Asthma
Asthma can be triggered. By exercise, allergen exposure, changes in
weather, and respiratory infection.
Guidelines. Treat underlying airway inflammation to control asthma and
reduce asthma-associated risks.
A key pathophysiological feature is airway hyperresponsiveness, which is an
exaggerated narrowing of the airway and response to a trigger or allergen
such as cold air, strong odors, pollen, or dust.
Chronic Asthma:
Asthma control considers the frequency and severity of sx
Use of short-acting B-Agonists SABA for quick relief
Asthma severity is determined by the level of treatment needed to achieve
control of asthma sx
Risk:
e Severe exacerbation
e Asthma-related death
¢ Progressive loss of lung function
¢ Reduced lung growth
¢ Drug-related adverse effects
Acute Asthma:
Wheezing, coughing, and shortness of breath increase.
Treatment/Desired Outcome
e Achieve good control of asthma symptoms. Maintain normal or near
normal pulmonary function.
e Maintain normal activity levels.
e So. Meets patients' and families expectations ofsatisfaction with
asthma care.
e Prevent exacerbations of asthma and the need of emergency
department visits or hospitalizations.
e Prevent progressive loss of lung function. Side optimal medications
with minimum or no adverse effects minimize the risk of asthma-
related death.
Nonpharmacologic Therapy:
,Smoking sensation.
If EIB uses Saba. Or ICS.formoterol 5-20 min prior to physical exercise
Occupational Exposure. The record shows when work-related exposures
and symptoms occur. When the bronchial dilator is needed. The peak
airflow at work versus home.
Ask about asthma before prescribing NSAIDs S. In stop if asthma worsens
after use. if
B blockers are indicated. Choose cardioselective agents such as atenolol
log. Asthma is not an absolute contraindication to B blockers use but
consider the risk versus benefits.
Pharmacologic Therapy
Treatment of chronic asthma involves avoidance of triggers and long-term
use of quick relief medications.
Long-term medications include ICS.
e Inhaled long-acting B agonist LABAS
e Oral leukotriene receptor antagonists (LTRAs)
e Inhaled long-acting muscarinic antagonist LAMA
e Biologic agents
yelooQUICK RELIEF:
¢ SABA
e ICS Formoterol
e Short-acting muscarinic antagonists (SAMAs)
e Short bursts of systemic corticosteroids
Maintenance medications.
¢ All adults and adolescents with persistent asthma should receive an
ICS containing treatment to control symptoms.
e It is recommended that the patient. With at least two symptoms. A day
each month the initiated on either daily
e low-dose ICS therapy along with a Saba as needed. Or low dose
ICS.formterol to use as needed
, e Corticosteroids are the most potent anti-inflammatory agent
available for asthma treatment. And is available inhaled, oral
or injectable. Improves respond to B agonist.
ICS are more effective than LtRA's in improving lung function and
preventing emergency department visits and hospitalizations due to asthma
exacerbations.
e ICS has a flat dose-response curve, and doubling the dose has a
limited additional effect on asthma control.
e Cigarette smoking decreases the response to ICS, and smokers
require higher doses. Of ICS. Two weeks of therapy is necessary to
see significant clinical effects. Long-term treatment may be necessary
to realize the full effects of airway inflammation.
Local adverse effects associated with ICS therapy include.
e Oral candida
¢ cough and dysphonia
The incidence of local adverse effects can be reduced by using a
metered dose inhaler with a spacer and having the patient rinse their mouth
with water.
. Decreasing. The dose reduces the incidence of hoarseness.
Systemic adverse effects such as adrenal suppression and decreased bone
mineral density may also occur with long-term high doses of ICS.
Growth suppression is a concern. However, final adult height is not thought
to be affected by ICs' use, but growth velocity is slightly reduced. In
children treated with low and medium doses, height after one year of
treatment decreases by less than 1 centimeter.
Risk of pneumonia. With a higher ICS dose. And adults.
Cushing syndrome. Adrenal insufficiency occurs when potent inhibitors of
CYP 3A4, such as ketoconazole, are administered with high doses of ICS
and it should be avoided whenever possible.
Systemic corticosteroids.
Prednisone, prednisolone, and Methylprednisolone should be considered a
last-line option for patients with severe uncontrolled asthma when all other
Asthma can be triggered. By exercise, allergen exposure, changes in
weather, and respiratory infection.
Guidelines. Treat underlying airway inflammation to control asthma and
reduce asthma-associated risks.
A key pathophysiological feature is airway hyperresponsiveness, which is an
exaggerated narrowing of the airway and response to a trigger or allergen
such as cold air, strong odors, pollen, or dust.
Chronic Asthma:
Asthma control considers the frequency and severity of sx
Use of short-acting B-Agonists SABA for quick relief
Asthma severity is determined by the level of treatment needed to achieve
control of asthma sx
Risk:
e Severe exacerbation
e Asthma-related death
¢ Progressive loss of lung function
¢ Reduced lung growth
¢ Drug-related adverse effects
Acute Asthma:
Wheezing, coughing, and shortness of breath increase.
Treatment/Desired Outcome
e Achieve good control of asthma symptoms. Maintain normal or near
normal pulmonary function.
e Maintain normal activity levels.
e So. Meets patients' and families expectations ofsatisfaction with
asthma care.
e Prevent exacerbations of asthma and the need of emergency
department visits or hospitalizations.
e Prevent progressive loss of lung function. Side optimal medications
with minimum or no adverse effects minimize the risk of asthma-
related death.
Nonpharmacologic Therapy:
,Smoking sensation.
If EIB uses Saba. Or ICS.formoterol 5-20 min prior to physical exercise
Occupational Exposure. The record shows when work-related exposures
and symptoms occur. When the bronchial dilator is needed. The peak
airflow at work versus home.
Ask about asthma before prescribing NSAIDs S. In stop if asthma worsens
after use. if
B blockers are indicated. Choose cardioselective agents such as atenolol
log. Asthma is not an absolute contraindication to B blockers use but
consider the risk versus benefits.
Pharmacologic Therapy
Treatment of chronic asthma involves avoidance of triggers and long-term
use of quick relief medications.
Long-term medications include ICS.
e Inhaled long-acting B agonist LABAS
e Oral leukotriene receptor antagonists (LTRAs)
e Inhaled long-acting muscarinic antagonist LAMA
e Biologic agents
yelooQUICK RELIEF:
¢ SABA
e ICS Formoterol
e Short-acting muscarinic antagonists (SAMAs)
e Short bursts of systemic corticosteroids
Maintenance medications.
¢ All adults and adolescents with persistent asthma should receive an
ICS containing treatment to control symptoms.
e It is recommended that the patient. With at least two symptoms. A day
each month the initiated on either daily
e low-dose ICS therapy along with a Saba as needed. Or low dose
ICS.formterol to use as needed
, e Corticosteroids are the most potent anti-inflammatory agent
available for asthma treatment. And is available inhaled, oral
or injectable. Improves respond to B agonist.
ICS are more effective than LtRA's in improving lung function and
preventing emergency department visits and hospitalizations due to asthma
exacerbations.
e ICS has a flat dose-response curve, and doubling the dose has a
limited additional effect on asthma control.
e Cigarette smoking decreases the response to ICS, and smokers
require higher doses. Of ICS. Two weeks of therapy is necessary to
see significant clinical effects. Long-term treatment may be necessary
to realize the full effects of airway inflammation.
Local adverse effects associated with ICS therapy include.
e Oral candida
¢ cough and dysphonia
The incidence of local adverse effects can be reduced by using a
metered dose inhaler with a spacer and having the patient rinse their mouth
with water.
. Decreasing. The dose reduces the incidence of hoarseness.
Systemic adverse effects such as adrenal suppression and decreased bone
mineral density may also occur with long-term high doses of ICS.
Growth suppression is a concern. However, final adult height is not thought
to be affected by ICs' use, but growth velocity is slightly reduced. In
children treated with low and medium doses, height after one year of
treatment decreases by less than 1 centimeter.
Risk of pneumonia. With a higher ICS dose. And adults.
Cushing syndrome. Adrenal insufficiency occurs when potent inhibitors of
CYP 3A4, such as ketoconazole, are administered with high doses of ICS
and it should be avoided whenever possible.
Systemic corticosteroids.
Prednisone, prednisolone, and Methylprednisolone should be considered a
last-line option for patients with severe uncontrolled asthma when all other
