLE="ASTHMA AND ALLERGY"><U><IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">xolair-anti IgE</U></A></div> <div> <A HREF="#xolair_controls_worst_asthma__study" TITLE="ASTHMA AND ALLERGY"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Xolair Controls Worst Asthma -Study</U></A></div> <div> <A HREF="#xolair_medwatch_anaphylaxis_may_occur" TITLE="ASTHMA AND ALLERGY"><U><I><IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Xolair may cause </I></U></A><A HREF="#xolair_medwatch_anaphylaxis_may_occur" TITLE="ASTHMA AND ALLERGY"><U><I>Anaphylaxis"</I></U></A></div> <div> <A HREF="#use_of_most_asthma_drugs_during" TITLE="ASTHMA AND ALLERGY"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">ASTHMA MEDICINE AND PREGNANCY</U></A></div> <div> <A HREF="#astma_drugs" TITLE="ASTHMA AND ALLERGY"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">SITES WHERE ASTHMA DRUGS WORK</U></A></div> <div> <B><U> <A NAME="asthma_websites"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></U></B><B><U>ASTHMA WEBSITES</U></B></div> <div> <A HREF="http://www.aafa.org/" TARGET="_top" TITLE="http://www.aafa.org/"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">ASTHMA AND ALLERGY FOUNDATION OF AMERICA</U></A></div> <div> <A HREF="http://www.aanma.org/" TARGET="_top" TITLE="http://www.aanma.org/"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">ASTHMA-(ALLERGY AND ASTHMA NETWORK)</U></A></div> <div> <B><U> <A NAME="asthma_general_information"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></U></B><B><U>ASTHMA GENERAL INFORMATION</U></B></div> <div> <A HREF="http://allergy.mcg.edu/lifequality/index.html" TARGET="_top" TITLE="http://allergy.mcg.edu/lifequality/index"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">ASTHMA LIFE QUALITY TEST</U></A></div> <div> <A HREF="#air_particles_we_breathe_" TITLE="ASTHMA AND ALLERGY"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Home Control Of Allergies And Asthma</U></A></div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Apples good for asthma</div> <div> <A HREF="#ph_test_may_offer_cheap_gauge_of_asthma" TITLE="ASTHMA AND ALLERGY"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Ph Test May Offer Cheap Gauge of Asthma Severity </U></A></div> <div> <A HREF="#asthma_and_allergy_triggers_" TITLE="ASTHMA AND ALLERGY"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">asthma triggers</U></A></div> <div> <A HREF="#heartburn_drug_may_relieve_severe" TITLE="ASTHMA AND ALLERGY"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Heartburn Drug May Relieve Severe Asthma </U></A></div> <div> <A HREF="#magnesium_added_to_nebulised_albuterol" TITLE="ASTHMA AND ALLERGY"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Magnesium Added to Nebulised Albuterol Provides Faster, Greater Improvement </U></A></div> <div> <A HREF="#in_some_throat_clearing_first_sign_of" TITLE="ASTHMA AND ALLERGY"><U><IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">In Some, Throat Clearing First Sign of Asthma</U></A></div> <div> <A HREF="#acid_reflux_therapy_may_cut_kids_" TITLE="ASTHMA AND ALLERGY"><U><IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Acid Reflux Therapy May Cut Kids' Asthma Drug Usage</U></A></div> <div> <A HREF="#controlling_sinus_problems_cuts_asthma" TITLE="ASTHMA AND ALLERGY"><U><IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Controlling Sinus Problems Cuts Asthma Risk</U></A></div> <bR> <bR> </tD> <tD VALIGN=TOP WIDTH="576"><div>  <A NAME="pollen_count"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> </tD> </tR> </TABLE></div> <bR> <bR> <div> <B><U> <A NAME="mechanism_of_asthma"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></U></B><B><U>Mechanism of asthma</U></B><FONT SIZE="3" COLOR="#660099" FACE="Arial" > </FONT></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">airways in your lungs are inflamed and swollen. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Muscles surrounding your airways, irritated by inflammation, tighten and constrict spontaneously. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Membranes in airway linings secrete excess mucus. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The result is narrowed airways and obstructed airflow that typically lead to coughing, wheezing and shortness of breath. </div> <div> <IMG SRC="1ff20230.jpg" border=0 width="544" height="291" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <U> <A NAME="what_is_asthma_"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></U><FONT SIZE="5" COLOR="#660099" FACE="Arial" ><B><U>What Is Asthma?</U></B></FONT></div> <div> You may not think of asthma as a killer disease. Yet nearly 500,000 Americans are hospitalized annually and more than 5,000 die annually of asthma.</div> <bR> <div> Asthma is a chronic condition that occurs when the main air passages of your lungs, the bronchial tubes, become inflamed. The muscles of the bronchial walls tighten and extra mucus is produced, causing your airways to narrow. This can lead to everything from minor wheezing to severe difficulty in breathing. In some cases your breathing may be so labored that an asthma attack becomes life-threatening.</div> <bR> <div> Yet asthma is a treatable disease, and most flare-ups and deaths can be prevented. In the past 20 years, scientists have gained a better understanding of asthma's cause. New drugs have been developed to replace standard medications. Greater emphasis also is now put on managing your own condition, much as people manage their diabetes with insulin. Together, you and your doctor can work to gain control over your symptoms, reduce the risk of severe attacks and help maintain a normal life.</div> <bR> <div> <B><U>Signs and Symptoms</U></B></div> <bR> <div> Asthma symptoms can range from mild to very severe. You may experience only occasional episodes of asthma with moderate, short-lived symptoms such as wheezing. You might also cough and wheeze most of the time or find that your symptoms become much worse after exposure to an asthma trigger such as pollen, mold or tobacco smoke. In severe cases, an asthma attack leaves you gasping for air.</div> <bR> <div> All asthma attacks give a warning. Learning to recognize warning signs and treating symptoms early can help prevent attacks or keep them from becoming worse. </div> <bR> <div> Warning signs for adults can include:</div> <bR> <div> Increased shortness of breath or wheezing </div> <bR> <div> Disturbed sleep caused by shortness of breath, coughing or wheezing </div> <bR> <div> Chest tightness or pain </div> <bR> <div> Increased need to use bronchodilators — medications that open up airways by relaxing the surrounding muscles </div> <bR> <div> A fall in peak flow rates as measured by a peak flow meter, a simple and inexpensive device that allows you to monitor your own lung function </div> <div> Warning signs for children may include: </div> <bR> <div> An audible whistling or wheezing when your child exhales </div> <bR> <div> Coughing, especially if the cough is frequent and occurs in spasms </div> <bR> <div> Waking at night with coughing or wheezing </div> <bR> <div> Shortness of breath, which may or may not occur when your child exercises </div> <bR> <div> A tight feeling in your child's chest</div> <div>    </div> <bR> <div> <B><U>Causes</U></B></div> <div> You're more likely to develop asthma if you have an inherited predisposition to the condition and are sensitive to allergens or irritants in the environment. In fact, the inflammation that causes asthma makes your airways overly sensitive to a wide range of environmental triggers. </div> <bR> <div> Asthma can develop at any age — even well into your 70s and beyond. If you're younger than age 30, your asthma is probably triggered by allergies. Many people older than 30 with asthma are also allergic to airborne particles. </div> <bR> <div> For the rest of adults with asthma, particularly older adults, respiratory allergies don't seem to play a role. Instead, exposure to any irritant — from a virus and cigarette smoke, to cold air, and even emotional stress — can trigger wheezing. </div> <bR> <div> In most cases though, asthma results from a combination of allergic and nonallergic responses. You may react to one or more of the following triggers:</div> <bR> <div> Allergens, such as pollen, cockroaches and molds. </div> <div> Air pollutants and irritants. </div> <div> Smoking and secondhand smoke. </div> <div> Respiratory infections, including the common cold. </div> <div> Physical exertion, including exercise. </div> <div> Cold air. </div> <div> Certain medications, including beta blockers such as propranolol (Inderal, Betachron), aspirin and other nonsteroidal anti-inflammatory drugs. </div> <div> Sulfites — preservatives added to some perishable foods. </div> <div> Emotional stress. </div> <div> Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into your food pipe (esophagus). GERD may trigger an asthma attack or make an attack worse. </div> <div> Sinusitis. </div> <bR> <bR> <div> <B><U>Risk Factors</U></B></div> <div> For reasons no one quite understands, the number of asthma cases has risen dramatically in the past decade, especially among children living in the inner city. Approximately 11 million Americans have an asthma attack each year, including about 3.8 million children.</div> <bR> <div> In fact, asthma is the most common chronic illness of childhood. Among young children, asthma is more common in boys than in girls. But after puberty asthma becomes more common in girls. </div> <bR> <div> Researchers have identified a number of factors that may increase your chances of developing asthma. These include:</div> <bR> <div> Living in a large urban area, especially the inner city, which may increase exposure to many environmental pollutants. </div> <div> Exposure to secondhand smoke. </div> <div> Exposure to occupational triggers, such as chemicals used in farming and hairdressing, and in paint, steel, plastics, and electronics manufacturing. </div> <div> Having one or both parents with asthma. </div> <div> Respiratory infections in childhood. </div> <div> Low birth weight. </div> <div> Obesity. </div> <div> Gastroesophageal reflux disease (GERD).</div> <bR> <bR> <div> <B><U>When to Seek Medical Advice</U></B></div> <div> Three key circumstances may lead you to talk to your doctor about asthma:</div> <bR> <div> If you think you have asthma. Wheezing, difficulty breathing, pain or tightening in your chest, or coughing without any other symptoms may all be signs of asthma. Wheezing, especially, is a frequent symptom of asthma in children. Yet some children with asthma never wheeze. Instead, they have recurrent, spasmodic coughs that are often worse at night. If you or your children have frequent coughs that last more than a few days or any other signs or symptoms of asthma, see your doctor.</div> <div> If you've received the diagnosis of asthma. If you've received the diagnosis of asthma, talk to your doctor about ways to manage your condition. Working as a team, you and your doctor can develop a plan to help you control symptoms, prevent an attack or stop an attack in progress. Don't try to treat asthma yourself. Most asthma deaths result from a lack of proper treatment.</div> <div> If your medication isn't working. Sometimes your medications may not offer the relief you need. Be sure to contact your physician right away if a prescribed dosage of medication doesn't work for you. In some cases you may not be using your metered-dose inhaler (MDI) correctly. Don't try to solve the problem by taking more medication though — overusing inhalers or taking too much medication can be dangerous. </div> <bR> <bR> <bR> <div> <B><U>Screening and Diagnosis</U></B></div> <div> Diagnosing asthma can be difficult. Symptoms can range from mild to very severe and are often similar to those of other lung conditions. </div> <bR> <div> One illness that may mimic asthma is vocal cord dysfunction (episodic laryngeal dysfunction). Signs and symptoms of this condition, which mainly affects women between the ages of 20 and 40, may include shortness of breath, wheezing, coughing and chest tightness. Yet vocal cord dysfunction is typically characterized by an acute onset of severe shortness of breath. If asthma has been diagnosed in you, and your treatments — especially use of a bronchodilator to open your airways — aren't controlling your symptoms, it's possible you may have vocal cord dysfunction. It's also possible that you have both conditions. </div> <bR> <div> Emphysema and early congestive heart failure also may cause symptoms similar to those of asthma. In order to rule out these and other possible conditions, your doctor will likely use several different evaluation methods to arrive at a diagnosis.</div> <bR> <div> In most cases you'll be asked to give a complete medical history and have a physical exam. You may also be given lung (pulmonary) function tests to determine how much air moves in and out as you breathe.</div> <bR> <div> One of the simplest lung function tests uses a peak flow meter to measure the rate at which you can expel air. You can also use a peak flow meter at home to help detect subtle increases in airway obstruction before you notice symptoms. If the readings are lower than usual, it's a sign your asthma may be about to flare up. Your doctor can give you instructions on how to deal with low readings.</div> <bR> <div> Lung function tests are usually done before and after taking a medication known as a bronchodilator to open your airways. If your lung function improves with use of a bronchodilator, it's likely you have asthma.</div> <bR> <div> In some cases your doctor may do a methacholine bronchial challenge. If you have asthma, inhaling the methacholine will cause mild constriction of your airways, which can be measured with a lung function test.</div> <bR> <div> <B><U>Complications</U></B></div> <div> Asthma accounts for millions of missed school days and workdays annually. It's also a frequent reason for emergency room visits and hospitalizations. You can reduce your risk of severe attacks by making sure your asthma is well controlled and by knowing how to recognize and treat attacks before they occur.</div> <bR> <div> If your asthma attacks are worse at night, you're not alone; many attacks occur between 2 a.m. and 4 a.m. If you wake up in the middle of the night wheezing or short of breath, talk to your doctor about changing or intensifying your treatment.</div> <bR> <div> The long-term use of oral and intravenous corticosteroids to treat asthma attacks may have serious side effects. The use of inhaled corticosteroids, which have fewer side effects, can help you reduce the need for other forms of these drugs.</div> <bR> <div> If you have asthma, you're more likely to be bothered by stomach acid backing up into your esophagus (acid reflux). In some cases acid reflux or gastroesophageal reflux disease (GERD) may actually cause your symptoms. To help prevent this problem, don't eat or drink for several hours before going to bed. You may also find it helpful to elevate the head of your bed.</div> <bR> <bR> <div> <B><U>Treatment</U></B></div> <div> Your doctor will recommend a course of treatment based on you or your child's age and on how persistent the symptoms are. In general, three types of medical treatments are available for asthma: </div> <bR> <div> Bronchodilator medications that relieve acute symptoms or prevent flare-ups </div> <bR> <div> Corticosteroids and other medications that suppress airway inflammation over days, weeks or months </div> <bR> <div> Immunotherapy or allergy desensitization shots</div> <div> In June 2002, the National Asthma Education and Prevention Program (NAEPP) issued updated asthma treatment guidelines recommending inhaled corticosteroids as a safe, effective and preferred first-line therapy for both children and adults who have persistent asthma. NAEPP is supported and coordinated by the National Heart, Lung and Blood Institute and the National Institutes of Health.</div> <bR> <div> The NAEPP also found that an inhaled corticosteroid plus a long-acting inhaled bronchodilator may work better than inhaled corticosteroids alone for some people with moderate, persistent asthma.</div> <bR> <div> The updated guidelines continue to recommend a "stepwise" approach in which your doctor adjusts the type and the dosage of your medications up or down based upon either improvement or worsening of symptoms over time.</div> <bR> <bR> <div> <B><U>Acute symptom relief</U></B></div> <bR> <div> Bronchodilators are medications that open up constricted airways and provide temporary relief of asthma symptoms. Bronchodilators may be short acting or long acting and include:</div> <bR> <div> Beta-2 agonists. Short-acting beta-2 agonists begin working within minutes and last 2 to 4 hours. Long-acting beta-2 agonists last up to 12 hours. The short-acting medications are typically prescribed for relief or prevention of asthma symptoms or flare-ups. The most common drugs, such as albuterol (Proventil, Ventolin) and pirbuterol (Maxair), act quickly to relieve symptoms and can be used as a prevention measure before you exercise or breathe cold air. Prescribed as needed, they may relieve your symptoms for up to 6 hours. Inhaled beta-2 agonists won't correct underlying inflammation, however, and can easily be overused. </div> <div> Ipratropium (Atrovent). This bronchodilator is an anticholinergic that isn't typically recommended for the immediate relief of asthma symptoms.</div> <div> Salmeterol (Serevent) and formoterol (Foradil). These long-acting bronchodilators relieve airway constriction for up to 12 hours. They're generally used to prevent symptoms, especially at night. They aren't recommended as a "rescue" medication that can be used for immediate relief during an asthma attack. You usually use salmeterol or formoterol with an anti-inflammatory medication such as inhaled corticosteroids. </div> <div> Theophylline (Slo-Bid, Theo-Dur). This type of bronchodilator is taken in pill form every day. It's especially helpful for relieving nighttime symptoms of asthma. But theophylline may cause side effects, including nausea and vomiting, severe abdominal pain, diarrhea, confusion, fast or irregular heartbeat, and nervousness. It can also promote GERD or acid reflux by relaxing the lower esophageal sphincter muscle. If you're taking theophylline, get regular blood tests to make sure you're getting the correct dosage.</div> <div> Long-term anti-inflammatory treatment</div> <bR> <div> Anti-inflammatory drugs are the mainstay medications for asthma. These drugs are taken continually to prevent attacks. Anti-inflammatory drugs reduce inflammation in your airways and prevent blood vessels from leaking fluid into airway tissues. The most widely used of these drugs include:</div> <bR> <div> Corticosteroids. These drugs are the most effective medications for asthma. They're completely different from the steroids that some athletes abuse. Different kinds of corticosteroids include prednisone, prednisolone, cortisone, triamcinolone, hydrocortisone and others. They help decrease the frequency of attacks and lower the dosage of other medications needed to calm symptoms. Long-term use of oral or intravenous corticosteroids can cause serious side effects, however, including decreased resistance to infection, loss of bone mineral (osteoporosis), muscle weakness, high blood pressure and thinning of the skin. Inhaled corticosteroids deliver medication directly to your airways and so have fewer side effects. They're also very effective at controlling most forms of asthma. These medications may include beclomethasone (Vanceril, Beclovent), fluticasone (Flovent), budesonide (Pulmicort), and flunisolide (Aerobid). Advair Diskus is a combination inhaler containing fluticasone and salmeterol. If you're using a metered-dose inhaler form of inhaled corticosteroids, be sure to use a spacer and gargle with water after use to rinse your mouth out. It's important to then spit out this water. This helps reduce the amount of drug that is swallowed and absorbed into the body by way of the stomach. It also reduces side effects such as mouth and throat irritation and oral yeast infections (thrush). Also, because inhaled corticosteroids may affect some children's growth, children taking these medications should have their growth rate regularly monitored. Long-term use of inhaled corticosteroids may increase the risk of cataracts.</div> <div> Leukotriene modifiers. Introduced in 1996, leukotriene modifiers were the first new class of prescription asthma medications to become available in 20 years. They include montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo). These drugs work by reducing the production, or blocking the action, of leukotrienes — substances released by cells in your lungs during an asthma attack. Leukotrienes cause the lining of your airways to become inflamed, which in turn leads to wheezing, shortness of breath and mucus production. By themselves, leukotriene modifiers are about as effective as theophylline and cromolyn, but used in conjunction with other medications, they may help prevent more attacks. Although generally not as effective as inhaled corticosterioids, leukotriene modifiers are an option.</div> <div> Other drugs. Although they're not effective for everyone, daily use of inhaled cromolyn (Intal) or nedocromil (Tilade) may help prevent attacks of mild to moderate asthma. In some cases they may also help prevent asthma triggered by exercise if taken an hour before any vigorous activity.</div> <bR> <bR> <div> <B><U>Immunotherapy</U></B></div> <bR> <div> If you have allergic asthma that can't be easily controlled by avoiding triggers and using medication, allergy desensitization shots (immunotherapy) may help. You'll have skin tests to determine the allergens that cause you the most trouble, followed by a series of injections containing small doses of those allergens. Injections are generally given once a week for a few months, then once a month for a period of 3 to 5 years. Over time, you should lose your sensitivity to the allergens. Immunotherapy isn't for everyone, however. You're most likely to benefit if it's clear you have allergic asthma. In addition, immunotherapy carries the risk of an allergic reaction to the shot. Life-threatening reactions are rare, but can occur.</div> <bR> <div> <B><U>Prevention</U></B></div> <div> The best way to prevent asthma attacks is to identify and avoid indoor and outdoor allergens and irritants. That's easier said than done, however, because thousands of outdoor allergens and irritants — ranging from pollen and mold to cold air and air pollution — can trigger an attack. A number of indoor allergens, including dust mites, cockroaches, some pets and mold, can do the same. The most common irritant overall is tobacco smoke. </div> <bR> <div> Even if you reduce indoor and outdoor allergens and irritants, managing asthma can be challenging. It often takes ongoing communication and teamwork with your doctor. But by working together, you and your doctor can design a step-by-step plan for living with your condition. In addition to knowing and avoiding your triggers, adopt the following behaviors:</div> <bR> <div> Develop an action plan. With your doctor and health care team, write a detailed plan for taking maintenance medications and managing an acute attack. Then be sure to follow your plan. Asthma is an ongoing condition that needs to be regularly monitored and treated. In addition, taking control of your treatment can make you feel more in control of your life in general.</div> <div> Monitor your breathing. Like many people, you may recognize your own signs of an impending attack, such as slight coughing, wheezing or shortness of breath. But because your lung function may decrease before you notice any symptoms, regularly measure your peak airflow with a home peak flow meter. </div> <div> Treat attacks early. If you act quickly, you're less likely to have a severe attack. You also won't need as much medication to control your symptoms. When your peak flow measurements alert you to an impending attack, take your medication as instructed and stop any activity that may have triggered the attack right away. If your symptoms don't improve, be sure to get medical help as directed in your action plan.</div> <bR> <div> <B><U>Self-Care</U></B></div> <bR> <div> Although many people with asthma rely on medications to relieve symptoms and control inflammation, you can do several things on your own to maintain overall health and lessen the possibility of attacks:</div> <bR> <div> Exercise. You don't have to be sedentary if you have asthma. Regular exercise can strengthen your heart and lungs so that they don't have to work so hard. It can also help you lose weight and lower your risk of developing other serious diseases, including cardiovascular disease and diabetes. Aim for 30 minutes of exercise on most days. If you've been inactive, start slowly and try to gradually increase your activity over time. Keep in mind that cold-weather exercises, such as skiing, are more likely to cause wheezing. If you do exercise in cold weather, wear a face mask to warm the air you breathe. And don't exercise if the temperature is below zero. Activities such as golf, walking and swimming are less likely to trigger attacks, but be sure to discuss any exercise program with your doctor.</div> <div> Use your air conditioner. This helps reduce your exposure to airborne pollen from trees, grasses and weeds. Air conditioning also lowers indoor humidity and can reduce your exposure to dust mites. If you don't have air conditioning, try to keep your windows closed during pollen season.</div> <div> Decontaminate your decor. To minimize dust that may aggravate nighttime symptoms, encase mattresses, pillows and box springs in dustproof covers that can be removed and cleaned frequently. Replace bedding made of down, kapok or foam rubber with synthetic materials such as Dacron. Wash sheets, pillowcases and mattress pads weekly in hot water. Replace synthetic pillows every 2 to 3 years. </div> <div> Maintain optimal humidity. Keep humidity low — 40 percent to 50 percent — in your home and office. If you live in a damp climate, talk to your doctor about using a dehumidifier. </div> <div> Keep indoor air clean. Have a utility company check your air conditioner and furnace once a year. Change the filters in your furnace and air conditioner according to the manufacturer's instructions. Also consider installing a small-particle filter in your ventilation system. If you use a humidifier, change the water daily.</div> <div> Reduce pet dander. If you're allergic to dander, avoid pets with fur or feathers. Having pets regularly bathed or groomed also may reduce the amount of dander in your surroundings.</div> <div> Clean regularly. Clean your home at least once a week. Because cleaning stirs up dust, however, wear a mask or, if you can, have someone else clean.</div> <bR> <div> Limit use of contacts. Try substituting eyeglasses for your contact lenses when the pollen count is high. Pollen grains can become trapped under the lenses.</div> <bR> <div> <B><U>Coping Skills</U></B></div> <div> Asthma presents many physical challenges, but it can also cause other kinds of distress. You may sometimes become frustrated, angry or depressed because you need to cut back on your usual activities to avoid environmental triggers. You may also feel hampered or embarrassed by the symptoms of the disease and by complicated management routines. </div> <bR> <div> But asthma doesn't have to be a limiting or depressing condition. The best way to overcome anxiety and a feeling of helplessness is to understand your condition and take control of your treatment. Here are some suggestions that may help:</div> <bR> <div> Identify the things that trigger your symptoms. This can be one of the most important ways to take control of your life. Also take peak flow measurements regularly and follow your action plan for using medications and managing attacks.</div> <div> Pace yourself. Take breaks between tasks and avoid activities that make your symptoms worse.</div> <div> Make a daily to-do list. This may help you avoid feeling overwhelmed. Reward yourself for accomplishing simple goals.</div> <div> Talk to others with your condition. Chat rooms and message boards on the Internet or support groups in your area can connect you with people facing similar challenges and let you know you're not alone. </div> <div> If you have a child with asthma, be encouraging and supportive. Focus attention on the things your child can do, not on the things he or she can't do. Involve teachers, school nurses, coaches, friends and relatives in helping your child manage an asthma condition.</div> <bR> <div> <B>© 1998-2002 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved.  A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.com," "Mayo Clinic Health Information,"  "Sharing our Tradition of Trusted Answers" and the triple-shield Mayo logo are trademarks of Mayo Foundation for Medical Education and Research. </B></div> <div> <B>www.MayoClinic.org</B></div> <div>  </div> <bR> <bR> <bR> <div> <B> <A NAME="air_particles_we_breathe_"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><FONT SIZE="4" COLOR="#660099" FACE="Arial" ><A HREF="#air_particles_we_breathe_" TITLE="ASTHMA AND ALLERGY"><U><B><U>Home Control Of Allergies And Asthma</U></B></U></A></FONT></div> <bR> <div> <B>AIR PARTICLES WE BREATHE</B><FONT SIZE="3" COLOR="#660099" FACE="Arial" > </FONT></div> <div> Many particles of different types and sizes are carried in the air we breathe. Some large particles may settle on the walls and furniture in your home. Other large particles are removed by your nose and mouth when you inhale. Smaller particles are breathed deep into the lungs. </div> <bR> <div> Asthma may be triggered by both the large and small particles. Some air particles come from the indoors. Others are carried in the outdoor air. Outdoor particles come into your home through windows, doors, and heating systems. </div> <bR> <div> For most people, the indoor air particles cause no problems. But people with allergic symptoms including asthma can have problems, right in their own home. </div> <bR> <div>  <A NAME="triggers"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><FONT SIZE="4" COLOR="#660099" FACE="helvetica" ><B>ASTHMA AND ALLERGY "TRIGGERS"</B></FONT> </div> <bR> <div> If you or someone you know have allergic symptoms or asthma, you are sensitive to "triggers," including particles carried in the air. These "triggers" can set off a reaction in your lungs and other parts of your body. Triggers can be found indoors or outdoors. They can be simple things like: </div> <bR> <div> Cold air. </div> <bR> <div> Tobacco smoke and wood smoke. </div> <bR> <div> Perfume, paint, hair spray, or any strong odors or fumes. </div> <bR> <div> Allergens (particles that cause allergies) such as dust mites, pollen, molds, pollution, and animal dander - tiny scales or particles that fall off hair, feathers or skin - and saliva from any pets. </div> <bR> <div> Common cold, influenza, and other respiratory illnesses. </div> <bR> <div> You may be able to add more triggers to this list. Other things may also trigger your asthma or allergies. It's important to learn which triggers are a problem for you. Ask your doctor to help. Your doctor my suggest: </div> <bR> <div> Keeping an asthma diary. </div> <bR> <div> Skin testing to test for allergies. </div> <bR> <div> Finding triggers isn't always easy. If you do know your triggers, cutting down exposure to them may help avoid asthma and allergy attacks. </div> <bR> <div> If you don't know your triggers, try to limit your exposure to one suspected trigger at a time. Watch to see if you get better. This may show you if the trigger was a problem for you. </div> <bR> <bR> <div>  <A NAME="air"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><FONT SIZE="4" COLOR="#660099" FACE="helvetica" ><B>OUTDOOR AIR, INDOOR AIR AND AIR-CONDITIONING</B></FONT> </div> <bR> <div> Controlling your exposure to triggers outdoors is hard. You may have to avoid outdoor air pollution, pollen, and mold spores. Any time air pollution and pollen levels are high, it's a good idea to stay indoors. </div> <bR> <div> The air at home is easier to control. Some people with asthma and allergies notice that their symptoms get worse at night. Trigger controls in the bedroom or wherever you sleep need the most care. </div> <bR> <div> Air-conditioning can help. It allows windows and doors to stay closed. This keeps some pollen and mold spores outside. It also lowers indoor humidity. Low humidity helps to control mold and dust mites. </div> <bR> <div> Avoid too much air-conditioning or too much heat. Room air temperature should be comfortable for someone with allergies or asthma. Some people can't tolerate a big change in temperature, particularly from warm to cold air. </div> <bR> <div> There are some devices that effectively remove particles from air. Their usefulness in reducing allergy symptoms is under study. </div> <bR> <div>  <A NAME="controls"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><FONT SIZE="4" COLOR="#660099" FACE="helvetica" ><B>TRIGGER CONTROLS</B></FONT> </div> <bR> <div> Here are some common triggers and some ways to help control them at home: </div> <bR> <div> <B>Tobacco Smoke</B> </div> <bR> <div> Smoke should not be allowed in the home of someone with asthma or allergies. Ask family members and friends to smoke outdoors. Suggest that they quit smoking. Your local American Lung Association can help. Ask your Lung Association how you can help a family member or friend <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>quit smoking.</U></FONT> </div> <bR> <div> <B>Wood Smoke</B> </div> <bR> <div> Wood smoke is a problem for children and adults with asthma and allergies. Avoid wood stoves and fireplaces. </div> <bR> <div> <B>Pets</B> </div> <bR> <div> Almost all pets can cause allergies, including dogs, cats and especially small animals like birds, hamsters and guinea pigs. All pets should be removed from the home if pets trigger asthma and allergy symptoms. </div> <bR> <div> Pet allergen may stay in the home for months after the pet is gone because it remains in house dust. Allergy and asthma symptoms may take some time to get better. </div> <bR> <div> If the pet stays in the home, keep it out of the bedroom of anyone with asthma or allergies. Weekly pet baths may help cut down the amount of pet saliva and dander in the home. </div> <bR> <div> Sometimes you hear that certain cats or dogs are "non-allergenic." There really is no such thing as a "non-allergenic" cat or dog, especially if the pet leaves dander and saliva in the home. Goldfish and other tropical fish may be a good substitute. </div> <bR> <div> <B>Cockroaches</B> </div> <bR> <div> Even cockroaches can cause problems, so it's important to get rid of roaches in your home. Small pieces of dead roaches and roach droppings settle in house dust and can end up in the air you breathe. </div> <bR> <div> Like humans, roaches need food and water and a place to live. Help keep your home roach free by storing food in sealable containers and keeping crumbs, dirty dishes and other sources of food waste cleaned up; fixing leacks and wiping up standing water; and cleaning up clutter where roaches find shelter. </div> <bR> <div> If you still have problems and you have to choose a pesticide, be sure to use it safely, and as directed on the label. Baits are less likely than sprays or foggers to harm your lungs. </div> <bR> <div> <B>Indoor Mold</B> </div> <bR> <div> When humidity is high, molds can be a problem in bathrooms, kitchens, and basements. Make sure these areas have good air circulation and are cleaned often. The basement in particular may need a dehumidifier. And remember, the water in the dehumidifier must be emptied and the container cleaned often to prevent forming mildew. </div> <bR> <div> Molds may form on foam pillows when you perspire. To prevent mold, wash the pillow every week, dry thoroughly and make sure to change it every year. </div> <bR> <div> Molds also form in houseplants, so check them often. You may have to keep all plants outdoors. </div> <bR> <div> <B>Strong Odors or Fumes</B> </div> <bR> <div> Perfume, room deodorizers, cleaning chemicals, paint, and talcum powder are examples of triggers that must be avoided or kept to very low levels. </div> <bR> <div> <B>Dust Mites</B> </div> <bR> <div> Dust mites are tiny, microscopic spiders usually found in house dust. Several thousand mites can be found in a pinch of dust. Mites are one of the major triggers for people with allergies and asthma. They need the most work to remove. </div> <bR> <div> Following these rules can also help get rid of dust mites: </div> <bR> <bR> <div> Put mattresses in allergen-impermeable covers. Tape over the length of the zipper. </div> <bR> <bR> <div> Put pillows in allergen-permeable covers. Tape over the length of the zipper. Or wash the pillow every week. </div> <bR> <bR> <div> Wash all bedding every week in water that is at least 130 degrees F. Removing the bedspread at night may help. </div> <bR> <bR> <div> Don't sleep or lie down on upholstered (stuffed) furniture. </div> <bR> <bR> <div> Remove carpeting in the bedroom. </div> <bR> <bR> <div> Clean up surface dust as often as possible. Use a damp mop or damp cloth when you clean. Don't use aerosols or spray cleaners in the bedroom. And don't clean the room when someone with asthma or allergies is present. </div> <bR> <bR> <div> Window coverings attract dust. Use window shades or curtains made of plastic or other washable material for easy cleaning. </div> <bR> <bR> <div> Remove stuffed furniture and stuffed animals (unless the animals can be washed), and anything under the bed. </div> <bR> <bR> <div> Closets need extra care. They should hold only needed clothing. Putting clothes pin a plastic garment bag may help. (Do not use the plastic bag that covers dry cleaning). </div> <bR> <bR> <div> Dust mites like moisture and high humidity. Cutting down the humidity in your home can cut down the number of mites. A dehumidifier may help. </div> <bR> <bR> <div> Air cleaning devices, including portable units and central filtration systems may be helpful in reducing some indoor air pollutants when used with effective source control and ventilation. Ask your doctor for advice about air cleaning devices. If you decide to use one, make sure it removes particles efficiently over an extended period of time and does not produce ozone. </div> <bR> <div>  <A NAME="rules"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><FONT SIZE="4" COLOR="#660099" FACE="helvetica" ><B>GENERAL RULES TO HELP CONTROL THE HOME ENVIRONMENT</B></FONT> </div> <bR> <div> Controlling the home environment is a very important part of asthma and allergy care. Some general rules for home control for all members of the family are: </div> <bR> <bR> <div> Reduce or remove as many asthma and allergy triggers from your home as possible. </div> <bR> <bR> <div> If possible, use air filters and air conditioners -- and properly maintain them -- to make your home cleaner and more comfortable. </div> <bR> <bR> <div> Pay attention to the problem of dust mites. Work hard to control this problem in the bedroom. </div> <bR> <bR> <div> Vacuum cleaners stir up dust and allergens in the air. A vacuum cleaner with a high efficiency air filter or a central vacuum cleaner with a collection bag outside the home may be of limited value. Anyone with asthma or allergies should avoid vacuuming. If vacuuming must be done, a dust mask may help. </div> <bR> <bR> <bR> <div>  <A NAME="what_is_asthma__"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><FONT SIZE="4" COLOR="#660099" FACE="helvetica" ><B><U>WHAT IS ASTHMA?</U></B></FONT><U> </U></div> <div> Asthma is a lung disease. It can be life threatening. </div> <bR> <div> Asthma is chronic. In other words, you live with it every day. </div> <bR> <div> Asthma causes breathing problems. </div> <bR> <div> These breathing problems are called attacks or episodes of asthma. </div> <bR> <div>  <A NAME="asthma"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><FONT SIZE="4" COLOR="#660099" FACE="helvetica" ><B><U>WHEN YOU HAVE ASTHMA</U></B></FONT><U> </U></div> <div> It's important to: </div> <bR> <div> Take your asthma seriously. </div> <bR> <div> Take your asthma medicines for asthma. </div> <bR> <div> When asthma symptoms don't improve, get help. </div> <bR> <div>  <A NAME="know"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><FONT SIZE="4" COLOR="#660099" FACE="helvetica" ><B><U>KNOW YOUR ASTHMA SYMPTOMS</U></B></FONT><U> </U></div> <div> "I cough a lot while I exercise or even when I rest after exercising." </div> <bR> <div> "I have shortness of breath." </div> <bR> <div> "I make a wheezing sound when I breathe." </div> <bR> <div> "I feel a tightness in my chest." </div> <bR> <div> Do you feel this way sometimes? Any one of these symptoms may mean that you have asthma. You can have one or more of these symptoms or even different ones. Symptoms are clues that let you know that you are having an asthma attack. </div> <bR> <div>  <A NAME="find"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><FONT SIZE="4" COLOR="#660099" FACE="helvetica" ><B><U>FIND OUT WHAT STARTS YOUR ASTHMA SYMPTOMS</U></B></FONT></div> <div> Usually symptoms get started or "triggered" by something that bothers your lungs. These things are called <I><B>asthma triggers.</B></I> </div> <bR> <div> There are many kinds of triggers. They can range from viruses (such as colds) to allergies, to gases and particles in the air. </div> <bR> <div> Given this range, you may find it hard to figure out what starts your asthma attacks. You may even think your attacks "just happen." But this is generally not true. Something usually triggers an attack. </div> <bR> <div>  <A NAME="so"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><FONT SIZE="4" COLOR="#660099" FACE="helvetica" ><B><U>SO WHAT'S THE GOOD NEWS IN ALL OF THIS?</U></B></FONT><U> </U></div> <div> Once you find out your triggers, you can do something to prevent your asthma attacks. This gives you control. The result is that <I>when and if</I> you have attacks, there's a good chance that they will be less severe and you won't have as many. </div> <bR> <div> For example, do you get an asthma attack after you've exercised? If you do, you should tell your doctor. You can get help. </div> <bR> <div> You can still exercise when you have asthma, but you may need to take rest breaks while you exercise. If you know that exercise triggers your asthma, the doctor may tell you to take your asthma medicine <I>before you exercise.</I> This way, you can still have fun exercising without having an asthma attack. </div> <bR> <div> There are other asthma triggers that you can get rid of or avoid. Good examples of these triggers are <FONT SIZE="3" COLOR="#008080" FACE="verdana" ><B>cold air, dust, feathers or molds.</B></FONT> </div> <bR> <div> <FONT SIZE="3" COLOR="#008080" FACE="verdana" ><B>Cigarette smoking</B></FONT> is another trigger that <I>must be avoided.</I> If you smoke, you need to <FONT SIZE="3" COLOR="#0000FF" FACE="verdana" ><U>quit.</U></FONT> Smoking cigarettes will make your asthma worse, and if you breathe the smoke from someone else's cigarette, you may get an asthma attack. </div> <bR> <div> This is true for children, too. In fact, children are especially at risk when they breathe secondhand smoke. Studies show that children of smokers are more likely to suffer asthma attacks. Their asthma gets worse, too. </div> <bR> <div> But you can do something about this. You can protect yourself (and if you're a parent with a child who has asthma, you can protect your child, too) when you know the risks of smoking cigarettes or breathing secondhand smoke. The wisest and healthiest things you can do are to live, work and play in places that are smoke free. </div> <bR> <div> Remember: </div> <bR> <div> Asthma symptoms and attacks usually get started by triggers. </div> <bR> <div> Talk to a doctor about these triggers. </div> <bR> <div> Find ways to avoid them. Find ways to get rid of them. </div> <bR> <bR> <div> <B> <A NAME="what_is_a_peak_flow_meter__"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>WHAT IS A PEAK FLOW METER? </B></div> <div> A Peak Flow Meter is a portable, inexpensive, hand-held device used to measure how air flows from your lungs in one "fast blast." In other words, the Meter measures your ability to push air out of your lungs. </div> <bR> <div> Peak Flow Meters may be provided in two ranges to measure the air pushed out of your lungs. A low range Peak Flow Meter is for small children, and a standard range meter is for older children, teenagers and adults. An adult has much larger airways than a child and needs the larger range. </div> <bR> <div> There are several types of Peak Flow Meters available. Talk to your doctor or pharmacist about which type to use. </div> <bR> <div> <B>  WHO CAN BENEFIT FROM USING A PEAK FLOW METER? </B></div> <div> Many doctors believe that people who have asthma can benefit from the use of a Peak Flow Meter. If you need to adjust your daily medication for asthma, a Peak Flow Meter can be an important part of your asthma management plan. </div> <bR> <div> Children as young as three years have been able to use a Meter to help manage their asthma. In addition, some people with chronic bronchitis and emphysema may also benefit from the use of a Peak Flow Meter. </div> <bR> <div> Not all physicians use Peak Flow Meters in their management of children and adults with asthma. Many doctors believe a Peak Flow Meter may be of most help for people with moderate and severe asthma. If your asthma is mild or you do not use daily medication, a Peak Flow Meter may not be useful for asthma management. </div> <bR> <div> <B>  WHY SHOULD I MEASURE MY PEAK FLOW RATE? </B></div> <div> Measurements with a Peak Flow Meter can help you and your doctor monitor your asthma. These measurements can be important and help your doctor prescribe medicines to keep your asthma in control. </div> <bR> <div> A Peak Flow Meter can show you that you may need to change the way you are using your medicines. For example, Peak Flow readings may help be a signal for you to implement the medication plan you and your doctor have developed for worsening asthma. </div> <bR> <div> On the other hand, if you are doing well, then measuring your Peak Flow may be helpful as you and your doctor try to lower the level of your medicines. </div> <bR> <div> A Peak Flow Meter can help you when your asthma is getting worse. Asthma sometimes changes gradually. Your Peak Flow may show changes before you feel them. It can allow your doctor to adjust your treatment to prevent urgent calls to the doctor, emergency room visits or hospitalizations. </div> <bR> <div> A Peak Flow Meter may help you and your doctor identify causes of your asthma at work, home or play. It may help parents to determine what might be triggering their child's asthma. </div> <bR> <div> A Peak Flow Meter can also be used during an asthma episode. It can help you determine the severity of the episode; decide when to use your rescue medication; and decide when to seek emergency care. </div> <bR> <div> Knowing your "personal" Peak Flow Rate allows you to elevate your readings. Being at your "best" can provide reassurance and make you feel more self-confident. </div> <bR> <div> <B>  HOW DO YOU USE A PEAK FLOW METER? </B></div> <div> Step 1: Before each use, make sure the sliding marker or arrow on the Peak Flow Meter is at the bottom of the numbered scale (zero or the lowest number on the scale). </div> <bR> <div> Step 2: Stand up straight. Remove gum or any food from your mouth. Take a deep breath (as deep as you can). Put the mouthpiece of the Peak Flow Meter into your mouth. Close your lips tightly around the mouthpiece. Be sure to keep your tongue away from the mouthpiece. In one breath blow out as hard and as quickly as possible. Blow a "fast hard blast" rather than "slowly blowing" until you have emptied out nearly all of the air from your lungs. </div> <bR> <div> Step 3: The force of the air coming out of your lungs causes the marker to move along the numbered scale. Note the number on a piece of paper. </div> <bR> <div> Step 4: Repeat the entire routine three times. (You know you have done the routine correctly when the numbers from all three tries are very close together.) </div> <bR> <div> Step 5: Record the highest of the three ratings. Do not calculate an average. This is very important. </div> <bR> <div> You can't breathe out too much when using your Peak Flow Meter but you can breathe out too little. Record your highest reading. </div> <bR> <div> Step 6: Measure your Peak Flow Rate close to the same time each day. You and your doctor can determine the best times. One suggestion is to measure your Peak Flow Rate twice daily between 7and 9 a.m. and between 6 and 8 p.m. </div> <bR> <div> You may want to measure your Peak Flow Rate before or after using your medicine. Some people measure Peak Flow both before and after taking medication. Try to do it the same way each time. </div> <bR> <div> Step 7: Keep a chart of your Peak Flow Rates. Discuss the readings with your doctor. </div> <bR> <div> <B>  HOW DO I CHART MY PEAK FLOW RATES? </B></div> <div> Chart the HIGHEST of the three readings. The chart could include the date at the top of the page with AM and PM listed. The left margin could list a scale, starting with zero (0) liters per minute (L/min) at the bottom of the page and ending with 600 L/min at the top. </div> <bR> <div> You could leave room at the bottom of the page for notes to describe how you are feeling or to list any other thoughts you may have. </div> <bR> <div> <B>  WHAT IS A "NORMAL" PEAK FLOW RATE? </B></div> <div> A "normal" Peak Flow Rate is based on a person's age, height, sex and race. A standardized "normal" may be obtained from a chart comparing the patient with a population without breathing problems. </div> <bR> <div> A personal best normal may be obtained from measuring the patient's own Peak Flow Rate. Therefore, it is important for you and your doctor to discuss what is considered "normal" for you. </div> <bR> <div> Once you have learned your usual and expected Peak Flow Rate, you will be able to better recognize changes or trends. </div> <bR> <div> <B>  HOW CAN I DETERMINE A "NORMAL" PEAK FLOW RATE FOR ME? </B></div> <div> Three zones of measurement are commonly used to interpret Peak Flow Rates. It is easy to relate the three zones to the traffic light colors: green, yellow, and red. In general, a normal Peak Flow Rate can vary as much as 20 percent. </div> <bR> <div> Be aware of the following general guidelines. Keep in mind that recognizing changes from "normal" is important. Your doctor may suggest other zones to follow. </div> <bR> <div> Green Zone: </div> <div> 80 to 100 percent of your usual or "normal" Peak Flow Rate signals all clear. A reading in this zone means that your asthma is under reasonably good control. It would be advisable to continue your prescribed program of management. </div> <bR> <div> Yellow Zone: </div> <div> 50 to 80 percent of your usual or "normal" Peak Flow Rate signals caution. It is a time for decisions. Your airways are narrowing and may require extra treatment. Your symptoms can get better or worse depending on what you do, or how and when you use your prescribed medication. You and your doctor should have a plan for yellow zone readings. </div> <bR> <div> Red Zone: </div> <div> Less than 50 percent of your usual or "normal" Peak Flow Rate signals a Medical Alert. Immediate decisions and actions need to be taken. Severe airway narrowing may be occurring. Take your rescue medications right away. Contact your doctor now and follow the plan he has given you for red zone readings. </div> <bR> <div> Some doctors may suggest zones with a smaller range such as 90 to 100 percent. Always follow your doctor's suggestions about your Peak Flow Rate. </div> <bR> <div>   <B>MANAGEMENT PLAN BASED ON PEAK FLOW READINGS </B></div> <div> It is important to know your Peak Flow reading, but it is even more important to know what you will do based upon that reading. Work with your doctor to develop an asthma management plan that follows your green-yellow-red zone guidelines. </div> <bR> <div> Record the Peak Flow readings that your doctor recommends for your green zone, yellow zone, and red zone. Then work out with your doctor what you plan to do when your Peak Flow falls in each of those zones. </div> <bR> <div> <B>  WHEN SHOULD I USE MY PEAK FLOW METER? </B></div> <div> Use of the Peak Flow Meter depends on a number of things. Its use should be discussed with your doctor. </div> <bR> <div> If your asthma is well controlled and you know the "normal" rate for you, you may decide to measure your Peak Flow Rate only when you sense that your asthma is getting worse. More severe asthma may require several measurements daily - or twice a day. </div> <bR> <div> Don't forget that your Peak Flow Meter needs care and cleaning. Dirt collected in the meter may make your Peak Flow measurements inaccurate. If you have a cold or other respiratory infection, germs or mucus may also collect in the meter. </div> <bR> <div> Proper cleaning with mild detergent in hot water will keep your Peak Flow Meter working accurately and may keep you healthier. </div> <bR> <div> <B>  DOES USING A PEAK FLOW METER HAVE ANY SIDE EFFECTS? </B></div> <div> A Peak Flow Meter is not a medicine. It has no major side effects. Sometimes pushing the air out of your lungs in a "fast blast" may cause you to cough or wheeze. </div> <bR> <div> Check with your doctor before you start using a Peak Flow Meter. </div> <bR> <div> Using the meter is as simple as taking a deep breath and blowing out a candle. If used properly, it can only help. </div> <bR> <div> You must realize that measuring Peak Flow is only one step in a program to manage asthma. Its importance must not be exaggerated or over-interpreted. </div> <bR> <div> Using a Peak Flow Meter is not a substitute for regular medical care. Ask your doctor to help you understand your Peak Flow measurements. </div> <bR> <div> <B>  IDEAS TO REVIEW </B></div> <div> Now you are aware of some of the techniques for using and caring for Peak Flow Meters. You also know how Meters may help manage asthma and other breathing problems. </div> <bR> <div> Discuss the use of a Peak Flow Meter with your doctor. Make measuring your Peak Flow Rate a part of your personal asthma management program. </div> <div>  </div> <div> The mission of the American Lung Association is to prevent lung disease and promote lung health.  </div> <bR> <div> <B> <A NAME="sample_peak_flow_chart"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B></div> <div>  <IMG SRC="1fdd31a0.png" border=0 width="467" height="282" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <bR> <bR> <bR> <bR> <bR> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="648" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 1247 WIDTH="644"><div> <B> <A NAME="tanox_inc__announces_xolair"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>Tanox, Inc. Announces Xolair (Omalizumab) Marketing Approval in Australia</B>HOUSTON, TX -- June 19, 2002 -- Tanox announced the decision by the Therapeutic Goods Administration (TGA) in Australia to approve the new anti-IgE therapy Xolair® (omalizumab) for treating adults and adolescents with moderate allergic asthma. This represents the first ever marketing approval anywhere for Xolair. Xolair is being developed under an agreement among Tanox, Inc., Novartis Pharma AG, and Genentech, Inc. "We are very pleased with the approval of Xolair in Australia and look forward to helping the many patients with allergic asthma," said Nancy T. Chang, CEO and founder of Tanox, Inc. Novartis has indicated that the decision comes after the Australian Drug Evaluation Committee agreed that Xolair should be indicated for the management of adult and adolescent patients with moderate allergic asthma who are already being treated with inhaled steroids and have raised levels of serum immunoglobulin E (IgE). Xolair is a humanized monoclonal antibody that works by binding to circulating IgE and preventing it from attaching to mast cells. Without the binding of IgE to mast cells, the presence of an allergen will not cause the release of chemical mediators like histamine and leukotrienes, which lead to the symptoms and inflammation of allergic asthma. Xolair is administered every two to four weeks subcutaneously (i.e. by injection under the skin), at a dose depending on the patient's body weight and IgE level. In June 2000, Novartis and Genentech filed a Biologics License Application (BLA) with the U.S. Food and Drug Administration (FDA) and a submission for marketing approval with health authorities in the EU, Switzerland, Australia, and New Zealand. Following receipt of a Complete Response Letter from the FDA in July 2001, Genentech and Novartis have indicated that they are planning to submit an amendment to the BLA in the fourth quarter of 2002, for allergic asthma in adults and adolescents. The content of this amendment will also address requests for additional information made by the FDA in the Complete Response Letter, and those companies expect that data from ongoing trials will satisfy those requests. About Tanox Tanox, Inc. is a biopharmaceutical company with demonstrated expertise in monoclonal antibody technology. The Company is engaged in the discovery and development of therapeutic monoclonal antibodies designed to address significant unmet medical needs in the areas of asthma, allergy, inflammation and other diseases affecting the human immune system. Statements in this press release about Xolair and its prospects for development and commercialization, other than statements of historical facts, are forward-looking statements and are subject to a number of uncertainties that may cause actual events or results to differ materially from those suggested in the forward-looking statements. Factors that could affect actual events or results include risks associated with obtaining regulatory approval for and market acceptance of Xolair, performance by the Company's present and future collaboration partners, competition and technological change, and existing and future government regulations. Other risks that may affect Tanox include the unpredictability of decisions by the FDA and other regulatory agencies, including decisions regarding whether sufficient data and compliance with other requirements exist to support product licensure. There can be no certainty that Xolair will be approved in any other market. This release and other information about Tanox, Inc. can be found on the World Wide Web at http://www.tanox.com . SOURCE: Tanox, Inc. </div> <bR> <bR> <bR> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="576" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 324 WIDTH="572"><div> <I> <A NAME="xolair_medwatch_anaphylaxis_may_occur"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></I><I>Xolair </I><I>"MedWatch: Anaphylaxis May Occur After Taking Xolair"</I></div> <div> BETHESDA, MD -- February 21, 2007 -- FDA notified asthmatic patients and healthcare professionals of new reports of serious and life-threatening allergic reactions (anaphylaxis) in patients after treatment with Xolair. Usually these reactions occur within two hours of receiving a Xolair subcutaneous injection. However, these new reports include patients who had delayed anaphylaxis-with onset two to 24 hours or even longer-after receiving Xolair treatment. Anaphylaxis may occur after any dose of Xolair (including the first dose), even if the patient had no allergic reaction to the first dose. Health care professionals who administer Xolair should be prepared to manage life-threatening anaphylaxis and should observe their Xolair-treated patients for at least two hours after Xolair is given. Patients under treatment with Xolair should be fully informed about the signs and symptoms of anaphylaxis, their chance of developing delayed anaphylaxis following Xolair treatment, and how to treat it when it occurs. FDA has requested Genentech add a boxed warning to the product label and to revise the label and provide a Medication Guide for patients. SOURCE: Food and Drug Administration </div> <bR> </tD> </tR> </TABLE></div> <bR> <bR> <bR> </tD> </tR> </TABLE></div> <div> <B> <A NAME="ph_test_may_offer_cheap_gauge_of_asthma"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><A HREF="#ph_test_may_offer_cheap_gauge_of_asthma" TITLE="ASTHMA AND ALLERGY"><U><B>Ph Test May Offer Cheap Gauge of Asthma</B></U></A><B>Ph Test May Offer Cheap Gauge of Asthma Severity</B><FONT SIZE="3" COLOR="#660099" FACE="Arial" > </FONT></div> <div> <I>Thu Jun 6, 5:34 PM ET</I> </div> <div> NEW YORK (Reuters Health) - Monitoring the acidity of the breath could help doctors estimate the degree of air passage inflammation in the lungs--a key contributor to asthma, Greek scientists report. </div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="12" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="4"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="4" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=CENTER WIDTH="1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <div> Asthma is marked by inflammation in the airways, which leads to symptoms including wheezing, breathlessness and coughing that can range from mild to severe. Asthma attacks are often triggered by an allergic response to an environmental irritant such as tobacco smoke, mold, pollen or cockroach allergen. The disease is becoming more common worldwide, particularly among US children living in urban areas. </div> <div> In the study, Dr. Konstantinos Kostikas and colleagues from the Athens Army General Hospital measured the acidity of the breath of 40 people with asthma, 20 with bronchiectasis (a relatively rare illness in which airways become enlarged), 20 with chronic obstructive pulmonary disease (COPD) and 10 healthy people. The researchers tested the breath after it had been cooled to liquid form, or condensed. </div> <div> As expected, the condensed breath of patients with bronchiectasis and COPD was more acidic than that of asthmatics and healthy people. This acidity is indicative of the chronic inflammation that these patients experience with their illness, the authors note. </div> <div> However, the investigation also revealed that the pH of the asthmatics' breath was more acidic in patients with moderate asthma compared to those with a mild form of the disease, according to the report in the American Journal of Respiratory and Critical Care Medicine. </div> <div> Specifically, the investigators found that asthmatics' breath was much more acidic during asthma attacks, but normalized after anti-inflammatory medication was given and the asthma attack abated. </div> <div> These findings suggest that measuring the pH of the breath may one day offer an inexpensive way to gauge airway inflammation in asthmatics and others with an inflammatory airway disease, Kostikas and colleagues conclude. </div> <div> "For about 10 years or so, we have realized that inflammation plays a very important role in asthma," Dr. Alfred Munzer of Washington Adventist Hospital in Takoma Park, Maryland, a spokesperson for and former president of the American Lung Association, told Reuters Health in an interview. Munzer did not participate in the study. </div> <div> "We used to think that spasms of the airway are what defined asthma, but there is more and more evidence that says, initially there is inflammation, and the inflammation in turn leads to the release of substances which cause constriction of the air passages," he explained. </div> <div> Measuring the pH of the breath might eventually be a way to measure the degree of inflammation in the air passages, which could indicate whether or not people are likely to have severe asthma attacks, Munzer added. </div> <bR> <bR> <div> <B><U> <A NAME="new_12_month_data_show_elidel"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></U></B><B><U>New 12-Month Data Show Elidel (Pimecrolimus) Cream Demonstrated Long-Term Eczema Control In Infants </U></B></div> <div> Elidel Reduced the Need For Topical Corticosteroids in Infants</div> <bR> <div> LOS ANGELES, CA -- May 16, 2002 -- Treatment with Elidel® (pimecrolimus) Cream 1% provided effective long-term control of eczema in infants, according to new 12-month data presented today at the Society for Investigative Dermatology congress in Los Angeles, CA. Early intervention with Elidel (application at the first signs or symptoms of the disease) lead to better long-term control of eczema in infants, compared with a conventional treatment regimen (emollients; reactive use of topical corticosteroids for disease flares). These results demonstrated that Elidel considerably reduced reliance on topical corticosteroid use.</div> <bR> <div> "Parents of infants with eczema should be aware of the risks commonly associated with chronic topical corticosteroid use," said Lawrence Eichenfield, MD, Chief of Pediatric and Adolescent Dermatology at Children's Hospital, San Diego. "These promising new data support the use of Elidel as a potential therapeutic option for this difficult-to-treat patient population." Dr. Eichenfield, while not an investigator in this study, is an expert in pediatric dermatology.</div> <bR> <div> Elidel treatment was significantly more effective than a conventional treatment regimen in controlling eczema flares. The proportion of patients remaining flare-free for 12 months was more than twice as high in the Elidel-treated group versus the conventional treatment group (57% vs. 28%). As a result, treatment with Elidel considerably reduced the need for topical corticosteroids, with only 36% of Elidel treated patients requiring a steroid over the 12-month period, versus 65% in the conventional treatment group.</div> <bR> <div> This 12-month, double-blind, multicenter, parallel-group study, comprising 251 patients aged 3-23 months, compared the long-term efficacy and safety of Elidel with that of a conventional treatment regimen. At the first signs or symptoms of eczema, patients applied study medication twice daily to prevent disease flares. Emollients were applied for dry skin, and mid-potency topical corticosteroids were used to treat disease flares not controlled by study medication.</div> <bR> <div> About Elidel</div> <div> Elidel is the first steroid-free prescription cream for mild to moderate eczema patients as young as two years old. It is approved for the short-term and intermittent long-term treatment of mild to moderate eczema in non-immunocompromised patients, for whom conventional therapies are inadvisable because of potential risks, inadequate response, or intolerance. Currently, eczema affects up to 17 percent of the US population. Mild to moderate sufferers make up the vast majority of this eczema patient population. As conventional therapies may be inadvisable and/or ineffective for some eczema patients, Elidel serves as a valuable treatment option for this large population.</div> <bR> <div> Elidel, which was approved by the FDA in December 2001, is now available in tubes of 15 g, 30 g and 100 g. The approval was based on safety and efficacy results of clinical trials in more than 1700 pediatric and adult patients. The most common side effect on the skin was a mild to moderate, temporary feeling of warmth or burning (occurring in 8 percent of children aged 2-17 years and in 26 percent of adults). This side effect was temporary, mostly seen at the beginning of treatment, and comparable to that experienced by patients on placebo cream. Other common side effects included headache and cold-like symptoms. Elidel did not induce contact sensitization, phototoxicity or photoallergy, nor did it show any cumulative irritation. In contrast to topical corticosteroids, Elidel did not cause skin atrophy.</div> <bR> <div> This release contains certain forward-looking statements, relating to the Company's business, which can be identified by the use of forward-looking terminology such as "promising," "support," "potential," or similar expressions, or by discussions of strategy, plans or intentions. Such statements include descriptions of the potential benefit of Elidel (pimecrolimus) Cream 1% as evidenced by clinical trial results and FDA approval. Those statements reflect the current views of the Company with respect to future events and are subject to certain risks, uncertainties and assumptions. Many factors could cause the actual results, performance or achievements of the Company to be materially different from any future results, performances or achievements that may be expressed or implied by such forward-looking statements. There are no guarantees that the aforementioned events will result in the commercial success of Elidel (pimecrolimus) Cream 1% in any market. Any such success can be affected by, among other things, uncertainties relating to product development, adverse results in clinical trials regulatory actions or delays or government regulation generally, the ability to obtain or maintain patent or other proprietary intellectual property protection, competition in general and other risks and factors referred to in the Company's current Form 20-F on file with the Securities and Exchange Commission of the United States.</div> <bR> <div> About Novartis</div> <div> Located in East Hanover, New Jersey, Novartis Pharmaceuticals Corporation is an affiliate of Novartis AG, a world leader in healthcare with core businesses in pharmaceuticals, consumer health, generics, eye-care, and animal health. In 2001, the Group's businesses achieved sales of CHF 32.0 billion (USD 19.1 billion) and a net income of CHF 7.0 billion (USD 4.2 billion). The Group invested approximately CHF 4.2 billion (USD 2.5 billion) in R&D. Headquartered in Basel, Switzerland, Novartis Group companies employ about 71,000 people and operate in over 140 countries around the world. For further information please consult <U>http://www.novartis.com</U>.</div> <bR> <div> SOURCE: Novartis Pharmaceuticals Corporation</div> <bR> <div> <B><U> <A NAME="spring_mattresses_rather_than_foam"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></U></B><B><U>Spring Mattresses Rather Than Foam Reduce Exposure to House Dust Mi</U></B><B><U>te Allergens</U></B></div> <div> <B>A DGReview of :</B><B><U>"House-dust mites and mattresses"  </U></B>05/31/2002 By Elda Hauschildt</div> <bR> <div> Replacing foam mattresses with spring mattresses can help reduce exposure to house dust-mite allergens.</div> <bR> <div> Foam mattresses with covers are four times as likely to house mite faeces and eight times as likely if they don't have covers.</div> <bR> <div> Norwegian and American researchers point out that surprisingly few studies have evaluated the allergen content in different types of mattresses, despite considerable efforts to develop anti-dust mite strategies.</div> <bR> <div> They investigated the presence of mite faeces as an indicator of mite-allergens in both spring and foam mattresses in the homes of 152 school children in northern Norway.</div> <bR> <div> Investigators from the University of Tromso in Norway and the University of California in Berkley collected dust samples from 24 foam mattresses without covers, 68 foam mattresses with covers and 24 spring mattresses. They used a guanine colorimetric paper test to detect mite faeces.</div> <bR> <div> Results show mite faeces were in 40.5 percent of the dust samples from foam mattresses without covers, in 26.3 percent of the foam mattresses with covers and in only 12.5 percent of the spring mattresses.</div> <bR> <div> The presence of mite faeces was associated with seven factors: signs of dampness, mattress age, mattress cleaning, frequency of vacuuming in the bedroom, mechanical ventilation, bedroom temperature and bedroom relative humidity. </div> <bR> <div> Allergy, 2002; 57: 538-542. <I><U>"House-dust mites and mattresses"</U></I></div> <bR> <bR> <bR> <div> <B> <A NAME="diet_can_influence_allergic_skin"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>Diet Can Influence Allergic Skin Reactions</B></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="626" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#00FFFF HEIGHT= 19 WIDTH="622"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="622" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <bR> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="626" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="622"><div> Updated: Tue, Oct 02 6:01 PM EDT</div> </tD> </tR> </TABLE></div> <bR> <div> NEW YORK (Reuters Health) - People who are plagued with a skin condition called contact dermatitis may benefit from ridding their diets of foods such as citrus fruits and tomatoes, according to the results of a small study.</div> <bR> <div> <B> <A NAME="use_of_most_asthma_drugs_during"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>Use of Most Asthma Drugs During Pregnancy Does Not Change Birth Outcomes </B></div> <bR> <div> WESTPORT, CT (Reuters Health) Jun 29 - Pregnant women who receive prescriptions for most commonly used asthma medications are no more likely than their counterparts to produce offspring with decreased gestational age, birth weight, or length at birth, according to data from a population-based study in Denmark. </div> <div> Dr. Charlotte Oleson of the University of Aarhus and associates linked data from several registries to identify 15,756 primiparous women who gave birth to singleton infants between 1991 and 1996. Of these, 303 had received at least one prescription for an asthma drug during their pregnancy. </div> <div> Prescriptions for inhaled and systemic ß-agonists and inhaled steroids were not associated with birth outcomes, the investigators report in the May/June issue of <I>Respiration</I>. However, offspring of the 24 women who received a prescription for theophyllamine or systemic steroid were more likely to be of low birth weight and small for gestational age compared with the reference group. </div> <div> There were two infants born with a malformation — clubfoot or pyloric stenosis — among the 11 women who used theophyllamine from 30 days prior to conception until 8 weeks of gestation. These could be "due to a drug effect, confounding, or chance," the authors write. </div> <div> The 78 women who decreased asthma medication during pregnancy gave birth to infants with lower mean gestational age, birth weight, and length at birth than infants born to the rest of the women in the cohort. According to Dr. Oleson's group, this finding may indicate that these women stopped therapy even though their asthma severity justified continuation. </div> <div> "Although authorities have argued that the risks of uncontrolled asthma appear to be higher than the risk of recommended drugs, the information on many drugs includes nonspecific warnings that may lead to a too-conservative drug use during pregnancy," the investigators conclude. </div> <div> <I>Respiration</I> 2001;68:256-261. </div> <bR> <bR> <div> <B> <A NAME="pollen_and_mold_counts_can_vary"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>Pollen and mold counts can vary throughout the day. </B></div> <div> <B>Peak times are:</B> </div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="635" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="99"><div> grass:</div> </tD> <tD VALIGN=CENTER WIDTH="521"><div> afternoon and early evening;</div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="99"><div> ragweed:</div> </tD> <tD VALIGN=CENTER WIDTH="521"><div> early midday;</div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 57 WIDTH="99"><div> mold: </div> </tD> <tD VALIGN=CENTER WIDTH="521"><div> some types peak during warm, dry, windy afternoons; other types occur at high levels during periods of dampness and rain and peak in the early morning hours.</div> </tD> </tR> </TABLE></div> <bR> <div> <B> <A NAME="asthma_and_allergy_triggers_"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B><U>ASTHMA AND ALLERGY "TRIGGERS"</U></B><FONT SIZE="3" COLOR="#660099" FACE="Arial" > </FONT></div> <div> If you or someone you know have allergic symptoms or asthma, you are sensitive to "triggers," including particles carried in the air. These "triggers" can set off a reaction in your lungs and other parts of your body. Triggers can be found indoors or outdoors. They can be simple things like: </div> <bR> <div> Cold air. </div> <bR> <div> Tobacco smoke and wood smoke. </div> <bR> <div> Perfume, paint, hair spray, or any strong odors or fumes. </div> <bR> <div> Allergens (particles that cause allergies) such as dust mites, pollen, molds, pollution, and animal dander - tiny scales or particles that fall off hair, feathers or skin - and saliva from any pets. </div> <bR> <div> Common cold, influenza, and other respiratory illnesses. </div> <bR> <div> You may be able to add more triggers to this list. Other things may also trigger your asthma or allergies. It's important to learn which triggers are a problem for you. Ask your doctor to help. Your doctor my suggest: </div> <bR> <div> Keeping an asthma diary. </div> <bR> <div> Skin testing to test for allergies. </div> <bR> <div> Finding triggers isn't always easy. If you do know your triggers, cutting down exposure to them may help avoid asthma and allergy attacks. </div> <bR> <div> If you don't know your triggers, try to limit your exposure to one suspected trigger at a time. Watch to see if you get better. This may show you if the trigger was a problem for you. </div> <bR> <div> <U>TRIGGER CONTROLS</U><FONT SIZE="3" COLOR="#660099" FACE="Arial" ><U> </U></FONT></div> <div> Here are some common triggers and some ways to help control them at home: </div> <bR> <div> <B><U>Tobacco Smoke</U></B><B><U> </U></B></div> <div> Smoke should not be allowed in the home of someone with asthma or allergies. Ask family members and friends to smoke outdoors. Suggest that they quit smoking. Your local American Lung Association can help. Ask your Lung Association how you can help a family member or friend <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>quit smoking.</U></FONT> </div> <div> <B><U>Wood Smoke</U></B><U> </U></div> <div> Wood smoke is a problem for children and adults with asthma and allergies. Avoid wood stoves and fireplaces. </div> <div> <B><U>Pets</U></B><U> </U></div> <div> Almost all pets can cause allergies, including dogs, cats and especially small animals like birds, hamsters and guinea pigs. All pets should be removed from the home if pets trigger asthma and allergy symptoms. </div> <bR> <div> Pet allergen may stay in the home for months after the pet is gone because it remains in house dust. Allergy and asthma symptoms may take some time to get better. </div> <bR> <div> If the pet stays in the home, keep it out of the bedroom of anyone with asthma or allergies. Weekly pet baths may help cut down the amount of pet saliva and dander in the home. </div> <bR> <div> Sometimes you hear that certain cats or dogs are "non-allergenic." There really is no such thing as a "non-allergenic" cat or dog, especially if the pet leaves dander and saliva in the home. Goldfish and other tropical fish may be a good substitute. </div> <bR> <div> <B><U>Cockroaches</U></B><U> </U></div> <div> Even cockroaches can cause problems, so it's important to get rid of roaches in your home. Small pieces of dead roaches and roach droppings settle in house dust and can end up in the air you breathe. </div> <bR> <div> Like humans, roaches need food and water and a place to live. Help keep your home roach free by storing food in sealable containers and keeping crumbs, dirty dishes and other sources of food waste cleaned up; fixing leacks and wiping up standing water; and cleaning up clutter where roaches find shelter. </div> <bR> <div> If you still have problems and you have to choose a pesticide, be sure to use it safely, and as directed on the label. Baits are less likely than sprays or foggers to harm your lungs. </div> <bR> <div> <B><U>Indoor Mold</U></B><B><U> </U></B></div> <div> When humidity is high, molds can be a problem in bathrooms, kitchens, and basements. Make sure these areas have good air circulation and are cleaned often. The basement in particular may need a dehumidifier. And remember, the water in the dehumidifier must be emptied and the container cleaned often to prevent forming mildew. </div> <bR> <div> Molds may form on foam pillows when you perspire. To prevent mold, wash the pillow every week, dry thoroughly and make sure to change it every year. </div> <bR> <div> Molds also form in houseplants, so check them often. You may have to keep all plants outdoors. </div> <bR> <div> <B><U>Strong Odors or Fumes</U></B><U> </U></div> <div> Perfume, room deodorizers, cleaning chemicals, paint, and talcum powder are examples of triggers that must be avoided or kept to very low levels. </div> <bR> <div> <B><U>Dust Mites</U></B><U> </U></div> <div> Dust mites are tiny, microscopic spiders usually found in house dust. Several thousand mites can be found in a pinch of dust. Mites are one of the major triggers for people with allergies and asthma. They need the most work to remove. </div> <bR> <div> <U>Following these rules can also help get rid of dust mites: </U></div> <bR> <div> Put mattresses in allergen-impermeable covers. Tape over the length of the zipper. </div> <bR> <div> Put pillows in allergen-permeable covers. Tape over the length of the zipper. Or wash the pillow every week. </div> <bR> <div> Wash all bedding every week in water that is at least 130 degrees F. Removing the bedspread at night may help. </div> <bR> <div> Don't sleep or lie down on upholstered (stuffed) furniture. </div> <bR> <div> Remove carpeting in the bedroom. </div> <bR> <div> Clean up surface dust as often as possible. Use a damp mop or damp cloth when you clean. Don't use aerosols or spray cleaners in the bedroom. And don't clean the room when someone with asthma or allergies is present. </div> <bR> <div> Window coverings attract dust. Use window shades or curtains made of plastic or other washable material for easy cleaning. </div> <bR> <div> Remove stuffed furniture and stuffed animals (unless the animals can be washed), and anything under the bed. </div> <bR> <div> Closets need extra care. They should hold only needed clothing. Putting clothes pin a plastic garment bag may help. (Do not use the plastic bag that covers dry cleaning). </div> <bR> <div> Dust mites like moisture and high humidity. Cutting down the humidity in your home can cut down the number of mites. A dehumidifier may help. </div> <bR> <div> Air cleaning devices, including portable units and central filtration systems may be helpful in reducing some indoor air pollutants when used with effective source control and ventilation. Ask your doctor for advice about air cleaning devices. If you decide to use one, make sure it removes particles efficiently over an extended period of time and does not produce ozone. </div> <bR> <bR> <bR> <div> <B><U> <A NAME="fda_gives_peanut_allergy_drug"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></U></B><B><U>FDA Gives Peanut-Allergy Drug Fast-Track Status </U></B></div> <div> Tue Sep 24, 5:33 PM ET </div> <div> <FONT SIZE="3" COLOR="#660099" FACE="Arial" >NEW YORK (Reuters Health) - </FONT>The maker of an experimental drug to treat peanut allergies reported Tuesday that the US Food and Drug Administration ( <FONT SIZE="3" COLOR="#0000FF" FACE="arial" ><U>news</U></FONT> - <FONT SIZE="3" COLOR="#0000FF" FACE="arial" ><U>web sites</U></FONT>) has given the medication fast-track status. </div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="12" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="4"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="4" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=CENTER WIDTH="1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <div> The drug, TNX-901, is made by Tanox Inc. </div> <div> The fast-track designation, intended for products that address an unmet medical need, entitles Tanox to meetings with the FDA for the agency's input on development plans, the option to submit its US marketing application in sections, and the option to base that application on surrogate endpoints. </div> <div> TNX-901 is an antibody to IgE, an immune system protein that interacts with inflammatory cells to produce many of the symptoms resulting from exposure to allergens. The drug is being developed to provide protection against reactions to unintentional peanut ingestion by people who have a severe allergy to peanuts. </div> <div> The drug recently completed a phase II trial, and additional studies are being planned, the Houston-based company said. </div> <bR> <bR> <bR> <bR> <bR> <div> <B><U> <A NAME="heartburn_drug_may_relieve_severe"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></U></B><B><U>Heartburn Drug May Relieve Severe Asthma </U></B></div> <div> 17 minutes ago </div> <div> <I><B>By Janice Billingsley</B></I></div> <div> <I>HealthScoutNews Reporter</I> </div> <div> MONDAY, Oct. 21 (HealthScoutNews) -- People suffering from severe asthma as well as acid reflux disease might find the medicine they take for the reflux provides some crossover relief for their breathing problems. </div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="12" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="4"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="4" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=CENTER WIDTH="1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <div> In a double-blind, six-month study of 207 asthma and acid reflux sufferers, those patients who took daily acid-reducing medicine along with their asthma medicine had fewer severe asthma attacks and an improvement in their quality of life, says Dr. Michael Littner, a professor of medicine at University of California in Los Angeles and the study's lead author.</div> <div> "Those patients with asthma and acid reflux symptoms who were taking two maintenance medicines, such as inhaled corticosteroids and long-acting beta-2 agonists, for asthma as well as lansoprazole had a significant, clinically important improvement," says Littner, who reported the findings today at the American College of Gastroenterology's annual meeting in Seattle.</div> <div> Lansoprazole is a category of drug called a proton pump inhibitor (PPI (<FONT SIZE="3" COLOR="#0000FF" FACE="arial" ><U>news</U></FONT> - <FONT SIZE="3" COLOR="#0000FF" FACE="arial" ><U>web sites</U></FONT>)), which inhibits the production of stomach acid and is used in treating acid reflux disease. Tap Pharmaceutical Products Inc. manufactures lansoprazole under the name Prevacid, and was the sponsor of the study.</div> <div> The benefits, Littner says, were that those on lansoprazole reported fewer severe asthma attacks, called exacerbations, than did those who took a placebo.</div> <div> "In the emotions domain of the questionnaires they filled out, they reported a better sense of general well-being," he adds.</div> <div> The improvements, though, were seen only in those with severe asthma, which was defined in the study as patients who took more than one long-term maintenance medication for their disease. Study participants who took only one asthma medicine showed no improvement in their asthma with the lansoprazole.</div> <div> Dr. Timothy Wang, chief of gastroenterology at the University of Massachusetts Medical School, says asthma and gastroesophageal reflux disease (GERD) seem to be closely linked, with each one leading to the worsening of the other. He also says there may be a small subgroup of asthma patients who are helped by taking acid inhibitors, but most patients will show no benefit.</div> <div> While this study has the advantage of being a randomized, double-blind study, he says "since all these patients had acid reflux disease in addition to asthma, they should have been taking the acid reflux medicine anyway, regardless of their asthma."</div> <div> Littner responds that the study participants had not been taking PPIs on a daily basis before the study. Asthma sufferers who were already taking daily PPI medication were not included in the study because if they were getting relief, the doctors did not want to take them off their medicines and put them on a placebo. </div> <div> "The patients in the study were those who thought their heartburn was being controlled by occasional antacids. When they were having a pizza, they'd take an antacid, or maybe a PPI, but normally did not take daily medications for reflux symptoms," he says.</div> <div> In the 24-week study, 207 regular asthma patients, recruited from 32 medical centers throughout the country, were divided into two groups -- one taking 30 milligrams daily of Prevacid, and the other taking a placebo. About half of the patients took more than one asthma medication, and they were divided equally between the Prevacid and placebo groups.</div> <bR> <bR> <bR> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="369" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 38 WIDTH="365"><bR> <bR> </tD> </tR> </TABLE></div> <bR> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="369" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="365"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="365" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <bR> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="369" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 917 WIDTH="365"><div> <B> <A NAME="magnesium_added_to_nebulised_albuterol"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>Magnesium Added to Nebulised Albuterol Provides Faster, Greater Improvement for Asthmatic Children</B></div> <div> By Maria Bishop Special to DG News BOSTON, MA -- October 23, 2002 -- Patients who received magnesium along with albuterol had a faster, greater and more sustained improvement in their forced expiratory volume in 1 second (FEV1) than those who received albuterol alone. The finding was presented here October 22 during a poster session at the annual meeting of the American Academy of Pediatrics (AAP). A prospective, randomised, double-blinded study was conducted in an inner city emergency department (Children's Hospital of Michigan, Detroit, Michigan). Sixty-two children between the ages of five and 17 years with mild to moderate asthma (resting FEV1 between 45-75 percent predicted for age) were randomised to either an albuterol plus saline (A+S) group, or an albuterol plus magnesium (A+M) group. The A+S group received a single dose of 2.5 mg (0.5 cc) of albuterol and 2.5 cc of normal saline. The A+M group received 2.5 mg (0.5 cc) of albuterol and 2.5 cc of isotonic magnesium sulfate. The net improvement from baseline to 20 minutes was nearly twice in the magnesium group than the saline group (15.5 percent versus 8.4 percent), noted research leader Prashant V. Mahajan, MD. At baseline, FEV1 absolute and as percentage predicted were similar between the two groups. FEV1 absolute at baseline was 1.15 L for the A+M group versus 1.06 L (p=0.35) for the A+S group. FEV1 percentage predicted at baseline was 59.9 percent for the A+M group versus 58.9 percent for the A+S group. At 10 minutes after treatment, there was a statistically significant improvement in FEV1 absolute when comparison was made between the two groups: 1.41 L versus 1.13 L (p=0.029). Within the A+M group, the improvement in absolute FEV1 and percentage predicted was highly significant from both baseline to 10 minutes (59.9 percent versus 74.57 percent; p=0.00) and baseline to 20 minutes (59.9 percent versus 75.41 percent; p=0.00). In the A+S group, the improvement in FEV1 absolute and as percentage predicted was statistically significant only from baseline to 20 minutes (58.9 percent versus 67.3 percent, p=0.036). </div> <bR> </tD> </tR> </TABLE></div> <div> <B> <A NAME="hope_for_people_with_deadly_peanut"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B><U>Hope for People with Deadly Peanut Allergy</U></B></div> <bR> <div> BOSTON (Reuters) - Life-threatening reactions to peanuts may soon be a thing of the past for millions of people around the world who are allergic to the legume, researchers said on Monday in a finding that may also help prevent allergic reactions to other foods. </div> <bR> <div> An experimental treatment that involved monthly injections successfully muted the severe reactions of people who risk death if they ingest the slightest amount of peanut protein, according to a study this week in the New England Journal of Medicine (news - web sites). </div> <bR> <div> "This is a huge advance for patients. Now they have something they can do in advance to protect themselves from accidental exposure," Hugh Sampson, one of the study's authors, told Reuters. "It allows them to go around and not be scared of their food. It really lifts a cloud." </div> <bR> <div> Approximately 1.5 million Americans are allergic to peanuts, and 50 to 100 people in the United States die each year from anaphylactic shock after being exposed to the legume. </div> <bR> <div> Peanut allergy can be so severe that people have been known to develop symptoms after eating just 1/2,000th of one peanut or kissing someone who has eaten peanuts. </div> <bR> <bR> <div> Scientists who released the results of the study at the American Academy of Allergy, Asthma and Immunology conference in Denver said the medicine is not be a green light to eating peanuts. </div> <bR> <bR> <div> "It increases the threshold of sensitivity to the peanut from accidental ingestion," said another of the study's authors, Donald Leung, head of pediatric allergy-immunology at the National Jewish Medical and Research Center in Denver. </div> <bR> <div> Even if people with the allergy do all they can to avoid peanuts, it's not always enough. Schools or day care centers may not be fully aware of the problem and waiters may not have enough information about ingredients. </div> <bR> <bR> <div> "Peanuts can be used to thicken brown gravy, or in pie crusts or even to hold an egg roll together," said Anne Munoz-Furlong, founder of the non-profit awareness group Food Allergy & Anaphylaxis Network. In some cases youngsters are teased about the allergy, she said. </div> <bR> <div> The study will appear in Thursday's New England Journal of Medicine. </div> <bR> <div> The treatment allowed volunteers who would normally develop symptoms after consuming a single peanut to eat an average of eight peanuts before experiencing nausea, pain, vomiting, hives, throat tightness or other symptoms. </div> <bR> <div> And because the shots block the chemical pathway responsible for other types of food allergies, the treatment may help people allergic to eggs, cats, dogs and other types of nuts, according to the study. </div> <bR> <div> However, the treatments didn't work for everyone and it may take a while for the therapy to get to consumers. Final testing has been halted because three companies are in court squabbling over rights to the treatment. </div> <bR> <div> FATAL ALLERGY </div> <bR> <div> The study, which looked at the reactions of more than 80 volunteers who received four monthly shots, focused on peanuts because the legume is the leading cause of fatal and near-fatal reactions in the United States, said Sampson, of the Mount Sinai School of Medicine in New York. </div> <bR> <div> In the study, only the patients who got the highest dose of the antibody showed significant improvement, and the treatment cut sensitivity to peanuts in 76 percent of those volunteers. </div> <bR> <div> But in 24 percent of those cases, the volunteers were able to consume the equivalent of 24 peanuts before showing signs of a reaction. </div> <bR> <div> Scientists have experimented with traditional allergy shots in the past, but the rate of side effects has been too high. </div> <bR> <div> The drug would have to be taken throughout a person's life because it doesn't completely block the allergic reaction. The next round of tests could help researchers develop a better dose that makes the injections even more effective, according to Sampson. </div> <bR> <div> But those tests, expected to lead to Food and Drug Administration (news - web sites) approval in three or four years, are now even farther off because of U.S. litigation that pits Tanox Inc. against Novartis Pharma AG and Genentech Inc. over development rights for the treatment. </div> <bR> <div> Tanox paid for the study and three Tanox researchers are among the study's authors. </div> <bR> <bR> <bR> <div> <B><U> <A NAME="in_some_throat_clearing_first_sign_of"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></U></B><B><U>In Some, Throat Clearing First Sign of Asthma</U></B></div> <bR> <div> University of Crete researchers looked at a group of children who, according to their parents, often cleared their throats. </div> <bR> <bR> <div> About 58 percent of those children had not been diagnosed with asthma. Half of the undiagnosed children underwent tests of lung function, and the results showed that those youngsters did, in fact, have the condition. </div> <bR> <bR> <div> "They all had a very mild form of asthma," Dr. Eva C. Mantzouranis told Reuters Health. </div> <bR> <bR> <div> She suggested that parents of a child who constantly clears his throat for no obvious reason should consider getting the child tested for asthma, even if he has no other symptoms of the condition. </div> <bR> <bR> <div> However, the typical questions doctors ask parents to determine whether children have asthma do not include throat clearing as a symptom, Mantzouranis noted. Children with asthma do better if they are treated earlier rather than later, she said, and doctors who don't ask about throat clearing symptoms may miss some early cases of the condition, she said. </div> <bR> <bR> <div> "It is important to start treatment early, because the prognosis is better," Mantzouranis explained. </div> <bR> <bR> <div> "I would definitely add that (question about throat clearing) to my standard questions for asthma," she added. </div> <bR> <bR> <div> According to the American Lung Association, asthma is the leading serious, chronic illness in childhood, diagnosed in at least 7.7 million people younger than 18 in the US alone. </div> <bR> <bR> <div> While wheezing and coughing are considered common symptoms of asthma, other symptoms that also signal the disease has arrived may be less recognized, Mantzouranis and her colleagues note. </div> <bR> <bR> <div> In an interview, Mantzouranis explained that she began to suspect that throat clearing could be a sign of asthma when some parents of children being treated for asthma reported that their children had also stopped constantly clearing their throats, a habit they had thought of as a "tic." </div> <bR> <bR> <div> To determine whether throat clearing was a sign of early asthma, the authors looked at questionnaires given to the parents of 2,609 children aged between three and five years old who attended a daycare center. The questionnaires asked parents about typical symptoms of asthma and included one additional query: "does your child have a habit of clearing his or her throat often?" </div> <bR> <bR> <div> Almost 18 percent of the children had been diagnosed with asthma during the previous year, and another 24 percent had been told they had the disease prior to the previous year, Mantzouranis and her colleagues report. </div> <bR> <bR> <div> Parents of 106 children said they were frequent throat clearers, 61 of whom had never been diagnosed with asthma, nor had any symptoms of the condition. </div> <bR> <bR> <div> To test whether these supposedly asthma-free children did, in fact, have the disease, the researchers measured lung function in 30 of the youngsters old enough to perform the test. </div> <bR> <bR> <div> This test revealed that these children, on average, had reduced lung function. After doctors gave them treatment for asthma, however, both their throat clearing and lung function improved. </div> <bR> <bR> <div> Seeing an improvement in symptoms after receiving asthma medication is "consistent with the diagnosis of clinically unrecognized asthma," Mantzouranis and her colleagues write. </div> <bR> <div>    </div> <bR> <bR> <bR> <div> Mantzouranis explained that children with asthma have sensitive airways that react poorly to different stimulants. In many children, this exposure leads to coughing or wheezing. But in others with a less severe form of the condition, their reaction is not strong enough to cause a cough or wheeze, and exposure to a stimulant may result in simple throat clearing, she said. </div> <bR> <div> SOURCE: The New England Journal of Medicine (news - web sites) 2003;348:1502-1503. </div> <bR> <bR> <div> <B><U> <A NAME="acid_reflux_therapy_may_cut_kids_"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></U></B><B><U>Acid Reflux Therapy May Cut Kids' Asthma Drug Usage</U></B></div> <bR> <div> Previous studies in adults have suggested that as many as 4 out of 5 asthmatics experience the chronic cough and hoarseness of acid reflux, a condition triggered by the regurgitation of stomach acid into the esophagus. While the connections between asthma and GERD remain unclear, researchers have noticed that antireflux medications can sometimes help asthma symptoms. </div> <bR> <bR> <div> In the current study, lead author Dr. Vikram Khoshoo and colleagues at the West Jefferson Medical Center in New Orleans, Louisiana, evaluated asthma medication usage among 27 children diagnosed with persistent moderate asthma and GERD. The group was compared to 19 other children (the control group) with asthma but no symptoms of GERD. </div> <bR> <bR> <div> Eighteen of the youngsters with both asthma and GERD received drugs, including prescription heartburn relievers known as proton pump inhibitors (PPIs), and 9 underwent surgical treatment for GERD. </div> <bR> <bR> <div> One year later, all of the patients who got some kind of anti-GERD treatment -- medication or surgery -- were able to reduce their asthma medication by more than 50 percent, according to the study published in the journal Chest. </div> <bR> <bR> <div> Among the children in the control group, 2 of 8 children with asthma but not GERD who took anti-GERD medication reduced their asthma medication usage, while the other 11 children, who took no such medication, did not reduce their asthma medication usage, the study indicates. </div> <bR> <bR> <div> "Children with persistent asthma often take the maximum amount of medications to maintain their asthma, yet they still end up in the emergency room on a regular basis," said Khoshoo in a prepared statement. </div> <bR> <bR> <div> "With anti-GERD treatments such as PPIs, we may be able to help to lighten our patients' asthma regimens and eventually reduce the number of emergency room visits and school days missed," the researcher added. </div> <bR> <bR> <div> SOURCE: Chest 2003;123:1008-1013. </div> <bR> <bR> <div>  <A NAME="singulair"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <div> <IMG SRC="28d4e260.png" border=0 width="590" height="550" ALT="Adobe Photoshop Elements Image" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <div> <B><U> <A NAME="advair_diskus"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></U></B><B><U>ADVAIR</U></B></div> <div> <B>Important information about ADVAIR</B>:</div> <div> ADVAIR won't replace fast-acting inhalers for sudden symptoms and should be taken twice daily. ADVAIR should not be taken more than twice daily. People switching from an oral steroid, like prednisone, to ADVAIR, which contains an inhaled steroid, need to be especially careful. While adjusting to the switch, your body may not be as able to heal after surgery, infection, or serious injury. Tell your healthcare professional if you have a heart condition or high blood pressure. Some people may experience increased blood pressure, heart rate, or changes in heart rhythm. See your healthcare professional if your asthma does not improve. ADVAIR is a long-term maintenance treatment for asthma in patients 12 and older. </div> <div> <B><U>How to Use ADVAIR DISKUS</U></B></div> <div> IT'S AS EASY<FONT SIZE="1" COLOR="#660099" FACE="Arial" >1</FONT> AS 1, 2, 3: OPEN, CLICK, INHALE* </div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="626" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 606 WIDTH="622"><div> Help take control of your asthma with ADVAIR DISKUS. Taking a dose of ADVAIR DISKUS requires the following three simple steps: Open, Click, Inhale.<FONT SIZE="1" COLOR="#660099" FACE="Arial" >*</FONT> (Please see complete Patient Instructions for Use provided with every ADVAIR DISKUS.) </div> <div> 1. OPEN </div> <div> Hold the DISKUS in one hand and put the thumb of your other hand on the <B>thumbgrip</B>. Push your thumb away from you as far as it will go until the mouthpiece appears and snaps into position. </div> <div> 2. CLICK </div> <div> Hold the DISKUS in a level, horizontal position with the mouthpiece towards you. Slide the <B>lever</B> away from you as far as it will go until it <B>clicks</B>. The DISKUS is now ready to use. </div> <div> Every time the <B>lever</B> is pushed back, a dose is ready to inhale. This is shown by a decrease in numbers on the dose counter. </div> <div> <B>To avoid releasing or wasting doses: Do not close the DISKUS. Do not tilt the DISKUS. Do not play with the lever. Do not advance the lever more than once. </B></div> <div> 3. INHALE </div> <div> Before inhaling your dose of ADVAIR DISKUS, breathe out as far as is comfortable, holding the DISKUS level and away from your mouth. Remember, never breathe out into the DISKUS mouthpiece. </div> <div> Put the mouthpiece to your lips. Breathe in quickly and deeply through the ADVAIR DISKUS, not through your nose. </div> <div> Remove the DISKUS from your mouth. Hold your breath for about 10 seconds, or for as long as is comfortable. Breathe out slowly. </div> <div> <FONT SIZE="1" COLOR="#660099" FACE="Arial" ><B>*</B></FONT><B>CLOSE the DISKUS when you are finished taking a dose so that the DISKUS will be ready for you to take your next dose</B>. Put your thumb on the thumbgrip and slide the thumbgrip back towards you as far as it will go. The DISKUS will click shut. The lever will automatically return to its original position. The DISKUS is now ready for you to take your next scheduled dose, due in approximately 12 hours. (Repeat steps 1 through 3.) </div> <div>  <A NAME="remember"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>REMEMBER:</div> <div> Never exhale into the DISKUS. Never attempt to take the DISKUS apart. Always activate and use the DISKUS in a level, horizontal position. After inhalation, rinse your mouth with water without swallowing. Never wash the mouthpiece or any part of the DISKUS. KEEP IT DRY. Always keep the DISKUS in a dry place. </div> </tD> </tR> </TABLE></div> <bR> <div> <B><U> <A NAME="livostin_eye_drops_"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></U></B><B><U>Livostin eye drops </U></B></div> <div> (CONTAINS - LEVOCABASTINE (AS HYDROCHLORIDE) 0.5mg/mL)  </div> <bR> <div> Livostin contains an antihistamine to relieve itchy, red and watery eyes. Shake Livostin well before use and follow directions on packaging. </div> <bR> <div> Dosage</div> <div>  Place 1 drop into each eye twice daily, or as directed. </div> <div> <FONT SIZE="3" COLOR="#660099" FACE="arial" > </FONT>To use the <I>eye drops</I>: </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">First, wash your hands. Tilt the head back and, pressing your finger gently on the skin just beneath the lower eyelid, pull the lower eyelid away from the eye to make a space. Drop the medicine into this space. Let go of the eyelid and gently close the eyes. Do not blink. Keep the eyes closed for 1 or 2 minutes to allow the medicine to be absorbed by the eye. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">If you think you did not get the drop of medicine into your eye properly, use another drop. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">To keep the medicine as germ-free as possible, do not touch the applicator tip to any surface (including the eye). Also, keep the container tightly closed. </div> <div> <I>In order for this medicine to work properly, it must be used every day in regularly spaced doses as ordered by your doctor</I>. A few days may pass before you begin to feel better.</div> <bR> <bR> <div> <B><U> <A NAME="exposure_to_lotions_containing_peanut"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></U></B><B><U>Exposure to Lotions Containing Peanut Oil or Consumption of Soy Protein May Predispose Infants to Peanut Allergy</U></B></div> <div> The prevalence of peanut allergy among children has increased in the last few decades. It's well known that a family history of <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>food allergies</U></FONT> can increase a child's risk of developing the condition, but researchers from London studied other potential factors in the development of peanut allergy.</div> <div> Almost 14,000 parents participated in a national health study for children from birth to 6 years of age that investigated how the features of a child's environment interact with genetic factors to cause health, behavioral, or developmental problems. The researchers examined the child's medical record and samples of umbilical cord blood, and parents answered questionnaires during the first, sixth, fifteenth, and eighteenth months after birth and every 6 months until 6 years of age. </div> <div> Parents answered questions about the types of rashes their child experienced, medications their child took, and details about the child's diet. When parents noted that their child had a reaction to peanuts, the child underwent testing to confirm the allergy. Parents whose children tested positive for peanut allergy were asked more detailed questions by telephone, such as whether there was a family history of peanut allergy, whether the mother consumed peanuts during pregnancy or breastfeeding, whether breast creams containing peanut oil were used during breastfeeding, or whether creams containing peanut oil were used on the infant's skin. </div> <div> The children with peanut allergy were compared to a group of children without peanut allergy and to a group of children with eczema, an allergic skin condition that causes redness and itching.</div> <div> Allergy testing confirmed that 23 of 36 children suspected to have an allergy did have peanut allergy. The amount of peanut butter the mother consumed during pregnancy did not appear to increase a child's risk of peanut allergy. However, peanut allergy was associated with the child consuming soy milk or soy formula. In addition, if a child had an eczema-like rash, there was also an increased risk of peanut allergy. Peanut allergy was also associated with using skin lotions and creams containing peanut oil during infancy.</div> <div> <B>What This Means to You:</B> The results of this study indicate that exposure to lotions containing peanut oil or consumption of soy products may increase a child's risk of developing peanut allergy. An allergy to peanuts can cause severe and even deadly symptoms in children, including itching, rash, swelling, and respiratory problems. Children with a family history of peanut allergy need to be especially careful to avoid products containing peanuts or peanut oil. Talk to your child's doctor if you're concerned that your child has or may be at risk for peanut allergy.</div> <div> Source: Gideon Lack, MB, BCh; Deborah Fox, BA; Kate Northstone, MSc; Jean Golding, PhD; <I>New England Journal of Medicine</I>, March 13, 2003</div> <div> <FONT SIZE="3" COLOR="#660099" FACE="Arial" >Reviewed by: </FONT><U> <A NAME="link0"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></U><U>Steven Dowshen, MD</U></div> <div> Date reviewed: April 2003</div> <bR> <div> <B><U> <A NAME="controlling_sinus_problems_cuts_asthma"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></U></B><B><U>Controlling Sinus Problems Cuts Asthma Risk</U></B></div> <div> Grab the phone and call your doctor to see if you're