Browsing by Subject "Asthma"
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Item Asthma and Gastro-Esophageal Reflux Disease: What are they and how are they related?(2010-07-29) Herman, MargotIt has been shown that persons with asthma have more acid-reflux or GERD (gastro-esophageal reflux disease) than the general population. This has led some physician scientists to suspect that the two may be related. This education tool discusses this relationship and the possible benefits of GERD treatment for asthma sufferers.Item Asthma and Oral Steroids: Treatment for Asthma Attacks in Children(2009-09-18) Barnes, SarahAsthma is a disease that affects airways, the pipes that carry air to a patient’s lungs. With asthma, when airways are irritated they swell and narrow. During an asthma attack, or exacerbation, this narrowing makes it hard to breathe. Some patients experience wheezing, coughing and chest tightness. This pamphlet explains what triggers and asthma attack and outlines asthma treatment, including oral steroids.Item Asthma Health Outcomes Achieved through a Clinic-based Quality Improvement Program(2018-02) Rojanasarot, SirikanAsthma is a chronic condition that is prevalent in both children and adults. However, despite numerous and costly national quality improvement efforts, persons with asthma continue to receive suboptimal care. This is due in part to providers’ non-adherence to asthma guidelines, which impedes achievement of asthma treatment goals, resulting in unnecessary use of health care resources. Thus, evidence-based quality improvement programs that enhance the quality of care would be beneficial to both providers and patients. The primary aim of my dissertation was to address research and practice gaps that exist in quality improvement research by establishing evidence for a community-based asthma care improvement program implemented in 65 clinic sites across four states. The aim of this program was to improve asthma care among providers in real-world practice. This dissertation focused on three outcomes: 1) six clinic-based, guideline-recommended performance measures of asthma care; 2) preventable health events due to asthma; and 3) total asthma-related health care costs. The results of this dissertation are presented as three publishable manuscripts. The first manuscript addresses the effect of the program on clinic-based performance measures. It was found that, compared with performance prior to program implementation, the rates of documenting the six guideline-based performance measures increased significantly and remained improved following program completion. The second manuscript examines the program’s effect on asthma-related emergency room visits and hospitalizations. The results showed that the rates of these two events decreased by 42.1% and 50.0%, respectively, during the 12-month implementation and 5-month post-program completion periods. Using patient-level administrative claims data in multilevel generalized linear modeling, the results from the third manuscript found that implementation was associated with a 56.4% reduction in total asthma-related health care costs, while post-program completion was associated with a 57.3% reduction. This dissertation contributes significantly to both clinical and policy perspectives on quality improvement research. First, this work provides evidence for the enhancement of both provider- and patient-focused asthma-related outcomes through standardized quality improvement efforts at the clinic level in diverse geographic areas and across multiple clinic sites. Further, this dissertation provides an analytical framework for the evaluation of real-world health care interventions that have been missing in quality improvement research. Policy researchers could apply the analytic framework documented in this dissertation in the evaluation of health outcomes of complex quality improvement programs, not only for patients with asthma, but also those with other chronic conditions.Item Asthma: What can I do?(2010-07-22) Ward, JasonAsthma action plans fitted to individuals using medication dose training, asthma education, and allergy skin testing is unlikely to increase the chances that a patient will take his or her inhaled steroid (control) asthma medication. Intense counseling may reduce the use of rescue inhalers short term and allow patients to be more confident in their control of asthma, but the cost of such treatment reduces the overall benefit.Item Did Cryptic Invasion of North America by Common Reed Change Exposure to Pollen Allergens?(2011-02-24) Schimpf, David J.; White, Natalie A.Common reed, Phragmites australis (reed), is a very tall grass that spread greatly to occupy large areas near many eastern North American cities over the past century. Its aerially dispersed pollen is known to incite allergic reactions, and possibly asthma, in some persons, but is not distinguished from that of any other grass in routine pollen monitoring. We hypothesize that this regional expansion by reed has increased late-season exposure to grass-pollen allergens in parts of these metropolitan areas. The information available indicates that reed's geographic location, high abundance, small pollen size, release of pollen relatively far above ground, substantial pollen productivity, pollen allergen composition, and late season of pollen release all point to its potential importance for a large number of persons whose health may be degraded by grass pollen. If the other common late-flowering grasses in the same area have larger pollen grains, it may be possible to visually distinguish reed pollen captured by monitoring devices. If not, ratios of stable isotopes of carbon in the pollen may permit differentiation. Otherwise, analytical techniques based on molecular differences need further development in order to estimate local population exposure to allergens from reed. Some 90 million North Americans may live close enough to large tracts of reed to be exposed to substantial concentrations of its pollen, so much more attention to this situation seems warranted. If reed pollen were found to be a health hazard for a particular metropolitan area, removal of the pollen sources may be more feasible than is the case for many other species.Item Healthy Lung Evaluation Prior to Surgery(2012-03-06) Abcejo, ArneyItem Regulation of CD38 expression in human airway smooth muscle (HASM) cells.(2009-05) Jude, Joseph AntonyCD38 is a multifunctional enzyme-cum-receptor expressed in a variety of mammalian tissues including airway smooth muscles (ASM). The ADP-ribosyl cyclase activity of CD38 generates cyclic ADP-ribose (cADPR), a Ca2+ mobilizing agent in ASM cells. In vivo studies in mice showed that CD38 plays an important role in the development of airway hyperresponsiveness (AHR) following exposure to cytokines. In vitro studies demonstrated that a variety of cytokines, including the inflammatory cytokine TNF-alpha, induce CD38 expression in human ASM (HASM) cells. Studies also showed that the TNF-alpha-induced CD38 expression in HASM cells is mediated through both the transcriptional and post-transcriptional mechanisms and involves activation of mitogen-activated protein kinases (MAPKs) and transcription factors NF-kappaB and AP-1. The role of CD38 in the pathogenesis of AHR in human asthmatics is not known. The current studies demonstrate that HASM cells isolated from asthmatic patients show differentially elevated CD38 expression following TNF-alpha exposure compared to non-asthmatic HASM cells. Basal and TNF-alpha-induced activation of extracellular signal- regulated kinase (ERK) and p38 MAPK are elevated in asthmatic HASM cells, whereas the TNF-alpha-induced activation of c-jun N terminal kinase (JNK) is elevated in non-asthmatic HASM cells compared to asthmatic cells. The TNF-alpha-induced NF-kappaB activation is elevated in asthmatic HASM cells, indicating that the differentially elevated CD38 expression in asthmatic HASM cells is mediated through transcriptional mechanisms. The role of cross-talk between ERK and phosphatidylinositol 3-kinase/Akt (PI3K/Akt) pathways in TNF-alpha-induced CD38 expression is investigated in the current studies. Two pharmacological inhibitors of PI3K, LY294002 and wortmannin, show differential effects on the TNF-alpha-induced CD38 expression in HASM cells. Transient expression of PI3K catalytic subunit (p110) elevates CD38 expression while transfection with phosphatase tensin homolog (PTEN) attenuates the TNF-alpha-induced CD38 expression, suggesting that PI3K/Akt pathway mediates CD38 expression in HASM cells in a non-ERK dependant manner. The role of adenylate-uridylate-rich elements (AREs) of the CD38 mRNA 3' untranslated region (3'UTR) in CD38 mRNA stability is currently being investigated. Preliminary findings show that, in HASM cells, the RNA-binding proteins HuR and TIA-1 selectively bind to an ARE of CD38 3'UTR in response to TNF-alpha-exposure, suggesting a potential role for the CD38 mRNA AREs in the post-transcriptional regulation of CD38 expression in HASM cells.Item Seasonal Allergies and Asthma, fighting one to improve another(2012-07-24) Regan, JamesItem Tylenol may increase the risk of asthma in children(2012-04-10) Tseng, Jack