Bronchial Asthma: Definition,Pathophysiology and ManagementMarko Makram
Definition and Pathophysiology of Asthma in addition to classification and recent updates in the management of asthma based on GINA-2019 Guidelines, by Dr. Marco Makram.
Definition and introduction to bronchial asthma - classification of bronchial asthma - pathophysiology and risk factors for bronchial asthma - diagnosis of bronchial asthma - clinical manifestations - investigations - management of bronchial asthma
Bronchial Asthma: Definition,Pathophysiology and ManagementMarko Makram
Definition and Pathophysiology of Asthma in addition to classification and recent updates in the management of asthma based on GINA-2019 Guidelines, by Dr. Marco Makram.
Definition and introduction to bronchial asthma - classification of bronchial asthma - pathophysiology and risk factors for bronchial asthma - diagnosis of bronchial asthma - clinical manifestations - investigations - management of bronchial asthma
Hello members...this is my 39th powerpoint...
It deals with LABA & SABA...The brochodilators used in the treatment of Pulmonary diseases like Asthma & COPD.
It gives a short insight into the drugs used, their indications with dosages, ADRs, interactions, etc.
Worthwhile for a precise information on the same!!
Happy reading!!!
:) :)
Asthma vs COPD - A quick summary of the differences between themLGM Pharma
Asthma is a lung disease that affects almost 20 million Americans. COPD, or chronic obstructive pulmonary disease is a chronic lung disease that afflicts 24 million patients in the U.S. COPD is mainly caused by smoking or secondhand smoke, while asthma can by caused by exposure to allergens, dust and air pollutants. Innovative treatments are needed to combat both asthma and COPD, and LGM Pharma provides quality API's for the R&D needs of clients seeking treatments for these lung diseases.
Asthma is a condition in which your airways narrow and swell and produce extra mucus. This can make breathing difficult and trigger coughing, wheezing and shortness of breath. For some people, asthma is a minor nuisance.
Hello members...this is my 39th powerpoint...
It deals with LABA & SABA...The brochodilators used in the treatment of Pulmonary diseases like Asthma & COPD.
It gives a short insight into the drugs used, their indications with dosages, ADRs, interactions, etc.
Worthwhile for a precise information on the same!!
Happy reading!!!
:) :)
Asthma vs COPD - A quick summary of the differences between themLGM Pharma
Asthma is a lung disease that affects almost 20 million Americans. COPD, or chronic obstructive pulmonary disease is a chronic lung disease that afflicts 24 million patients in the U.S. COPD is mainly caused by smoking or secondhand smoke, while asthma can by caused by exposure to allergens, dust and air pollutants. Innovative treatments are needed to combat both asthma and COPD, and LGM Pharma provides quality API's for the R&D needs of clients seeking treatments for these lung diseases.
Asthma is a condition in which your airways narrow and swell and produce extra mucus. This can make breathing difficult and trigger coughing, wheezing and shortness of breath. For some people, asthma is a minor nuisance.
Declaration de Politique Générale du Premier Ministre Nomme Jack Guy LafontantStanleylucas
Ce document a 42 pages et comprend sept chapitres. Plus de vingt trois thèmes sont abordes dans les domaines économiques, politiques, sociaux et culturels. Le chapitre sept couvre les voies et moyens. Bonne lecture
Comprando os produtos ELFO você está adquirindo qualidade, proteção e segurança no uso do smartphone. Nossos acessórios tem ampla compatibilidade e garantia de um ano contra defeitos de fabricação. São entregues em embalagens próprias, com design planejado que instrui sobre o uso correto e apresenta as possibilidades de cada acessório além de promover uma boa exposição dos produtos em sua loja.
Chronic Obstructive Pulmonary Disease basis of drugs used in treatment and Describe the factors which affect the quality of life of individuals suffering from COPD
ASTHMA etiology, risk factors, pathophysiology and it's managementPoovarasanA5
Asthma is a common disease which we come across all over the world, certain factors helps to avoid and try to improve livelihood by changing life style modifications
Bronchial asthma for pharnacy student.pptxmekulecture
Under normal conditions, only approximately 1 mL of the 125 mL of glomerular filtrate that is formed each minute is excreted in the urine.
The other 124 mL is reabsorbed in the tubules.
This means that the average output of urine is approximately 60 mL/hour… approximately 1.5L urine per day.
pharmacothrapy of asthma.pptxBronchial asthma is a chronic respiratory diseas...AbhishekKumarGupta86
pharmacotherpy of asthma M pharm 2nd sem.
Bronchial asthma is a chronic respiratory disease characterized by inflammation and narrowing of airways in the lungs, which cause difficulty in breathing.
Symptoms can include coughing, wheezing, shortness of breath and chest tightness. These symptoms can be mild or severe and can come and go over time.
Although asthma can be a serious condition, it can be managed with the right treatment.
Asthma affected an estimated 262 million people in 2019 (1) and caused 455 000 deaths.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
4. Asthma, irrespective of the severity, is
a chronic inflammatory disorder of the airways.
Airway inflammation is associated with:
● Airway hyperresponsiveness
● Airflow limitation
● Respiratory symptoms.
Definition of AsthmaDefinition of Asthma
6. 6
o …… in susceptible individuals, inflammatory symptoms
are usually associated with widespread but variable
airflow obstruction and an increase in airway response
to a variety of stimuli.
o Obstruction is often reversible, either spontaneously
or with treatment.
Asthma definition
8. 8
• Inflammation in asthma patients can be
present during symptom-free periods:
o Symptoms resolve quickly. Inflammation, however, as
measured by airway hyperresponsiveness, takes far
longer time .
o As chronic inflammation causes an increase in airway
hyperresponsiveness, if the inflammation is not
controlled, symptoms are likely to reoccur.
9. 9
Can asthma be cured?
Asthma is an eminently controllable illness. Indeed, for
most sufferers, control is so effective that it amounts to
a virtual cure. But asthma is not curable
Asthma is a long-term disease that has no cure.
The goal of asthma treatment is to control the
disease.
10. 10
Aim of management
Aim of asthma management is to control the disease
Complete Control is defined as
1. No daytime symptoms
2. No night-time awakening due to asthma
3. No need for rescue medication
4. No asthma attacks
5. No limitations on activity including exercise
6. Normal lung function (in practical terms FEV1 and/or
PEF>80% predicted or best)
7. Minimal side effects from medication.
11. 11
Underlying principles of management
•Before initiating drug
treatment check
– Compliance with
existing treatment
– Inhaler technique
– Eliminate trigger factors
24. 24
• The following medicines act as short-acting
bronchodilators:
Inhaled short-acting β 2
agonists
Inhaled ipratropium bromide
β 2
agonist tablets or syrup
Theophyllines.
• Inhaled SABA works more quickly and/or with
fewer side effects than the alternatives
30. 30
Salbutamol is the commonly used inhaled bronchodilator
therapy .
It is a short- acting ß-2 agonist, has a rapid onset of action
(within five minutes) and usually provides 4–6 hours of
bronchodilation.
It should be used as a reliever therapy and is in the first
step of all guidelines on asthma management.
31. 31
The use of short-acting inhaled beta2-agonists
on a daily basis, or increasing use, indicates
the need for additional long term control
therapy.
33. 33
Oral preparations of beta2 agonists have been used
extensively in the past with children but are less
effective than inhaled preparations and have
more side-effects
34. 34
The use of albuterol syrup has fallen out of favor over
the past decade with the advent of better modalities of
targeted, inhaled delivery systems (e.g., MDI with
spacer/holding chamber, nebulizer solution).
• AAAAI Guidelines (2004, p88) prefer inhaled
beta2-agonists to oral because higher
concentrations are delivered more effectively to
the airways, the onset of action is substantially
shorter, and systemic side effects can be
avoided or minimized.
• Authors concluded lack of updated information was a possible reason that
community-based PCPs continued to prescribe syrup.
Special Consideration – Albuterol
Syrup
35. 35
It is important that while reviewing a patient with
asthma, the practitioner establishes how often the
patient needs the reliever therapy.
Need for frequent bronchodilator therapy, especially for
interval symptoms such as exercise intolerance or night
coughs, may indicate escalation of therapy .
36. 36
Increasing use of SABA treatment or the use of SABA >
3 doses a week for symptom relief (not prevention of
EIB) generally indicates inadequate asthma control and
the need for initiating or intensifying anti-inflammatory
therapy.
Regularly scheduled, daily, chronic use of SABA
is not recommended.
38. 38
Good asthma control is associated with little or no
need for short-acting β2
agonist.
Anyone prescribed more than one short acting bronchodilator
inhaler device a month should be identified and have their
asthma assessed urgently and measures taken to improve
asthma control if this is poor.
41. 41
• Inhaled corticosteroids are the recommended
& most effective preventer drug for adults
and children with asthma , for achieving overall
treatment goals.
42. 42
• There is an increasing body of evidence
demonstrating that, at recommended doses, ICS are
also safe and effective in children under five with
asthma.
52. 52
In adults, a reasonable starting dose of inhaled
corticosteroids will usually be 400 micrograms
BDP per day and in children 200 micrograms
BDP per day.
Titrate the dose of inhaled corticosteroid to the
lowest dose at which effective control of asthma is
maintained
53. 53
Is important that while considering a change of the type of
steroids or inhaler device used (e.g. Turbohaler),
equivalent doses of inhaled steroids relative to
beclometasone are given before the change is initiated to
avoid any inadvertent risk of overdosing with steroids.
54. 54
BDP and Budesonide are approximately equivalent in clinical
practice, although there may be variations with different delivery
devices.
At present a 1:1 ratio should be assumed when changing between
BDP and budesonide.
Fluticasone provides equal clinical activity to BDP& budesonide
at half the dosage
Mometasone appears to provide equal clinical activity to BDP
and budesonide at half the dosage.
COMPARISON OF INHALED
CORTICOSTEROIDS
55. 55
Most current ICS are slightly more effective when taken
twice rather than once daily, but may be used once daily
in some patients with milder disease.
There is little evidence of benefit for dosage frequency
more than twice daily.
Give inhaled corticosteroids initially twice daily
(except ciclesonide which is given once daily).
Frequency of dosing of inhaled corticosteroids
56. 56
ICS usage as a preventer therapy should be
explained to the parents in simple, plain
terms.
58. Children’s Healthcare of Atlanta
Dose, drug, &Dose, drug, &
route dependentroute dependent
Corticosteroids for Asthma: Benefits and Risks
ReducesReduces
inflammationinflammation
Most effectiveMost effective
long-term controllong-term control
medication formedication for
asthma*asthma*
DecreasesDecreases
morbidity / mortalitymorbidity / mortality
Generally knownGenerally known
and can beand can be
monitoredmonitored
BenefitsBenefits
RisksRisks
59. 59
The safety of ICS is of crucial importance and a balance
between benefits and risks for each individual needs to
be assessed.
Account should be taken of other topical steroid
therapy (e.g. for eczema) when assessing systemic risk
Steroid warning cards should be issued to patients on
higher dose inhaled steroids, and at every review,signs of
systemic steroid toxicity should be actively looked for .
60. 60
Administration of medium or high dose ICS (at or
above 400 micrograms BDP a day or equivalent)
may be associated with systemic side effects(e.g
growth failure and adrenal suppression) .
Isolated growth failure is not a reliable indicator of adrenal
suppression and monitoring growth cannot be used as a
screening test of adrenal function .
61. 61
Monitor growth (height and weight centile) of
children with asthma on an annual basis.
The lowest dose of inhaled corticosteroids
compatible with maintaining disease control should be
used.
63. 63
In general,while the use of ICS may be associated with
adverse effects (including the potential to reduced bone
mineral density) with careful ICS dose adjustment this
risk is likely to be outweighed by their ability to reduce
the need for multiple bursts of oral corticosteroids .
64. 64
1. Oropharyngeal candidiasis
2. Hoarseness
3. Coughing
To reduce the potential for adverse affects:
Use the lowest dose necessary to maintain control.
Administer with spacers/holding chambers.
Advise patients to (Rinse with water , gargle and
spit out) after inhalation.
Local side effects
67. 67
In children, pMDI and spacer are the preferred method of
delivery of β2 agonists or inhaled corticosteroids.
A face mask is required until the child can breathe
reproducibly using the spacer mouthpiece.
Where this is ineffective a nebuliser may be required
74. Choosing an inhaler device for children with asthma *
-
Age group Preferred device Alternative device
Younger than 4 years
Pressurized metered-dose
inhaler plus dedicated spacer
with face mask
Nebulizer with face mask
4-5 years
Pressurized metered-dose
inhaler plus dedicated spacer
with mouthpiece
Nebulizer with mouthpiece
Older than 6 years
Dry powder inhaler or
breath actuated pressurized
metered-dose inhaler or
pressurized metered-dose
inhaler with spacer with
Nebulizer with mouthpiece
78. 78
Inhaled medications is a waste of money if not used properly
Poor technique is a barrier to good control
Check at each visit
Don’t rely on patient’s knowledge – ask them to
demonstrate
79. 79
Fate of inhaled drugs – Good Technique
Swallowed
GI tract
Deposited in lung
Lungs
Metabolism or absorption
from the lung
Liver
Oral
bioavailability
Absorption
from gut
First-pass
metabolism
Systemic
Circulation
Mouth
pharynx
mucociliary
clearance
80%
20%
Schematic representation of potential dose distribution
A Guide to Aerosol Delivery Devices for Respiratory Therapists. American Association for
Respiratory Care. 1st Edition. Page 1.
Webpage: http://www.aarc.org/education/aerosol_devices/
Adapted from Barnes et al. AJRCCM 1998;157:S1-S53
80. 80
Fate of inhaled drugs – Good Technique
Swallowed
GI tract
Deposited in lung
Lungs
Metabolism or absorption
from the lung
Liver
Oral
bioavailability
Absorption
from gut
First-pass
metabolism
Systemic
Circulation
Mouth
pharynx
mucociliary
clearance
80%
20%
Schematic representation of potential dose distribution
A Guide to Aerosol Delivery Devices for Respiratory Therapists. American Association for
Respiratory Care. 1st Edition. Page 1.
Webpage: http://www.aarc.org/education/aerosol_devices/
Adapted from Barnes et al. AJRCCM 1998;157:S1-S53
Swallowed
GI tract
Deposited in lung
Lungs
Metabolism or absorption
from the lung
Liver
Oral
bioavailability
Absorption
from gut
First-pass
metabolism
Systemic
Circulation
Mouth
pharynx
mucociliary
clearance
95%
5%
Schematic representation of potential dose distribution Adapted from Barnes et al. AJRCCM 1998;157:S1-S53
A Guide to Aerosol Delivery Devices for Respiratory Therapists. American Association for
Respiratory Care. 1st Edition. Page 1.
Webpage: http://www.aarc.org/education/aerosol_devices/
Fate of inhaled drugs – Poor Technique
81. 81
Stepping down therapy once asthma is controlled is
recommended , but often not implemented leaving some
patients overtreated.
Patients should be maintained at the lowest possible
dose of inhaled corticosteroid.
Reduction in inhaled corticosteroid dose should be slow
as patients deteriorate at different rates.
82. 82
Stepping down therapy
Reductions should be considered every three months,
decreasing the dose by approximately 25–50% each time.
Regular review of patients as treatment is stepped down
is important .
83. Treatment Options for adult Patients
Not Controlled on Inhaled Steroids
Patients not controlled on inhaled steroidsPatients not controlled on inhaled steroids Patients not controlled on inhaled steroidsPatients not controlled on inhaled steroids
Increase theIncrease the
dose of inhaleddose of inhaled
steroidsteroid
Add leukotrieneAdd leukotriene
receptor receptor
antagonistsantagonists
Add long-acting
beta2-agonists
Add Add
theophyllinetheophylline
86. Children’s Healthcare of Atlanta
• Recent data indicating a possible increased risk of
asthma Related death associated with use of LABA in a
small group of individuals has resulted in increased
emphasis on the message that:
• LABA should not be used as monotherapy in asthma &
must only be used in combination with an appropriate
dose of ICS.
87. 87
Long-acting inhaled β2
agonists should only be started in
patients who are already on inhaled corticosteroids, and
the inhaled corticosteroid should be continued.
The benefits of these medicines used in conjunction with
ICS in the control of asthma symptoms outweigh any
apparent risks.
SAFETY OF LONG-ACTING Β2
AGONISTS
88. 88
In clinical practice, however, it is generally considered that
combination inhalers (ICS and LABA) aid adherence and
also have the advantage of guaranteeing that the LABA
is not taken without the ICS
112. 112
ANTI-IgE MONOCLONAL ANTIBODY
Omalizumab is a humanised monoclonal antibody which binds
to circulating IgE, reducing levels of free serum IgE.
In adults and children over 6 years of age, it is licensed in
the UK with the following indication:
patients on high-dose ICS and long-acting β2
agonists
who have impaired lung function, are symptomatic
with frequent asthma attacks, and have allergy as an
important cause of their asthma.
116. 116
Omalizumab is given as a subcutaneous injection every
two or four weeks depending on IgE level and weight.
The total IgE must be <1,300 international units
(IU)/ml for children over 6 years of age.
In adults and children >12 years, the licensed
indication is a IgE up to 1,500 IU/ml but there is no
published data to support its efficacy and safety above
700 IU/ml.
117. 117
Local skin reactions may occur , Anaphylaxis, presenting
as bronchospasm, hypotension, syncope, urticaria,
and/or angioedema of the throat or tongue has been
reported to occur after administration of omalizumab.
Anaphylaxis has occurred as early as the first dose, but
has also occurred after one year.
Due to risk of anaphylaxis, omalizumab should only be
administered to patients in a healthcare setting under
direct medical supervision.
118. 118
Omalizumab given by subcutaneous injection may be
considered in patients with a high steroid burden to
reduce the steroid burden for the patient.
Omalizumab treatment should only be initiated in
specialist centres with experience of evaluation and
management of patients with severe and difficult
asthma.
As with any treatment strategy, the benefits of the regimen must be balanced with the potential risks. The benefits of corticosteroids in asthma management have been well documented. The risks of corticosteroids, which are dependent on the specific agent, its dose, and route of administration, are generally known and can be monitored.