Asthma

context: Asthma is thought to be caused by a combination of genetic and environmental factors. Environmental factors include exposure to air pollution and allergens. Other potential triggers include medications such as aspirin and beta blockers. Diagnosis is usually based on the pattern of symptoms, response to therapy over time, and spirometry. Asthma is classified according to the frequency of symptoms, forced expiratory volume in one second (FEV1), and peak expiratory flow rate. It may also be classified as atopic or non-atopic where atopy refers to a predisposition toward developing a type 1 hypersensitivity reaction.
qas: answers: text: genetic and environmental factors
question: What two factors cause asthma?

answers: text: exposure to air pollution and allergens
question: What are two enviromental factors?

answers: text: aspirin and beta blockers
question: What medications can also trigger asthma?

answers: text: the pattern of symptoms, response to therapy over time, and spirometry
question: What patterns are used to diagnose asthma?

answers: text: according to the frequency of symptoms, forced expiratory volume in one second (FEV1), and peak expiratory flow rate
question: How is asthma classified?

context: There is no cure for asthma. Symptoms can be prevented by avoiding triggers, such as allergens and irritants, and by the use of inhaled corticosteroids. Long-acting beta agonists (LABA) or antileukotriene agents may be used in addition to inhaled corticosteroids if asthma symptoms remain uncontrolled. Treatment of rapidly worsening symptoms is usually with an inhaled short-acting beta-2 agonist such as salbutamol and corticosteroids taken by mouth. In very severe cases, intravenous corticosteroids, magnesium sulfate, and hospitalization may be required.
qas: answers: text: There is no cure for asthma
question: Is there a cure for asthma?

answers: text: by avoiding triggers, such as allergens and irritants, and by the use of inhaled corticosteroids
question: How can symptoms be prevented?

answers: text: an inhaled short-acting beta-2 agonist such as salbutamol and corticosteroids
question: What is taken by mouth to treat rapidly worsening symptoms?

answers: text: intravenous corticosteroids, magnesium sulfate, and hospitalization may be required
question: What happens in very severe cases of asthma?

context: Asthma is characterized by recurrent episodes of wheezing, shortness of breath, chest tightness, and coughing. Sputum may be produced from the lung by coughing but is often hard to bring up. During recovery from an attack, it may appear pus-like due to high levels of white blood cells called eosinophils. Symptoms are usually worse at night and in the early morning or in response to exercise or cold air. Some people with asthma rarely experience symptoms, usually in response to triggers, whereas others may have marked and persistent symptoms.
qas: answers: text: recurrent episodes of wheezing, shortness of breath, chest tightness, and coughing
question: What are the characteristics of asthma?

answers: text: at night and in the early morning or in response to exercise or cold air
question: When are symptoms of asthma normally worse?

answers: text: Sputum
question: What is produced in the lungs by coughing?

answers: text: worse at night
question: Is asthma worst during the day or at night time?

answers: text: Some people with asthma rarely experience symptoms, u
question: Does everyone have horrible episodes of asthma?

context: A number of other health conditions occur more frequently in those with asthma, including gastro-esophageal reflux disease (GERD), rhinosinusitis, and obstructive sleep apnea. Psychological disorders are also more common, with anxiety disorders occurring in between 16–52% and mood disorders in 14–41%. However, it is not known if asthma causes psychological problems or if psychological problems lead to asthma. Those with asthma, especially if it is poorly controlled, are at high risk for radiocontrast reactions.
qas: answers: text: more frequently
question: Do other health concerns happen less frequently or more frequently with asthma?

answers: text: gastro-esophageal reflux disease (GERD), rhinosinusitis, and obstructive sleep apnea
question: What are three of the other health conditions that occur more frequently with asthma?

answers: text: Psychological disorders
question: What other type of disorders are frequent in asthma sufferers?

answers: text: radiocontrast reactions
question: What are those with asthma that is poorly controll more susceptable to? 

context: Many environmental factors have been associated with asthma's development and exacerbation including allergens, air pollution, and other environmental chemicals. Smoking during pregnancy and after delivery is associated with a greater risk of asthma-like symptoms. Low air quality from factors such as traffic pollution or high ozone levels, has been associated with both asthma development and increased asthma severity. Exposure to indoor volatile organic compounds may be a trigger for asthma; formaldehyde exposure, for example, has a positive association. Also, phthalates in certain types of PVC are associated with asthma in children and adults.
qas: answers: text: allergens, air pollution, and other environmental chemicals
question: What are some of the enviromental factors that have been linked to asthma?

answers: text: Smoking during pregnancy and after delivery
question: What two things are associated with a greater risk of asthma-like symptoms?

answers: text: Low air quality from factors such as traffic pollution or high ozone levels
question: What can cause symptoms and asthma serverity to change?

answers: text: indoor volatile organic compounds
question: Exposure to what compounds can also trigger asthma?

context: The hygiene hypothesis attempts to explain the increased rates of asthma worldwide as a direct and unintended result of reduced exposure, during childhood, to non-pathogenic bacteria and viruses. It has been proposed that the reduced exposure to bacteria and viruses is due, in part, to increased cleanliness and decreased family size in modern societies. Exposure to bacterial endotoxin in early childhood may prevent the development of asthma, but exposure at an older age may provoke bronchoconstriction. Evidence supporting the hygiene hypothesis includes lower rates of asthma on farms and in households with pets.
qas: answers: text: The hygiene hypothesis
question: What hypothesis tries to explain the increased amount of asthma world wide?

answers: text: a direct and unintended result of reduced exposure, during childhood, to non-pathogenic bacteria and viruses
question: How does the hygiene hypothesis explain the increase in asthma?

answers: text: increased cleanliness and decreased family size in modern societies
question: What has caused the reduced exposure in childhood?

answers: text: Exposure to bacterial endotoxin in early childhood
question: What could prevent asthma?

answers: text: lower rates of asthma on farms and in households with pets.
question: What is some of the evidence backing the hygiene hypothesis?

context: Family history is a risk factor for asthma, with many different genes being implicated. If one identical twin is affected, the probability of the other having the disease is approximately 25%. By the end of 2005, 25 genes had been associated with asthma in six or more separate populations, including GSTM1, IL10, CTLA-4, SPINK5, LTC4S, IL4R and ADAM33, among others. Many of these genes are related to the immune system or modulating inflammation. Even among this list of genes supported by highly replicated studies, results have not been consistent among all populations tested. In 2006 over 100 genes were associated with asthma in one genetic association study alone; more continue to be found.
qas: answers: text: Family history
question: What else is a risk factor for asthma?

answers: text: approximately 25%
question: If one identical twin has asthma, what are the odds of the other twin having asthma?

answers: text: 25 genes
question: How many genes were associated with asthma by the end of 2005?

answers: text: over 100 genes
question: How many genes were associated with asthma in 2006?

answers: text: the immune system or modulating inflammation
question: What else are these genes closely related to?

context: Asthma is the result of chronic inflammation of the conducting zone of the airways (most especially the bronchi and bronchioles), which subsequently results in increased contractability of the surrounding smooth muscles. This among other factors leads to bouts of narrowing of the airway and the classic symptoms of wheezing. The narrowing is typically reversible with or without treatment. Occasionally the airways themselves change. Typical changes in the airways include an increase in eosinophils and thickening of the lamina reticularis. Chronically the airways' smooth muscle may increase in size along with an increase in the numbers of mucous glands. Other cell types involved include: T lymphocytes, macrophages, and neutrophils. There may also be involvement of other components of the immune system including: cytokines, chemokines, histamine, and leukotrienes among others.
qas: answers: text: chronic inflammation of the conducting zone of the airways
question: What is asthma the result of?

answers: text: the bronchi and bronchioles
question: What two airways are most effected by asthma?

answers: text: an increase in eosinophils and thickening of the lamina reticularis
question: In what ways do airways change?

answers: text: T lymphocytes, macrophages, and neutrophils
question: What other cell types are involced with the changing of airways?

answers: text: cytokines, chemokines, histamine, and leukotrienes among others
question: What other components of the immune systems are included?

context: While asthma is a well recognized condition, there is not one universal agreed upon definition. It is defined by the Global Initiative for Asthma as "a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. The chronic inflammation is associated with airway hyper-responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness and coughing particularly at night or in the early morning. These episodes are usually associated with widespread but variable airflow obstruction within the lung that is often reversible either spontaneously or with treatment".
qas: answers: text: there is not one universal agreed upon definition
question: Is there a universal definition of astham?

answers: text: many cells and cellular elements play a role
question: What main components play a role in asthma?

answers: text: airway hyper-responsiveness
question: What is the inflamation a result of?

answers: text: episodes of wheezing, breathlessness, chest tightness and coughing
question: What does hyper-responsiveness of the airways cause?

answers: text: spontaneously or with treatment
question: What are two ways to reverse an asthma attack?

context: There is currently no precise test with the diagnosis typically based on the pattern of symptoms and response to therapy over time. A diagnosis of asthma should be suspected if there is a history of: recurrent wheezing, coughing or difficulty breathing and these symptoms occur or worsen due to exercise, viral infections, allergens or air pollution. Spirometry is then used to confirm the diagnosis. In children under the age of six the diagnosis is more difficult as they are too young for spirometry.
qas: answers: text: There is currently no precise test
question: Is there a test to determine asthma in an individual?

answers: text: pattern of symptoms and response to therapy over time
question: What is diagnosis based on typically?

answers: text: if there is a history of: recurrent wheezing, coughing or difficulty breathing
question: When should you suspect asthma?

answers: text: Spirometry
question: What is used to confirm the diagnosis of asthma?

answers: text: children under the age of six
question: What age is too young to use spirometry to determine asthma?

context: Spirometry is recommended to aid in diagnosis and management. It is the single best test for asthma. If the FEV1 measured by this technique improves more than 12% following administration of a bronchodilator such as salbutamol, this is supportive of the diagnosis. It however may be normal in those with a history of mild asthma, not currently acting up. As caffeine is a bronchodilator in people with asthma, the use of caffeine before a lung function test may interfere with the results. Single-breath diffusing capacity can help differentiate asthma from COPD. It is reasonable to perform spirometry every one or two years to follow how well a person's asthma is controlled.
qas: answers: text: Spirometry
question: What is recommended to help in the diagnosis of asthma?

answers: text: It is the single best test for asthma
question: Why is spirometry so commonly used to diagnose asthma?

answers: text: If the FEV1 measured by this technique improves more than 12% following administration of a bronchodilator
question: What helps support the evidence of asthma?

answers: text: caffeine
question: What substance can skew the results of an asthma test?

answers: text: Single-breath diffusing capacity
question: What test can tell the difference between asthma and COPD?

context: Other supportive evidence includes: a ≥20% difference in peak expiratory flow rate on at least three days in a week for at least two weeks, a ≥20% improvement of peak flow following treatment with either salbutamol, inhaled corticosteroids or prednisone, or a ≥20% decrease in peak flow following exposure to a trigger. Testing peak expiratory flow is more variable than spirometry, however, and thus not recommended for routine diagnosis. It may be useful for daily self-monitoring in those with moderate to severe disease and for checking the effectiveness of new medications. It may also be helpful in guiding treatment in those with acute exacerbations.
qas: answers: text: ≥20%
question: What is the rate that is used in most of the evidence?

answers: text: . Testing peak expiratory flow
question: What is more variable than spirometry but not recommended?

context: Asthma is clinically classified according to the frequency of symptoms, forced expiratory volume in one second (FEV1), and peak expiratory flow rate. Asthma may also be classified as atopic (extrinsic) or non-atopic (intrinsic), based on whether symptoms are precipitated by allergens (atopic) or not (non-atopic). While asthma is classified based on severity, at the moment there is no clear method for classifying different subgroups of asthma beyond this system. Finding ways to identify subgroups that respond well to different types of treatments is a current critical goal of asthma research.
qas: answers: text: according to the frequency of symptoms, forced expiratory volume in one second (FEV1), and peak expiratory flow rate
question: How is asthma clinically classified?

answers: text: as atopic (extrinsic) or non-atopic (intrinsic)
question: How else is asthma classified?

answers: text: atopic
question: When asthma is caused by allergens that is called what? 

answers: text: severity
question: What  is asthma usually classified based on?

answers: text: Finding ways to identify subgroups that respond well to different types of treatments
question: What is a important goal of asthma research?

context: Although asthma is a chronic obstructive condition, it is not considered as a part of chronic obstructive pulmonary disease as this term refers specifically to combinations of disease that are irreversible such as bronchiectasis, chronic bronchitis, and emphysema. Unlike these diseases, the airway obstruction in asthma is usually reversible; however, if left untreated, the chronic inflammation from asthma can lead the lungs to become irreversibly obstructed due to airway remodeling. In contrast to emphysema, asthma affects the bronchi, not the alveoli.
qas: answers: text: a chronic obstructive condition
question: What kind of condition is asthma?

answers: text: bronchiectasis, chronic bronchitis, and emphysema
question: What are examples of chronic obstructive pulmonary disease?

answers: text: asthma is usually reversible
question: Is the airway obstuction reversable in asthma?

answers: text: alveoli
question: What part of the airway does emphysema affect?

answers: text: the bronchi
question: What part of the airway does asthma affect?

context: Exercise can trigger bronchoconstriction both in people with or without asthma. It occurs in most people with asthma and up to 20% of people without asthma. Exercise-induced bronchoconstriction is common in professional athletes. The highest rates are among cyclists (up to 45%), swimmers, and cross-country skiers. While it may occur with any weather conditions it is more common when it is dry and cold. Inhaled beta2-agonists do not appear to improve athletic performance among those without asthma however oral doses may improve endurance and strength.
qas: answers: text: professional athletes
question: Exercise-induced bronchoconstriction is common in what profession?

answers: text: cyclists (up to 45%), swimmers, and cross-country skiers
question: What professions has the highest rate of Exercise-induced bronchoconstriction?

answers: text: when it is dry and cold
question: What conditions are more likely to cause Exercise-induced bronchoconstriction?

answers: text: Inhaled beta2-agonists
question: What does not appear to help athletic performance that do not have asthma?

context: Asthma as a result of (or worsened by) workplace exposures, is a commonly reported occupational disease. Many cases however are not reported or recognized as such. It is estimated that 5–25% of asthma cases in adults are work–related. A few hundred different agents have been implicated with the most common being: isocyanates, grain and wood dust, colophony, soldering flux, latex, animals, and aldehydes. The employment associated with the highest risk of problems include: those who spray paint, bakers and those who process food, nurses, chemical workers, those who work with animals, welders, hairdressers and timber workers.
qas: answers: text: occupational disease
question: Asthma that is the result of or made worse by workplace exposure is reported as what?

answers: text: It is estimated that 5–25%
question: What percent of asthma cases in adults are work-related?

answers: text: isocyanates, grain and wood dust, colophony, soldering flux, latex, animals, and aldehydes
question: What are some of the most common agents?

answers: text: those who spray paint, bakers and those who process food, nurses, chemical workers, those who work with animals, welders, hairdressers and timber workers
question: What professions normally have the highest risk of problems?

context: Many other conditions can cause symptoms similar to those of asthma. In children, other upper airway diseases such as allergic rhinitis and sinusitis should be considered as well as other causes of airway obstruction including: foreign body aspiration, tracheal stenosis or laryngotracheomalacia, vascular rings, enlarged lymph nodes or neck masses. Bronchiolitis and other viral infections may also produce wheezing. In adults, COPD, congestive heart failure, airway masses, as well as drug-induced coughing due to ACE inhibitors should be considered. In both populations vocal cord dysfunction may present similarly.
qas: answers: text: allergic rhinitis and sinusitis
question: What is a condition that can cause symptoms of astham in children?

answers: text: foreign body aspiration, tracheal stenosis or laryngotracheomalacia, vascular rings, enlarged lymph nodes or neck masses
question: What are some other causes of airway obstruction?

answers: text: Bronchiolitis and other viral infections
question: What other conditions can cause wheezing?

answers: text: COPD, congestive heart failure, airway masses, as well as drug-induced coughing due to ACE inhibitors
question: In adults, what conditions can cause the symptoms of asthma?

context: Chronic obstructive pulmonary disease can coexist with asthma and can occur as a complication of chronic asthma. After the age of 65 most people with obstructive airway disease will have asthma and COPD. In this setting, COPD can be differentiated by increased airway neutrophils, abnormally increased wall thickness, and increased smooth muscle in the bronchi. However, this level of investigation is not performed due to COPD and asthma sharing similar principles of management: corticosteroids, long acting beta agonists, and smoking cessation. It closely resembles asthma in symptoms, is correlated with more exposure to cigarette smoke, an older age, less symptom reversibility after bronchodilator administration, and decreased likelihood of family history of atopy.
qas: answers: text: Chronic obstructive pulmonary disease
question: What is a complication of chronic asthma?

answers: text: asthma and COPD
question: If you are 65 years old and have an obstructive airway disesase, you are more likely to have what other conditions?

answers: text: by increased airway neutrophils, abnormally increased wall thickness, and increased smooth muscle in the bronchi
question: How is COPD differentiated?

answers: text: due to COPD and asthma sharing similar principles of management
question: Why is this not determined in a patient with COPD?

answers: text: corticosteroids, long acting beta agonists, and smoking cessation
question: What are the principles of management for asthma and COPD?

context: The evidence for the effectiveness of measures to prevent the development of asthma is weak. Some show promise including: limiting smoke exposure both in utero and after delivery, breastfeeding, and increased exposure to daycare or large families but none are well supported enough to be recommended for this indication. Early pet exposure may be useful. Results from exposure to pets at other times are inconclusive and it is only recommended that pets be removed from the home if a person has allergic symptoms to said pet. Dietary restrictions during pregnancy or when breast feeding have not been found to be effective and thus are not recommended. Reducing or eliminating compounds known to sensitive people from the work place may be effective. It is not clear if annual influenza vaccinations effects the risk of exacerbations. Immunization; however, is recommended by the World Health Organization. Smoking bans are effective in decreasing exacerbations of asthma.
qas: answers: text: The evidence for the effectiveness of measures to prevent
question: What is weak that is not helping prevent the development of asthma?

answers: text: none are well supported enough to be recommended for this indication
question: What preventative measures always work to prevent asthma?

answers: text: have not been found to be effective and thus are not recommended
question: What has been determined about dietry restrictions during pregnancy and when breast feeding?

answers: text: effective in decreasing exacerbations of asthma
question: Why are smoking bans in place?

answers: text: World Health Organization
question: Who recoomends immunizations?

context: Avoidance of triggers is a key component of improving control and preventing attacks. The most common triggers include allergens, smoke (tobacco and other), air pollution, non selective beta-blockers, and sulfite-containing foods. Cigarette smoking and second-hand smoke (passive smoke) may reduce the effectiveness of medications such as corticosteroids. Laws that limit smoking decrease the number of people hospitalized for asthma. Dust mite control measures, including air filtration, chemicals to kill mites, vacuuming, mattress covers and others methods had no effect on asthma symptoms. Overall, exercise is beneficial in people with stable asthma. Yoga could provide small improvements in quality of life and symptoms in people with asthma.
qas: answers: text: Avoidance of triggers
question: What is a key component of control and preventing asthma attacks?

answers: text: allergens, smoke (tobacco and other), air pollution, non selective beta-blockers, and sulfite-containing foods
question: What are some of the more common triggers?

answers: text: Cigarette smoking and second-hand smoke
question: What can reduce the effectiveness of medications?

answers: text: decrease the number of people hospitalized for asthma
question: What did law that limit smoking accomplish? 

answers: text: Yoga
question: What type of exercise can provide small improvements?

context: For those with severe persistent asthma not controlled by inhaled corticosteroids and LABAs, bronchial thermoplasty may be an option. It involves the delivery of controlled thermal energy to the airway wall during a series of bronchoscopies. While it may increase exacerbation frequency in the first few months it appears to decrease the subsequent rate. Effects beyond one year are unknown. Evidence suggests that sublingual immunotherapy in those with both allergic rhinitis and asthma improve outcomes.
qas: answers: text: For those with severe persistent asthma not controlled by inhaled corticosteroids and LABAs
question: What type of person would use bronchial thermoplasty as an option?

answers: text: It involves the delivery of controlled thermal energy to the airway wall during a series of bronchoscopies
question: What does bronchial thermoplasty consist of?

answers: text: it appears to decrease the subsequent rate.
question: What effect does bronchial thermoplasty have?

answers: text: sublingual immunotherapy
question: What treatment helps improve those with allergic rhinitis and asthma?

context: The prognosis for asthma is generally good, especially for children with mild disease. Mortality has decreased over the last few decades due to better recognition and improvement in care. Globally it causes moderate or severe disability in 19.4 million people as of 2004 (16 million of which are in low and middle income countries). Of asthma diagnosed during childhood, half of cases will no longer carry the diagnosis after a decade. Airway remodeling is observed, but it is unknown whether these represent harmful or beneficial changes. Early treatment with corticosteroids seems to prevent or ameliorates a decline in lung function.
qas: answers: text: generally good
question: What is the prognosis for asthma? 

answers: text: due to better recognition and improvement in care
question: What has caused the mortality rate to decrease?

answers: text: 19.4 million people as of 2004
question: Worldwide, how many people suffer from asthma?

answers: text: half of cases will no longer carry the diagnosis after a decade
question: How many cases that are diagnosed in childhood make it past 10 years with asthma?

context: As of 2011, 235–330 million people worldwide are affected by asthma, and approximately 250,000–345,000 people die per year from the disease. Rates vary between countries with prevalences between 1 and 18%. It is more common in developed than developing countries. One thus sees lower rates in Asia, Eastern Europe and Africa. Within developed countries it is more common in those who are economically disadvantaged while in contrast in developing countries it is more common in the affluent. The reason for these differences is not well known. Low and middle income countries make up more than 80% of the mortality.
qas: answers: text: 235–330 million people worldwide are affected by asthma
question: By 2011, how many people were affected by asthma?

answers: text: 250,000–345,000 people
question: How many people die per year from asthma?

answers: text: It is more common in developed than developing countries
question: What countries is asthma more commonly seen?

answers: text: The reason for these differences is not well known
question: Why are different countries effected differently?

context: From 2000 to 2010, the average cost per asthma-related hospital stay in the United States for children remained relatively stable at about $3,600, whereas the average cost per asthma-related hospital stay for adults increased from $5,200 to $6,600. In 2010, Medicaid was the most frequent primary payer among children and adults aged 18–44 years in the United States; private insurance was the second most frequent payer. Among both children and adults in the lowest income communities in the United States there is a higher rates of hospital stays for asthma in 2010 than those in the highest income communities.
qas: answers: text: about $3,600
question: How much was the average cost of hospital stays for asthma-related issues for children??

answers: text: from $5,200 to $6,600
question: How much was the average cost of hospital stays for asthma-related issues for adults?

answers: text: Medicaid
question: Who was the most frequent primary payer amount children and adults?

answers: text: the lowest income communities
question: Who was more likely to seek hospital help in the US for asthma reasons?

context: In 1873, one of the first papers in modern medicine on the subject tried to explain the pathophysiology of the disease while one in 1872, concluded that asthma can be cured by rubbing the chest with chloroform liniment. Medical treatment in 1880, included the use of intravenous doses of a drug called pilocarpin. In 1886, F.H. Bosworth theorized a connection between asthma and hay fever. Epinephrine was first referred to in the treatment of asthma in 1905. Oral corticosteroids began to be used for this condition in the 1950s while inhaled corticosteroids and selective short acting beta agonist came into wide use in the 1960s.
qas: answers: text: In 1873
question: When was the first paper written about asthma?

answers: text: by rubbing the chest with chloroform liniment
question: What was first used as a cure for asthma?

answers: text: pilocarpin
question: In 1880 what was used intraveniously for asthma?

answers: text: in the 1960s
question: When did inhaled corticosteroids and short acting beta agonist start being used?