Asthma management and prevention: current perspectives

Global epidemiology and holistic prevention of pancreatitis

Knowledge of pancreatitis in the 20th century was shaped predominantly by animal data and clinical trials. Several large general population-based cohort studies and comprehensive systematic literature reviews in the 21st century have had a major effect on our understanding of pancreatitis and its sequelae. This Review provides precise and up-to-date data on the burden of acute pancreatitis, chronic pancreatitis and post-pancreatitis diabetes mellitus. Exocrine pancreatic insufficiency and altered bone metabolism following pancreatitis are also discussed. Furthermore, the article introduces a framework for the holistic prevention of pancreatitis with a view to providing guidance on strategies and intervention objectives at primary, secondary and tertiary levels. Concerted efforts by not only gastroenterologists and surgeons but also primary care physicians, endocrinologists, radiologists, pain specialists, dietitians, epidemiologists and public health specialists will be required to reduce meaningfully the burden of pancreatitis and its sequelae over the ensuing decades.

Hydroethanolic extract from Echinodorus scaber Rataj leaves inhibits inflammation in ovalbumin-induced allergic asthma

ETHNOPHARMACOLOGICAL RELEVANCE

Echinodorus scaber, Alismataceae, is popularly known in Brazil as "chapéu-de-couro". The plant leaves are used by the population as decoction, infusion, or maceration in bottled spirits, to treat inflammatory respiratory diseases.

AIM OF THE STUDY

To investigate the anti-inflammatory mechanism of the hydroethanolic extract of leaves of Echinodorus scaber (HEEs) in allergic asthma. A phytochemical analysis of the extract was performed as well.

MATERIALS AND METHODS

The leaves of Echinodorus scaber were prepared by maceration in 75% ethanol. Preliminary phytochemical analysis was carried out using basic classical methods, and the secondary metabolites detected in HEEs were analyzed and confirmed by high-performance liquid chromatography (HPLC). The in vivo anti-inflammatory activity of HEEs was evaluated in Swiss male albino mice sensitized and challenged by OVA. The HEEs (1, 5 and 30mg/kg, p.o.) was administered to mice twice a day, 1h before the challenge, from days 19 through 24. The mechanism of action of HEEs was studied by evaluating the levels of T_H2 cytokines (IL-4, IL-5 and IL-13) in bronchoalveolar lavage fluid (BALF) and IgE production in blood plasma. Histopathological changes triggered by OVA-sensitization/challenge in the lung tissue were also investigated.

RESULTS

HEEs reduced total leukocyte, eosinophil, neutrophil, and mononuclear cell counts at all doses tested, with maximum effect at 30mg/kg (73.9%, 75.9%, 75.5%, and 65.2% reduction, p<0.001, respectively). Increases in T_H2 cytokine secretion (IL-4, IL-5 and IL-13) and in IgE levels were also attenuated by HEEs. Preliminary phytochemical screening seems to indicated the presence of phenolic compounds, flavonoids and alkaloids. HPLC analyses evidenced the presence of phenolic compounds, such as gallic acid, rutin and vitexin.

CONCLUSION

Our findings provided pharmacological preclinical evidence for the popular use of the leaves of Echinodorus scaber in allergic inflammation. Its anti-inflammatory effect was dependent on the decrease in migratory inflammatory cells, and both T_H2 cytokines and IgE levels. It is suggested that vitexin, gallic acid and rutin, known anti-inflammatory compounds, may participate in the anti-asthamtic effect of the HEEs, by acting jointly along with other components present in the extract.

Impact of symptom management training among asthmatic children and adolescents on self-efficacy and disease course

PURPOSE

The study was conducted to examine the effect of a training program provided to asthmatic children/adolescents on disease course and self-efficacy.

METHODS

This prospective study consisted of both experimental and control subjects. The study population was composed of children/adolescents aged 10-18 years, who presented at Health Centers within Tokat province with asthma and who were currently using inhaler treatments. The study sample included 40 patients each in both the control and experimental groups. Asthmatic Child Information Form, Disease Evaluation Form, Peak Expiratory Flow Rate Evaluation Form and an Asthmatic Child/Adolescent Self-Efficacy Scale were used to collect data on research outcomes. Data were statistically analyzed with paired sample t-test, McNemar's test, independent samples t-test.

RESULTS

A significant increase in mean self-efficacy score was observed in the experimental group following training sessions. The experimental training was also associated with a reduction in asthma symptoms, less limitations to daily function and fewer attacks following physical activity relative to the control subjects. The children/adolescents in the experimental group were more conscious of the symptoms of asthma attacks and used preventive and rescue medications regularly, and reported fewer absences from school and fewer emergency room visits (p < 0.05). The average peak expiratory flow rate was 62.5% in the experimental group. After training, there were significant decreases in the number of attacks and the need of increasing inhaler doses in the experimental group.

CONCLUSIONS

The study results show that the training program is effective in increasing self-efficacy and improving asthma symptoms among children/adolescents. Nurses should offer the training program to support children/adolescents during asthma attacks, and encourage the development of self-efficacy.