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Medicine is to heal from the inside

Exercise For Asthma: Good or Bad?

Asthma is chronic inflammation of the breathing passages (bronchi) of the lungs. The inflammation respons are triggered by allergen, basically asthma is allergic response.

Asthma is characterized by sudden attacks of dyspnea, cough, and wheeze separated by periods of mild symptoms, or no symptoms at all. The inflammatory reaction of asthma is triggered by external factors or specific situations. When a person with asthma is exposed to one of his or her triggers, the inflammation worsens and symptoms begin. Fortunately, the airway obstruction in asthma attack is reversible.
Exercise for Asthma Patient


Each individual with asthma has his or her own specific trigger or set of triggers. These triggers generally are related to the way we breathe or the condition of the atmosphere we breathe in. Triggers include contaminants in the air, such as smoke, pollution, vapors, dust, or other particles; respiratory infections, such as colds and flu (viruses); allergens in the air, such as molds, animal dander, and pollen; extremes of temperature or humidity; and emotional stress.

The prevalence of asthma is about 5-7% of general population, the disease affects people of all races and ethnic groups worldwide, from infancy to old age, with slightly more boys than girls affected and, after puberty, more women than men. Dramatic increases in the prevalence of atopy and asthma have occurred over the past few decades in Westernized countries and more recently in less-developed nations. Estimates suggest that as many as 300 million persons are affected worldwide.


Exercise and Asthma
Exercise is a double-edged sword for asthma patients. Exercise is a common trigger for asthmatic attack, but in the other side, exercise can be used in helping asthma control.

Normal physical activities without any limitation is one of the goals of asthma treatment. Asthma has become a giant wall for patients to begin the exercise, most of them are afraid of having attack during the exercise. Well, it's true that basic of asthma is prevention, patient actually has recognized the triggers and avoid it. But, does exercise so bad?

I'll try to explain it in simple words: When we are at rest, we breathe through our nose, which serves to warm, humidify, and cleanse the air that we inhale to make it more like the air in the lungs. But, when we are exercising, you breathe through our mouth, and the air that hits our lungs is colder and drier. The contrast between the warm air in the lungs and the cold inhaled air or the dry inhaled air and moist air in the lungs, can trigger an attack. Once the attack is triggered, the airways begin to swell (bronchospasm) and secrete large amounts of mucus.

If the airways is obstructed, our breathing become discomfort, we experience hunger of air, chest tightness, etc. So, clearly exercise can induce an asthma attack.

Does the exercise has any benefit for asthma patients? Yes, It does. As long as your asthma is under control, exercising is recommended to keep your lungs and body in good shape. Exercise offers benefits such as: strengthen the breathing muscles, boost our immune system, and keep a healthy body weight. All of these benefits can improve asthma in the long run.

The key of exercise in asthma patient is "having asthma under-controlled." Asthma can't be cured with our current knowledges, but it can be controlled therefore helps in achieving normal activities.
Don't Give Up your Exercise

Exercise that suits asthma
Activities with focus on endurance and aerobic, suit best for asthma patients. Swimming, which is a strong endurance sport, is generally well tolerated by many people with asthma because it is usually performed in a warm, moist air environment. It is also an excellent activity for maintaining physical fitness.
Other beneficial activities for people with asthma include both outdoor and indoor biking, aerobics, walking, or running on a treadmill.

Prepare before Exercise
- Always use pre-exercise asthma inhalers (inhaled bronchodilators) before beginning exercise.
- Perform warm-up exercises and maintain an appropriate cool-down period after exercise.
- If the weather is cold, exercise indoors or wear a mask or scarf over nose and mouth.
- If you have allergic asthma, avoid exercising outdoors when pollen counts are high and when there is high air pollution.
- Restrict exercise when you have a viral infection, like a cold.
- Exercise at a level that is appropriate for you.

Remember: asthma is not a reason to avoid exercise. With proper diagnosis and the most effective treatment, you should be able to enjoy the benefits of an exercise program without experiencing asthma symptoms.
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Atopic Dermatitis at a Glance

Introduction
Atopic dermatitis is an acute, subacute or chronic relapsing skin disorder that cause by our body hypersensitivity reaction that manifests to the skin or in simple words, atopic dermatitis is skin manifestations of allergy.

When we hear about allergy, first though in our mind is pruritus of the skin after eating something. Well, from that, we can see that most of us already know what is atopic dermatitis.
eczema baby

Atopic dermatitis is common disease especially during childhood. It is usually begin in infancy, the incidence of atopic dermatitis decreased along with increasing of ages. It is estimated about 20-30% in early childhood, but atopic dermatitis becomes a rare disease in adult.

Allergic reaction in atopic dermatitis, has many factors that involved in. One of them is family history. Allergy related disease such as atopic dermatitis, asthma, is believed to have genetic predispositions. Eventhough environmental factors also determine the outcomes.

The decreasing incidence of atopic dermatitis along with ages, until know is not well explained. The concept is related to our immune system maturations that will be shown as a curve of allergic march. Most of child with atopic dermatitis may cure spontaneous, but may undergo another kind of allergic disease such as asthma or allergic rhinitis.

Eliciting factors
Inhalants, specific aeroallergens, especially dust mites and pollens, have been shown to cause exacerbations of atopic dermatitis.

Mircobial agents, several infections, may stimulate activation of allergic reaction.

Food, subsets of infants and children have flares of atopic dermatitis with eggs, milk, peanuts, soybeans, fish and wheat.

Other factors that can contribute as exacerbating factors such as cold weather, dehidration, and emotional stress.

Pathogenesis
Allergic reaction in atopic dermatitis, basically is same with others atopic disease such asthma and allergic rhinitis. There is a complex interaction between genetic, environment, and immunologic factors that happens inside the skin.

IgE and histamines play role in skin inflammation of atopic dermatitis, that being activated by several exacerbating factors. Allergen binding with IgE causing histamine release from inflammatory cells, mediates tissue response.

Clinical Manifestations
Skin symptoms most patients have dry skin. Pruritius is the sine qua non of atopic dermatitis - "eczema is the itch that rashes. The constant scratching leads to a vicious cycle of itch --> scratch --> rash --> itch --> scrath.

Course and Prognosis
Untreated involved sites persists for months or years. Spontaneous, more or less complete remission during childhood occurs in >40% cases. In many patients, the disease persists for 15-20 years, but is less severe. From 30-50% of patients develop asthma or hay fever.

Management
Basic of allergic treatment is Avoidance.
It is important for someone with atopic disease, recognize the exacerbating factors and avoid thus factors.

Avoidance not only useful in prevention of atopy recurrence but also helpful in treatment since the stimulate factors is being removed or minimalized. In this case, with disturbing symptoms, atopic dermatitis will be treated with several drugs depends on severity and course of the disease.

Most of patients can't easily avoid the allergen since the allergen is around them, such as the pollen, dust mites. These patients will be helpful if given a pharmacotherapy compare to the patients that allergen is food, that can easily avoid.

When a patient is diagnosed atopic dermatitis, it would be better if patient undergo allergen identifying by patch skin test, thus will identify what kind of allergen that a person is sensitive, thus will be helpful in prevention.

Pruritus or itching is the most incomfortable symptoms of atopic dermatitis thus give impact to the quality of life and also as risk factors for skin infection from epithelial tear by scratching.

Rubbing and Scratching needs to be avoided in management of symptomatic atopic dermatitis. Topical antipruritic agents such as menthol is helpful in controlling the symptoms.

Another topical applicants that is important in atopic dermatitis is emoliens, in order to prevent skin dehidration, thus prevent the exacerbation.

Oral antihistamines can be used to reduced the pruritus and minimalized the scratching, in order to prevent the skin infection.

In some cases, with skin infection, topical antibiotic or oral antibiotic will be prescribed. Steroids usages in atopic dermatitis mostly topical, except in severe cases, because the side-effects of steroids such as osteoporosis, cataract, cushing syndrome and hyperglicemia.

For more explanation of atopic dermatitis and its treatment, someone can consult with the doctor and discuss about their conditions and modalities of the treatment.
Atopic dermatitis

Atopic disease maybe disturb someone daily activities, and impair their quality of life. But, it is a sign for someone with atopic to move to the another place that is better. Because, most of atopic patients can achieved remissions while they move from their previous place of living.

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Hygiene not always good for your health!

Introduction
Hygiene is being known for long time as basic prevention of infectious disease. I also agree with that, because lots of evidence related with that. Infection cases are higher in poor hygiene area.
So, where is the point of bad? The cost? or what?
hygiene


In to the Depth
Until know, it is still just a hypothesis about impact of hygiene of health. First, i have to explain about immune system because it's related. Our immune system main function is to protect against harmful things, whether it is a infectious agent, or maybe foreign body.
In our immune system, we know there is two kind of polarity, whether is TH1 or TH2, in simple words cellular mediated or humoral immunity.
What is the relation between hygiene and immune?
It's being hypothesize that hygiene condition make our immune system shift it's polarization to humoral. In simple words, hygiene make our soldier don't fight, so they become lack of knowledge of war.
The impact of this is a disease related to immune. That is an allergy. "Lack of knowledge of war" makes our immune missrecognized the "enemy" ( harmful things). They overreact to non-harmful stimulus. Allergy disease is cause not by the stimulus but by inflammatory reaction. Our immune system produce to many IgE that responsible for mast cell activation that will produce inflammatory effects.
Schematic

This is being known as hygiene hypothesis, you search in the literature about it.
That's why allergy more often seen in developed country than underdeveloped country

Choice to made
We want to have allergy or infection? Like the egg on edge.
Egg at the edge

Both of them, have own consequences. Infection maybe seems to be dangerous and cause more morbidity. But several infection provides protection from re- infection, not like allergy.
Asthma, allergic rhinitis, dermatitis allergy also brings impacts to quality of life.
From my point of view, our nature prefer middle path rather than extreme sides. It's not to avoid the diseases, but to assure the well living as human.

Related news
Based on hygiene hypothesis, one of allergy treatment modalities is "infects" the patient with the worms. Eventhough, the antibody is about same in worms infections (IgE) but the interaction (cytokine) is different and the cytokines in worms infections can suppressed the polarity to the allergy. But you should check the literature for that.

Thank you before
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References
1. Cotran, Kumar, Collins: Robbins Pathologic Basis of Disease, 1999.
2. Benjamin, E. Sunshine, G. Leskowitz, S.: Immunology A short Course, 1996.
3. Durham, SR. et al., Long-term clinical efficacy of grass-pollen immunotherapy. The New Eng J Med 1999; 341(7): 468-475.
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