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Hussein N, Liew SM, Hanafi NS, Lee PY, Cheong AT, Ghazali SS, Chinna K, Pang YK, Kassim A, Parker RA, Schwarze J, Sheikh A, Pinnock H, Khoo EM. Asthma control and care among six public health clinic attenders in Malaysia: A cross-sectional study. Health Sci Rep 2023; 6:e1021. [PMID: 37152232 PMCID: PMC10154831 DOI: 10.1002/hsr2.1021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 05/09/2023] Open
Abstract
Background and Aims Asthma is common in Malaysia but neglected. Achieving optimal asthma control and care is a challenge in the primary care setting. In this study, we aimed to identify the risk factors for poor asthma control and pattern of care among adults and children (5-17 years old) with asthma attending six public health clinics in Klang District, Malaysia. Methods We conducted a cross-sectional study collecting patients' sociodemographic characteristics, asthma control, trigger factors, healthcare use, asthma treatment, and monitoring and use of asthma action plan. Descriptive statistics and stepwise logistic regression were used in data analysis. Results A total of 1280 patients were recruited; 85.3% adults and 14.7% children aged 5-17 years old. Only 34.1% of adults had well-controlled asthma, 36.5% had partly controlled asthma, and 29.4% had uncontrolled asthma. In children, 54.3% had well-controlled asthma, 31.9% had partly controlled, and 13.8% had uncontrolled asthma. More than half had experienced one or more exacerbations in the last 1 year, with a mean of six exacerbations in adults and three in children. Main triggers for poor control in adults were haze (odds ratio [OR] 1.51; 95% confidence interval [CI] 1.13-2.01); cold food (OR 1.54; 95% CI 1.15-2.07), extreme emotion (OR 1.90; 95% CI 1.26-2.89); air-conditioning (OR 1.63; 95% CI 1.20-2.22); and physical activity (OR 2.85; 95% CI 2.13-3.82). In children, hot weather (OR 3.14; 95% CI 1.22-8.11), and allergic rhinitis (OR 2.57; 95% CI 1.13-5.82) contributed to poor control. The majority (81.7% of adults and 64.4% of children) were prescribed controller medications, but only 42.4% and 29.8% of the respective groups were compliant with the treatment. The importance of an asthma action plan was reported less emphasized in asthma education. Conclusion Asthma control remains suboptimal. Several triggers, compliance to controller medications, and asthma action plan use require attention during asthma reviews for better asthma outcomes.
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Affiliation(s)
- Norita Hussein
- Department of Primary Care Medicine, Faculty of MedicineUniversiti MalayaKuala LumpurMalaysia
| | - Su May Liew
- Department of Primary Care Medicine, Faculty of MedicineUniversiti MalayaKuala LumpurMalaysia
| | - Nik Sherina Hanafi
- Department of Primary Care Medicine, Faculty of MedicineUniversiti MalayaKuala LumpurMalaysia
| | - Ping Yein Lee
- UM eHealth Unit, Faculty of MedicineUniversiti MalayaKuala LumpurMalaysia
| | - Ai Theng Cheong
- Department of Family Medicine, Faculty of Medicine and Health SciencesUniversiti Putra MalaysiaSeri KembanganMalaysia
| | - Sazlina Shariff Ghazali
- Department of Family Medicine, Faculty of Medicine and Health SciencesUniversiti Putra MalaysiaSeri KembanganMalaysia
| | - Karuthan Chinna
- Faculty of Business and ManagementUCSI UniversityKuala LumpurMalaysia
| | - Yong Kek Pang
- Department of Medicine, Faculty of MedicineUniversiti MalayaKuala LumpurMalaysia
| | - Asiah Kassim
- Kuala Lumpur Women and Children Hospital, Ministry of HealthKuala LumpurMalaysia
| | - Richard A. Parker
- Edinburgh Clinical Trials Unit, Usher InstituteThe University of EdinburghEdinburghUK
| | - Jürgen Schwarze
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher InstituteThe University of EdinburghEdinburghUK
- Child Life and Health, Centre for Inflammation ResearchThe University of EdinburghEdinburghUK
| | - Aziz Sheikh
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher InstituteThe University of EdinburghEdinburghUK
| | - Hilary Pinnock
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher InstituteThe University of EdinburghEdinburghUK
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of MedicineUniversiti MalayaKuala LumpurMalaysia
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Jaber D, Ghannam RA, Rashed W, Shehadeh M, Zyoud SH. Use of complementary and alternative therapies by patients with eye diseases: a hospital-based cross-sectional study from Palestine. BMC Complement Med Ther 2021; 21:3. [PMID: 33397355 PMCID: PMC7784325 DOI: 10.1186/s12906-020-03188-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Generally, complementary and alternative therapies (CAT) are accepted methods of treatment by patients with various types of conditions. Their use is becoming especially prevalent among patients with eye problems even in developed countries. Thus, we aimed to determine the pattern of use of CAT in this patient population, to identify the patient characteristics associated with the use of CAT, and to assess the types of CAT used. METHODS A descriptive, cross-sectional study was conducted in Palestine at An-Najah National University Hospital between the time periods of October 2019 to May 2020, using questionnaire-based face to face interviews. Data were collected through convenience sampling. Patients responded to the questionnaire, which was focused on information adapted from previous research in this area, covering socio-demographic and clinical characteristics, types of CAT, source of information, and side effects on CAT use. RESULTS A total of 86 patients were interviewed for our study. Over two thirds, 67% reported using CAT for the specific purpose of improving their eye condition, and about one third (29.1%) received more than one therapy. The most common therapies reported were duea' (i.e. supplication) (47.1%) and herbal therapies (24.1%). It was shown that patients with bilateral involvement of their eyes were almost twice more likely to describe using CAT than patients with unilateral eye pathology (p = 0.006). Also, patients who underwent surgery as their route of treatment were significantly less likely to use CAT (p = 0.043). Most of our study participants mentioned a non-physician source as their source of information regarding CAT with family members being the most frequently mentioned (30.2%) followed by the internet (25.6%) and friends (19.8%). CONCLUSIONS The prevalence of CAT use among patients with eye disease is somewhat high in our study population. Because CAT may trigger adverse reactions, influence the progression of the disease, and interfere with conventional treatment, the ophthalmologist should frequently be asked patients with such diagnostics regarding the use of these therapies. Further work is required to analyze the mechanisms of action and to establish realistic guidelines for the use of these modalities.
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Affiliation(s)
- Dania Jaber
- grid.11942.3f0000 0004 0631 5695Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Rafat Abu Ghannam
- grid.11942.3f0000 0004 0631 5695Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Waleed Rashed
- grid.11942.3f0000 0004 0631 5695Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Mohammad Shehadeh
- grid.11942.3f0000 0004 0631 5695Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Department of Ophthalmology, An-Najah National University Hospital, 44839 Nablus, Palestine
| | - Sa’ed H. Zyoud
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, Department of Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Clinical Research Center, An-Najah National University Hospital, Nablus, 44839 Palestine
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Amelioration of airway inflammation and pulmonary edema by Teucrium stocksianum via attenuation of pro-inflammatory cytokines and up-regulation of AQP1 and AQP5. Respir Physiol Neurobiol 2020; 284:103569. [PMID: 33144273 DOI: 10.1016/j.resp.2020.103569] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/17/2020] [Accepted: 10/25/2020] [Indexed: 01/21/2023]
Abstract
Current study investigates the immunomodulatory effects of T. stocksianum using mouse model of ovalbumin (OVA)-induced allergic asthma. The mice were treated with methanolic extract, n-hexane, and ethyl acetate fractions for consecutive 7 days along with intranasal challenge. The mRNA expression levels of interleukin-4 (IL-4), IL-5, Aquaporin-1 (AQP1) and Aquaporin-5 (AQP5) were evaluated using reverse transcription polymerase chain reaction. The data showed that T. stocksianum significantly reduced airway inflammation as indicated by reduced inflammatory cell infiltration in lungs, and attenuated total and differential leukocyte counts both in blood and BALF. Expression levels of pro-inflammatory IL-4 and IL-5 in lungs were also found significantly reduced. T. stocksianum significantly reduced pulmonary edema as indicated by reduced lung wet/dry ratio and goblet cell hyperplasia. AQP1 and AQP5 expression levels were also found elevated in treatment groups. In conclusion, T. stocksianum possesses anti-asthmatic activity which may be attributed to reduction in IL-4 and IL-5 expression levels, and elevation in AQP1 and AQP5 expression levels.
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Immunomodulatory and Anti-Inflammatory Potential of Curcumin for the Treatment of Allergic Asthma: Effects on Expression Levels of Pro-inflammatory Cytokines and Aquaporins. Inflammation 2020; 42:2037-2047. [PMID: 31407145 DOI: 10.1007/s10753-019-01066-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Curcumin is well known for possessing anti-inflammatory properties and for its beneficial effects in the treatment of asthma. Current study investigates the immunomodulatory and anti-inflammatory effects of curcumin using mouse model of ovalbumin-induced allergic asthma. BALB/c mice were immunized with ovalbumin on day 0 and 14 to induce allergic asthma. Animals were treated with two different doses of curcumin (20 mg/kg and 100 mg/kg) and methylprednisolone from day 21 to 28. Mice were also daily challenged intranasally with ovalbumin during treatment period, and all groups were sacrificed at day 28. Histopathological examination showed amelioration of allergic asthma in treated groups as evident by the attenuation of infiltration of inflammatory cells, goblet cell hyperplasia, alveolar thickening, and edema and vascular congestion. Curcumin significantly reduced total and differential leukocyte counts in both bronchoalveolar lavage fluid and blood. Reverse transcription polymerase chain reaction analysis showed significantly suppressed mRNA expression levels of IL-4 and IL-5 (pro-inflammatory cytokines), TNF-α, TGF-β (pro-fibrotic cytokines), eotaxin (chemokine), and heat shock protein 70 (marker of airway obstruction) in treated groups. Attenuation of these pro-inflammatory markers might have led to the suppression of airway inflammation. The expression levels of aquaporin-1 (AQP) and AQP-5 were found significantly elevated in experimental groups which might be responsible for reduction of pulmonary edema. In conclusion, curcumin significantly ameliorated allergic asthma. The anti-asthmatic effect might be attributed to the suppression of pro-inflammatory cytokines, and elevation of aquaporin expression levels, suggesting further studies and clinical trials to establish its candidature in the treatment of allergic asthma.
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The effect of stress management incorporating progressive muscle relaxation and biofeedback-assisted relaxation breathing on patients with asthma: a randomised controlled trial. ADVANCES IN INTEGRATIVE MEDICINE 2019. [DOI: 10.1016/j.aimed.2018.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ahsan F, Shabbir A, Shahzad M, Mobashar A, Sharif M, Basheer MI, Tareen RB, Syed NIH. Amelioration of allergic asthma by Ziziphora clinopodioides via upregulation of aquaporins and downregulation of IL4 and IL5. Respir Physiol Neurobiol 2019; 266:39-46. [PMID: 31015030 DOI: 10.1016/j.resp.2019.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/29/2019] [Accepted: 04/10/2019] [Indexed: 01/26/2023]
Abstract
Ziziphora clinopodioides has been frequently used as an anti asthmatic plant in traditional medication. Recent work explores the anti-asthmatic activity of Z. clinopodioides in allergen-induced asthmatic mice. Intraperitoneal sensitization followed by intranasal challenge were given with ovalbumin (allergen) to develop allergic asthma. Investigational groups of animals were administered with drug methylprednisolone (MP) (15 mg/kg body weight), n-hexane fraction, ethylacetate fraction, and methanolic extract of Z. clinopodioides extract (500 mg/kg b.w.) for successive 07 days. Hematoxyline and eosin (H&E) and periodic acid-Schiff (PAS) stains were used to evaluate histopathological parameters on lung tissues. As an index of lungs tissues edema, wet/dry weight ratio of lungs was determined. Evaluation of expression levels of AQP1, AQP5, IL4, and IL5 was conducted by using RT-PCR. The data exhibited that both Z. clinopodioides and MP attenuated differential and total leukocyte counts in hematological examination i.e. in BALF and blood. Treatment with Z. clinopodioides also caused suppression of inflammatory cell infiltration and expression levels of IL4 and IL5, the later could have caused attenuation of pulmonary inflammation. The study also found decline in lung wet/dry ratio and goblet cellh hyperplasia in treated groups which indicates amelioration of lung edema. Treatment with Z. clinopodioides significantly increased the expression levels of aquaporin-1 and -5, which could have led to reduction in lung edema. The treatment with MP showed comparable results to Z. clinopodioides. Current investigation revealed that Z. clinopodioides possessed anti-asthmatic property which might be accredited to upregulagted AQP1 and AQP5 levels and downregulated IL4 and IL5 levels.
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Affiliation(s)
- Fatima Ahsan
- Pharmacology section, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Arham Shabbir
- Pharmacology section, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan; Department of Pharmacy, The University of Lahore-Gujrat Campus, Gujrat, Pakistan.
| | - Muhammad Shahzad
- Department of Pharmacology, The University of Health Sciences, Lahore, Pakistan
| | - Aisha Mobashar
- Pharmacology section, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Marriam Sharif
- Pharmacology section, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
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The ameliorative effect of AST2017-01 in an ovalbumin-induced allergic rhinitis animal model. Inflamm Res 2019; 68:387-395. [PMID: 30874868 DOI: 10.1007/s00011-019-01226-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/08/2019] [Accepted: 03/09/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE AST2017-01 is developed to be used for treatment and prevention of allergic diseases and composed of processed-Cordyceps militaris and processed-Rumex crispus. But, effect of AST2017-01 remains unclear in an allergic rhinitis (AR). So, this study aimed to explore the effects of AST2017-01 in ovalbumin (OVA)-induced AR animal model. METHODS OVA-induced AR animals were orally administered AST2017-01 and chrysophanol, an active component of AST2017-01 for 10 days. RESULTS In mice with AR, AST2017-01 and chrysophanol markedly decreased number of rubs, IgE, histamine, thymic stromal lymphopoietin, tumor necrosis factor-α, interleukin (IL)-1β, IL-4, IL-5, and IL-13 in serum or nasal mucosa tissues. Moreover, activities and protein levels of caspase-1 were markedly diminished by oral administration of AST2017-01 and chrysophanol. Declines of macrophage inflammatory protein-2, intercellular adhesion molecules-1, eosinophil, and mast cells were also noted in nasal mucosa tissues of AST2017-01 and chrysophanol groups. CONCLUSIONS Taken together, these findings indicate that AST2017-01 has an anti-allergic effect as a therapeutic agent or functional food for treating and preventing AR.
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[Role of non pharmacological Interventions for asthma]. Presse Med 2019; 48:282-292. [PMID: 30871852 DOI: 10.1016/j.lpm.2019.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 12/27/2018] [Accepted: 02/13/2019] [Indexed: 12/14/2022] Open
Abstract
Smoking cessation remains a major issue for asthmatic smokers. Respiratory rehabilitation and respiratory physiotherapy have shown a benefit in controlling symptoms, preventing exacerbations and improving the quality of life. The control of the environment is crucial and must be approached in a global way. Management of obesity and psychological disorders should be systematically proposed. Allergen immunotherapy may be discussed in allergic persistent asthma to house dust mites. Certain dietary interventions or alternative medicines have not proved their worth.
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Kim KA, Jung JH, Choi YS, Kang G, Kim ST. Anti-inflammatory effect of wogonin on allergic responses in ovalbumin-induced allergic rhinitis in the mouse. ALLERGY & RHINOLOGY 2018; 9:2152656718764145. [PMID: 29977652 PMCID: PMC6028163 DOI: 10.1177/2152656718764145] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background Wogonin is commonly used for the treatment of allergic diseases. However, neither its precise effect in preventing allergic rhinitis (AR) nor its mechanism of action are known. Objectives In this study, the effect of wogonin on allergic responses in ovalbumin (OVA) induced AR was investigated in mice. Methods BALB/c mice were sensitized with intraperitoneal (i.p.) OVA and then challenged intranasally with OVA. Wogonin (10 and 30 mg/kg) was given to the treatment groups, and the effect of wogonin on the release of allergic inflammatory mediators, specifically OVA-specific immunoglobulin E (IgE) and inflammatory cytokines, was explored. Eosinophil infiltration and the levels of interleukin (IL) 5 and IL-13 were measured by immunohistochemistry. Results In mice with AR, wogonin decreased OVA-specific IgE levels in serum, and the levels of the cytokines IL-4, IL-5, IL-13, eotaxin, and RANTES in nasal lavage fluid. Serum levels of IL-4, IL-5, and IL-13 were lower in both groups of wogonin-pretreated mice than in the OVA group. A reduction in eosinophil infiltration of the nasal mucosa and inhibition of the expression of IL-5 and IL-13 were also noted in the treated groups. Conclusion Wogonin induced antiallergic effects in a murine model of AR by decreasing the infiltration of eosinophils and levels of T-helper type 2 cytokines. Thus, wogonin merits consideration as a therapeutic agent for treating AR.
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Affiliation(s)
- Kyeong Ah Kim
- Department of Otolaryngology-Head and Neck Surgery, Gachon University Gil Medical Center, Incheon, Korea.,This work was supported by the Gachon University Gil Medical Center (Grant Number: 2014-33).,K. Ah Kim and J.H. Jung contributed equally to this work.,The authors have no conflicts of interest to declare pertaining to this article
| | - Joo Hyun Jung
- Department of Otolaryngology-Head and Neck Surgery, Gachon University Gil Medical Center, Incheon, Korea.,This work was supported by the Gachon University Gil Medical Center (Grant Number: 2014-33).,K. Ah Kim and J.H. Jung contributed equally to this work.,The authors have no conflicts of interest to declare pertaining to this article
| | - Yun Sook Choi
- Department of Otolaryngology-Head and Neck Surgery, Gachon University Gil Medical Center, Incheon, Korea.,This work was supported by the Gachon University Gil Medical Center (Grant Number: 2014-33).,K. Ah Kim and J.H. Jung contributed equally to this work.,The authors have no conflicts of interest to declare pertaining to this article
| | - Gyu Kang
- Department of Otolaryngology-Head and Neck Surgery, Gachon University Gil Medical Center, Incheon, Korea.,This work was supported by the Gachon University Gil Medical Center (Grant Number: 2014-33).,K. Ah Kim and J.H. Jung contributed equally to this work.,The authors have no conflicts of interest to declare pertaining to this article
| | - Seon Tae Kim
- Department of Otolaryngology-Head and Neck Surgery, Gachon University Gil Medical Center, Incheon, Korea.,This work was supported by the Gachon University Gil Medical Center (Grant Number: 2014-33).,K. Ah Kim and J.H. Jung contributed equally to this work.,The authors have no conflicts of interest to declare pertaining to this article
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Inam A, Shahzad M, Shabbir A, Shahid H, Shahid K, Javeed A. Carica papaya ameliorates allergic asthma via down regulation of IL-4, IL-5, eotaxin, TNF-α, NF-ĸB, and iNOS levels. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2017; 32:1-7. [PMID: 28732802 DOI: 10.1016/j.phymed.2017.04.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/02/2017] [Accepted: 04/09/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Natural products have a prime importance as an essential source for new drug discovery. Carica papaya leaves (CPL) have been used to treat inflammation in traditional system of medicine. AIM/HYPOTHESIS Current study evaluates the anti-inflammatory and immunomodulatory effects of CPL extract using mouse model of ovalbumin- (OVA) induced allergic asthma. METHODS All the mice were intraperitoneally sensitized and subsequently given intranasal challenge with OVA except the control group. Group-III and -IV were treated for seven consecutive days with CPL extract and methylprednisolone (MP), respectively. At the end of study, histopathological examination of the lungs was performed and inflammatory cell counts were done in blood as well as bronchoalveolar lavage fluid (BALF). The mRNA expression levels of IL-4, IL-5, eotaxin, TNF-α, NF-ĸB, and iNOS were measured using reverse transcription polymerase chain reaction (RT-PCR). RESULTS Results showed significant attenuation of lung infiltration of inflammatory cells, alveolar thickening, and goblet cell hyperplasia after treatment with CPL extract. We also found significant suppression of total and differential leukocyte counts in both blood and BALF samples of CPL extract treated group. CPL extract also alleviated the expression levels of IL-4, IL-5, eotaxin, TNF-α, NF-ĸB, and iNOS. Similarly, treatment with MP, used as a reference drug, also significantly ameliorated all the pro-inflammatory markers. CONCLUSION Current study shows that CPL extract possesses anti-inflammatory effect in mouse model of allergic airway inflammation by down-regulating IL-4, IL-5, eotaxin, TNF-α, NF-ĸB, and iNOS expression levels.
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Affiliation(s)
- Asma Inam
- Department of Pharmacology, University of Health Sciences, Lahore, Pakistan
| | - Muhammad Shahzad
- Department of Pharmacology, University of Health Sciences, Lahore, Pakistan.
| | - Arham Shabbir
- Department of Pharmacology, University of Health Sciences, Lahore, Pakistan; Pharmacology Section, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Hira Shahid
- Department of Pharmacology, University of Health Sciences, Lahore, Pakistan
| | - Khadija Shahid
- Riphah Institute of Pharmaceutical Sciences, Riphah International University, Islamabad, Pakistan
| | - Aqeel Javeed
- Department of Pharmacology and Toxicology, University of Veterinary and Animal Sciences, Lahore, Pakistan
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Agnihotri S, Kant S, Mishra SK, Verma A. Assessment of significance of Yoga on quality of life in asthma patients: A randomized controlled study. Ayu 2017; 38:28-32. [PMID: 29861589 PMCID: PMC5954264 DOI: 10.4103/ayu.ayu_3_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Asthma is a chronic inflammatory respiratory disease characterized by periodic attacks of wheezing, shortness of breath and a tight feeling in the chest. The current study is based on the effect of Yoga on quality of life in asthmatics in Northern India. Materials and Methods: A total of 300 participants of mild-to-moderate persistent asthma (FEV1 >60%) aged between 12 and 60 years were recruited from the Department of Pulmonary Medicine. Their quality of life was assessed with the help of mini asthma quality-of-life questionnaire (AQLQ) at baseline and then after 3rd and 6th month from baseline. Forty-five participants were dropped out during the study while 255 participants completed the study successfully. Results: In “the Yoga group,” significant improvements were found in all the subdomains of AQLQ at 3rd month and at 6th month in comparison to “the control group.” The number needed to treat was found to be 2.67 for the total AQLQ score which was greater than the minimal important difference. Conclusion: “The Yoga group” got significantly better improvement in asthma quality-of-life scores than “the control group.” Thus, Yoga can be used as an adjuvant therapy in the management of asthma.
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Affiliation(s)
- Shruti Agnihotri
- Department of Pulmonary Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Surya Kant
- Department of Pulmonary Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Satyendra Kumar Mishra
- Department of Social Work, Institute of Naturopathic and Yogic Sciences, Lucknow University, Lucknow, Uttar Pradesh, India
| | - Ajay Verma
- Department of Pulmonary Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
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Hendrickson D, Zollinger B, McCleary R. Determinants of the Use of Four Categories of Complementary and Alternative Medicine. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/1533210106288080] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this research is to assess the social and health determinants of the use of four separate and distinct categories of complementary and alternative medical therapies: biologically based, mind-body, manipulative, and whole CAM medical systems. The behavioral model of health services use, which holds that health service use is a function of predisposing, enabling, and need characteristics, is used as the theoretical framework for linking specific determinants with the four categories of CAM use. Data are taken from a statewide interview survey of Kansas adults ( N = 2,166) conducted in 2001. Results from multivariate analyses demonstrate that there is variation in the determinants of the use of different categories of CAM therapies. Overall, the results indicate that future research on the determinants of CAM must delineate between various CAM therapies to gain an accurate portrayal of the factors contributing to CAM use.
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Affiliation(s)
- Darren Hendrickson
- Department of Sociology & Anthropology, Eastern Illinois University, 600 Lincoln Avenue, Charleston, IL 61920
| | - Brett Zollinger
- Docking Institute of Public Affairs; Department of Sociology and Social Work at Fort Hays State University
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Rana S, Shahzad M, Shabbir A. Pistacia integerrima ameliorates airway inflammation by attenuation of TNF-α, IL-4, and IL-5 expression levels, and pulmonary edema by elevation of AQP1 and AQP5 expression levels in mouse model of ovalbumin-induced allergic asthma. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2016; 23:838-845. [PMID: 27288919 DOI: 10.1016/j.phymed.2016.04.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 02/11/2016] [Accepted: 04/24/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Natural products are considered as an essential source for the search of new drugs. Pistacia integerrima galls (PI) have been used for the treatment of asthma and cough in traditional system of medicine. AIM/HYPOTHESIS Current study investigates the immunomodulatory and anti-inflammatory activities of P. integerrima in mouse model of ovalbumin-induced allergic asthma. METHODS Mice were intraperitoneally sensitized and subsequently challenged intranasally with ovalbumin to induce allergic asthma. Experimental group mice were treated with methanol extract of P. integerrima extract (200mg/kg b. w.) and Methylprednisolone (MP) (15mg/kg b. w.) for 07 consecutive days, alongside intranasal challenge. Lung tissues were stained with Hematoxyline and Eosin (H & E), and Periodic Acid-Schiff (PAS) stains for histopathological evaluation. Lung wet/dry weight ratio was measured as an index of lung tissue edema. Albumin was injected in the right ear 24h before sacrificing the mice and difference of weight was taken as a degree of delayed type hypersensitivity (DTH). mRNA expression levels of TNF-α, IL-4, IL-5, Aquaporin-1 (AQP1), and AQP5 were evaluated using reverse transcription polymerase chain reaction (RT-PCR) followed by gel electrophoresis. RESULTS The data showed both PI extract and MP significantly alleviated DTH and nearly normalized total leukocyte count and differential leukocyte count in both blood and BALF. We found significantly suppressed goblet cell hyperplasia and inflammatory cell infiltration after treatment with both PI extract and MP. Expression levels of TNF-α, IL-4, and IL-5 were also found significantly reduced after treatment with both PI extract and MP, which might have resulted in the amelioration of airway inflammation. Current study displayed that both PI extract and MP significantly decreased lung wet/dry ratio, suggesting reduction in pulmonary edema. RT-PCR analysis showed significant increase in AQP1 and AQP5 expression levels after treatment with both PI extract and MP, which might have caused the alleviation of pulmonary edema. CONCLUSION Our study displays that P. integerrima possesses significant anti-asthmatic activity which may be attributed to reduction in TNF-α, IL-4, and IL-5 expression levels, and increase in AQP1 and AQP5 expression levels.
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Affiliation(s)
- Shazana Rana
- Department of Pharmacology, University of Health Sciences, Lahore, Pakistan
| | - Muhammad Shahzad
- Department of Pharmacology, University of Health Sciences, Lahore, Pakistan.
| | - Arham Shabbir
- Department of Pharmacology, University of Health Sciences, Lahore, Pakistan
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Ashraf MI, Shahzad M, Shabbir A. Oxyresveratrol ameliorates allergic airway inflammation via attenuation of IL-4, IL-5, and IL-13 expression levels. Cytokine 2015; 76:375-381. [PMID: 26431781 DOI: 10.1016/j.cyto.2015.09.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 08/13/2015] [Accepted: 09/16/2015] [Indexed: 01/15/2023]
Abstract
AIM Oxyresveratrol is known to possess anti-inflammatory property. Current study investigates the immunosuppressive effect of oxyresveratrol by using mouse model of ovalbumin (OVA)-induced allergic airway inflammation. METHODS BALB/c mice were randomly divided into five groups having 8 mice in each group. Treatment with low dose (7 mg/kg) and high dose (15 mg/kg) of oxyresveratrol, and methylprednisolone (15 mg/kg; standard drug) was started 2 week after immunization of mice with ovalbumin and continued for 7d. Ovalbumin was also injected into pinna of right ear 24h before sacrificing the mice to evaluate delayed type hypersensitivity (DTH). H&E and PAS staining were used for histopathological evaluation of lungs. Reverse transcription polymerase chain reaction followed by gel electrophoresis were used for evaluation of mRNA expression levels of IL-4, IL-5, and IL-13. RESULTS Oxyresveratrol significantly reduced total leucocyte count in both blood and bronchoalveolar lavage fluid (BALF). Treatment with oxyresveratrol normalized altered eosinophil and neutrophil counts in both blood and BALF. OVA-specific T-cell response was also significantly inhibited by oxyresveratrol. A significant attenuation of inflammatory cell infiltration and goblet cell hyperplasia was observed after treatment with oxyresveratrol. Data showed that oxyresveratrol significantly suppressed Th2 (T helper cells) type immune response which was obvious by the reduction in mRNA expression levels of IL-4, IL-5, and IL-13. Similarly, treatment with methylprednisolone also significantly reduced all the immunomodulatory and inflammatory parameters. CONCLUSIONS Our study demonstrates that oxyresveratrol ameliorates allergic asthma. The anti-asthmatic activity might in part occur via the down regulation of IL-4, IL-5, and IL-13 expression levels.
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Affiliation(s)
| | - Muhammad Shahzad
- Department of Pharmacology, University of Health Sciences, Lahore, Pakistan.
| | - Arham Shabbir
- Department of Pharmacology, University of Health Sciences, Lahore, Pakistan
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Khan AM, Shahzad M, Raza Asim MB, Imran M, Shabbir A. Zingiber officinale ameliorates allergic asthma via suppression of Th2-mediated immune response. PHARMACEUTICAL BIOLOGY 2015; 53:359-67. [PMID: 25420680 DOI: 10.3109/13880209.2014.920396] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
CONTEXT Ginger has been used commonly in the traditional system of medicine for the treatment of respiratory disorders. OBJECTIVE The present study investigates the immunosuppressive activity of ginger by using the mouse model of ovalbumin-induced allergic asthma. MATERIALS AND METHODS Treatment with ethanol extract (500 mg/kg) and aqueous extract (720 mg/kg) of rhizomes, and methylprednisolone (5 mg/kg) was initiated 1 week after second sensitization of mice with ovalbumin and continued for 7 d. RT-PCR followed by gel electrophoresis and ELISA were used for the evaluation of mRNA expression levels and protein levels of Th2 type markers, respectively. Lung tissue histopathology was conducted by using H&E and PAS staining. RESULTS We observed significant reduction in goblet cell hyperplasia (0.83 ± 0.17 and 1.0 ± 0.26), infiltration of inflammatory cells in airways (0.67 ± 0.33 and 1.0 ± 0.37), and edema with vascular congestion (1.0 ± 0.26 and 1.2 ± 0.17) by both ethanol and aqueous extracts, respectively. A highly significant reduction of total and differential count of eosinophils and neutrophils in BALF, and eosinophil count in blood were also observed. Both extracts significantly inhibited Th2-mediated immune response, which is evident by a decrease in mRNA expression levels of IL-4 and IL-5. Protein levels of IL-4 and IL-5 in BALF, along with total serum IgE levels, were also significantly suppressed by both extracts. DISCUSSION AND CONCLUSION Our study validated the traditional use of ginger in respiratory disorders and suggests that ginger reduces allergic airway inflammation, possibly by the suppression of Th2-mediated immune response.
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Affiliation(s)
- Asad Mahmood Khan
- Department of Pharmacology, University of Health Sciences , Lahore , Pakistan
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Huo N, Ray GE, Mehta S, LoBello SG. Complementary and alternative medicine use among people with asthma and health-related quality of life. J Asthma 2014; 52:308-13. [PMID: 25203936 DOI: 10.3109/02770903.2014.963867] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study investigated the relationship between complementary and alternative medicine (CAM) use and self-reported health-related quality of life among people with asthma. METHOD Data from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) survey and the 2010 Asthma Callback Survey (ACBS) were used. Survey respondents were men and women with asthma who were 18-99 years of age who responded to both surveys. RESULTS CAM use was associated with an increase in the number of days of poor mental health (OR = 1.02, 95% CI 1.02, 1.03) and poor physical health (OR = 1.02, 95% CI 1.01, 1.02). The odds ratios are adjusted for covariates such as asthma severity, age, sex, race/ethnicity, income, and educational attainment. CAM users report more days of poor mental health (7.2 versus 4.6) and poor physical health (9.6 versus 6.5) compared with those not using CAM therapies. CONCLUSIONS Contrary to the hypotheses, CAM use is associated with poorer health-related quality of life. Implications for research and practice are discussed in detail.
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Affiliation(s)
- Nan Huo
- Department of Psychology, Auburn University Montgomery , Montgomery, AL , USA
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McCormick SP, Nezu CM, Nezu AM, Sherman M, Davey A, Collins BN. Coping and social problem solving correlates of asthma control and quality of life. Chron Respir Dis 2014; 11:15-21. [PMID: 24431407 DOI: 10.1177/1479972313516878] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In a sample of adults with asthma receiving care and medication in an outpatient pulmonary clinic, this study tested for statistical associations between social problem-solving styles, asthma control, and asthma-related quality of life. These variables were measured cross sectionally as a first step toward more systematic application of social problem-solving frameworks in asthma self-management training. Recruitment occurred during pulmonology clinic service hours. Forty-four adults with physician-confirmed diagnosis of asthma provided data including age, gender, height, weight, race, income, and comorbid conditions. The Asthma Control Questionnaire, the Mini Asthma Quality of Life Questionnaire (Short Form), and peak expiratory force measures offered multiple views of asthma health at the time of the study. Maladaptive coping (impulsive and careless problem-solving styles) based on transactional stress models of health were assessed with the Social Problem-Solving Inventory-Revised: Short Form. Controlling for variance associated with gender, age, and income, individuals reporting higher impulsive-careless scores exhibited significantly lower scores on asthma control (β = 0.70, p = 0.001, confidence interval (CI) [0.37-1.04]) and lower asthma-related quality of life (β = 0.79, p = 0.017, CI [0.15-1.42]). These findings suggest that specific maladaptive problem-solving styles may uniquely contribute to asthma health burdens. Because problem-solving coping strategies are both measureable and teachable, behavioral interventions aimed at facilitating adaptive coping and problem solving could positively affect patient's asthma management and quality of life.
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Affiliation(s)
- Sean P McCormick
- 1Department of Public Health, Temple University, Philadelphia, PA, USA
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Chen W, FitzGerald JM, Rousseau R, Lynd LD, Tan WC, Sadatsafavi M. Complementary and alternative asthma treatments and their association with asthma control: a population-based study. BMJ Open 2013; 3:e003360. [PMID: 24005131 PMCID: PMC3773646 DOI: 10.1136/bmjopen-2013-003360] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Many patients with asthma spend time and resources consuming complementary and alternative medicines (CAMs). This study explores whether CAM utilisation is associated with asthma control and the intake of asthma controller medications. DESIGN Population-based, prospective cross-sectional study. SETTING General population residing in two census areas in the province of British Columbia, Canada. Recruitment was based on random-digit dialling of both landlines and cell phones. PARTICIPANTS 486 patients with self-reported physician diagnosis of asthma (mean age 52 years; 67.3% woman). PRIMARY AND SECONDARY OUTCOME MEASURES We assessed CAM use over the previous 12 months, level of asthma control as defined by the Global Initiative for Asthma and the self-reported intake of controller medications. Multivariate logistic regression was performed to study the relationship between any usage of CAMs (outcome), asthma control and controller medication usage, adjusted for potential confounders. RESULTS A total of 179 (36.8%) of the sample reported CAM usage in the past 12 months. Breathing exercises (17.7%), herbal medicines (10.1%) and vitamins (9.7%) were the most popular CAMs reported. After adjustment, female sex (OR 1.66; 95% CI 1.09 to 2.52) and uncontrolled asthma (vs controlled asthma, OR 2.25, 95% CI 1.30 to 3.89) were associated with a higher likelihood of using any CAMs in the past 12 months. Controller medication use was not associated with CAM usage in general and in the subgroups defined by asthma control. CONCLUSIONS Clinicians and policy makers need to be aware of the high prevalence of CAM use in patients with asthma and its association with lack of asthma control.
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Affiliation(s)
- Wenjia Chen
- Faculty of Pharmaceutical Sciences, Collaboration for Outcomes Research and Evaluation, University of British ColumbiaVancouver British Columbia Canada
- Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - J Mark FitzGerald
- Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Institute for Heart and Lung Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Roxanne Rousseau
- Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Larry D Lynd
- Faculty of Pharmaceutical Sciences, Collaboration for Outcomes Research and Evaluation, University of British ColumbiaVancouver British Columbia Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wan C Tan
- Institute for Heart and Lung Health, University of British Columbia, Vancouver, British Columbia, Canada
- James Hogg Research Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohsen Sadatsafavi
- Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Institute for Heart and Lung Health, University of British Columbia, Vancouver, British Columbia, Canada
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Tait EM, Laditka SB, Laditka JN, Nies MA, Racine EF. Use of complementary and alternative medicine for physical performance, energy, immune function, and general health among older women and men in the United States. J Women Aging 2012; 24:23-43. [PMID: 22256876 DOI: 10.1080/08952841.2012.638875] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
We examined use of complementary and alternative medicine (CAM) for health and well-being by older women and men. Data were from the 2007 National Health Interview Survey, representing 89.5 million Americans ages 50+. Multivariate logistic regression accounted for the survey design. For general health, 52 million people used CAM. The numbers for immune function, physical performance, and energy were 21.6, 15.9, and 10.1 million respectively. In adjusted results, women were much more likely than men to use CAM for all four reasons, especially energy. Older adults, particularly women, could benefit from research on CAM benefits and risks.
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Affiliation(s)
- Elizabeth M Tait
- College of Health and Human Services, Western Carolina University, Cullowhee, NC 28723, USA.
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Pbert L, Madison JM, Druker S, Olendzki N, Magner R, Reed G, Allison J, Carmody J. Effect of mindfulness training on asthma quality of life and lung function: a randomised controlled trial. Thorax 2012; 67:769-76. [PMID: 22544892 DOI: 10.1136/thoraxjnl-2011-200253] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND This study evaluated the efficacy of a mindfulness training programme (mindfulness-based stress reduction (MBSR)) in improving asthma-related quality of life and lung function in patients with asthma. METHODS A randomised controlled trial compared an 8-week MBSR group-based programme (n=42) with an educational control programme (n=41) in adults with mild, moderate or severe persistent asthma recruited at a university hospital outpatient primary care and pulmonary care clinic. Primary outcomes were quality of life (Asthma Quality of Life Questionnaire) and lung function (change from baseline in 2-week average morning peak expiratory flow (PEF)). Secondary outcomes were asthma control assessed by 2007 National Institutes of Health/National Heart Lung and Blood Institute guidelines, and stress (Perceived Stress Scale (PSS)). Follow-up assessments were conducted at 10 weeks, 6 and 12 months. RESULTS At 12 months MBSR resulted in clinically significant improvements from baseline in quality of life (differential change in Asthma Quality of Life Questionnaire score for MBSR vs control: 0.66 (95% CI 0.30 to 1.03; p<0.001)) but not in lung function (morning PEF, PEF variability and forced expiratory volume in 1 s). MBSR also resulted in clinically significant improvements in perceived stress (differential change in PSS score for MBSR vs control: -4.5 (95% CI -7.1 to -1.9; p=0.001)). There was no significant difference (p=0.301) in percentage of patients in MBSR with well controlled asthma (7.3% at baseline to 19.4%) compared with the control condition (7.5% at baseline to 7.9%). CONCLUSIONS MBSR produced lasting and clinically significant improvements in asthma-related quality of life and stress in patients with persistent asthma, without improvements in lung function. CLINICAL TRIAL REGISTRATION NUMBER Asthma and Mindfulness-Based Reduction (MBSR) Identifier: NCT00682669. clinicaltrials.gov.
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Affiliation(s)
- Lori Pbert
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA
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Kim H, Song MJ. Traditional plant-based therapies for respiratory diseases found in North Jeolla Province, Korea. J Altern Complement Med 2012; 18:287-93. [PMID: 22394156 DOI: 10.1089/acm.2010.0848] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aims to record and conserve orally transmitted traditional plant-based therapies for respiratory diseases in North Jeolla Province, Korea. METHODS Data were collected with semistructured questionnaires through the participatory rural appraisal method. RESULTS This study reveals that overall, 14 respiratory diseases have been treated with a total of 43 species of medicinal plants belonging to 40 genera in 26 families. This study also reports 149 different modes of plant-based therapeutic application of medicinal material. The informant consensus factor for the common cold is 0.84, the highest among 14 different respiratory ailments, followed by whooping cough, asthma, nosebleed, bronchitis, cough, and so on. Medicinal plants used to treat seven respiratory ailments had a 100% fidelity level. CONCLUSIONS This study can help to preserve the traditional knowledge and local health traditions of North Jeolla Province amid rapid industrialization and urbanization. The findings of this study warrant follow-up clinical research to determine the most effective traditional remedies toward development of herbal medicinal products for integration into the Korean health care system.
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Affiliation(s)
- Hyun Kim
- School of Alternative Medicine and Health Science, Jeonju University, Jeonju, Republic of Korea.
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Knoeller GE, Mazurek JM, Moorman JE. Complementary and alternative medicine use among adults with work-related and non-work-related asthma. J Asthma 2011; 49:107-13. [PMID: 22126603 DOI: 10.3109/02770903.2011.637597] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The prevalence of complementary and alternative medicine (CAM) use among adults with current asthma has been estimated to be 40%. To our knowledge, there is no information on the prevalence of CAM use among individuals with work-related asthma (WRA). OBJECTIVES To examine the associations between WRA, CAM use, and adverse asthma events. METHODS We analyzed data from the 2006-2008 Behavioral Risk Factor Surveillance System Asthma Call-Back Survey from 37 states and the District of Columbia for ever-employed adults with current asthma. We defined WRA as health-professional-diagnosed WRA. We calculated prevalence ratios (PRs) adjusted for age, sex, race/ethnicity, education, income, health insurance, and geographic region of residence. RESULTS Of ever-employed adults with current asthma, an estimated 38.1% used CAM and 8.6% had WRA. An estimated 56.6% of individuals with WRA reported using CAM compared with 27.9% of those with non-WRA (PR = 2.0). People with WRA were more likely than those with non-WRA to have adverse asthma events including an asthma attack in the past month (PR = 1.43), urgent treatment for worsening asthma (PR = 1.74), emergency room visit (PR = 1.95), overnight hospital stay (PR = 2.49), and poorly controlled asthma (PR = 1.27). The associations of WRA with adverse asthma events remained after stratifying for CAM use. CONCLUSIONS Compared with non-WRA, individuals with WRA were more likely to use CAM to control their asthma. However, there was no evidence that the use of CAM modified the association of WRA with adverse asthma events.
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Affiliation(s)
- Gretchen E Knoeller
- Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV 26505, USA.
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Use of complementary and alternative medicine in children with asthma. Can Respir J 2011; 17:183-7. [PMID: 20808977 DOI: 10.1155/2010/682142] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Because of the potential risk of interaction with, and underuse of, conventional medications, it is important to document the prevalence of the use of complementary and alternative medicines (CAMs) in asthmatic children. OBJECTIVE To ascertain the prevalence and type of CAMs, and to identify factors associated with their use. METHODS A cross-sectional survey of children who presented to the Asthma Centre of The Montreal Children's Hospital (Montreal, Quebec) between 1999 and 2007 was conducted. At the initial consultation, parents completed a questionnaire inquiring, in part, about CAM use. Computerized health records provided information regarding patient characteristics and their condition. RESULTS The median age of the 2027 children surveyed was 6.1 years (interquartile range 3.3 to 10.5 years); 58% were male and 59% of children had persistent asthma. The prevalence of CAM use was 13% (95% CI 12% to 15%). Supplemental vitamins (24%), homeopathy (18%) and acupuncture (11%) were the most commonly reported CAMs. Multivariable logistic regression analysis confirmed the association of CAM use with age younger than six years (OR 1.86; 95% CI 1.20 to 2.96), Asian ethnicity (OR 1.89; 95% CI 1.01 to 3.52), episodic asthma (OR 1.88; 95% CI 1.08 to 3.28) and poor asthma control (OR 1.98; 95% CI 1.80 to 3.31). CONCLUSION The prevalence of reported CAM use among Quebec children with asthma remained modest (13%), with vitamins, homeopathy and acupuncture being the most popular modalities. CAM use was associated with preschool age, Asian ethnicity, episodic asthma and poor asthma control.
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Abstract
Allergy describes a constellation of clinical diseases that affect up to 30% of the world's population. It is characterized by production of allergen-specific IgE, which binds to mast cells and initiates a cascade of molecular and cellular events that affect the respiratory tract (rhinitis and asthma), skin (dermatitis, urticaria), and multiple systems (anaphylaxis) in response to a variety of allergens including pollens, mold spores, animal danders, insect stings, foods, and drugs. The underlying pathophysiology involves immunoregulatory dysfunctions similar to those noted in highly stressed populations. The relationships in terms of potential for intervention are discussed.
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Sibbritt D, Adams J, Lui CW. A longitudinal analysis of complementary and alternative medicine use by a representative cohort of young Australian women with asthma, 1996-2006. J Asthma 2011; 48:380-6. [PMID: 21391870 DOI: 10.3109/02770903.2011.560323] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is evidence of asthma patients using complementary and alternative medicine (CAM). This article reports the findings of the first ever longitudinal study of CAM use among women with asthma from a large nationally representative sample. METHODS A longitudinal analysis of questionnaires completed in 1996, 2000, 2003, and 2006 as part of the Australian Longitudinal Study on Women's Health. The cohort began with 14,701 randomly selected young women (aged 18-22 years). CAM use was defined as a consultation with a range of complementary practitioners in the 12 months prior to each survey. Statistical analyses included the use of generalized estimating equations. RESULTS Over the 10-year period, approximately 26% of the women were asthmatic. Asthmatic women were significantly more likely to use CAM (19%, 22%, and 36% for surveys 2-4, respectively) than non-asthmatic women (15%, 20%, and 32% for surveys 2-4, respectively). CAM use increased as time since asthma diagnosis increased. However, only the increase in consultations with a naturopath/herbalist remains statistically significant when the CAM modalities are considered individually alongside asthma status. The longitudinal model suggests that women with asthma are 1.13 (95% CI: 1.05-1.21) times more likely to consult with a CAM practitioner (p< .001). The study also shows that CAM users have a higher dissatisfaction with conventional healthcare services and consultations when compared to CAM non-users. CONCLUSION These findings suggest that women with asthma may turn to CAM after conventional care fails to adequately address their healthcare needs.
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Affiliation(s)
- David Sibbritt
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.
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Regional variations in the use of complementary and alternative medicines (CAM) for inflammatory bowel disease patients in Italy: an IG-IBD study. J Crohns Colitis 2010; 4:291-300. [PMID: 21122518 DOI: 10.1016/j.crohns.2009.12.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 12/14/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Complementary and alternative medicines (CAM) are being used increasingly by patients with Crohn's disease (CD) and ulcerative colitis (UC). We aimed to assess the prevalence and usage of CAM in different geographical areas of Italy and possible predictors of their use. METHODS AND MATERIALS A structured questionnaire, administered to outpatients, attending 8 general hospitals and 9 tertiary referral centres, was completed by 2011 patients (909 CD, 1087 UC and 15 indeterminate colitis). 583 patients lived in the North, 659 in Central Italy and 769 in the South. RESULTS CAM users were 475 (23.6%) with no regional differences in their distribution. Usage correlated significantly with female gender (p=0.030), higher education (p=0.021), hospitalization rates (p=0.000), extra-intestinal complications (p=0.000), non-adherence to conventional treatments (p=0.054), adverse reactions to conventional treatments (p=0.000), and active disease (p=0.007); 5-ASA usage was associated with a more limited use of CAM (p=0.005). Dietary changes or supplements and prayer were significantly more frequently reported in South, while Northern Italian patients more frequently used homeopathy, herbal medicines and physical exercises. Patients in Central Italy adopted an intermediate behavior. CAM use ameliorated the patient's general well-being according to two thirds of the users. Costs were higher for Northern patients than in Central or Southern Italy. CONCLUSION One in four IBD patients in Italy use CAM. More money is spent on CAM in Northern Italy. Regional differences emerged as regards the type of CAM but not in terms of disease features, frequency of and reasons for CAM use, or perceived effects.
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Kopnina H, Haafkens J. Necessary alternatives: patients' views of asthma treatment. Patient Prefer Adherence 2010; 4:207-17. [PMID: 20622919 PMCID: PMC2898120 DOI: 10.2147/ppa.s10870] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2010] [Indexed: 11/23/2022] Open
Abstract
This article is based on semistructured interviews and focus groups conducted with 27 asthma patients in The Netherlands who chose complementary and alternative medicine (CAM) for treatment of their condition. All subjects were contacted through an online forum for asthma patients hosted by the Dutch Asthma Foundation. Nineteen subjects (12 women and seven men) between the ages of 29 and 65 years participated in the interviews, held between June 2009 and January 2010. All of the participating subjects had experience with conventional medications, including anti-inflammatory corticosteroids and bronchodilators. For the focus group meeting, held in February 2010, the sample included seven subjects (four women and three men) between the ages of 31 and 46 years, none of whom had ever used conventional medication and all of whom were using CAM. All subjects in the sample had been diagnosed with asthma by their physician or lung specialist. The study examined the causes of patient noncompliance with the prescribed medical regime. It is argued that evidence-based rationality on the part of subjects is an overlooked dimension of their experience of asthma. This study demonstrates the role that the patients' social network, including medical practitioners, friends, and family, and other asthmatics, plays in the process of decision-making and choices about treating asthma. It also demonstrates the role of patients' information-searching strategies. The author concludes that patient noncompliance with commonly prescribed medication and selection of alternative medical treatment is less a matter of denial of their diagnosis or the severity of their illness, but more a matter of choice informed by evidence-based rationality.
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Affiliation(s)
- Helen Kopnina
- Amsterdam Institute for Advanced Labor Studies, University of Amsterdam, The Netherlands.
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Adams SK, Koinis-Mitchell D. Perspectives on complementary and alternative therapies in asthma. Expert Rev Clin Immunol 2010; 4:703-11. [PMID: 20477120 DOI: 10.1586/1744666x.4.6.703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Asthma is a chronic disease that affects millions of individuals living in the USA. Proper asthma management is essential for controlling asthma symptoms and exacerbations. In recent years, however, there has been increased recognition of individuals using complementary and alternative medicine (CAM) to treat asthma. This article reviews the status of the current literature on various cultural factors that influence CAM use. In addition, current research of two widely used forms of CAM, herbal remedies and relaxation techniques, is presented. Future directions and recommendations to increase the methodological rigor of CAM research are discussed, particularly as they pertain to herbal remedies and relaxation strategies. The importance of well-designed research studies, including observational studies and randomized controlled trials, is highlighted.
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Affiliation(s)
- Sue K Adams
- University of Rhode Island, Department of Human Development and Family Studies, 2 Lower College Road, Transition Center 210, Kingston, RI 02881, USA.
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Argüder E, Bavbek S, Sen E, Köse K, Keskin O, Saryal S, Misirligil Z. Is there any difference in the use of complementary and alternative therapies in patients asthma and COPD? A cross-sectional survey. J Asthma 2009; 46:252-8. [PMID: 19373632 DOI: 10.1080/02770900802647524] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Data on the use and efficacy of complementary and alternative medicine (CAM) in patients with asthma are limited, and there is a lack of studies documenting the use of CAM in patients with chronic obstructive pulmonary disease (COPD) in Turkey. AIM To determine the prevalence of CAM usage in patients with asthma and COPD and to assess the clinical and demographic factors associated with the use of CAM. MATERIALS AND METHODS A total of 521 patients (313 with asthma and 208 with COPD) were randomly enrolled into this cross-sectional survey. A face-to-face interview was conducted using a structured questionnaire. RESULTS One hundred sixty-three patients (52%) with asthma and 70 patients (33%) with COPD were reported to be using some form of CAM (p < 0.001). The most popular modalities were herbal remedies (46% and 28% in the two groups, respectively) and animal products (28% and 5% in the two groups, respectively). CAM-practicing asthma patients were typically younger with longer duration of disease and higher income than the CAM-practicing COPD patients. For the patients, the main source of information on CAM practices was their relatives and friends. Only a small number of the patients consulted with their physicians about CAM. The main reasons to use CAM for patients with asthma and COPD were harmlessness and symptomatic relief, respectively. CAM-related adverse effects and difficulties to obtain CAM were significantly higher in patients with asthma than in patients with COPD. CONCLUSION There is a high prevalence of CAM usage in patients with asthma and COPD in Turkey. Hence, becoming familiar with CAM therapy and inquiring about patient practice of CAM as part of the routine medical history will allow the physicians to provide reliable information to their patients on these medical practices.
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Affiliation(s)
- Emine Argüder
- Department of Chest Diseases, Bayindir Hospital, Turkey
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Black seed oil ameliorates allergic airway inflammation by inhibiting T-cell proliferation in rats. Pulm Pharmacol Ther 2009; 22:37-43. [DOI: 10.1016/j.pupt.2008.11.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2008] [Revised: 10/26/2008] [Accepted: 11/15/2008] [Indexed: 11/23/2022]
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Sidora-Arcoleo K, Yoos HL, Kitzman H, McMullen A, Anson E. Don't ask, don't tell: parental nondisclosure of complementary and alternative medicine and over-the-counter medication use in children's asthma management. J Pediatr Health Care 2008; 22:221-9. [PMID: 18590866 PMCID: PMC2517627 DOI: 10.1016/j.pedhc.2007.07.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Revised: 07/09/2007] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Parent-health care provider (HCP) communication is an important component of pediatric asthma management. Given the high prevalence of complementary and alternative medicine (CAM) and over-the-counter (OTC) medication use among this population, it is important to examine parental nondisclosure of these asthma management strategies. METHOD One-time interview and 1-year retrospective medical record review with 228 parents of 5- to 12-year-old children with asthma enrolled from six pediatric primary care practices examining parental nondisclosure of CAM and OTC medication use, reasons for nondisclosure, medical record documentation of CAM usage, and association between parent-HCP relationship and nondisclosure. RESULTS Seventy-one percent of parents reported using CAM and/or OTC medication for children's asthma management, and 54% of those parents did not disclose usage. Seventy-five percent "did not think" to discuss it. Better parent-HCP relationship led to decreased nondisclosure. DISCUSSION HCPs can play an important role in creating an environment where parents feel comfortable sharing information about their children's asthma management strategies in order to arrive at a shared asthma management plan for the child, leading to improved asthma health outcomes.
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Affiliation(s)
- Kimberly Sidora-Arcoleo
- Arizona State University College of Nursing & Healthcare Innovation, Phoenix, Arizona 85004, USA.
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Sidora-Arcoleo K, Yoos HL, McMullen A, Kitzman H. Complementary and alternative medicine use in children with asthma: prevalence and sociodemographic profile of users. J Asthma 2007; 44:169-75. [PMID: 17454333 DOI: 10.1080/02770900701209640] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Research on complementary and alternative medicine use in children with asthma is in its infancy. This study examined the prevalence, types of CAM used and sociodemographic differences in CAM use among children 5-12 years with asthma. 65% of parents reported using CAM. Usage was highest among black, poor, lesser educated parents and children with persistent symptoms. Types of CAM differed by poverty and a trend for differences by race and education emerged. Health care providers who educate themselves on CAM therapies parents use for asthma can then discuss the implications of using these therapies and potentially improve adherence to the prescribed medication regimen.
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Affiliation(s)
- Kimberly Sidora-Arcoleo
- Arizona State University College of Nursing and Healthcare Innovation, Phoenix, AZ 85004, USA.
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Wang G, Liu CT, Wang ZL, Yan CL, Luo FM, Wang L, Li TQ. Effects of Astragalus membranaceus in promoting T-helper cell type 1 polarization and interferon-gamma production by up-regulating T-bet expression in patients with asthma. Chin J Integr Med 2007; 12:262-7. [PMID: 17361521 DOI: 10.1007/s11655-006-0262-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To explore the effect of Astragalus membranaceus (AM) on T-helper cell type 1 (Thl) specific transcription factor T-box expressed in T cells (T-bet) expression and Thl/Th2 equilibrium. METHODS The levels of T-bet mRNA in peripheral blood mononuclear cells (PBMCs) from 15 patients with asthma and 15 healthy subjects were determined by reverse transcription-polymerase chain reaction (RT-PCR). PBMCs in asthma patients were incubated with AM and then the concentration of interferon gamma (IFN-gamma) and interleukin-4 (IL-4) in the supernate before and after AM intervention were determined by ELISA. The numbers of CD4 + CCR3 + and CD4 + CCR5 + cells were counted by flow cytometry. RESULTS The expression of T-bet mRNA and the level of IFN-gamma were lower, but level of serum IL-4 was higher in asthma patients when compared with those in healthy subjects respectively. After AM (60 microg/ml) intervention, the former two parameters raised and showed a positive correlation between them, while the level of IL-4 was decreased. The mean percentage of CD4 + CCR3 + cells in asthma patients was significantly higher but that of CD4 + CCR5 + cells was lower when compared with those in healthy subjects respectively. After AM intervention, the abnormal change in the two indexes was improved to certain extent, showing a reversing status of Th2 polarization. CONCLUSION AM could increase the expression of T-bet mRNA and Thl cytokines such as IFN-Y, and might reverse the Th2 predominant status in asthma patients.
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Affiliation(s)
- Gang Wang
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu (610041)
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Kurup VP, Barrios CS, Raju R, Johnson BD, Levy MB, Fink JN. Immune response modulation by curcumin in a latex allergy model. Clin Mol Allergy 2007; 5:1. [PMID: 17254346 PMCID: PMC1796894 DOI: 10.1186/1476-7961-5-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Accepted: 01/25/2007] [Indexed: 11/23/2022] Open
Abstract
Background There has been a worldwide increase in allergy and asthma over the last few decades, particularly in industrially developed nations. This resulted in a renewed interest to understand the pathogenesis of allergy in recent years. The progress made in the pathogenesis of allergic disease has led to the exploration of novel alternative therapies, which include herbal medicines as well. Curcumin, present in turmeric, a frequently used spice in Asia has been shown to have anti-allergic and inflammatory potential. Methods We used a murine model of latex allergy to investigate the role of curcumin as an immunomodulator. BALB/c mice were exposed to latex allergens and developed latex allergy with a Th2 type of immune response. These animals were treated with curcumin and the immunological and inflammatory responses were evaluated. Results Animals exposed to latex showed enhanced serum IgE, latex specific IgG1, IL-4, IL-5, IL-13, eosinophils and inflammation in the lungs. Intragastric treatment of latex-sensitized mice with curcumin demonstrated a diminished Th2 response with a concurrent reduction in lung inflammation. Eosinophilia in curcumin-treated mice was markedly reduced, co-stimulatory molecule expression (CD80, CD86, and OX40L) on antigen-presenting cells was decreased, and expression of MMP-9, OAT, and TSLP genes was also attenuated. Conclusion These results suggest that curcumin has potential therapeutic value for controlling allergic responses resulting from exposure to allergens.
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Affiliation(s)
- Viswanath P Kurup
- Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
- Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
- Research Service, V A Medical Center, 5000 West National Avenue, Milwaukee, WI 53295, USA
| | - Christy S Barrios
- Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Raghavan Raju
- Neuromuscular Diseases Section, National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, MD 20892, USA
- University of Alabama School of Medicine, Department of Surgery and Department of Microbiology and Immunology, Volker Hall, Room G094, 1670 University Boulevard, AL 35294, USA
| | - Bryon D Johnson
- Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Michael B Levy
- Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Jordan N Fink
- Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
- Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
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Bensoussan M, Jovenin N, Garcia B, Vandromme L, Jolly D, Bouché O, Thiéfin G, Cadiot G. Complementary and alternative medicine use by patients with inflammatory bowel disease: results from a postal survey. ACTA ACUST UNITED AC 2006; 30:14-23. [PMID: 16514377 DOI: 10.1016/s0399-8320(06)73072-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIMS Thirty to 50% of north American patients with inflammatory bowel disease (IBD) have been reported to use complementary and alternative medicine (CAM). There is no data in France. The aim of this study was to evaluate the frequency of CAM use and the reasons in a French population of patients with IBD. PATIENTS AND METHODS An anonymous postal survey was done with a questionnaire mailed to all the patients with IBD, 16 to 79 year-old, followed-up in a public and a private medical centre of Reims, between January 2001 and December 2003. RESULTS The final sample included 447 patients; 325 (72.7%) filled up the questionnaire: 219 (67.4%) had Crohn's disease, 94 (28.8%) ulcerative colitis and 12 (3.7%) indeterminate colitis. Sixty-nine patients (21.2%) reported CAM use for IBD. The mean number of CAM used simultaneously was 2.9. The most frequently used CAM treatment was homeopathy (40.6%), followed by magnetism (34.8%) and acupuncture (33.3%). The majority of patients (74.8%) never talked about CAM use with their IBD physician. Multivariate analysis showed that the factors significantly associated with CAM use were female gender (odds ratio (OR)=3.5, CI95%: 1.8-6.9), the low level of confidence in their doctor (OR=4.8, CI95%: 1.1-19.8) and the research of informations about their disease (OR=4.6, CI 95%: 2.0-10.7). CONCLUSION Twenty-one percent of patients with IBD are using CAM, most of the time without talking about it with their physician. The quality of the relationship between the patient and his physician and female sex, more than the perceived severity of the disease, were the main determinants of that use.
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Mullins RJ, Heddle RJ, Smith P. Non‐conventional approaches to allergy testing: reconciling patient autonomy with medical practitioners’ concerns. Med J Aust 2005; 183:173-4. [PMID: 16097911 DOI: 10.5694/j.1326-5377.2005.tb06986.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2005] [Accepted: 07/12/2005] [Indexed: 11/17/2022]
Abstract
It may be difficult for patients to distinguish current concepts of immune function from other, non-conventional explanations of illness.
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Current World Literature. Curr Opin Allergy Clin Immunol 2005. [DOI: 10.1097/01.all.0000162314.10050.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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