Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Homoeopathy, Technikon Natal, 2000. / This study aimed to evaluate the use of homoeopathic remedies, as an adjunct to allopathic medicines.in the management of asthma. A.double blind randomised placebo-controlled design was used in the-trial, Thirty-two patients who were medically diagnosed suffering from atopic asthma took part in.the.study. Certain limiting criteria such. as. age, smoking, pregnancy were used to focus the patients into a more homogenous group. The patients selected for this trial were using only salbutamel; a bronchodilator, in a metered unit dose inhaler to treat their asthmatic symptoms. Limited use of additional medication was allowed, if asthmatic symptoms were exacerbated during the trial. Both subjective and objective records were used to determine the efficacy of the homoeopathic medications used. The subjective data were collected using the Asthma Quality of Life Questionnaire (Marks, et al. 1992). Objective data were collected using daily Peak Expiratory Flow readings, salbutamol inhaler Pump Usage and Asthma Severity Scores (Woolcock and Jenkins, 1991). / M

Asthma is a chronic disease, which affects over 300 million people worldwide.Despite the introduction of both national and international guidelines, asthma control remains poor. The aim of this thesis is therefore to explore possible new strategies for improving the management of asthma. The first strategy to be explored is ‘titrating asthma treatment to suppress underlying airway inflammation’. The benefits of such a strategy have already been demonstrated,however, the lack of an adequate ‘inflammometer’ have limited its application to the research/ hospital setting. Mannitol challenge appears to be the most promising candidate, as it is portable and relatively cheap. The aim of the first study in this thesis is therefore to trial the use of mannitol challenge in a community setting. The selection of an appropriate ‘inflammometer’ is not limited to the clinical setting, it is equally important in research. This is particularly true when determining therapeutic equivalence between inhaled steroids. The aim of the second study in this thesis is therefore to determine which inflammatory outcomes demonstrate sufficient assay sensitivity, as part of a cross-over trial, to detect dose response effects on airway and systemic markers The second strategy to be examined in this thesis is tailoring asthma therapy according to asthmatic phenotype. Two groups of asthmatics that differ significantly from traditional ‘inflammatory asthma’ have been selected. Asthmatic smokers are known to develop relative resistance to the beneficial effects of inhaled steroids. A recent post hoc analysis of the GOAL trial has suggested that smokers may gain greater benefit from the addition of a long-acting beta-2 agonist vs. doubling the dose of inhaled steroid. The third study in this thesis therefore aims to examine this in a prospective fashion. Another group of individuals in whom the traditional approach to asthma management and diagnosis may not be appropriate is elite athletes. In has been well documented that the mechanism of bronchospasm in athletes involves the drying/ cooling of airways. However, even within this category there are athletes to which this mechanism of action is unlikely to apply.Elite swimmers, for example, exercise in a warm, humidified environment. It therefore seems unlikely that tests designed to reproduce hyperosmolar shifts will have the same diagnostic sensitivity as they do in cold weather or track athletes. The aim of the fourth and fifth studies included in this thesis is therefore to compare various diagnostic tests in swimmers to determine which are the most sensitive.

Thesis (M Med (Family Medicine))--University of Limpopo (Medunsa Campus), 2011. / AIM AND OBJECTIVE: To determine metered dose inhaler usage technique among asthmatic patients attending outpatient clinic and assess relationship between proficiency and specific factors for efficient or non-efficient usage. DESIGN: A cross-sectional study was conducted in outpatient clinic; the inhalation technique was assessed in six steps. SETTING: outpatient clinic of Witpoort hospital, Limpopo province, South Africa. RESULT: Total of 102 patients (32 male and 70 female) was assessed with age ranging from 10 to 77(mean 44) between September to November 2008. Only three (2.9%) of patients could perform all six steps correctly. Percentage of patients performing each step correctly were: 20.6% , 65.7%, 4.9%, 4.9% and 1% got none of the step, one step, two steps, three steps, and four steps correctly respectively. None got up to five steps correctly. The 2.9% that got all six steps correctly were taught by a doctor and had asthma duration of greater than five year. CONCLUSION: This study shows a high level of incorrect usage of metered dose inhaler among asthmatic patient attending witpoort hospital. Sex (gender), age and educational level did not play a role in proficiency of inhaler use.

Thesis M.Med.(Family Medicine))--University of Limpopo (Medunsa Campus), 2010. / Background Asthma mortality in many countries is reported to be falling but the morbidity remains unacceptably high. One of the reasons for the latter is the reluctance to, and the inappropriate use of MDIs by patients resulting in inadequate dosing of medication and therefore poor asthma control. For family physicians to appropriately manage their asthmatic patients, they need to understand the patients’ knowledge and practice on the use of MDIs. Aim The aim of the study was to determine the knowledge and practice of asthmatic patients seen in a private general practice on the use of MDIs. Methodology A descriptive cross-sectional study was undertaken with fifty randomly selected participants. A structured questionnaire was used for data collection and data analysis was done using Microsoft Excel spreadsheet and SPSS version 17 software. Results Sixty percent (60%, n=30) of the participants were females and forty percent (40%, n=20) were males. The majority of the participants eighty two percent (82%, n=41) had asthma for more than five years. All the participants used MDIs. Ninety four percent (94%, n=47) used Asthavent® and 88% Budeflam®. Ninety four percent knew that Asthavent® was a reliever and only 20% knew that Budeflam® was a preventer. Conversely, forty percent (40%, n=20) thought that Budeflam® was a reliever. The majority of the participants were unable to correctly demonstrate the main steps in the practical use of the MDI. Conclusion The correct use of MDI was found to be poor for most participants. The majority of the participants lacked knowledge and skill for effective use of the MDI. The findings from this study provide reasons for family physicians to continuously educate their patients on the correct use of the MDI.

In the U.S., the prevalence rates of obesity and asthma have increased over the past 20 years and led to speculation that a correlation exists between them. Most of the research that has been conducted on the association between obesity and asthma has been done so in adults. Little data are available on this association in children. Obesity and asthma are associated with significant morbidity and mortality risk. Concern that the prevalence of overweight and asthma in children will persist and/or worsen in adulthood has prompted the current study. This study analyzed the association between asthma and allergy prevalence and measures of overweight, dietary intake, supplement use, ethnicity, child’s guardian, mother’s education level, and whether the mother smokes among children aged 9 to 11 years and 13 to 15 years. This study also analyzed the association between the use of prescription asthma and allergy medication and asthma and allergy diagnosis, measures of overweight, dietary intake, supplement use, ethnicity, guardian, mother’s education level, and whether the mother smokes. The findings of this study revealed that non-White children had greater odds of asthma diagnosis and were more likely to use asthma medications. A positive correlation was found between asthma diagnosis and allergy diagnosis and between asthma diagnosis and the use of allergy medication. Positive correlations were found between asthma diagnosis and BMI category, subscapular skinfold thickness, and waist circumference among children 9 to 11 years old. Age and weight were found to be inversely correlated with asthma diagnosis among children 13 to 15 years old. BMI category was found to be positively associated with asthma diagnosis among males, but not among females. Asthma diagnosis in females was not found to be significantly correlated with any of the variables. Dietary intake, multi-vitamin/mineral and omega-3 fatty acid supplementation, guardian, waist/hip ratio, mother’s smoking habit, and mother’s education level were not found to be significantly correlated with asthma or allergy diagnosis or with asthma or allergy medication use. A significance value of p<0.05 was used for all analyses.

In the U.S., the prevalence rates of obesity and asthma have increased over the past 20 years and led to speculation that a correlation exists between them. Most of the research that has been conducted on the association between obesity and asthma has been done so in adults. Little data are available on this association in children. Obesity and asthma are associated with significant morbidity and mortality risk. Concern that the prevalence of overweight and asthma in children will persist and/or worsen in adulthood has prompted the current study. This study analyzed the association between asthma and allergy prevalence and measures of overweight, dietary intake, supplement use, ethnicity, child’s guardian, mother’s education level, and whether the mother smokes among children aged 9 to 11 years and 13 to 15 years. This study also analyzed the association between the use of prescription asthma and allergy medication and asthma and allergy diagnosis, measures of overweight, dietary intake, supplement use, ethnicity, guardian, mother’s education level, and whether the mother smokes. The findings of this study revealed that non-White children had greater odds of asthma diagnosis and were more likely to use asthma medications. A positive correlation was found between asthma diagnosis and allergy diagnosis and between asthma diagnosis and the use of allergy medication. Positive correlations were found between asthma diagnosis and BMI category, subscapular skinfold thickness, and waist circumference among children 9 to 11 years old. Age and weight were found to be inversely correlated with asthma diagnosis among children 13 to 15 years old. BMI category was found to be positively associated with asthma diagnosis among males, but not among females. Asthma diagnosis in females was not found to be significantly correlated with any of the variables. Dietary intake, multi-vitamin/mineral and omega-3 fatty acid supplementation, guardian, waist/hip ratio, mother’s smoking habit, and mother’s education level were not found to be significantly correlated with asthma or allergy diagnosis or with asthma or allergy medication use. A significance value of p<0.05 was used for all analyses.

Thesis (Ph. D.)--University of Missouri-Columbia, 2001. / Typescript. Vita. Includes bibliographical references (leaves [139]-149). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 2001. / Typescript. Vita. Includes bibliographical references (leaves [139]-149). Also available on the Internet.

Thesis (M.P.H.)--University of Queensland. / Includes bibliographical references.

Muscarinic M2 and M3 receptors are important for the development of airway hyperresponsiveness in asthma. While there is currently no evidence to suggest altered function of M3 receptors in airway disease, a dysfunctionality of M2 receptors has been reported to occur in asthmatic patients. Current studies suggest that this dysfunctionality may be caused by allosteric modulation induced by endogenous mediators released by pro-inflammatory cells in inflamed airways. However, it is not known whether genetic variation in the coding or transcriptional regulatory regions of the gene contributes to this observed dysfunction. In order to identify potential genetic contribution, the following approaches were used: (a) the muscarinic M2 and M3 receptor genes and flanking sequences were screened for polymorphic variation in asthmatic individuals and controls, using single stranded conformation polymorphism analysis and direct sequencing; (b) the promoter region and 5'UTR arrangement of the muscarinic M2 receptor gene were identified, using a 5'RACE approach on cDNA obtained from human airway smooth muscle (HASM) cells; (c) regions of major transcriptional regulatory activity were identified using transient transfection reporter gene assays; (d) the major regulatory region was screened for polymorphic genetic variation, using an approach which involved cloning and sequencing; (e) identified promoter polymorphic variants were studied in a reporter gene assay system in order to identify the polymorphism contribution to transcriptional regulation and (t) transmission disequilibrium testing was performed in asthmatic families in order to identify whether overtransmission of any promoter variants occurs to asthmatic offspring. This study identified two rare degenerate single nucleotide polymorphisms in the coding region of the muscarinic M2 receptor gene at positions 976 (A~C) and 1197 (T~C) (c.f. ATG). In addition, a common polymorphism was identified within the 3'UTR (1696T~A) (allelic frequency 65%) and an extra 'A' was present at position 1793 in all samples investigated by sequencing or RFLP analysis, suggesting that there is a missing base in the published NCBI sequence M16404. TDT analysis suggested that the 1696T ~A SNP is not linked to asthma. The muscarinic M2 receptor coding sequence is preceded by a splice site located 46bp upstream of the ATG start codon. Five exons with alternative splicing patterns are present upstream of this splice site, separated by introns ranging from 87bp to 145.4kb. Three major regions of transcriptional initiation were identified (TSS 1, TSS2, TSS3), with multiple transcriptional start sites (TSSs) clustered around each region. There is evidence for the gene being under the control of a TAT A-less promoter with Sp 1, GATA and AP binding sites. Polymorphism screening revealed a O.5kb hypervariable region located 648bp upstream of the most 5' TSS, a multiallelic (CA) tandem repeat 96bp downstream of the most 5' TSS and a common C~A SNP located 136bp upstream of the most 5' TSS. Functional studies in primary HASM cells and the BEAS-2B cell line, demonstrated the highest promoter activity to be upstream of the TSS3 cluster, with potential repressor elements operating in a cell-type dependent manner, located upstream of ISSl. Based on the frequency of 5'RACE products obtained, transcription initiation occurs most frequently from the TSS3 cluster, and transcription factor consensus sequence mapping shows the region upstream of TSS3 to be the richest in Spl, AP and GATA sites. Seven variants of the CA repeat have been identified, and have been shown to influence reporter gene transcriptional regulation in HASM and BEAS-2B cells. The three low expressing variants ~(CA)I, ~(CA)3 and ~(CA)8 showed positive TDT results in asthmatic families, suggesting that these polymorphisms may contribute to the expression of the asthma phenotype. This project has identified a high conserved status of the human muscarinic M2 and M3 gene coding sequences, and concludes that the observed genetic variation within these genes is unlikely to contribute to phenotypic variation. Specific CA repeat promoter variants, have however been shown to alter transcriptional regulation in transiently transfected cell culture models, and to be linked to the asthma phenotype in patients. These variants may therefore contribute to the development of the disease status or to its severity. Subsequent studies may identify further roles of these polymorphisms in determining treatment responses.