romikgosai/squad_modified huggingface dataset:
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.

Questions and answers:
['
Q: What are some of the enviromental factors that have been linked to asthma?
A: allergens, air pollution, and other environmental chemicals', '
Q: What two things are associated with a greater risk of asthma-like symptoms?
A: Smoking during pregnancy and after delivery', '
Q: What can cause symptoms and asthma serverity to change?
A: Low air quality from factors such as traffic pollution or high ozone levels', '
Q: Exposure to what compounds can also trigger asthma?
A: indoor volatile organic compounds']
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.

Questions and answers:
['
Q: What hypothesis tries to explain the increased amount of asthma world wide?
A: The hygiene hypothesis', '
Q: How does the hygiene hypothesis explain the increase in asthma?
A: a direct and unintended result of reduced exposure, during childhood, to non-pathogenic bacteria and viruses', '
Q: What has caused the reduced exposure in childhood?
A: increased cleanliness and decreased family size in modern societies', '
Q: What could prevent asthma?
A: Exposure to bacterial endotoxin in early childhood', '
Q: What is some of the evidence backing the hygiene hypothesis?
A: lower rates of asthma on farms and in households with pets.']
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.

Questions and answers:
['
Q: What else is a risk factor for asthma?
A: Family history', '
Q: If one identical twin has asthma, what are the odds of the other twin having asthma?
A: approximately 25%', '
Q: How many genes were associated with asthma by the end of 2005?
A: 25 genes', '
Q: How many genes were associated with asthma in 2006?
A: over 100 genes', '
Q: What else are these genes closely related to?
A: the immune system or modulating inflammation']
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.

Questions and answers:
['
Q: What is asthma the result of?
A: chronic inflammation of the conducting zone of the airways', '
Q: What two airways are most effected by asthma?
A: the bronchi and bronchioles', '
Q: In what ways do airways change?
A: an increase in eosinophils and thickening of the lamina reticularis', '
Q: What other cell types are involced with the changing of airways?
A: T lymphocytes, macrophages, and neutrophils', '
Q: What other components of the immune systems are included?
A: cytokines, chemokines, histamine, and leukotrienes among others']
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".

Questions and answers:
['
Q: Is there a universal definition of astham?
A: there is not one universal agreed upon definition', '
Q: What main components play a role in asthma?
A: many cells and cellular elements play a role', '
Q: What is the inflamation a result of?
A: airway hyper-responsiveness', '
Q: What does hyper-responsiveness of the airways cause?
A: episodes of wheezing, breathlessness, chest tightness and coughing', '
Q: What are two ways to reverse an asthma attack?
A: spontaneously or with treatment']
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.

Questions and answers:
['
Q: Is there a test to determine asthma in an individual?
A: There is currently no precise test', '
Q: What is diagnosis based on typically?
A: pattern of symptoms and response to therapy over time', '
Q: When should you suspect asthma?
A: if there is a history of: recurrent wheezing, coughing or difficulty breathing', '
Q: What is used to confirm the diagnosis of asthma?
A: Spirometry', '
Q: What age is too young to use spirometry to determine asthma?
A: children under the age of six']
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.

Questions and answers:
['
Q: What is recommended to help in the diagnosis of asthma?
A: Spirometry', '
Q: Why is spirometry so commonly used to diagnose asthma?
A: It is the single best test for asthma', '
Q: What helps support the evidence of asthma?
A: If the FEV1 measured by this technique improves more than 12% following administration of a bronchodilator', '
Q: What substance can skew the results of an asthma test?
A: caffeine', '
Q: What test can tell the difference between asthma and COPD?
A: Single-breath diffusing capacity']
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.

Questions and answers:
['
Q: What is the rate that is used in most of the evidence?
A: ≥20%', '
Q: What is more variable than spirometry but not recommended?
A: . Testing peak expiratory flow']
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.

Questions and answers:
['
Q: How is asthma clinically classified?
A: according to the frequency of symptoms, forced expiratory volume in one second (FEV1), and peak expiratory flow rate', '
Q: How else is asthma classified?
A: as atopic (extrinsic) or non-atopic (intrinsic)', '
Q: When asthma is caused by allergens that is called what? 
A: atopic', '
Q: What  is asthma usually classified based on?
A: severity', '
Q: What is a important goal of asthma research?
A: Finding ways to identify subgroups that respond well to different types of treatments']
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.

Questions and answers:
['
Q: What kind of condition is asthma?
A: a chronic obstructive condition', '
Q: What are examples of chronic obstructive pulmonary disease?
A: bronchiectasis, chronic bronchitis, and emphysema', '
Q: Is the airway obstuction reversable in asthma?
A: asthma is usually reversible', '
Q: What part of the airway does emphysema affect?
A: alveoli', '
Q: What part of the airway does asthma affect?
A: the bronchi']
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.

Questions and answers:
['
Q: Exercise-induced bronchoconstriction is common in what profession?
A: professional athletes', '
Q: What professions has the highest rate of Exercise-induced bronchoconstriction?
A: cyclists (up to 45%), swimmers, and cross-country skiers', '
Q: What conditions are more likely to cause Exercise-induced bronchoconstriction?
A: when it is dry and cold', '
Q: What does not appear to help athletic performance that do not have asthma?
A: Inhaled beta2-agonists']
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.

Questions and answers:
['
Q: Asthma that is the result of or made worse by workplace exposure is reported as what?
A: occupational disease', '
Q: What percent of asthma cases in adults are work-related?
A: It is estimated that 5–25%', '
Q: What are some of the most common agents?
A: isocyanates, grain and wood dust, colophony, soldering flux, latex, animals, and aldehydes', '
Q: What professions normally have the highest risk of problems?
A: those who spray paint, bakers and those who process food, nurses, chemical workers, those who work with animals, welders, hairdressers and timber workers']
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.

Questions and answers:
['
Q: What is a condition that can cause symptoms of astham in children?
A: allergic rhinitis and sinusitis', '
Q: What are some other causes of airway obstruction?
A: foreign body aspiration, tracheal stenosis or laryngotracheomalacia, vascular rings, enlarged lymph nodes or neck masses', '
Q: What other conditions can cause wheezing?
A: Bronchiolitis and other viral infections', '
Q: In adults, what conditions can cause the symptoms of asthma?
A: COPD, congestive heart failure, airway masses, as well as drug-induced coughing due to ACE inhibitors']
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.

Questions and answers:
['
Q: What is a complication of chronic asthma?
A: Chronic obstructive pulmonary disease', '
Q: If you are 65 years old and have an obstructive airway disesase, you are more likely to have what other conditions?
A: asthma and COPD', '
Q: How is COPD differentiated?
A: by increased airway neutrophils, abnormally increased wall thickness, and increased smooth muscle in the bronchi', '
Q: Why is this not determined in a patient with COPD?
A: due to COPD and asthma sharing similar principles of management', '
Q: What are the principles of management for asthma and COPD?
A: corticosteroids, long acting beta agonists, and smoking cessation']
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.

Questions and answers:
['
Q: What is weak that is not helping prevent the development of asthma?
A: The evidence for the effectiveness of measures to prevent', '
Q: What preventative measures always work to prevent asthma?
A: none are well supported enough to be recommended for this indication', '
Q: What has been determined about dietry restrictions during pregnancy and when breast feeding?
A: have not been found to be effective and thus are not recommended', '
Q: Why are smoking bans in place?
A: effective in decreasing exacerbations of asthma', '
Q: Who recoomends immunizations?
A: World Health Organization']
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.

Questions and answers:
['
Q: What is a key component of control and preventing asthma attacks?
A: Avoidance of triggers', '
Q: What are some of the more common triggers?
A: allergens, smoke (tobacco and other), air pollution, non selective beta-blockers, and sulfite-containing foods', '
Q: What can reduce the effectiveness of medications?
A: Cigarette smoking and second-hand smoke', '
Q: What did law that limit smoking accomplish? 
A: decrease the number of people hospitalized for asthma', '
Q: What type of exercise can provide small improvements?
A: Yoga']
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.

Questions and answers:
['
Q: What type of person would use bronchial thermoplasty as an option?
A: For those with severe persistent asthma not controlled by inhaled corticosteroids and LABAs', '
Q: What does bronchial thermoplasty consist of?
A: It involves the delivery of controlled thermal energy to the airway wall during a series of bronchoscopies', '
Q: What effect does bronchial thermoplasty have?
A: it appears to decrease the subsequent rate.', '
Q: What treatment helps improve those with allergic rhinitis and asthma?
A: sublingual immunotherapy']
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.

Questions and answers:
['
Q: What is the prognosis for asthma? 
A: generally good', '
Q: What has caused the mortality rate to decrease?
A: due to better recognition and improvement in care', '
Q: Worldwide, how many people suffer from asthma?
A: 19.4 million people as of 2004', '
Q: How many cases that are diagnosed in childhood make it past 10 years with asthma?
A: half of cases will no longer carry the diagnosis after a decade']
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.

Questions and answers:
['
Q: By 2011, how many people were affected by asthma?
A: 235–330 million people worldwide are affected by asthma', '
Q: How many people die per year from asthma?
A: 250,000–345,000 people', '
Q: What countries is asthma more commonly seen?
A: It is more common in developed than developing countries', '
Q: Why are different countries effected differently?
A: The reason for these differences is not well known']
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.

Questions and answers:
['
Q: How much was the average cost of hospital stays for asthma-related issues for children??
A: about $3,600', '
Q: How much was the average cost of hospital stays for asthma-related issues for adults?
A: from $5,200 to $6,600', '
Q: Who was the most frequent primary payer amount children and adults?
A: Medicaid', '
Q: Who was more likely to seek hospital help in the US for asthma reasons?
A: the lowest income communities']