PHCP312 Asthma,A.R.,COPD W1

• Asthma is a chronic allergic disorder characterized by episodes of severe breathing difficulty, coughing, and wheezing, which are usually reversible.
• Omega-3 fatty acids, which are found in fish, flaxseed, and other foods, may reduce the inflammation that leads to asthma symptoms.
• Herbal remedies such as butterbur, Indian frankincense, and Pycnogenol may help improve asthma symptoms.
• The late phase inflammatory reaction in asthma occurs 6-9 hours after allergen provocation and involves the activation of eosinophils, T lymphocytes, basophils, neutrophils and macrophages.
• Eosinophils migrate to the airways and release inflammatory mediators (leukotrienes and granule proteins), cytotoxic mediators and cytokines.
• T-lymphocytes release cytokines from type 2 T-helper cells that mediate allergic inflammation (IL-4, IL-5 and IL-13).
• Type 1 - T-helper produces IL-2 and Interferon gamma that are essential for cellular defense mechanism.
• Mast cells degranulate and release histamine, eosinophil and neutrophil chemotactic factors, leukotriene C4, D4 and E4, prostaglandin and platelet activating factors.
• Histamine is capable of inducing smooth muscle constriction and bronchospasm and may play a role in mucosal edema and mucus secretion.
• Alveolar macrophages release a number of inflammatory mediators including PAF and leukotrienes B4, C4 and D4.
• Bronchial epithelial cells release eicosanoids, peptidases, matrix proteins, cytokines and nitric oxide.
• Clinical presentation of chronic asthma is characterized by episodic dyspnea with wheezing, coughing particularly at night, and these often occur during exercise.
• Clinical presentation of severe acute asthma includes progression to acute state with inflammation, airway edema, excessive mucus accumulation, and severe bronchospasm.
• Diagnosis of asthma is made through history of recurrent episodes of coughing, wheezing and chest tightness, spirometry, and family history.
• Mast cell stabilizers inhibit acute responses to cold air, exercise, and sulfur dioxide.
• Corticosteroids are administered to replace deficient endogenous hormones.
• 5-lipoxygenase inhibitors act on leukotrienes.
• Monoclonal antibody is indicated for moderate-to-severe persistent asthma in patients who react to perennial allergens, in whom symptoms are not controlled by inhaled corticosteroids.
• Beta2 agonists relieve reversible bronchospasm by relaxing the smooth muscles of the bronchi and act as bronchodilators.
• Leukotriene receptor antagonists are either 5-lipoxygenase inhibitors or leukotriene-receptor antagonists.
• Long-acting bronchodilators are used for the preventive treatment of nocturnal asthma or exercise-induced asthmatic symptoms.
• Steroids are the most potent anti-inflammatory agents.
• Mast cell stabilizers stabilize the mast cell membrane, and inhibit the activation and release of mediators from eosinophils and epithelial cells. Example: Cromolyn sodium (Intal)
• Other controller options include leukotriene receptor antagonists (LTRA), theophylline, and as-needed short-acting beta2-agonist (SABA).
• In healthy adults, the preferred controller choice is low dose ICS.
• Anticholinergic agents such as ipratropium may be added to beta2-agonist therapy for acute exacerbations.
• Methylxanthines are used for long-term control and prevention of symptoms, especially nocturnal symptoms.
• Beta2-agonist/corticosteroid combinations may decrease asthma exacerbations when inhaled short-acting beta2 agonists and corticosteroids have failed.
• Patients should avoid triggers such as using an air conditioner, decontaminating decor, preventing mold spores, reducing pet dander, cleaning regularly, and covering the nose and mouth if it's cold out.
• For patients prescribed BDP/formoterol or BUD/formoterol maintenance and reliever therapy, tiotropium is indicated as add-on treatment.
• FEV1/FVC (FEV1%): The ratio of FEV1 to FVC
• Peak Expiratory flow and FEV1 are less than 50% of normal predicted values
• Factors that increase chances of developing asthma: Having a blood relative with asthma, having another allergic condition, being overweight, being a smoker, exposure to secondhand smoke, having a mother who smoked while pregnant, exposure to exhaust fumes or other types of pollution, exposure to occupational triggers, exposure to allergens, exposure to certain germs or parasites, having some types of bacterial or viral infection
• Decreased level of arterial oxygenation and O2 saturation
• History of previous asthma exacerbations
• Forced expiratory volume in one second with reversibility after bronchodilators (at least 12% improvement)
• Allergens: Allergic reactions to some foods, respiratory infections, physical activity, air pollutants and irritants, certain medications, strong emotions and stress, preservatives, gastroesophageal reflux disease (GERD), airborne allergens
• Types of asthma: Exercise-induced asthma, occupational asthma, allergy-induced asthma
• Baseline spirometry is normal
• Diagnosis: Acute Severe Asthma