1. Asthma is a chronic inflammatory disorder of the airways that affects 15-20 million people in India. It is characterized by airway hyperresponsiveness and inflammation.
2. Proper diagnosis involves assessing patient history of symptoms, performing a physical exam, and measuring lung function through methods like peak flow meters. Treatment involves a stepwise approach using reliever and preventer medications.
3. Relievers provide quick symptom relief but are not for regular use. Preventers help control inflammation and symptoms over the long-term and include inhaled corticosteroids, long-acting beta-agonists, and other drugs. Combination inhalers containing both a preventer and reliever are often ideal
BRONCHIAL ASTHMA
ntroduction
Definition
Etiological factors
Pathophysiology
Types of asthma
Clinical manifestation Restlessness Wheezing or crackles Absent or diminished lung sounds Hyper resonance Use of accessory muscles for breathing Tachypnea with hyperventilation
Clinical manifestation
Diagnostic evaluation
Bronchoprovocation Testing: Testing that is done to identify inhaled allergens; mucous membranes are directly exposed to suspected allergen in increasing amounts. Skin Testing: Done to identify specific allergens. Exercise Challenges: Exercise is used to identify the occurrence of exercise-induced bronchospasm. Radio allergosorbent Test: Blood test used to identify a specific allergen. Chest Radiograph: May show hyper expansion of the airways.
Managemnet
Goal- Promote bronchodilationn Reduce inflammation Remove secretions Prevent ongoing symptoms Prevent asthma attack Maintain normal lung function Avoid triggers
Pharmacological therapy 1. Long term control medication- Inhaled corticosteroid Leukotriene modifiers Long acting beta agonist Methylxanthines Combine inhaler
2 Quick relief medication Short acting beta agonist Anticholinergic Oral or I/V corticosteroid
3 Bronchial thermoplasty- Form severe asthma that does not respond to medication
Non- pharmacological
Oxygen therapy Postural drainage & chest physiotherapy Coughing & deep breathing exercise Avoidance of allergen relaxation technique acupuncture
Prevention
Patients with recurrent asthma should undergo tests to identify the substances that precipitate the symptoms. Possible causes are dust, dust mites, roaches, certain types of cloth, pets, horses, detergents, soaps, certain foods, molds, and pol- lens. If the attacks are seasonal, pollens can be strongly sus- pected. Patients are instructed to avoid the causative agents whenever possible.
Complications Complications of asthma may include status asthmaticus, respiratory failure, pneumonia, and atelectasis. Airway obstruction, particularly during acute asthmatic episodes, often results in hypoxemia, requiring the administration of oxygen and the monitoring of pulse oximetry and arterial blood gases. Fluids are administered, because people with asthma are frequently dehydrated from diaphoresis and in- sensible fluid loss with hyperventilation.
Nursing diagnosis
Impaired gas exchange r/t altered oxygen supply Ineffective airway clearance r/t bronchospasm & obstruction from narrow lumen Ineffective breathing pattern r/t bronchospasm Risk for increasing attack of r
espiratory distress r/t exposure to allergens
BRONCHIAL ASTHMA
ntroduction
Definition
Etiological factors
Pathophysiology
Types of asthma
Clinical manifestation Restlessness Wheezing or crackles Absent or diminished lung sounds Hyper resonance Use of accessory muscles for breathing Tachypnea with hyperventilation
Clinical manifestation
Diagnostic evaluation
Bronchoprovocation Testing: Testing that is done to identify inhaled allergens; mucous membranes are directly exposed to suspected allergen in increasing amounts. Skin Testing: Done to identify specific allergens. Exercise Challenges: Exercise is used to identify the occurrence of exercise-induced bronchospasm. Radio allergosorbent Test: Blood test used to identify a specific allergen. Chest Radiograph: May show hyper expansion of the airways.
Managemnet
Goal- Promote bronchodilationn Reduce inflammation Remove secretions Prevent ongoing symptoms Prevent asthma attack Maintain normal lung function Avoid triggers
Pharmacological therapy 1. Long term control medication- Inhaled corticosteroid Leukotriene modifiers Long acting beta agonist Methylxanthines Combine inhaler
2 Quick relief medication Short acting beta agonist Anticholinergic Oral or I/V corticosteroid
3 Bronchial thermoplasty- Form severe asthma that does not respond to medication
Non- pharmacological
Oxygen therapy Postural drainage & chest physiotherapy Coughing & deep breathing exercise Avoidance of allergen relaxation technique acupuncture
Prevention
Patients with recurrent asthma should undergo tests to identify the substances that precipitate the symptoms. Possible causes are dust, dust mites, roaches, certain types of cloth, pets, horses, detergents, soaps, certain foods, molds, and pol- lens. If the attacks are seasonal, pollens can be strongly sus- pected. Patients are instructed to avoid the causative agents whenever possible.
Complications Complications of asthma may include status asthmaticus, respiratory failure, pneumonia, and atelectasis. Airway obstruction, particularly during acute asthmatic episodes, often results in hypoxemia, requiring the administration of oxygen and the monitoring of pulse oximetry and arterial blood gases. Fluids are administered, because people with asthma are frequently dehydrated from diaphoresis and in- sensible fluid loss with hyperventilation.
Nursing diagnosis
Impaired gas exchange r/t altered oxygen supply Ineffective airway clearance r/t bronchospasm & obstruction from narrow lumen Ineffective breathing pattern r/t bronchospasm Risk for increasing attack of r
espiratory distress r/t exposure to allergens
Bronchitis is an acute inflammation of the air passages within the lungs. It occurs when the trachea (windpipe) and the large and small bronchi (airways) within the lungs become inflamed because of infection or irritation from certain causes. Homeopathy is the best treatment with no side effects. For further information contact Ph. : +91-265-2250212,
(M) +91 97236 69210
Skype Id : cosmic1021
Email:
drmahavrat@homeopathyhealing.net
Dr Kishore Kumar Ubrangala, MD
Professor, Dept. of Medicine,
Yenepoya Medical College,
Yenepoya (Deemed to be) University, Mangalore, India.
sankish@gmail.com
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.
Bronchitis is an acute inflammation of the air passages within the lungs. It occurs when the trachea (windpipe) and the large and small bronchi (airways) within the lungs become inflamed because of infection or irritation from certain causes. Homeopathy is the best treatment with no side effects. For further information contact Ph. : +91-265-2250212,
(M) +91 97236 69210
Skype Id : cosmic1021
Email:
drmahavrat@homeopathyhealing.net
Dr Kishore Kumar Ubrangala, MD
Professor, Dept. of Medicine,
Yenepoya Medical College,
Yenepoya (Deemed to be) University, Mangalore, India.
sankish@gmail.com
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.
Asthma is a chronic inflammatory condition associated with airway hyperresponsiveness (an exaggerated airway-narrowing response to specific triggers such as viruses, allergens and exercise).
Physiotherapy can provide relief from symptoms of uncontrolled asthma, including coughing, wheezing, tightness in the chest, shortness of breath and QOL.
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
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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
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
2. Magnitude of the Problem
15- 20 million asthmatics in India.
A recent study conducted in Delhi established
asthma prevalence to be 12% in
schoolchildren.
Significant cause of school/work absence.
Health care expenditures very high.
Morbidity and mortality are on the rise.
JAPI 2002; Vol 50: 462.
3. The Treatment Gap in Asthma
Patients are not detected
Do not seek medical attention
No access to health service
Missed diagnosis (bronchitis, LRTI)
4. Current Understanding of Asthma
A chronic inflammatory disorder of the
airway
Infiltration of mast cells, eosinophils
and lymphocytes
Airway hyperresponsiveness
Recurrent episodes of wheezing,
coughing and shortness of breath
Widespread, variable and often
reversible airflow limitation
7. Risk Factors that Lead to Asthma Development
Predisposing Factors
Atopy
Causal Factors
Indoor Allergens
– Domestic mites
– Animal Allergens
– Cockroach Allergens
– Fungi
Outdoor Allergens
– Pollens
– Fungi
Occupational Sensitizers
Contributing Factors
Respiratory infections
Small size at birth
Diet
Air pollution
– Outdoor pollutants
– Indoor pollutants
Smoking
– Passive Smoking
– Active Smoking
8. DIAGNOSIS OF ASTHMA
History and patterns of symptoms
Physical examination
Measurements of lung function
9. PATIENT HISTORY
Has the patient had an attack or recurrent
episodes of wheezing?
Does the patient have a troublesome cough,
worse particularly at night, or on awakening?
Does the patient cough after physical activity
(eg. Playing)?
Does the patient have breathing problems
during a particular season (or change of
season)?
10. Do the patient’s colds ‘go to the chest’
or take more than 10 days to resolve?
Does the patient use any medication
(e.g. bronchodilator) when symptoms
occur? Is there a response?
If the patient answers “YES” to any of
the above questions, suspect asthma.
11. Physical Examination
Wheeze -
Usually heard without a stethoscope
Dyspnoea -
Rhonchi heard with a stethoscope
Use of accessory muscles
Remember -
Absence of symptoms at the time of examination
does not exclude the diagnosis of asthma
12. Diagnostic testing
Diagnosis of asthma can be confirmed
by demonstrating the presence of
reversible airway obstruction using
Peak flow meter.
13. Classification of Asthma Severity
STEP 4
Severe
Persistent
STEP 3
Moderate
Persistent
STEP 2
Mild
Persistent
STEP 1
Intermittent
The presence of one of the features of severity is sufficient to place a patient in that category.
Global Initiative for Asthma (GINA) WHO/NHLBI, 2002
Symptoms
Nighttime
Symptoms
PEF
CLASSIFY SEVERITY
Clinical Features Before Treatment
Continuous
Limited physical
activity
Daily
Use β2-agonist daily
Attacks affect activity
>1 time a week but
<1 time a day
< 1 time a week
Asymptomatic and
normal PEF
between attacks
Frequent
>1 time week
>2 times a month
<2 times a month
<60% predicted
Variability >30%
>60%-<80%
predicted
Variability >30%
>80% predicted
Variability 20-30%
>80% predicted
Variability <20%
14. Goals to Be Achieved in Asthma
Control
Achieve and maintain control of symptoms
Prevent asthma episodes or attacks
Minimal use of reliever medication
No emergency visits to doctors or hospitals
Maintain normal activity levels, including exercise
Maintain pulmonary function as close to normal
as possible
Minimal (or no) adverse effects from medicine
15. Tool Kit for Achieving Management
Goals
Relievers
Preventers
Peak Flow meter
Patient education
16. What Are Relievers?
- Rescue medications
- Quick relief of symptoms
- Used during acute attacks
- Action lasts 4-6 hrs
22. Anti-inflammatory
Takes time to act (1-3 hours)
Long-term effect (12-24 hours)
Only for regular use
(whether well or not well)
Preventer
23. ICS + LABA
Which LABA ?
Formoterol: Immediate relief (as fast as
salbutamol)
12 hours effect
Can be combined with
budesonide
24. Ideal combination
Formoterol ( fast relief and sustained
relief ) +
Budesonide ( twice or even once daily
use )
Dose: 1- 4 puffs ( OD/BD )
Another combination
Salmeterol + Fluticasone
25. Formoterol + Budesonide combination
the ‘flexible’ preventer
Asthmasigns
Time
2x2 2x2 1x1
1x21x2
Quickly
gains control
Maintains
control
Asthma
worsening
Maintains
control
Reduce to
lowest
adequate
dose that
maintains
control
26. All Asthma Drugs Should Ideally Be
Taken Through The Inhaled Route.
27. Why inhalation therapy?
Oral
Slow onset of action
Large dosage used
Greater side effects
Not useful in acute
symptoms
Inhaled route
Rapid onset of action
Less amount of drug
used
Better tolerated
Treatment of choice
in acute symptoms
28. Aerosol delivery systems currently available
Metered dose inhalers
Dry powder inhalers (Rotahaler)
Spacers / Holding chambers
30. Advantages of Spacer
No co-ordination required
No cold - freon effect
Reduced oropharyngeal deposition
Increased drug deposition in the lungs
31. The Zerostat advantage
Non - static spacer made up
of polyamide material
Increased respirable fraction → Increased
deposition of drug in the airways
Increased aerosol half - life → Plenty of time for
the patient to inhale after actuation of the drug
No valve → No dead space → Less wastage of the
drug
Small, portable, easy to carry → Child friendly
32. Rotahaler - The dry powder advantage
Overcomes hand-lung
coordination problems that
are encountered with MDIs.
Can be easily used by children, elderly and
arthritic patients.
Can take multiple inhalations if the entire drug
has not been inhaled in one inhalation.
33. Age-wise selection of inhaler devices
< 3 years – MDI + Spacer + Mask or nebulisers
3 – 5 years – MDI + Spacer + Mask or
Rotahaler
5 – 8 years – Rotahaler or MDI + Spacer
> 8 years – Rotahaler or MDI + Spacer
34. Patient Education in the Clinic
Explain nature of the disease (i.e.
inflammation)
Explain action of prescribed drugs
Stress need for regular, long-term therapy
Allay fears and concerns
Peak flow reading
Treatment diary / booklet
35. Key Messages
Asthma is a common disorder
It can happen to anybody
It is not caused by supernatural forces
Asthma is not contagious
It produces recurrent attacks of cough with
or without wheeze
Between attacks people with asthma lead
normal lives as anyone else
In most cases there is some history of
allergy in the family.
36. Key Messages
Asthma can be effectively controlled, although it cannot
be cured.
Effective asthma management programs include
education, objective measures of lung function,
environmental control, and pharmacologic therapy.
A stepwise approach to pharmacologic therapy is
recommended. The aim is to accomplish the goals of
therapy with the least possible medication.
Editor's Notes
Formoterol would be the long-acting beta2-agonist of choice.
This drug amazingly acts as fast as salbutamol, but has a prolonged 12 hour effect as well. Therefore it combines immediate relief with sustained relief. This makes it the ideal beta2-agonist for use in asthma.
The beauty is that Formoterol can be combined with Budesonide in the same inhaled formulation today and therefore provides the ideal combination for long-term use.
This combination is available today in both metered dose and dry powder inhalers (Rotacaps).
It is available in 3 different Rotacap strengths where the dose of formoterol remains constant but the budesonide dose varies according to the need (severity of asthma); i.e. 100, 200 and 400 mcg of budesonide in 3 different Rotacaps.