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A sthma is a variable disease characterized by periods of generally well-controlled asthma interspersed with worsenings and, if allowed to progress, more severe exacerbations. The current management of asthma focuses on achieving optimal asthma control through the use of recommended maintenance therapies such as inhaled corticosteroids (ICSs), leukotriene receptor antagonists (LTRAs), or ICS/ long-acting beta-2 agonist (LABA) combinations (1,2). Despite these treatments, asthma control remains suboptimal (3). Surveys of asthma patients have shown that the majority of those prescribed a combination ICS/LABA treatment or ICS therapy alone still experience periods of asthma worsenings requiring daily short-acting beta-2 agonist (SABA) therapy at least once per day, with high proportions reporting daytime symptoms, night-time awakenings and hospital admissions due to asthma (4-7). Furthermore, even those with well-controlled disease experience periods of asthma worsenings (4). A recent randomized trial of over 2000 asthma patients who had experienced an exacerbation in the previous year found that despite using moderate to high doses of combination ICS/LABA therapy, episodes of high reliever use on a single day were common and were often associated with a high subsequent risk of an exacerbation (8). AsthmA WorseninGs WorkinG Group©2008 Pulsus Group Inc. All rights reserved Most asthma patients prescribed maintenance asthma therapies still experience periods of asthma worsenings characterized by daytime or nighttime symptoms, or an increased need for rescue medication. In fact, these episodes are highly prevalent even in patients with well-controlled disease. Published literature suggests that asthma worsenings likely represent a window of opportunity during which patients could intervene early to prevent exacerbations or further deterioration of asthma symptoms. However, current evidence suggests that most patients fail to respond or to self-manage appropriately during these periods. To address the issue of asthma worsenings, an interdisciplinary committee of respirologists, allergists, family physicians, pharmacists and certified asthma educators from across Canada developed a practical definition of asthma worsenings and provided approaches to the prevention and management of these episodes based on current literature. To date, combination inhaled corticosteroid/long-acting beta-agonist therapy, particularly single inhaler maintenance and reliever therapy, appears to be an effective strategy for preventing asthma worsenings and exacerbations. Addressing the potential barriers to appropriate patient self-management of asthma worsenings, such as failure to adequately identify and respond to worsenings, low expectations for controlling asthma, low health literacy and poor patient-health care professional communication, are also critical to the successful prevention and management of these episodes. Finally, an interdisciplinary team approach involving patients and their families, certified asthma educators, primary c...

The formation of posterior pharyngeal pouches is generally attributed to dysfunction of the cricopharyngeal sphincter.

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Most asthma patients prescribed maintenance asthma therapies still experience periods of asthma worsenings characterized by daytime or night-time symptoms, or an increased need for rescue medication. In fact, these episodes are highly prevalent even in patients with well-controlled disease. Published literature suggests that asthma worsenings likely represent a window of opportunity during which patients could intervene early to prevent exacerbations or further deterioration of asthma symptoms. However, current evidence suggests that most patients fail to respond or to self-manage appropriately during these periods.To address the issue of asthma worsenings, an interdisciplinary committee of respirologists, allergists, family physicians, pharmacists and certified asthma educators from across Canada developed a practical definition of asthma worsenings and provided approaches to the prevention and management of these episodes based on current literature. To date, combination inhaled corticosteroid/long-acting beta-agonist therapy, particularly single inhaler maintenance and reliever therapy, appears to be an effective strategy for preventing asthma worsenings and exacerbations. Addressing the potential barriers to appropriate patient self-management of asthma worsenings, such as failure to adequately identify and respond to worsenings, low expectations for controlling asthma, low health literacy and poor patient-health care professional communication, are also critical to the successful prevention and management of these episodes. Finally, an interdisciplinary team approach involving patients and their families, certified asthma educators, primary care physicians, pharmacists and specialists is likely to have the greatest impact on the identification, prevention and management of asthma worsenings.

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a group of 7 Canadian experts in obesity, primary care, pharmacy, nutrition and consumer wellness convened to discuss the public health crisis of obesity and access to obesity treatment. The publication in 2007 of the Canadian clinical practice guidelines on the management and prevention of obesity in adults and children provides an important context for the panel's work. The objective of the panel of experts was to understand the current landscape of weight loss and weight management in Canada, and to identify the gaps and barriers that challenge Canadians attempting to achieve a therapeutic weight loss (5% to 10% body weight) to realize significant health benefi ts. Finally, the consensus panel was charged with making recommendations for improving access to evidence-based approaches for obesity self-management.