Background: Asthma is a global health problem affecting people of all ages. Despite huge progress on the management of asthma in recent decades, suboptimal health outcomes associated with under-management is still commonly encountered. Self management was shown to be a both clinically and cost effective approach to improve asthma outcomes in some studies. The role of pharmacists in promoting self management of asthma was explored in individual studies but limited review was conducted to assess its effectiveness. Objective: To investigate the effectiveness of pharmacist interventions on the self management of asthma patients in the community setting and to examine if the benefits, if any, could be realized by implementing such interventions in Hong Kong. Methods: A systematic search was conducted on Medline, Embase, Pubmed and Cochrane Library without time limit to identify studies assessing the clinical, humanistic and economic outcomes of pharmacist-led self management interventions towards adolescent or adult patients with asthma compared to usual care. Risk of bias of studies was appraised using a tool adapted from the Effective Practice of Organization of Care version of the Cochrane Risk of Bias Tool. Results: The search yielded 504 studies of which eight studies were eligible for inclusion. The included studies involved 1674 patients, were published between 2001 and 2008 and were originated from seven countries. Discrepancies of findings were noted in the majority of outcome measures reviewed. Significant benefits of pharmacist interventions included improvement of inhalation technique and reduction of rescue medication use although no significant effect was observed with regard to forced expiratory volume in one second and days lost from work or school. Conclusions: The evidence of pharmacist interventions on the self management of asthma remains inconsistent, probably attributable to variable quality of studies and heterogeneous assessment methods and outcome measures. Future research should aim to produce randomized, controlled studies incorporating allocation concealment with a follow-up period of over one year. Nevertheless, pharmacist-led asthma self management initiatives could be implemented at the general outpatient clinic setting in Hong Kong to further improve the quality of primary care. / published_or_final_version / Public Health / Master / Master of Public Health

No description available.

Elucidation of the inflammatory mechanisms of asthma has highlighted the role of the eosinophil as a major effector cell in asthma pathogenesis due to the arsenal of toxic granule proteins and other biological mediators secreted by this cell. Apoptosis induction in eosinophils and their consequent phagocytic removal from the inflamed lung would prevent the release of their detrimental cell constituents and would facilitate inflammation resolution. This thesis first established that airway epithelial cells (AEC) could specifically recognise and ingest apoptotic and not freshly isolated peripheral blood eosinophils. AEC also differentiated between apoptotic neutrophils and apoptotic eosinophils with the former not being recognised or ingested. Colon, mammary and retinal-pigmented epithelium exhibited the same selective phagocytosis suggesting that this was a ubiquitous epithelial phenomenon. Exposure of the AEC to the pro-inflammatory cytokines IL-1 and TNFa, or the glucorcorticoid dexamethasone enhanced the phagocytic capacity of these cells in a time and concentration dependent manner. Enhancement was observed both in terms of the number of cells within a monolayer phagocytosing apoptotic eosinophils and also with respect to the number of cells phagocytosed by these phagocytic AEC. CD44 ligation on the surface of A549 was also revealed to enhance phagocytic ability. The receptors utilised for apoptotic eosinophil recognition and phagocytosis were avb3, avb5, b5, CD36, PSr and unidentified lectins, which recognise the amino sugars, glucosamine, n-acetyl-glucosamine and n-acetyl-galactosamine but not their parent sugars. Neither cytokine nor glucorcorticoid of phagocytosis was associated with an increase in the expression of these receptors. Preliminary data was also found suggesting that cell-cell interactions between freshly isolated eosinophils and small airway epithelial cells (SAECs) that were co-cultured for 24h resulted in eosinophil apoptosis induction that was above that of constitutive apoptosis and only partially abrogated by IL-5 addition to the co-culture medium.

No description available.

No description available.

No description available.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

Thesis (Ph. D.)--University of New South Wales, 2003. / Also available online.