The Art of Paying Attention

Focusing, which implements the F in FUN, is a pivotal technique for paying attention — one that most of us have never been taught. When you Focus, you attend to asthma in a nonjudgmental way; you expand your awareness and acknowledge the personal beliefs in which your symptoms are rooted. Thus, you begin to notice that your beliefs, symptoms, and relationships are intimately connected, to one another as well as to the various circumstances of your life. Learning to Focus is an awakening process. It enables you to see how your Committee tries to undermine your authority at every moment. The allegory that follows mirrors the simplicity and importance of Focusing.

A man who had sacrificed much and worked hard traveled a great distance to meet a spiritual master from whom he hoped to learn the secret of life Kamagra Australia. Upon being introduced, though he was overwhelmed at being in the presence of this person, he finally gained the courage to ask his question.

“I have waited many years for this,” he explained, “and now that I am here there is one thing that I must know before I die: What is the secret of life?” The master was quiet for a moment and then said, “There are three things, not one. Listen closely, for I will not repeat myself. The first, is pay attention … The second, is pay attention … And the third is, pay attention.

If the man had come looking for anything complex or obscure, he was surely disappointed.

The secret the master shared was deceptively simple. Yet it tells us a great deal. It informs us of our need to stay awake despite the hypnotic distractions of everyday existence. As you begin to cultivate the art of paying attention through Focusing, you will learn the ancient technique of “concentrating without effort.” In this state of mind you suspend judgment and accept not knowing as normal rather than thinking of it as a character flaw. Thus, instead of immediately seeking the solution to the difficulty, when you Focus, you restrain your ego, become detached, and say “I don’t know,” without worrying about why not. But when it comes to dealing with asthma, not knowing the solution, feeling detached from the symptoms, and not worrying about the future are skills that most of us have not learned to cultivate.

BECOME A WATCHER

Becoming the Watcher can help you do this. The Watcher is accepting instead of judgmental, analytical, or self-conscious. The Watcher Focuses by forgoing control and trying to fix things. Thus, when you become the Watcher you begin to foster forgiveness of your shortcomings. You stop dwelling on things or jumping to conclusions. The ordinary, thinking mind steps aside, and you begin to watch, instead of judge, all that occurs, both on the inside and the outside. As the Watcher, you experience a sense of freedom, perhaps for the first time, from the physical symptoms of asthma and the difficulties experienced in everyday life. No shift or change is actively sought, although changes in thinking, feeling, and living usually occur as a natural consequence.

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Of the 49 studies, 23 were for grass pollen, nine for trees, five for Parietaria, two for ragweed, eight for house dust mite, one for cat, and one for mixed allergens (birch and grass). Overall, SLIT led to a significant reduction in symptoms (SMD, -0.49; 95% CI, -0.64 to -0.34) and medication use (SMD, -0.32; 95% CI, -0.43 to -0.21). Sophisticated subgroup analyses were also included to reveal greater efficacy for house dust mite (perennial allergens) than other seasonal allergens, including grass. A trend toward a greater reduction in symptom scores was noted with a longer duration ( > 12 months) of SLIT.

Another meta-analysis, exclusively in the pediatric population, included 10 studies, of which four were for house dust mites, three for grass mixes, one each for Parietaria and olive, and one for pollen mix Kamagra online. Overall, a significant decline in both symptoms (SMD, 0.56; 95% CI, -1.01 to -0.10) and rescue medication use (SMD, 0.76; 95% CI, -1.46 to -0.06) was found. In concordance with the previous meta-analysis, subgroup analyses also found a greater efficacy when SLIT was used for a longer duration ( > 18 months). Interestingly, and in contrast, subgroup analyses with this meta-analysis suggested that SLIT administered for pollen was more efficacious than for house dust mites (Table 4).

Long-term clinical efficacy has been reaffirmed by Durham in a study of SLIT for grass pollen-induced allergic rhinoconjunctivitis. Sustained clinical improvement and immunomodulatory changes were noted at 1 year after treatment. There remains a relative paucity of data for SLIT in animal allergy, although the few available studies with cat extracts have shown potential efficacy. SLIT for AR also has the potential to mitigate the inception of new sensitizations as documented by Marogna et al,4³ showing an incidence of 3.1% in the SLIT-treated patients vs 34.8% (P = .01) in control subjects at a 3-year follow-up.

An important caveat to bear in mind with the various meta-analyses published for SCIT and SLIT is the significant heterogeneity with regard to patient population, allergen extracts used, and disease outcomes measured.

The presence of publication bias also introduces an element of statistical heterogeneity into these meta-analyses. These limitations suggest a cautious interpretation of results when extending to all patient populations, allergens, and AR vs asthma.

See Table 1 and 3 legends for expansion of other abbreviations. (Reproduced with permission from Calderon)

The complexity of using SIT and interpreting its efficacy is particularly evident with the concept of single vs multiallergen extract use. In the United States, allergists favor using multiallergen extracts, with the hope of addressing all major sensitivities, whereas allergists in Europe recommend against this practice Avanafil Canada, citing the rationale that inclusion of multiple allergens could potentially lead to a dilution effect, such that an effective dose is not given and also that proteolytic action of one extract on another might lead to its degradation.

The combination of formoterol/budesonide has recently been approved in the United States for maintenance treatment of asthma. In patients receiving formoterol/ budesonide as maintenance therapy, the use of the combination for rescue therapy on an as-needed basis significantly reduced the exacerbation risk by 45 to 54% vs the use of a short-acting P2-agonist for rescue therapy in two different studies (p < 0.001). Use of the combination for both maintenance and rescue therapy was associated with improvements in lung function and in daytime and nighttime symptoms. In patients who were symptomatic while receiving formoterol/budesonide maintenance therapy, the use of the combination as rescue therapy significantly delayed the time to the first severe exacerbation compared to rescue therapy with formoterol or terbutaline (p = 0.0048). Over the course of the 1-year study, the rate of severe exacerbations with formoterol/budesonide rescue therapy was significantly decreased (vs formoterol: rate ratio, 0.67; 95% CI, 0.56 to 0.80; vs terbutaline: rate ratio, 0.52; 95% CI, 0.44 to 0.62).

Ciclesonide, a novel ICS that is currently in clinical development, is essentially inactive until it is activated by esterases in the lung by a steroid with potent local antiinflammatory activity. Thus, ciclesonide may allow targeted antiinflammatory activity in the lung, causing only minimal local or systemic side effects and, consequently, permitting the use of higher ICS doses. In patients with steroid-dependent asthma, administering ciclesonide, 640 or 1,280 mg/d, significantly reduced oral prednisone requirements by 47% and 63%, respectively; whereas, the oral steroid dose rose slightly in the group receiving placebo (p < 0.0003). After 12 weeks, prednisone therapy was discontinued in approximately 30% of patients receiving ciclesonide vs 11% of those receiving placebo (p < 0.04). The reductions in prednisone dose achieved with ciclesonide therapy were accompanied by improved FEV1 relative to therapy with placebo (p < 0.03) without increasing local or systemic side effects. Thus, ciclesonide may reduce the need for oral steroids in patients Kamagra online with severe asthma while maintaining asthma control.

Epidemiologic studies have shown that farmers are exposed to a variety of inhaled agents including inorganic/organic dust, micro-organisms, myco-toxins, endotoxins, pollens, mites, molds, animal danders, and pesticides. These exposures have been shown to give rise to a variety of respiratory disorders such as asthma, chronic bronchitis, hypersensitivity pneumonitis, and organic dust toxic syndrome.

Kogevinas et al, in a study on occupational asthma in Europe and other industrialized areas, have shown that farmers and agricultural workers were among the occupations with the highest risk of asthma.

The prevalence and the type of allergic respiratory disorders among agricultural populations differ due to the diversity of agricultural practices in different regions of the world. Respiratory disorders and allergy are well-documented in animal farmers but, there is a lack of data for allergic respiratory disorders in crop farmers. The European Farmers’ study suggested that flower growing is an important risk factor for asthma, whereas the cultivation of oil plants is associated with acute respiratory symptoms in European crop farmers. It has also been reported that the cultivation of flowers and/or ornamental plants inside greenhouses is related to occupational asthma through sensitization to flower allergens and workplace molds. There are few data regarding allergic respiratory disorders in grape farmers. Gamsky et al found that California grape farmers had lower FVC lung volumes compared to tomato and citrus farmers.

Grape farming is a traditional agricultural practice in Crete, one of the largest grape growing areas in Greece. The basic variety is “sultana” raisin, and the cultivation of grapes is focused on raisin production more than wine production. The farms are small in size, and the cultivation of grapes is in most cases a family enterprise. Grape farmers have no regular contact with livestock, and agricultural practices are restricted to grape cultivation. Cultivation is performed in the open field, starting in early spring and continuing until the end of September (the blossom period of most plants in Crete). The use Tadalafil Canada of pesticides and fertilizers in grape cultivation is a common everyday practice. The principal chemical agents used are herbicides to control weeds, fungicides to control fungus, and insecticides to control various insects.