Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. Chronic inflammation is associated with airway hyper-responsiveness, which leads to various airway symptoms. Approaches to asthma treatment have been changing because our knowledge about the pathogenesis and treatment of asthma is continually evolving. Until recently, the stepwise approach to the treatment of asthma was based on a patient's asthma severity. However, new international guidelines have recommended that treatment should be adjusted in a continuous cycle driven by the patient's asthma-control status. If asthma is not controlled on the current treatment regimen, treatment should be stepped up until control is achieved. When control is maintained for at least 3 months, treatment can be stepped down. Ongoing monitoring is essential to maintain control and to establish the lowest step and dose of treatment to minimize cost and maximize safety. However, the stepwise approach and recommended treatments are meant to assist, not replace, the clinical decision making necessary to determine the most appropriate treatment to meet the individual patient's needs and circumstances. This article is a review of the stepwise approach to the treatment of asthma recommended by the Global Initiative for Asthma 2009 and Expert Panel Report 3 of National Heart, Lung, and Blood Institute 2007.
Asthma ; Decision Making ; Inflammation ; National Heart, Lung, and Blood Institute (U.S.)

PURPOSE: It is now understood that blood pressure (BP) measurement in the routine pediatric examination is very important because of the relevance of childhood BP to pediatric health care and the development of adult essential hypertension. There hasn't been a reference table of BP for Korean children and adolescents up to now. This study was to make normative BP references and to provide criteria of hypertension for Korean children and adolescents. METHODS: BP measurements were done on 57,433 Koean children and adolescents (male: 29,443, female: 27,990), paged 7 to 20 years, in 2005. Heights and weights were measured simultaneously. Oscillometric devices, Dinamap Procare 200 (GE Inc., Milwaukee, Wi, USA), were used for the measurements. BPs were measured 2 times and mean levels were gathered for the analysis. Outliers of 2,373 subjects with overweight per height, over +3SD, were excluded for the analysis. For the BP centiles adjusted by sex, age and height, fixed modified LMS method which was adopted from the mixed effect model of 2004 Task Force in NHLBI (USA) was used. RESULTS: Normative BP tables for Korean children and adolescents adjusted for height percentiles (5th, 10th, 25th, 50th, 75th, 90th, 95th), gender (male, female) and age(7 to 18 years) were completed. Height centiles of Korean children and adolescents are available from Korean Center for Disease Control and Prevention homepage, http://www.cdc.go.kr/webcdc/. Criteria of hypertension (95th, 99th percentile) and normal range of BP (50th, 90th) adjusted for height percentiles, age and gender were made. CONCLUSION: This is the first study to make normative BP tables and define hypertension for the Korean children and adolescents. Reliability and accuracy of Dinamap Procare 200 oscillometer for BP measurements remains debatable.
Adolescent ; Adult ; Advisory Committees ; Blood Pressure ; Centers for Disease Control and Prevention (U.S.) ; Child ; Delivery of Health Care ; Humans ; Hypertension ; National Heart, Lung, and Blood Institute (U.S.) ; Overweight ; Reference Values ; Weights and Measures

Obesity is a major contributor to many chronic diseases and a risk factor for cardiovascular disease. It is also associated with increased risk of all-cause and cardiovascular disease (CVD) mortality. Toward the goals of the American College of Cardiology (ACC) and American Heart Association (AHA) for preventing CVD and promoting cardiovascular health, the ACC and AHA have collaborated with the National Heart, Lung, and Blood Institute and professional organizations to develop the "2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults". The 2013 guideline is the second edition of the 'Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: the Evidence Report' published in 1998. The new guideline maintains its focus on primary care practitioners (PCPs) and their patients in an effort to manage obesity more effectively and to reduce cardiovascular risk. The new guideline limits its scope by using five critical questions (CQs) and provides a summary of evidence-based recommendations and a treatment algorithm derived from the five CQs. The five CQs deal with the risks of overweight and obesity and the benefits of weight loss, and evaluate the following three treatment areas: diet, behavioral therapy, and surgical therapy. The recommendations and treatment algorithm serve as a guide for PCPs in the evaluation, prevention, and management of being overweight and obesity.
Adult ; American Heart Association ; Cardiology ; Cardiovascular Diseases ; Chronic Disease ; Diet ; Humans ; Mortality ; National Heart, Lung, and Blood Institute (U.S.) ; Obesity* ; Overweight* ; Primary Health Care ; Risk Factors ; Societies ; Weight Loss

Cardiovascular disease (CVD) is a leading cause of death worldwide including Korea. The risk factors of CVD are known as positive family history of early CVD, obesity, hypertension, diabetes, and dyslipidemia. Among those, dyslipidemia is one of modifiable risk factors. Dyslipidemia starts in childhood and progress to adulthood. Furthermore, dyslipidemia cause atherosclerosis and is closely related to other CVD risks. On the rationale that early identification and control of pediatric dyslipidemia will reduce the risk and severity of CVD in adulthood, the National Heart, Lung, and Blood Institute guidelines expanded to universal screening for lipid levels. However, there was no guideline for lipid screening and management in Korean children and adolescents yet. This review deals with the rationale of early identification and control of pediatric dyslipidemia along with the current Korean status of pediatric dyslipidemia. This review also deals with how to screen, diagnosis, and treatment of pediatric dyslipidemia.
Adolescent ; Atherosclerosis ; Cardiovascular Diseases ; Cause of Death ; Child ; Collodion ; Dyslipidemias ; Humans ; Hypertension ; Korea ; Mass Screening ; National Heart, Lung, and Blood Institute (U.S.) ; Obesity ; Risk Factors

BACKGROUND: Many studies have reported that high intraocular pressure (IOP), a well-known risk factor for glaucoma and especially primary open angle glaucoma, is associated with age, sex, hypertension, diabetes mellitus and obesity. We investigated the association between IOP and metabolic syndrome (MS). METHODS: We measured IOP and MS components according to the National Cholesterol Education Program Adult Treatment Panel III and the American Heart Association and the National Heart, Lung, and Blood Institute with modified guideline for waist circumference. High IOP was defined as > or =21 mmHg in one or both eyes. RESULTS: Looking at the components of MS in men, those with high blood pressure (BP) had significantly higher IOP. In regression analysis, fasting glucose, triglyceride, systolic BP and diastolic BP were positively, and age was negatively associated with IOP. In women, those with high fasting glucose and BP had significantly higher IOP. In regression analysis, diastolic BP, systolic BP, fasting glucose, body mass index and triglyceride were positively associated with left IOP while diastolic BP, fasting glucose and triglyceride were positively associated with right IOP. There were significantly increasing odds ratios for high IOP according to the number of components of MS. CONCLUSIONS: These findings suggest that MS and its components are significantly associated with IOP.
Adult ; American Heart Association ; Blood Glucose ; Blood Pressure ; Body Mass Index ; Cholesterol ; Diabetes Mellitus ; Fasting ; Female ; Glaucoma ; Glaucoma, Open-Angle ; Glucose ; Humans ; Hypertension ; Intraocular Pressure ; Male ; National Heart, Lung, and Blood Institute (U.S.) ; Obesity ; Odds Ratio ; Risk Factors ; Waist Circumference

Cardiovascular disease is one of the most frequent causes of death in both males and females throughout the world. However, women exhibit a greater symptom burden, more functional disability, and a higher prevalence of nonobstructive coronary artery disease (CAD) compared to men when evaluated for signs and symptoms of myocardial ischemia. This paradoxical sex difference appears to be linked to a sex-specific pathophysiology of myocardial ischemia including coronary microvascular dysfunction, a component of the 'Yentl Syndrome'. Accordingly, the term ischemic heart disease (IHD) is more appropriate for a discussion specific to women rather than CAD or coronary heart disease. Following the National Heart, Lung, and Blood Institute Heart Truth/American Heart Association, Women's Ischemia Syndrome Evaluation and guideline campaigns, the cardiovascular mortality in women has been decreased, although significant gender gaps in clinical outcomes still exist. Women less likely undergo testing, yet guidelines indicate that symptomatic women at intermediate to high IHD risk should have further test (e.g. exercise treadmill test or stress imaging) for myocardial ischemia and prognosis. Further, women have suboptimal use of evidence-based guideline therapies compared with men with and without obstructive CAD. Anti-anginal and anti-atherosclerotic strategies are effective for symptom and ischemia management in women with evidence of ischemia and nonobstructive CAD, although more female-specific study is needed. IHD guidelines are not "cardiac catheterization" based but related to evidence of "myocardial ischemia and angina". A simplified approach to IHD management with ABCs (aspirin, angiotensin-converting enzyme inhibitors/angiotensin-renin blockers, beta blockers, cholesterol management and statin) should be used and can help to increases adherence to guidelines.
Cardiovascular Diseases ; Cause of Death ; Cholesterol ; Coronary Artery Disease ; Coronary Disease ; Diagnosis* ; Exercise Test ; Female ; Heart ; Humans ; Ischemia ; Male ; Microvascular Angina ; Mortality ; Myocardial Ischemia* ; National Heart, Lung, and Blood Institute (U.S.) ; Prevalence ; Prognosis ; Sex Characteristics

Cardiovascular disease is one of the most frequent causes of death in both males and females throughout the world. However, women exhibit a greater symptom burden, more functional disability, and a higher prevalence of nonobstructive coronary artery disease (CAD) compared to men when evaluated for signs and symptoms of myocardial ischemia. This paradoxical sex difference appears to be linked to a sex-specific pathophysiology of myocardial ischemia including coronary microvascular dysfunction, a component of the 'Yentl Syndrome'. Accordingly, the term ischemic heart disease (IHD) is more appropriate for a discussion specific to women rather than CAD or coronary heart disease. Following the National Heart, Lung, and Blood Institute Heart Truth/American Heart Association, Women's Ischemia Syndrome Evaluation and guideline campaigns, the cardiovascular mortality in women has been decreased, although significant gender gaps in clinical outcomes still exist. Women less likely undergo testing, yet guidelines indicate that symptomatic women at intermediate to high IHD risk should have further test (e.g. exercise treadmill test or stress imaging) for myocardial ischemia and prognosis. Further, women have suboptimal use of evidence-based guideline therapies compared with men with and without obstructive CAD. Anti-anginal and anti-atherosclerotic strategies are effective for symptom and ischemia management in women with evidence of ischemia and nonobstructive CAD, although more female-specific study is needed. IHD guidelines are not "cardiac catheterization" based but related to evidence of "myocardial ischemia and angina". A simplified approach to IHD management with ABCs (aspirin, angiotensin-converting enzyme inhibitors/angiotensin-renin blockers, beta blockers, cholesterol management and statin) should be used and can help to increases adherence to guidelines.
Cardiovascular Diseases ; Cause of Death ; Cholesterol ; Coronary Artery Disease ; Coronary Disease ; Diagnosis* ; Exercise Test ; Female ; Heart ; Humans ; Ischemia ; Male ; Microvascular Angina ; Mortality ; Myocardial Ischemia* ; National Heart, Lung, and Blood Institute (U.S.) ; Prevalence ; Prognosis ; Sex Characteristics

Two major definitions of metabolic syndrome have been proposed. One focuses on the accumulation of risk factors, a measure used by the American Heart Association (AHA) and the National Heart, Lung, and Blood Institute (NHLBI); the other focuses on abdominal obesity, a measure used by the International Diabetes Federation (IDF) and the Japanese government. The latter definition takes waist circumference (WC) into consideration as an obligatory component, whereas the former does not. In 2009, the IDF, NHLBI, AHA, and other organizations attempted to unify these criteria; as a result, WC is no longer an obligatory component of those systems, while it remains obligatory in the Japanese criteria. In 2008, a new Japanese cardiovascular screening and education system focused on metabolic syndrome was launched. People undergoing screening are classified into three groups according to the presence of abdominal obesity and the number of metabolic risk factors, and receive health educational support from insurers. This system has yielded several beneficial outcomes: the visibility of metabolic syndrome at the population level has drastically improved; preventive measures have been directed toward metabolic syndrome, which is expected to become more prevalent in future generations; and a post-screening education system has been established. However, several problems with the current system have been identified and are under debate. In this review, we discuss topics related to metabolic syndrome, including (1) the Japanese criteria for metabolic syndrome; (2) metabolic syndrome and the universal health screening and education system; and (3) recent debates about Japanese criteria for metabolic syndrome.
American Heart Association ; Asian Continental Ancestry Group ; Education* ; Health Education ; Humans ; Insurance Carriers ; Japan* ; Mass Screening* ; Metabolic Syndrome X ; National Heart, Lung, and Blood Institute (U.S.) ; Obesity, Abdominal ; Risk Factors ; Social Responsibility ; Waist Circumference

Two major definitions of metabolic syndrome have been proposed. One focuses on the accumulation of risk factors, a measure used by the American Heart Association (AHA) and the National Heart, Lung, and Blood Institute (NHLBI); the other focuses on abdominal obesity, a measure used by the International Diabetes Federation (IDF) and the Japanese government. The latter definition takes waist circumference (WC) into consideration as an obligatory component, whereas the former does not. In 2009, the IDF, NHLBI, AHA, and other organizations attempted to unify these criteria; as a result, WC is no longer an obligatory component of those systems, while it remains obligatory in the Japanese criteria. In 2008, a new Japanese cardiovascular screening and education system focused on metabolic syndrome was launched. People undergoing screening are classified into three groups according to the presence of abdominal obesity and the number of metabolic risk factors, and receive health educational support from insurers. This system has yielded several beneficial outcomes: the visibility of metabolic syndrome at the population level has drastically improved; preventive measures have been directed toward metabolic syndrome, which is expected to become more prevalent in future generations; and a post-screening education system has been established. However, several problems with the current system have been identified and are under debate. In this review, we discuss topics related to metabolic syndrome, including (1) the Japanese criteria for metabolic syndrome; (2) metabolic syndrome and the universal health screening and education system; and (3) recent debates about Japanese criteria for metabolic syndrome.
American Heart Association ; Asian Continental Ancestry Group ; Education ; Health Education ; Humans ; Insurance Carriers ; Japan ; Mass Screening ; Metabolic Syndrome X ; National Heart, Lung, and Blood Institute (U.S.) ; Obesity, Abdominal ; Risk Factors ; Social Responsibility ; Waist Circumference

BACKGROUND: Aging and obesity are both positive determinants of chronic disease in the elderly. This study was done to examine the relationship between obesity and functional status and, to examine the relationship between comorbidity and the different levels of BMI among older Koreans. METHODS: A total of 920 community dwelling women and men who completed both the home questionnaire and medical examination that was conducted in 1998 were chosen as subjects. The proportion of subjects with prevalence of obesity-related diseases and functional limitation by NHLBI classifications was determined. Risks for functional limitation associated with comorbidity of obesity-related diseases and fat distribution were examined using multivariate adjusted logistic regression methods. RESULTS: Among 920 subjects studied, 91% were functionally independent. The underweight were one in ten and the overweight were one in four. The overall prevalence of functional limitation in a major activity among underweight was one in ten, but that of overweight or over was one in two. After multivariate adjustment, significant predictors for functional limitation in ADLs and IADLs were vision and hearing impairment, unemployed occupational status, depression, living with spouse, and a history of stroke. Though not significantly shown in the statistics, comorbidity (>or=3) of six obesity-related diseases had odds of 5.4 times and in obese elderly women the odds were 7.9 times. CONCLUSION: We suggest that there is a positive trend between overweight and functional limitation. Although there is no statistical significance, obesity in older Korean women had higher odds for functional limitation in ADLs and IADLs.
Activities of Daily Living ; Aged* ; Aging ; Chronic Disease ; Classification ; Comorbidity ; Cross-Sectional Studies ; Depression ; Employment ; Female ; Hearing Loss ; Humans ; Logistic Models ; Male ; National Heart, Lung, and Blood Institute (U.S.) ; Nutrition Surveys* ; Obesity* ; Overweight ; Prevalence ; Spouses ; Stroke ; Thinness ; Surveys and Questionnaires