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symptoms of asthma 4
- cough
- SOB
- chest tightness
- wheezing
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demographics of asthma
- common disorder in < 18 age group
- boys > girls
- after puberty girls > boys
- #1 reason for absence from work and school
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most important player in the immune function in the airway
T-lymphocytes
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cytotoxic cells of T-lymphocytes
CD8 Tc
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helper cells of T-lymphocytes
CD4 Th
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what do TH1 cells respond to
infections
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what do TH2 cell mediate
allergic inflammation
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4 steps of the pathogenesis of asthma
- bronchoconstriction
- airway edema
- airway hyperresponsiveness
- airway remodeling
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3 contributors to acute bronchoconstriction
exacerbations
- IgE-dependent release of mediators
- aspirin or NSAIDS - jack up the LOX path
- exercise, cold air, stress
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what is used as a testing method for airway hyperresponsiveness
methacholine - contractile response
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3 main causes of asthma
- innate immunity
- genetic factors
- environmental
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3 points of early asthmatic response
- peaks at 10-20 min
- 1.5-3h duration
- reversed by b-agonist
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3 keys to late asthmatic response
- peaks 4-8h after acute response
- lasts several days
- b-agonists not so effective
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what criteria is used for initiating therapy
severity
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what criteria is used for monitoring therapy
control
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at what step of asthma management do you add a LABA
3
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at what step of asthma managment do you add an oral corticosteroid
6
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components of intermttent severity 5
- symptoms - <2 days/wk
- nighttime awakenings - <2x/month
- SABA for symptom control - <2days/wk
- interference with normal activity - none
- lung function - normal
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components of mild asthma severity 4
- symptoms - >2days/wk but not daily
- nighttime awakenings - 3-4X month
- SABA for sym. control - >2d/wk, but not daily or more than once a day
- interfer with normal activity - minor irritation
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components of moderate asthma severity 4
- symptoms - daily
- nighttime awakenings - >1/wk not nightly
- SABA for sym. - daily
- interfer with norm activity - some irritation
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components of severe asthma severity 4
- symptoms - throughout the day
- nighttime awakening - often 7x/wk
- SABA for sym. - several times/day
- interfer with norm activ - extremely limiting
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preferred therapy for steps 1-6 of asthma
- 1. SABA PRN
- 2. low dose ICS
- 3. low dose ICS + LABA
- 4. medium dose ICS + LABA
- 5. high dose ICS + LABA
- 6. high dose ICS + LABA + oral corticosteroid
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3 quick acting b2-selective adrenergic agonists
- albuterol - ventolin, proventil
- levalbuterol - xopenex
- pirbuterol - maxair
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which b2 agonist is not recommended for PRN use and is more for COPD
ipratropium
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LABA
potent bronchodilator
sustained activity > 12h
onset 10-20 min
salmeterol - serevent diskus
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LABA
potent bronchodilator
onset 5 min
formoterol - foradil
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BBW of LABA 4
- not to be taken long term (unless uncontrollable)
- never used alone, used w/ controller meds
- use shortest duraton to achieve control
- these don't apply for COPD
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polymorphism affects of LABA's
- gly/gly - same w/ or w/o LABA
- arg/arg - stop LABA improved asthma
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moa - inhibits mast cell degranulaton
prophylactic - exercise and antigen asthma, chronic asthma
does not treat ongoing bronchoconstriction
nasal or eye drops
useful for allergic rhinoconjunctivitis
- cromolyn sodium - intal
- nedocromil sodium - tilade
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moa - competitive cysteinyl leukotriene-receptor antagonist
onset hrs
max effect - few days
ind - systemic eosinophilia and vasculitis
- montelukast - singulair
- zafirlukast - accolate
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moa - inhibits production of the cysteinyl leukotrienes by inhibiting 5-lipoxygenase
extended release
monitor hepatic function - chemical hepatitis
zileuton
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methyxanthines
theophylline
aminophylline
not recommended
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anticholinergic
slower and less intense bronchodilation
use only in pts resistant to LABA or emergency situations (status asthmaticus)
ipratropium bromide - atrovent
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ind - moderate and severe persistent asthma when no other drugs work
use when IgE levels are elevated
> 12 yo
moa - binds to IgE preventing binding to the mast cells
omalizumab - xolair
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