1.  Approximately 20 million Americans have asthma  Nine million of these cases occurred in children under the age of 18  From 1980 to 1994, prevalence has increased by a 75%  Asthma prevalence in children under five has increased by over 160% during this same time period  Annually, asthma contributes to about 5,000 deaths 1

2.  “A common disorder in which chronic inflammation of the bronchial tubes (bronchi) makes them swell, narrowing the airways. Asthma involves only the bronchial tubes and does not affect the air sacs (alveoli) or the lung tissue (the parenchyma of the lung) itself.” 2  Three hallmark signs of asthma: a)Coughing b)Wheezing c)Dyspnea  The recurrent episodes that occur are due to airflow obstruction and are often reversible (spontaneously or with medication

3.  Includes 70-80% of asthmatics  Asthma symptoms occur exclusively at night  Common Causes:  Supine posture  GE reflux  Late phase reaction to antigens  Exposure to allergens in bedding (mites)  Fluctuations in airway caliber  Impaired mucociliary clearance

4.  A variety of changes in the airway are responsible for limiting the airway, all of which are influenced by airway inflammation:  Bronchoconstriction  Airway Hyperresponsivness  Airway Edema  Causes of airway reactivity:  Pharmacologic and Immunologic Stimuli  Physical Agents  Thermal Stimuli

5. a) Allergic  35-55% of asthmatic patients  Antigen antibody reaction  Animal dander, mites, cockroaches, mice b) Physical Exercise  Especially in cold weather  Usually short in duration c) Respiratory infection d) Occupational Stimuli  Animal handlers  Bakers  Platinum refiners  Wood and vegetable sources

6. e) Environment and air pollution  Cold weather  Ozone  NO 2 f) Pharmacologic  Aspirin  Tartrazine dye  Beta-Blockers  Sulfites  Contrast Media g) Psychological  Anxiety  Fear  Stress  Laughter

7.  Dyspnea, cough, wheezing  Chest tightness  Anxiety  Lungs hyperinflated  One word responses  Rapid pulse

8.  Prevent bothersome and chronic asthma symptoms  Reduce the use of the inhaled SABA to ≤2 days per week  Maintain normal pulmonary function  Maintain normal activity levels (work, school, exercise)  Meet both the patient’s and family members’ satisfaction with asthma care

9. 1) Eliminate any precipitating factors  Smoking, pets, clean sheets more often 2) Keep hydrated  Water, coffee 3) Avoid sedatives  Respiratory Function

10.  Classify patient based on severity:

11.  Use lowest level of treatment required to maintain asthma control :

12. MDI Products SABA: short-acting beta agonist Generic Name Brand Name(s)Dosage FormOnset of Action Duration of Action AlbuterolProventil HFA Ventolin HFA ProAir HFP 108mcg per actuation 5-15 min4-6 hrs EpinephrinePrimatene Mist Bronchial Mist 200mcg epinephrine per actuation 1-5 min1-3 hrs Levalbuterol HFA Xopenex HFA45mcg/puff10-17 min6-8 hours

13. MDI Products LABA: long-acting beta agonist Generic NameBrand NameDosage FormOnset of Action Duration of Action FormoterolForadil12mcg powder per capsule 1-3 min12 hrs Metaprotereno l Alupent650mcg per actuation 5-30 min2-6 hrs PirbuterolMaxair Autohaler 200mcg per actuation Within 5 min 5 hrs SalmeterolSerevent Diskus25 mcg per actuation Within 20 min 12 hrs

14. Theophylline Very narrow therapeutic window (5 to 15 mcg/ml) Available IV and PO Many drug interactions due to metabolism via CYP450’s Side Effects:  GI- nausea, vomiting, abdominal pain  CNS- nervousness, insomnia, headache  Cardiac-increased heart rate, ventricular tachycardia, and seizures Bottom line: not used anymore in asthma

15. Corticosteroids  Known as the “backbone” of asthma therapy  Downfall: side effects affect every organ  By-mouth therapy May be required at any step of therapy QOD therapy is usually ineffective Initial prednisone dose is 40-60mg/day then taper

16.  MDI Products

17.  1. see notes  2. asthma def. www.emedicinehealth.com