International Journal of Chronic Obstructive Pulmonary Disease

The development and pilot testing of the Self-management Programme of Activity, Coping and Education for Chronic Obstructive Pulmonary Disease (SPACE for COPD)

Original Research

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Authors: Apps LD, Mitchell KE, Harrison SL, Sewell L, Williams JE, Young HML, Steiner M, Morgan M, Singh SJ

Published Date July 2013 Volume 2013:8 Pages 317 - 327

DOI: http://dx.doi.org/10.2147/COPD.S40414

Received:	16 November 2012
Accepted:	11 January 2013
Published:	09 July 2013

Lindsay D Apps,¹ Katy E Mitchell,¹ Samantha L Harrison,¹ Louise Sewell,¹ Johanna E Williams,¹Hannah ML Young,¹ Michael Steiner^,1 Mike Morgan,¹ Sally J Singh^1,2
1National Institute of Health Research CLAHRC-LNR Pulmonary Rehabilitation Research Group, University Hospitals of Leicester NHS, Leicester, UK; ²Applied Research Centre, Health and Lifestyle Interventions, Coventry University, Coventry, UK

Purpose: There is no independent standardized self-management approach available for chronic obstructive pulmonary disease (COPD). The aim of this project was to develop and test a novel self-management manual for individuals with COPD.
Patients: Participants with a confirmed diagnosis of COPD were recruited from primary care.
Methods: A novel self-management manual was developed with health care professionals and patients. Five focus groups were conducted with individuals with COPD (N = 24) during development to confirm and enhance the content of the prototype manual. The Self-management Programme of Activity, Coping and Education for Chronic Obstructive Pulmonary Disease (SPACE for COPD) manual was developed as the focus of a comprehensive self-management approach facilitated by health care professionals. Preference for delivery was initial face-to-face consultation with telephone follow-up. The SPACE for COPD manual was piloted with 37 participants in primary care. Outcome measures included the Self-Report Chronic Respiratory Questionnaire, Incremental Shuttle Walk Test, and Endurance Shuttle Walking Test (ESWT); measurements were taken at baseline and 6 weeks.
Results: The pilot study observed statistically significant improvements for the dyspnea domain of the Self-Report Chronic Respiratory Questionnaire and ESWT. Dyspnea showed a mean change of 0.67 (95% confidence interval 0.23–1.11, P = 0.005). ESWT score increased by 302.25 seconds (95% confidence interval 161.47–443.03, P < 0.001).
Conclusion: This article describes the development and delivery of a novel self-management approach for COPD. The program, incorporating the SPACE for COPD manual, appears to provoke important changes in exercise capacity and breathlessness for individuals with COPD managed in primary care.

Keywords: self-management, primary care, Self-Report Chronic Respiratory Questionnaire, dyspnea, Endurance Shuttle Walking Test



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Dr. Sarah Anvari reviews the diagnosis and management of diseases of the sinuses.

Dr. Sarah Anvari reviews the diagnosis and management of diseases of the sinuses.
 

COLA (Conferences On-Line Allergy) is a live series of online allergy conferences held at Children's Mercy Hospital in Kansas City, Missouri. World experts give presentations on topics related to allergy and immunology. Live conferences are held on Monday and Friday from 10-noon (central time). They can be joined by going to http://www.childrensmercy.org/cola

Dr. Lanny Rosenwasser reviews the use of cytokine antibodies and antagonists to manage inflammatory diseases such as asthma.

Dr. Lanny Rosenwasser reviews the use of cytokine antibodies and antagonists to manage inflammatory diseases such as asthma. 

COLA (Conferences On-Line Allergy) is a live series of online allergy conferences held at Children's Mercy Hospital in Kansas City, Missouri. World experts give presentations on topics related to allergy and immunology. Live conferences are held on Monday and Friday from 10-noon (central time). They can be joined by going to http://www.childrensmercy.org/cola

Dr. Jay Portnoy discusses some common misconceptions related to food allergy

Dr. Jay Portnoy discusses some common misconceptions related to food allergy. Held on May 24, 2013.

COLA (Conferences On-Line Allergy) is a live series of online allergy conferences held at Children's Mercy Hospital in Kansas City, Missouri. World experts give presentations on topics related to allergy and immunology. Live conferences are held on Monday and Friday from 10-noon (central time). They can be joined by going to http://www.childrensmercy.org/cola

• Front Pharmacol
• v.4; 2013
• PMC3671179

Front Pharmacol. 2013; 4: 71.

Published online 2013 June 4. doi:  10.3389/fphar.2013.00071

PMCID: PMC3671179

The effects of cocoa on the immune system

Francisco J. Pérez-Cano,1,2 Malen Massot-Cladera,1,2 Àngels Franch,1,2 Cristina Castellote,1,2 and Margarida Castell1,2,*

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Abstract

Cocoa is a food relatively rich in polyphenols, which makes it a potent antioxidant. Due to its activity as an antioxidant, as well as through other mechanisms, cocoa consumption has been reported to be beneficial for cardiovascular health, brain functions, and cancer prevention. Furthermore, cocoa influences the immune system, in particular the inflammatory innate response and the systemic and intestinal adaptive immune response. Preclinical studies have demonstrated that a cocoa-enriched diet modifies T cell functions that conduce to a modulation of the synthesis of systemic and gut antibodies. In this regard, it seems that a cocoa diet in rats produces changes in the lymphocyte composition of secondary lymphoid tissues and the cytokines secreted by T cells. These results suggest that it is possible that cocoa could inhibit the function of T helper type 2 cells, and in line with this, the preventive effect of cocoa on IgE synthesis in a rat allergy model has been reported, which opens up new perspectives when considering the beneficial effects of cocoa compounds. On the other hand, cocoa intake modifies the functionality of gut-associated lymphoid tissue by means of modulating IgA secretion and intestinal microbiota. The mechanisms involved in these influences are discussed here. Further research may elucidate the cocoa compounds involved in such an effect and also the possible medical approaches to these repercussions.

Keywords: cocoa, lymphocyte, macrophage, antibody, cytokine, gut-associated lymphoid tissue, thymus, spleen

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Focus on work-related asthma

 

European Annals of Allergy and Clinical Immunology Vol 45, No 3 (2013) > Moscato

Focus on work-related asthma

G. Moscato

Abstract

Work-related asthma, encompassing both occupational asthma and work-exacerbatedasthma, accounts for 10%-25% of adult asthma in Europe and occupational asthma iscurrently one of the most common forms of occupational lung disease in many industrializedcountries. It is cause of direct and indirect costs for the worker, the employer andthe society and it is probably still underdiagnosed. Hence, the possibility of work-relatedasthma should be considered in all adult patients in whom asthma started or worsenedduring their working life. The investigation of WRA includes assessing the presenceof asthma, and demonstrating its work-relatedness, that requires training andexpertise. Due to the frequent association of occupational asthma and rhinitis, thepresence of both upper and lower airway symptoms should be investigated. Furthermore,since is work-related asthma is a preventable disease all efforts should be madefor effective prevention strategies.

Keywords

Work-related-asthma,work-related-rhinitis, diagnosis,management, medicolegal aspects

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Review

Diagnosis and management of non-IgE-mediated cow's milk allergy in infancy - a UK primary care practical guide

Carina Venter, Trevor Brown, Neil Shah, Joanne Walsh and Adam T Fox

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Clinical and Translational Allergy 2013, 3:23 doi:10.1186/2045-7022-3-23

Published: 8 July 2013

Abstract (provisional)

The UK NICE guideline on the Diagnosis and Assessment of Food Allergy in Children and Young People was published in 2011, highlighting the important role of primary care physicians, dietitians, nurses and other community based health care professionals in the diagnosis and assessment of IgE and non-IgE-mediated food allergies in children. The guideline suggests that those with suspected IgE-mediated disease and those suspected to suffer from severe non-IgE-mediated disease are referred on to secondary or tertiary level care. What is evident from this guideline is that the responsibility for the diagnostic food challenge, ongoing management and determining of tolerance to cow's milk in children with less severe non-IgE-mediated food allergies is ultimately that of the primary care/community based health care staff, but this discussion fell outside of the current NICE guideline. Some clinical members of the guideline development group (CV, JW, ATF, TB) therefore felt that there was a particular need to extend this into a more practical guideline for cow's milk allergy. This subset of the guideline development group with the additional expertise of a paediatric gastroenterologist (NS) therefore aimed to produce a UK Primary Care Guideline for the initial clinical recognition of all forms of cow's milk allergy and the ongoing management of those with non-severe non-IgE-mediated cow's milk allergy in the form of algorithms. These algorithms will be discussed in this review paper, drawing on guidance primarily from the UK NICE guideline, but also from the DRACMA guidelines, ESPGHAN guidelines, Australian guidelines and the US NIAID guidelines.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Ultrastructure of Vascular Permeability in Urticaria

ORIGINAL ARTICLES

Ultrastructure of Vascular Permeability in Urticaria

P.R. Criado, R.F.J. Criado, C.F.H. Takakura, C. Pagliari, J.F. de Carvalho, M.N. Sotto and C. Vasconcellos

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Click on the icon on the upper right hand side for the article written by Paulo R. Criado, MD, Roberta F.J. Criado, MD, Cleusa F.H. Takakura, BS, Carla Pagliari, BS, Jozelio F. de Carvalho, MD, Mirian N. Sotto, MD and Cidia Vasconcellos, MD.
IMAJ 2012: 15: April: 173-177

ABSTRACT

 Background: Few studies have addressed the ultrastructure of vascular permeability in urticaria.

Objectives: To describe the types of endothelial cell organelles involved in vascular permeability in drug-induced acute urticaria (DIAU).

Methods: Seven patients with DIAU were enrolled in the study. Biopsies of urticarial lesions and apparently normal skin were performed. The 14 collected fragments were processed with immunogold electron microscopy using single stains for tryptase and factor XIIIa (FXIIIa) and double immunogold labeling for both tryptase and FXIIIa.

Results: Some sections demonstrated mast cells in the degranulation process, in both anaphylactic and piecemeal degranulation. After double immunogold staining, 10 nm (FXIIIa) and 15 nm (tryptase) gold particles were both present, covering the granules in the mast cells, indicating that both tryptase and FXIIIa were localized within the granules of these cells. Interestingly, we found strong evidence of the presence of caveolae and vesico-vacuolar organelles (VVOs) in the endothelial cells of the biopsies. In addition to these findings, we were able to demonstrate the presence of tryptase and FXIIIa in the endothelial cells, in urticarial lesions and in apparently normal skin.

Conclusions: VVOs are present in the endothelial cells of post-capillary venules in DIAU. This is the first report on the expression of FXIIIa and tryptase in the cytoplasm of endothelial cells in urticaria.