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Tag: asthma

  • Asthma Linked To Stress And Anxiety In Teens

    Asthma seems to be as prevalent as it ever was and so are stressed out teens. It was only a matter of time before someone made the connection and that time has come.

    A new study by the Henry Ford Hospital in Detroit followed the stress and anxiety levels in 38 asthma patients that ranged in age from 14-17. Their stress and anxiety levels were significantly higher than the general population.

    Interestingly enough, the asthma symptoms and specific triggers broke down into two categories.

    In general, the asthma study found that when the kids woke at night with asthma symptoms, it was usually due to anxiety. Shortness of breath during activity were more likely due to stress.

    However, just like most studies, it is not the last word in asthma research.

    Cathryn Luria, MD and the study’s lead author, said, “While we found a link between asthma symptoms and stress and anxiety, it’s not clear which came first – the symptoms or the stress and anxiety. More study is needed to determine that.”

    She added, “Because these patients may be particularly vulnerable to stress and anxiety, this information can be helpful to physicians as they counsel their patients about the importance of managing their asthma.”

    In similar news, a new asthma treatment is making waves in the world of allegery sufferers. The treatment, called bronchial thermoplasty, is the first effective non-drug treatment for asthma.

    One successful case involved Jenny McLeland, 33, of St. Louis. McLeland had severe asthma that was seriously affecting her life.

    She tried everything up to the maximum dose on many medications. Since having bronchial thermoplasty, she hasn’t had a single asthma attack.

    The treatment is only for those who have tried medication and it hasn’t helped. And those who can afford $15,000 to $20,000 depending for the procedure. Oh, and most insurance companies won’t pay for it.

    Would it be worth it to you to be able to change the way asthma affects your life?

  • Asthma: What Triggers Your Asthma Attacks?

    Asthma: What Triggers Your Asthma Attacks?

    Asthma can be a serious and frustrating disease to deal with and while there are many medications that will help treat the symptoms, the best way to avoid an asthma attack is to avoid whatever triggers it.

    It can be hard to determine what triggers your asthma. While some triggers are obvious, there are several that you might not expect as well.

    Here are a few to beware of.

    Pests
    Rats and insects are annoying, but did you know that they can also trigger asthma? Ladybugs, stink bugs, mice and rats can all trigger asthma. These creatures can sneak into your home without you knowing it and could cause your asthma to act up. It can be hard to find them and get rid of them and you may need to call an exterminator if you find them living in your home.

    Pollution
    We know pollution is bad, but it can be especially bad for people with asthma. Car emissions are one of the biggest asthma triggers that people don’t think about. If you live near a highway, the pollution from the cars that travel that highway could be making your asthma worse.

    Obesity
    If you are obese, you are at risk for asthma. Dr. Timothy Craig, DO, a Fellow of the American Academy of Allergy Asthma and Immunology said, “obesity may predispose them to increased risk of allergic diseases as well as increased risks of asthma and severe asthma.” By losing weight you may reduce your allergy symptoms. While you obviously can’t avoid your own body, you can lose weight and stop yourself from triggering your own asthma attacks.

    If you are suffering from asthma and can’t figure out what is triggering it, check your home and surroundings. If you notice any of these triggers, remove them as soon as possible and see if your asthma symptoms clear up. Remember, some of them may be easier to spot than others, and you may want to talk to your doctor about other possible triggers that you should avoid.

    Image via Wikimedia Commons

  • Four Asthma Myths You Should Stop Spreading

    When summer weeds and pollen are at their peak, asthma sufferers just wish they could stay inside the rest of the season. If you know someone with asthma, it is helpful if you understand the difficulty they go through. But there are also some common myths about asthma that you should know about so you can help when help is needed.

    Myth: Asthma Sufferers Shouldn’t Exercise

    When non-sufferers think of exercise, they think of all the heavy breathing that aerobic exercise involves. It may be tempting to think that this is bad for asthma sufferers. In fact, for most sufferers, exercise can help. Regular exercise can help improve lung function. It can also help in maintaining a healthy body weight, which aids breathing.

    Myth: Asthma Medications are Addictive

    The medications themselves are not addictive. However, since asthma is a chronic disease, sufferers commonly use their medication once or twice a day on a regimen. While rescue inhalers are used only as needed, maintenance medications are intended to be taken regularly. This is not an addiction, but rather a prescribed maintenance schedule that can help prevent the need for emergency medications and treatment in most sufferers.

    Myth: Rescue Inhaler Steroids are the Same as Athletic Steroids

    Steroids used by asthma sufferers are corticosteroids, which are anti-inflammatory drugs. Those sometimes used by athletes are anabolic steroids.

    Myth: Asthma is a Psychological Condition

    Asthma is a physical problem. The sufferer’s lungs and immune system over-react to irritants and other triggers in the air. While some stressors may aggravate this reaction more than usual, the problem is still one of the immune system, not a mental one.

    Image via YouTube

  • Asthma Symptoms Get Subdued By New Molecule

    As I live and breathe!

    Wait – where did that saying come from? We can’t very well do the former sans the latter. That’s why it’s awesome news for asthmatics that a medicine capable of suppressing allergen-induced asthma attacks might be imminent.

    Of the 25 million plus Americans with this condition, 60% have attacks caused by allergens. Research headed by Dr. Minoru Fukuda (of the Tumor Microenvironment and Metastasis Program at Sanford-Burnham) discovered a synthetic molecule capable of mitigating the symptoms during these kinds of attacks. The study shows how the novel molecule intervenes with perceived immune threats precipitating episodes in mice

    “We have identified a synthetic molecule, a sulfate monosaccharide, that inhibits the signal that recruits T cells to the lungs to start an asthma attack,” Dr. Fukuda states.

    This signal occurs when an asthmatic’s system interprets pollen, smoke, dust (any number of irritants that are airborne) as a grave danger. While others might just cough or sneeze, the affected have a cascade of protein reactions happening inside them that end in inflammation and narrowed airways (as shown in the process below). This means an inability to get enough oxygen.

    Pretty frightening stuff.

    But there’s hope! This new player they’ve cooked up in the lab is capable of blocking communications of chemokine CCL20 (a T cell signaling protein) and heparin sulfate (a molecule that protects CCL20 and keeps it on lung epithelial cells).

    “The molecule substantially lessened asthma symptoms such as inflammation, mucus production, and airway constriction,” describes Fukuda.

    You could think of it like a basketball player setting a pick. With the new molecule in place, chemokine CCL20 can’t do its usual job of recruiting the T cells. Since those T cells (now blocked, thanks to our hero molecule) ultimately cause brutal bouts of suffocating and wheezing, that means asthma loses the game and the home teams wins (cue cheering crowd).

    Right now treatments include antibiotics, anti-inflammatories, and bronchodilators (that’s the medicine inhalers contain that reduce mucus and inflammation in lungs). What’s cool about this new find, however, is that test subjects responded to multiple methods. Whether the sulfate monosaccharide was mainlined or merely respired, the mice likewise demonstrated reduced reactions during attacks.

    Fukuda and his team are continuing their efforts in hopes of eventually helping sufferers everywhere via this new method. He explains, “Pulmonary inhalation of this new molecule may help reduce asthma symptoms by suppressing chemokine-mediated inflammatory responses,” and added:

    “We look forward to the further development of the molecule to treat the millions of people who suffer from this chronic disease.”

    Image via Wikimedia Commons

  • Asthma Symptoms: How To Manage And Cope With Asthma

    Asthma is a disease characterized by periods when the sufferer has a hard time breathing or getting enough oxygen. These periods are referred to as asthma attacks and can be scary and dangerous.

    During an asthma attack, the person’s airways become inflamed and swollen, making it harder for air to get through. Shortness of breath, wheezing, coughing and chest tightness are common symptoms of asthma. Because asthma is a disease, there is no cure for it and the symptoms can only be treated.

    Asthma can occur occasionally or often and can interfere with a person’s daily routine and quality of life. Many people who have asthma are unable to participate in sports, enjoy certain activities or even sleep well at night.

    Inhalers are one of the best and most convenient ways to control asthma. If you use an inhaler, you should always carry it with you. It is never a good idea to share inhalers or use one if you are not having an asthma attack or feel one coming on.

    There are also certain things that can trigger asthma attacks that should be avoided. These triggers can vary, but common asthma triggers include certain foods, chemicals, allergens, pets and even certain fabrics.

    If you know what triggers your asthma, you can avoid the triggers and reduce your chances of having an asthma attack. Some people have more than one trigger and will have to use trial and error to determine exactly what triggers an asthma attack.

    Certain activities can cause asthma attacks as well. Running, jumping, coughing and even getting overly excited or being scared can all cause asthma attacks. If these things can’t be avoided, it is best to try to control your breathing during or after the activity to reduce your chances of having an asthma attack.

    Asthma can be frustrating and scary at times, but knowing how to manage and cope with the disease can help you live a better and happier life and have less asthma attacks and symptoms.

    Image via Wikimedia Commons

  • Idris Elba Attends “Mandela” Premiere After Hospitalization For Asthma Attack

    Not even a brief stay in the hospital can keep Idris Elba away from doing his job.

    On Friday, Elba suffered an asthma attack after boarding a flight set for South Africa. He was immediately taken to a hospital in the United Kingdom.

    “I’ve battled asthma most of my life and it just overwhelmingly took me down on Friday while I was sitting on a plane. It was a very scary moment for me. A doctor on the plane helped me through it,” said Elba.

    Elba was on his way to Johannesburg to do some press for his upcoming film, Mandela: Long Walk to Freedom, before the actual premiere. Elba’s arrival to South Africa was delayed, but not for long.

    On Sunday, 41-year-old Elba may not have been his usual self, but he was able to attend the premiere, along with co-star Naomie Harris.

    It is reported that Elba was seen wiping his brow from time to time. He was also seen sitting beside Nelson Mandela’s ex-wife, Winnie Madikizela-Mandela.

    Mandela: Long Walk to Freedom is the first film about Nelson Mandela that has been approved by the Mandela Foundation. In the film, Elba portrays Mandela and Harris portrays Winnie Madikizela-Mandela. The film spans from Mandela’s early life, his education, his 27 years in prison, and his inauguration as president of South Africa.

    Elba took the role very seriously, traveling to South Africa to prepare for the role, and even spending a night locked in a cell on Robben Island. The cell was located next to the same one Mandela spent 18 years in. Elba said, “I wanted the audience to know what it was like once Mandela and his colleagues were jailed and the crowds dissipated.” He added, “Every time I did the cell scenes in the film, I thought of that night. It wasn’t pretend for me.”

    The movie has seen much praise from many different film festivals, as well as from the Mandela’s themselves.

    For those who have been lucky enough to see the film, they have nothing but good things to say about the film, as well as Elba’s and Harris’ performances.

    Mandela: Long Walk to Freedom hits theaters December 18, 2013.

    [Image via Idris Elba’s Twitter.]

  • FDA On-Track to Eliminate CFC Inhalers This Year

    The U.S. Food and Drug Administration (FDA) today announced that it is nearing the end of its decade-spanning elimination of all medical inhalers that contain chlorofluorocarbons (CFCs). Such inhalers will be entirely phased out by the end of 2013.

    The agency was tasked with eliminating the products as part of the Montreal Protocol treaty formed in 1987 to protect the Earth’s ozone layer by eliminating substances believed to contribute to its destruction. CFCs were once widely used as propellants in a variety of consumer products, but have been just as widely phased out after evidence emerged that the compounds could contribute to ozone depletion.

    “CFCs were used as propellants to move the drug out of inhalers so that patients can inhale the medicine,” said Dr. Badrul Chowdhury, director of the Pulmonary, Allergy, and Rheumatology Products division at the FDA. “For more than two decades, the FDA and EPA have collaborated to phase-out CFCs in inhalers – a process that included input from the public, advisory committees, manufacturers, and stakeholders.”

    According to the FDA, only two medical inhaler products that use CFCs are still on the market in the U.S.: Combivent Inhalation Aerosol and Maxair Autohaler. Both of the products are used to treat asthma or chronic obstructive pulmonary disease (COPD), and patients using the products are urged to talk to a doctor about changing their medication before the products become unavailable after December 31.

    “The EPA and FDA’s partnership has facilitated a safe, gradual transition to CFC-free inhalers in the United States,” said Drusilla Hufford, director of the Stratospheric Protection division at the EPA. “This action is an important contribution to the global effort to repair the Earth’s protective ozone layer and save millions of lives through the prevention of skin cancer.”

  • Epinephrine Pens Now Stocked at Schools in 29 States

    Schools around the United States have been managing a new anxiety: whether or not their students will drop dead during recess of unanticipated allergic shock. Fox News reported that 15 states enacted laws permitting their schools to carry epinephrine pens, joining the 11 that already have.

    Parents are slightly torn over the issue: while some parents worry that an irresponsible school official might misdiagnose a situation (since some of the states that permitted Epi-Pens eliminated their school nurses), other parents worry about what would happen if the schools didn’t keep extra Epi-Pens in case a child needed one.

    The House of Representatives had passed legislation in July that gives states that create epinephrine policies for schools will receive special preference when applying for asthma grants, which likely explains the deluge of states suddenly permitting their schools to stock Epi-Pens.

    In Tennessee, which permitted Epi-Pens in schools just this year, school nurse Amanda Williams found herself using one almost immediately when a third-grader suffered a wasp sting, triggering an asthma attack. The ER doctor informed the third-grader’s parents that without that quick epinephrine injection, their son may have died. “It would have been tragic,” Williams said of the incident.

    The senior vice president of public policy and advocacy for the Allergy Foundation, Charlotte Collins, said the rapidly-spreading trend is probably connected to the death of a Virginia first-grader, who died of cardiac arrest in a hospital after eating a nut on a playground. Experts, in that case, speculated that the girl would still be alive if the school had retained an Epi-Pen on hand.

    Dr. Michael Pistiner, a pediatric allergist, said of the new trend that “Epinephrine is the first line treatment for these severe reactions… Studies show that delays in treatment with epinephrine increase risk of death.”

    The laws apply quite differently across the states: while Virginia, Maryland, Nebraska, and Nevada are the only states to require epinephrine doses to be kept on hand, most of the other states merely allow Epi-Pens to be stored at school.

    [Image via an identical YouTube report to the one featured above]

  • ADHD Linked to Allergies, Asthma in Children

    As the number of children with attention-deficit/hyperactivity disorder (ADHD) rises, doctors are now searching for an answer to why diagnoses are becoming more common. Last year, a study linked low-level mercury exposure in pregnant women to the disorder. This week, a new study has linked ADHD to childhood allergies and asthma, which are also on the rise.

    The study, published in the journal Annals of Allergy, Asthma & Immunology, found that boys who have a history of allergies or asthma are at greater risk for being diagnosed with ADHD. Researchers looked at over 4,400 boys, some of whom had been diagnosed with ADHD. 34% of those with ADHD also had asthma, and 35% had an “allergic disorder.” An intolerance to milk was particularly linked to ADHD.

    “ADHD, a chronic mental health disorder, is most commonly found in males, while asthma is also more common in young boys than girls,” said Eelko Hak, lead author of the study and a professor at the University of Groningen. “We found there is an increased risk of ADHD in boys with a history of asthma and an even stronger risk associated with milk intolerance.”

    Hak and his colleagues point out that allergies and asthma often run in families, and that the conditions known to be closely linked. They also suggested that medicine used to treat asthma and allergies could be contributing to the rise in ADHD.

    “Further research is needed to understand why there appears to be an increased risk of developing ADHD in children with allergy and asthma,” said Dr. Gailen Marshall, editor-in-chief of Annals of Allergy, Asthma & Immunology. “Medications for these conditions far outweigh the risks, and can be life-saving in some conditions. Treatment should not be stopped, unless advised by a board-certified allergist.”

  • Asthma Cases in Children Fall in Wake of Smoke-Free Laws

    A new study has shown that hospital admissions for childhood asthma have fallen significantly following the introduction of a smoke-free law in the U.K. The study, published today in the journal Pediatrics, showed a 12.3% fall in admissions for childhood asthma in the first year after the law was put in place.

    A law banning smoking in enclosed public spaces and workplaces was implemented in the U.K in 2007. Before the law, hospital admissions were rising by 2.2% a year, and peaked at 26,969 in 2006/2007. After the law, the trend immediately reversed among all children, regardless of gender, socioeconomic status, or whether they lived in rural or urban areas.

    “There is already evidence that eliminating smoking from public places has resulted in substantial population health benefits in England, and this study shows that those benefits extend to reducing hospital admissions for childhood asthma,” said Dr. Christopher Millett, lead author of the study and a senior lecturer in the Imperial College London’s School of Public Health. “Previous studies have also suggested that the smoke-free law changed people’s attitudes about exposing others to second-hand smoke and led more people to abstain from smoking voluntarily at home and in cars. We think that exposing children to less second-hand smoke in these settings probably played in important role in reducing asthma attacks.

    Researchers analyzed NHS (National Health Service) data from the first year following the passage of the anti-smoking law, and observed that asthma admissions continued to fall in subsequent years. According to the study, this corresponds to 6,802 fewer admissions in the first three years of the legislation.

    “The findings are good news for England, and they should encourage countries where public smoking is permitted to consider introducing similar legislation,” said Millett.

  • Fertility Treatments Linked to Asthma in Children

    A new study has shown that asthma was more common in children born after fertility treatments than those conceived naturally.

    The study found that five-year-old children born to “sub-fertile parents” were more likely to have asthma, wheezing, and to be taking anti-asthmatic medication. “Sub-fertile” parents were define as those who tried for at least one year before successful conception or those who received a form of assisted reproduction technology (ART). The trend was greatest for children born after in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI), who were two to four times more likely to have asthma.

    “Although the children born after ART were more likely to be diagnosed and treated for asthma than other children, it is important to remember that in absolute terms the difference is quite small,” said Dr. Claire Carson, a researcher at the National Perinatal Epidemiology Unit at the University of Oxford. “Fifteen percent of the children in our study had asthma at the age of five. Although this figure was higher, 24%, in the IVF children, it isn’t much higher than the one in five risk for all children in the UK.

    “Although we found an association, we cannot tell at this time if it is causal. Further research is needed to establish what might be causing the association and the underlying mechanism involved. It is also important to remember that for most children, asthma is a manageable condition and shouldn’t prevent children from living a full and active life.”

    The study, published last month in the journal Human Reproduction, looked at 13,000 five-year-olds from the U.K. Millennium Cohort Study. Their mothers were surveyed about their conception and pregnancy, and the study was controlled for the mothers’ history of asthma, smoking, BMI, socioeconomic status, gestational age at the time of delivery, the type of delivery, and breast feeding.

    The researchers stated that explanations for the link include the severity of infertility, over-reporting of asthmatic symptoms by overly protective parents, the infertility treatments themselves, or other factors not taken into account.

    “Childhood asthma is a common condition in the UK where the prevalence of the condition is higher than other European countries, and (to our knowledge) this is the first UK study of asthma after IVF conceptions,” said Carson. “Our analysis suggests that it is the ART group in particular who are at higher risk. However, we do need to be reasonably cautious when interpreting the results because there is a relatively small number of IVF cases in our study – just 104 babies.”

  • Asthma Drug Rejected by U.K.’s NICE

    Asthma Drug Rejected by U.K.’s NICE

    The U.K.’s National Institute for Health and Clinical Excellence (NICE) this weekend issued a draft guidance stating that it does not recommend omalizumab, an asthma medication marketed as Xolair by Novartis Pharmaceuticals. NICE is a U.K. health authority that publishes guidelines for the National Health Service.

    Omalizumab currently has a U.K. marketing authorization as an add-on therapy for persistent allergic asthma in adults and children. It works by blocking immunoglobulin E antibodies from attaching to allergens.

    NICE stated that new evidence, including new mortality data, that has be come available influenced its decision. It also took into account the dosing schedule for the drug, and the effect that had on its cost effectiveness. These factors and other “uncertainties in the evidence and analysis presented,” influenced NICE to withhold a recommendation for omalizumab. The health-related quality of life benefits of the drug are not currently considered quantifiable, and were not part of the economic modeling used by NICE.

    “The Committee is aware that severe, persistent allergic asthma can have a detrimental effect on a person’s life and that omalizumab is an effective therapy for children, adolescents and adults with severe persistent allergic asthma,” said Sir Andrew Dillon, chief executive of NICE. “But new evidence that has become available since our original appraisal of omalizumab in 2007 indicates that it is not as clinically or cost-effective as was first thought. The Committee explored ways to identify a subgroup of people for whom omalizumab might provide a cost effective treatment, including using favorable assumptions in the modeling. In addition, the Committee recognized that there could be additional health-related benefits for patients and carers as a result of using omalizumab. However, there was no quantifiable data relating to these benefits. Unfortunately, the Committee was unable to continue to recommend omalizumab for use in the NHS. The next step is for the manufacturer and other consultees to respond to the Committee’s concerns.”

  • Asthma Inhalers Could Stunt Height Growth, Study Finds

    A new study has found that children who use certain types of asthma inhalers end up shorter than normal in adulthood.

    The study, published this week in the New England Journal of Medecine, looked at over 1,000 children from ages 5 to 12 who were treated for asthma through the Childhood Asthma Management Program (CAMP) clinical trial. The children were split into three groups, one that used asthma inhalers with budesonide, one that used inhalers without budesonide, and one that used a placebo. Researchers followed up with the children until they were of adult height, 18 years old for girls and 20 years old for boys.

    The findings show that those children who used inhalers with budesonide were an average of half-an-inch shorter than their peers when fully grown. It has long been known that budesonide, an inhaled corticosteroid, slowed growth in children. These new findings are the first evidence that the stunted growth sticks with children into adulthood.

    “This was surprising because in previous studies, we found that the slower growth would be temporary, not affecting adult height,” said Dr. Robert Strunk, professor of pediatrics at Washington University School of Medicine and lead author of the study. “But none of those studies followed patients from the time they entered the study until they had reached adult height.”

    The study controlled for gender, ethnicity, allergies, age at the start of the trial, severity of asthma symptoms, and the height of the parents. Strunk keeps careful track of inhaled steroid use by the children he treats at the St. Louis Children’s Hospital, but also downplayed the side-effect of lowered height.

    “If a child is not growing as they should, we may reduce their steroid dose,” Strunk says. “But we think that the half-inch of lowered adult height must be balanced against the well-established benefit of inhaled corticosteroids in controlling persistent asthma. We will use the lowest effective dose to control symptoms to minimize concerns about effects on adult height.”

  • Lung Disease Drug Trials Point Toward Approval

    Lung Disease Drug Trials Point Toward Approval

    GlaxoSmithKline (GSK) this week announced that phase III of trials for its new long-acting muscarinic antagonist/long-acting beta2 agonist (LAMA/LABA) drug are complete. The drug, which is administered via inhaler, is a once-daily medicine for treatment of chronic obstructive pulmonary disease (COPD), one of the most common forms of lung disease. The trials involved around 6,000 patients with COPD. The medication was developed in association with Theravance, a biopharmaceutical research company.

    According to GSK, the LAMA/LABA being studied is a combination of two molecules – umeclidinium bromide (UMEC) and vilanterol. The UMEC is the experimental aspect of the medication that is currently being developed for the treatment of COPD. A 50-week safety study of UMEC and vilanterol has been completed, as well as two different 12-week crossover exercise studies.

    The trials appear to be a success, though the results of this study and others will be presented “at future scientific meetings.” Still, GSK stated that it intends to file for approval of the drug throughout its global markets.

    The UMEC and vilanterol LAMA/LABA is only one of a few respiratory drugs GSK is researching. It already has tradmarks on the brand names RELVAR and BREO for a fluticasone furoate/vilanterol drug, though it too is not yet approved anywhere. These drugs have the potential to become GSK’s next generation of respiratory treatment drugs. GSK currently markets Advair as a treatment for respiratory symptoms.

  • Doctor Launches Collaborative Asthma Wiki

    Doctor Launches Collaborative Asthma Wiki

    Imagine that you have asthma, and rather than give you a set of instructions about what to do if you have an attack, your doctor invites you to help write them?

    Would that make patients feel more engaged and empowered in managing their health care, and would that ultimately make them happier if not healthier?

    These questions are being raised by Dr. Samir Gupta, a respirologist at St. Michael’s Hospital.

    His research has found that a wiki – a website developed collaboratively by a community of users, allowing any user to add and edit content – can be an innovative new tool for developing individual asthma action plans.

    “We’ve introduced a new way of getting patients engaged in developing tools that might improve their health,” Dr. Gupta said. “We’re empowering patients, involving patients in the health care process.”

    Dr. Gupta said a lot of asthma action plans – a one-page set of instructions for managing a patient’s asthma – are developed by experts without input from patients or the clinics that distribute them. When they are difficult to read or understand, patients don’t follow them, especially these days when health care providers face competition from such things as the Internet and iPad apps for patients’ attention.

    He got together a group of respirologists, patients, family doctors and asthma educators, set up a wiki and allowed them to choose their own content, fonts, colour and design for an asthma action plan. There were also voting mechanisms to select choices and a blog to explain them. Participants could log on as often as they wanted.

    He said the results were collaborative and without the frequent hierarchical issues that can define the patient-doctor relationship.

    “People were very engaged,” he said. “People logged on regularly and all the time. There were lots of comments, lots of rich discussion. The end results were highly useful.”

    Dr. Gupta said this method of decision-making could be used in other medical fields, as well as in marketing, where consumers could have a role.