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Talk: Non-pharmacological treatments for asthma (34 min)

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X Navigable Slide Index
  1. Introduction
  2. Assessment of asthma
  3. Important trigger factors and co-morbidities
  4. Assessment of asthma - management plan
  5. Non-pharmacological interventions
  6. Allergen avoidance: house dust mite
  7. Improved home ventilation and allergic asthma
  8. Home ventilation allergic asthma: results
  9. Nocturnal home-based TLA treatment (1)
  10. Nocturnal home-based TLA treatment (2)
  11. Allergen avoidance: pet and other allergens
  12. Allergen avoidance: multi-trigger intervention (1)
  13. Allergen avoidance: multi-trigger intervention (2)
  14. Avoidance in occupational asthma
  15. Exposure to passive smoke and asthma
  16. Avoidance of exposure to passive smoke
  17. Legislation regarding cigarette smoking in public
  18. Avoidance of exposure to air pollutants
  19. Avoidance of drugs and asthma
  20. Adverse effects of cigarette smoking in asthma
  21. Cigarette smoke and smoking cessation
  22. Clinical benefits of smoking cessation
  23. High BMI and weight reduction in asthma (1)
  24. High BMI and weight reduction in asthma (2)
  25. Nutritional supplements: fish oils
  26. Nutritional supplements: selenium
  27. Nutritional supplements: sodium
  28. Nutritional supplements: vitamin C
  29. Injection allergen immunotherapy
  30. Influenza vaccination
  31. Influenza vaccination: adverse effects
  32. Bronchial thermoplasty
  33. AlairĀ® system for bronchial thermoplasty
  34. Bronchial thermoplasty: technique
  35. Asthma quality of life and healthcare utilisation
  36. Bronchial thermoplasty: safety
  37. GINA guidelines for the management of asthma
  38. Exercise training
  39. Swimming training
  40. Inspiratory muscle training
  41. Breathing exercises
  42. Buteyko breathing
  43. Dysfunctional breathing
  44. Breathing training for dysfunctional breathing
  45. Psychological treatments: family therapy
  46. Psychological interventions in children
  47. Psychological interventions in adults
  48. Vocal cord dysfunction
  49. Complementary and alternative medicine
  50. Acupuncture
  51. Air ionisers
  52. Herbal and traditional Chinese medicine
  53. Homeopathy
  54. Hypnosis and relaxation therapies
  55. Manual therapy
  56. Yoga
  57. Conclusions
  58. Thank you
  59. END
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DETAILED SLIDE INDEX

  1. 1. Introduction
  2. 2. Assessment of asthma
  3. 3. Important trigger factors and co-morbidities
  4. 4. Assessment of asthma - management plan
  5. 5. Non-pharmacological interventions
  6. 6. Allergen avoidance: house dust mite
  7. 7. Improved home ventilation and allergic asthma
  8. 8. Home ventilation allergic asthma: results
  9. 9. Nocturnal home-based TLA treatment (1)
  10. 10. Nocturnal home-based TLA treatment (2)
  11. 11. Allergen avoidance: pet and other allergens
  12. 12. Allergen avoidance: multi-trigger intervention (1)
  13. 13. Allergen avoidance: multi-trigger intervention (2)
  14. 14. Avoidance in occupational asthma
  15. 15. Exposure to passive smoke and asthma
  16. 16. Avoidance of exposure to passive smoke
  17. 17. Legislation regarding cigarette smoking in public
  18. 18. Avoidance of exposure to air pollutants
  19. 19. Avoidance of drugs and asthma
  20. 20. Adverse effects of cigarette smoking in asthma
  21. 21. Cigarette smoke and smoking cessation
  22. 22. Clinical benefits of smoking cessation
  23. 23. High BMI and weight reduction in asthma (1)
  24. 24. High BMI and weight reduction in asthma (2)
  25. 25. Nutritional supplements: fish oils
  26. 26. Nutritional supplements: selenium
  27. 27. Nutritional supplements: sodium
  28. 28. Nutritional supplements: vitamin C
  29. 29. Injection allergen immunotherapy
  30. 30. Influenza vaccination
  31. 31. Influenza vaccination: adverse effects
  32. 32. Bronchial thermoplasty
  33. 33. AlairĀ® system for bronchial thermoplasty
  34. 34. Bronchial thermoplasty: technique
  35. 35. Asthma quality of life and healthcare utilisation
  36. 36. Bronchial thermoplasty: safety
  37. 37. GINA guidelines for the management of asthma
  38. 38. Exercise training
  39. 39. Swimming training
  40. 40. Inspiratory muscle training
  41. 41. Breathing exercises
  42. 42. Buteyko breathing
  43. 43. Dysfunctional breathing
  44. 44. Breathing training for dysfunctional breathing
  45. 45. Psychological treatments: family therapy
  46. 46. Psychological interventions in children
  47. 47. Psychological interventions in adults
  48. 48. Vocal cord dysfunction
  49. 49. Complementary and alternative medicine
  50. 50. Acupuncture
  51. 51. Air ionisers
  52. 52. Herbal and traditional Chinese medicine
  53. 53. Homeopathy
  54. 54. Hypnosis and relaxation therapies
  55. 55. Manual therapy
  56. 56. Yoga
  57. 57. Conclusions
  58. 58. Thank you
  59. 59. END

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TALK'S CITATION

Thomson, N. (2014), "Non-pharmacological treatments for asthma", in Barnes, P. (ed.), Advances in Asthma: New mechanisms, management strategies and treatments, The Biomedical & Life Sciences Collection, Henry Stewart Talks Ltd, London (online at http://hstalks.com/?t=BL1403622)

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ABOUT THIS TALK

Speaker(s)

Prof. Neil Thomson Show Biography

SPEAKER BIOGRAPHY

Prof. Neil Thomson – Institute of Infection, Immunity & Inflammation, University of Glasgow, UK

Neil Thomson is Emeritus Professor of Respiratory Medicine at the University of Glasgow. He is the co-editor of several textbooks on asthma and COPD and has published over 200 scientific articles and chapters on airway diseases. His current research interests include corticosteroid insensitivity in asthma, the role of biomarkers in asthma and the assessment of novel treatments for severe asthma.

Publication Date

January, 2014

Topics Covered

Non-pharmacological treatments in the management of patients with asthma... more

TOPICS COVERED IN THIS TALK

  • Non-pharmacological treatments in the management of patients with asthma
  • Avoidance measures
  • Dietary measures
  • Immunotherapy
  • Bronchial thermoplasty
  • Physical therapies
  • Psychological treatments
  • Complementary therapies
  • Need for high quality research to assess the effectiveness of some interventions

Series

Advances in Asthma

OTHER TALKS IN THIS SERIES

EPIDEMIOLOGY AND RISK FACTORS
Play '1. The changing prevalence of asthma'
1. The changing prevalence of asthma More info
Dr. Deborah Jarvis

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  • Measuring asthma prevalence in community studies
  • Geographical variation in prevalence of disease
  • Early studies showing an increase in disease
  • More recent studies of time trends
  • Possible reasons for changing prevalence of disease
Play '2. Recent advances in asthma genetics'
2. Recent advances in asthma genetics More info
Prof. Miriam Moffatt

TOPICS COVERED IN THIS TALK

  • Incidence of asthma
  • Environment and genetic causes
  • Disease identification prior to completion of sequencing of the human genome
  • Genome Wide Association Study (GWAS)
  • Omic technologies including global gene expression
  • GABRIEL and Asthma susceptibility genes identified by GWAS
  • Asthma and infection
  • 16S rRNA and metagenomics
  • What next
Play '3. Asthma: an epidemic caused by epigenetics?'
3. Asthma: an epidemic caused by epigenetics? More info
Prof. David Schwartz

TOPICS COVERED IN THIS TALK

  • Genetic and biological determinants of diseases influenced by the environment
  • Epigenetics
  • Epigenetic mechanisms can be influenced by environmental exposures and aging
  • Histone modifications and innate immunity
  • Asthma is a major public health problem
  • Epigenetics and airway immunology
  • DNA methylation changes and asthma
  • Runx3 and airway disease
  • In utero folate supplementation and asthma
  • Sib pair asthma study
  • Preliminary analysis
  • Global methylation patterns: asthmatics vs. nonasthmatics
  • Hypomethylation of GATA3 or MUC5B is associated with asthma in concordant sib pairs
  • Hypermethylation of NOS2 is associated with concordant asthma
  • Asthma: an epidemic caused by epigenetics?
Play '4. Diet and asthma'
4. Diet and asthma More info
Prof. Lewis Smith

TOPICS COVERED IN THIS TALK

  • Increase in asthma worldwide
  • Parallel environmental changes including diet
  • Assessing role of diet is complex
  • Focus on antioxidant vitamins, vitamin D and genistein
Play '5. Obesity and asthma'
5. Obesity and asthma More info
Dr. Anne Dixon

TOPICS COVERED IN THIS TALK

  • Obesity as a risk factor for asthma
  • Unique characteristics of asthma in the obese
  • Role of comorbidities in asthma in the obese
Play '6. Occupational asthma: management beyond the textbooks'
6. Occupational asthma: management beyond the textbooks More info
Prof. Paul Cullinan

TOPICS COVERED IN THIS TALK

  • A wide variety of agents can cause occupational asthma
  • A case study of possible occupational asthma
  • Important points to consider for potential occupational asthma sufferers; diagnosis and approach
  • Identification and care of patients
CLINICAL PHENOTYPES
Play '7. The origins of asthma'
7. The origins of asthma More info
Prof. Peter Sly

TOPICS COVERED IN THIS TALK

  • Asthma is a multifactorial condition
  • Asthma as a "Syndrome"
  • Causes of asthma: genetic and environmental
  • Development of asthma
  • Growth of respiratory system
  • Maturation of the immune system
  • Prenatal exposures which cause asthma
  • Asthma risk factors
  • Considering atopy when assessing asthma risk
Play '8. Asthma phenotypes in children'
8. Asthma phenotypes in children More info
Prof. Andrew Bush

TOPICS COVERED IN THIS TALK

  • Severe asthma
  • Getting the basics right
  • Rarity of genuine severe therapy resistant asthma
  • Differences between childhood and adult asthma
  • Protocol driven investigations to determine nature of any inflammation
  • Phenotype discordance
  • Steroid responsiveness
  • Presence of fixed airflow obstruction
  • Exacerbating phenotype particularly difficult to treat
Play '9. Smoking asthmatics'
9. Smoking asthmatics More info
Prof. Neil Thomson

TOPICS COVERED IN THIS TALK

  • High prevalence rates of smoking in asthma
  • Detrimental effects of smoking on clinical outcomes
  • Impaired response to corticosteroids
  • Mechanisms of adverse effects
  • Management includes smoking cessation, but optimum drug therapy not established
Play '10. Aspirin exacerbated respiratory disease'
10. Aspirin exacerbated respiratory disease More info
Prof. Chris Corrigan

TOPICS COVERED IN THIS TALK

  • Clinical features
  • AERD as a disease of excessive leukotriene production
  • Alterations in eicosanoid metabolism
  • The protective role of Prostaglandin E2 (PGE2)
  • Reduced PGE2 signalling as a mechanism for AERD
  • The PGE2 receptor EP2 as a molecular target
MECHANISMS OF ASTHMA
Play '11. Advances in asthma: airway inflammation'
11. Advances in asthma: airway inflammation More info
Prof. William Busse

TOPICS COVERED IN THIS TALK

  • Airway inflammation is a complex, interactive, redundant immune response
  • Components of inflammation in asthma
  • "Traditional" inflammatory cells in airway inflammation
  • Mast cells and eosinophils
  • Lymphocytes
  • Using monoclonal antibodies to gain insight into the clinical significance of inflammation in asthma
  • IgE, IL-5, and IL-13
  • The diversity of patterns of inflammation in asthma
  • Personalized medicine
Play '12. The role of mast cells in asthma'
12. The role of mast cells in asthma More info
Prof. Peter Bradding

TOPICS COVERED IN THIS TALK

  • Mast cell biology
  • Mast cell cytokines
  • Mast cell activation in asthma
  • Mast cell tissue microlocalisation in asthma
  • Mast cell-airway smooth muscle interactions as a key feature of asthma
Play '13. Dendritic cells in asthma'
13. Dendritic cells in asthma More info
Prof. Bart Lambrecht

TOPICS COVERED IN THIS TALK

  • The global immune response of the lungs
  • Dendritic cells (DCs): localisation, trafficking, probing for antigen, activation, behaviour in airways during asthma and inflammation
  • Controlling responsiveness to the node T cell area & Immunological synapse formation
  • Peptide presentation by MHC class II molecules
  • Cascade of costimulatory events
  • Th2 lymphocytes role in airway inflammation
  • Targeting DCs
  • Allergen exposure activation
  • Epithelial vs. DC expression of TLR4
  • Metabolic alterations
  • Uric acid and antigen sensitisation in mice
  • DC depletion
  • Basement membrane thickening in asthma
  • Model of chronic airway remodelling in the lungs
  • Collagen deposition & antigen uptake/recognition
  • Presentation of neoantigen
Play '14. The airway smooth muscle in asthma'
14. The airway smooth muscle in asthma More info
Prof. Judith Black

TOPICS COVERED IN THIS TALK

  • Remodelling of the asthmatic airway
  • Airway smooth muscle (ASM)
  • increased deposition of matrix proteins
  • Asthma increases ASM
  • Characteristics of ASM cells in non-asthmatics
  • Characteristics of ASM in asthmatics
  • ASM produces extracellular matrix (ECM) proteins
  • Differences in ECM in asthmatics
  • Fibulin-1 in asthma
  • Fibulin as a therapeutic target
Play '15. Role of virus infection in asthma - Part 1'
15. Role of virus infection in asthma - Part 1 More info
Prof. Sebastian Johnston

TOPICS COVERED IN THIS TALK

  • Role of viruses in asthma exacerbations
  • Huge clinical problem unmet by current therapies
  • Viruses major cause in all age groups
  • Deficient anti-viral immunity in asthma
  • Potential therapies; specific anti-virals and broad-spectrum approaches
Play '16. Role of virus infection in asthma - Part 2'
16. Role of virus infection in asthma - Part 2 More info
Prof. Sebastian Johnston

TOPICS COVERED IN THIS TALK

  • Role of viruses in development of asthma
  • Association between early life severe lower respiratory viral illness and later development of asthma
  • Is this association due to a common risk factor, a causal factor, or both?
  • Future studies
Play '17. Severe asthma: characterisation, mechanisms  & treatment'
17. Severe asthma: characterisation, mechanisms & treatment More info
Prof. Fan Chung

TOPICS COVERED IN THIS TALK

  • Definition and characterisation
  • From difficult-to-treat asthma to severe asthma
  • Phenotypes and characteristics
  • Current treatment modalities
  • Chronic airflow obstruction
  • Corticosteroid insensitivity
  • Future treatments: specific targets for specific phenotypes
Play '18. Steroid resistance in asthma: mechanisms and potential therapies'
18. Steroid resistance in asthma: mechanisms and potential therapies More info
Prof. Ian Adcock

TOPICS COVERED IN THIS TALK

  • Overview of asthma pathophysiology
  • Patterns of severe refractory asthma
  • Methods to improve steroid efficacy in severe asthma
  • Mechanisms that induce steroid insensitivity; Th2 cytokines, IL-17 and infections
  • Pathophysiology of severe treatment refractory asthma
  • Novel anti-inflammatory approaches
  • Can new combinations of drugs reverse steroid insensitivity in severe asthma?
Play '19. Macrophage in asthma'
19. Macrophage in asthma More info
Prof. Douglas Robinson

TOPICS COVERED IN THIS TALK

  • Contributing factors to asthma include abnormal epithelium, predominant Th2 cytokines, and inappropriate repair leading to airway remodeling
  • Alternative activation of macrophages (via IL-4 and IL-13) leads to chitinase production
  • Interstitial macrophages may have regulatory role (via IL-10)
  • IL-13 may be a key cytokine in activation of airway macrophages
  • IL-13 amplifies features of asthma such as airway hyperresponsiveness and mucus production
DIAGNOSIS OF ASTHMA
Play '20. Physiology of asthma and involvement of small airways'
20. Physiology of asthma and involvement of small airways More info
Prof. Charles G. Irvin

TOPICS COVERED IN THIS TALK

  • Physiology of asthma, a syndrome defined by lung dysfunction
  • Airflow limitation
  • Small airways
  • Reversibility of airflow limitation
  • Periodicity and variability of airflow limitation
  • Airways hyperresponsiveness
Play '21. Induced sputum in asthma'
21. Induced sputum in asthma More info
Prof. Antonio Spanevello

TOPICS COVERED IN THIS TALK

  • Induced Sputum: facilities and procedure
  • Induced Sputum as a biomarker of airway disease in asthma
  • Comparison with other techniques
  • Reference values and comparison between healthy and patients
  • Induced sputum in asthma: clinical implications
Play '22. Advances in asthma: the role of exhaled nitric oxide in the assessment and management of asthma '
22. Advances in asthma: the role of exhaled nitric oxide in the assessment and management of asthma  More info
Prof. Robin Taylor

TOPICS COVERED IN THIS TALK

  • Exhaled nitric oxide (NO) in asthma
  • The relationship between exhaled NO and airway inflammation
  • Use of exhaled NO in diagnosis of respiratory symptoms
  • Exhaled NO as a predictor of steroid responsiveness
  • Strengths and weaknesses use of exhaled NO in monitoring asthma
  • Guideline for the clinical application of exhaled NO
THERAPY AND MANAGEMENT
Play '23. The management of chronic asthma'
23. The management of chronic asthma More info
Prof. Mark Fitzgerald

TOPICS COVERED IN THIS TALK

  • Importance of reviewing patient's history
  • Identification of potential environmental factors
  • Patients with uncontrolled asthma may require anti-inflammatory medications with inhaled corticosteroids (ICS) being the standard treatment
  • Asthmatics on ICS with uncontrolled asthma may require adjunct therapy such as a long acting beta agonist and or a leukotriene antagonist
  • Education program and written action plan
Play '24. Inhaled corticosteroids and beta2-agonists'
24. Inhaled corticosteroids and beta2-agonists More info
Dr. Omar Usmani

TOPICS COVERED IN THIS TALK

  • Asthma treatment guidelines
  • Pharmacology of inhaled corticosteroids and long-acting beta agonists
  • Clinical evidence for combination therapy in asthma
  • Molecular interactions between inhaled corticosteroids and long-acting beta agonists
Play '25. Management of "difficult asthma"'
25. Management of "difficult asthma" More info
Prof. Elisabeth Bel

TOPICS COVERED IN THIS TALK

  • Difficult asthma and severe refractory asthma
  • Heterogeneous reasons for severe asthma
  • "High dose" therapy
  • Treatments for severe asthma
  • Eosinophilic vs. non eosinophilic inflammation
  • Effect of CRS treatment on asthma
  • Mechanism of action of anti IgE
  • Effect of anti IgE on severe asthma exacerbations
  • Effect of anti IL-5 (mepolizumab) on spontaneous asthma exacerbations
  • Clarithromycin in neutrophilic asthma
  • Macrolides in chronic stable asthma
  • Mechanisms of asthma severity in obese patients
  • Implications for the future
Play '26. Management of acute exacerbations of asthma'
26. Management of acute exacerbations of asthma More info
Dr. Chris Fanta

TOPICS COVERED IN THIS TALK

  • Asthma prevention, assessment, treatment and disposition
  • Risk factors and physical findings in severe asthma attacks
  • Treatments: Steroids, MDI, Nebulizer, Beta-agonists, Bronchodilators, Magnesium, Heliox & Antibiotics
  • Unproven and unconventional therapies
  • Rationale for in-hospital treatment and indications for admission
  • Indications for intubation & mechanical ventilation
  • Discharge criteria and patient education prior to hospital discharge
Now Playing
27. Non-pharmacological treatments for asthma
Prof. Neil Thomson
Play '28. Asthma: beyond the prescription'
28. Asthma: beyond the prescription More info
Prof. Martyn Partridge

TOPICS COVERED IN THIS TALK

  • Patient/health professional contact
  • The role of the asthma patients
  • Denial of the diagnosis
  • Knowledge of asthma amongst the parents
  • Levels of asthma control
  • How patients perceive their asthma
  • Treatment guidelines
  • Assessing patients' preferences
  • Defining the ideal relationship with a specialist
  • Involvement in treatment decisions
  • British asthma guidelines
  • Compliance of practices with recommendations
  • Written asthma action plans
  • Software
  • Literacy and health
  • The use of technology
  • Sources of information
  • Better compliance with electronic reminders
  • Use of non technological adjuncts
  • Consultation is important for patients
Play '29. New drugs for asthma'
29. New drugs for asthma More info
Prof. Peter Barnes

TOPICS COVERED IN THIS TALK

  • Improvements in existing therapies have been the main approach
  • New classes of drug in development
  • Upcoming oral and inhaled therapies that target inflammation in asthma
  • Patients with severe disease
  • Inflammation in severe asthma is usually corticosteroid insensitive
Play '30. Anti-IgE therapy for asthma'
30. Anti-IgE therapy for asthma More info
Dr. Andrew Menzies-Gow

TOPICS COVERED IN THIS TALK

  • Anti-IgE therapy for asthma
  • Allergy can be associated with severe asthma
  • Omalizumab, a monoclonal anti-IgE, is the first targeted biological therapy for severe asthma with good clinical efficacy
  • Patient selection, drug administration and length of treatment are discussed

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