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26 - Developmental origins of asthma and related allergic disorders

Published online by Cambridge University Press:  08 August 2009

By
J. O. Warner
Edited by
Peter Gluckman  and
Mark Hanson
J. O. Warner
Affiliation:
University of Southampton
Peter Gluckman
Affiliation:
University of Auckland
Mark Hanson
Affiliation:
University of Southampton
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Summary

Introduction

Asthma is a chronic disorder affecting the conducting airways, in which genetic and environmental factors interact to produce both inflammation and structural changes in the airway wall (Tattersfield et al. 2002). The consequence of these pathological changes is variable airflow limitation which is manifested by recurrent cough and wheeze. Recent asthma guidelines have emphasised the importance of treating the underlying inflammatory response as well as relieving the symptoms of asthma, but beyond the use of inhaled corticosteroids (ICS) and beta-2 adrenoceptor agonists, which were introduced 30–40 years ago, there has been very little new to add to the therapeutic algorithm (British Thoracic Society 2003). While utilisation of these two pharmacotherapies is highly effective in controlling symptoms and improving quality of life, there is no evidence that these therapies either alter the natural history of the disease or ever effect a cure (Martinez 2003). With the possible exception of immunotherapy no treatment has been shown to modify the natural course of the disease and no cure has been identified (Durham et al. 1999).

Most asthma has its origins in early life, and the best predictors of continuation into adulthood are an early age of onset, sensitisation to house dust mites (in environments where this is the major allergen), reduced lung function, and increased bronchial hyper-responsiveness (BHR) in early life (Sears et al. 2003). Even employment of ICS at a very early stage in the disease evolution does not influence outcomes (Covar et al. 2004).

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Developmental Origins of Health and Disease , pp. 349 - 369
Publisher: Cambridge University Press
Print publication year: 2006

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