The document discusses the pharmacotherapy of asthma. It begins by defining asthma and describing its global epidemiology. Asthma is a chronic inflammatory disease of the airways that affects hundreds of millions worldwide. It then covers the etiology and pathophysiology of asthma, noting it has multiple genetic and environmental factors and involves airway inflammation and hyperresponsiveness. The clinical presentation, diagnosis, assessment of severity, and general management approach are outlined. Pharmacological treatment options for asthma include controllers to reduce inflammation, relievers for acute symptoms, and oral corticosteroids for exacerbations. Initial and adjusted long-term control is emphasized.
Chronic obstructive pulmonary disease..It is one of the most affecting lung disease.. In detailed explanation of disease is there and including its ayurvedic aspect of management is also there...
#Ayurveda#Emphysema#Chronic brochitis
Chronic obstructive pulmonary disease..It is one of the most affecting lung disease.. In detailed explanation of disease is there and including its ayurvedic aspect of management is also there...
#Ayurveda#Emphysema#Chronic brochitis
Etiopathogenesis and pharmacotherapy of Asthma
the pathophysiology of selected disease states and the rationale for drug therapy;
b. the therapeutic approach to management of these diseases;
c. the controversies in drug therapy;
d. the importance of preparation of individualised therapeutic plans based on diagnosis;
e. needs to identify the patient-specific parameters relevant in initiating drug therapy,
and monitoring therapy (including alternatives, time-course of clinical and laboratory
indices of therapeutic response and adverse effects);
f. describe the pathophysiology of selected disease states and explain the rationale for
drug therapy;
g. summarise the therapeutic approach to management of these diseases including
reference to the latest available evidence;
h. discuss the controversies in drug therapy;
i. discuss the preparation of individualised therapeutic plans based on diagnosis; and
j. identify the patient-specific parameters relevant in initiating drug therapy, and
monitoring therapy (including alternatives, time-course of clinical and laboratory indices of therapeutic response and adverse effects).
Etiopathogenesis and pharmacotherapy of Asthma
the pathophysiology of selected disease states and the rationale for drug therapy;
b. the therapeutic approach to management of these diseases;
c. the controversies in drug therapy;
d. the importance of preparation of individualised therapeutic plans based on diagnosis;
e. needs to identify the patient-specific parameters relevant in initiating drug therapy,
and monitoring therapy (including alternatives, time-course of clinical and laboratory
indices of therapeutic response and adverse effects);
f. describe the pathophysiology of selected disease states and explain the rationale for
drug therapy;
g. summarise the therapeutic approach to management of these diseases including
reference to the latest available evidence;
h. discuss the controversies in drug therapy;
i. discuss the preparation of individualised therapeutic plans based on diagnosis; and
j. identify the patient-specific parameters relevant in initiating drug therapy, and
monitoring therapy (including alternatives, time-course of clinical and laboratory indices of therapeutic response and adverse effects).
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
2. Definition and Epidemiology of Asthma
• Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation.
It is defined by the history of respiratory symptoms, such as wheeze, shortness of breath, chest
tightness and cough, that vary over time and in intensity, together with variable expiratory airflow
limitation.
• It is a common chronic disorder of the airways that involves a complex interaction of airflow obstruction,
bronchial hyper responsiveness and an underlying inflammation.
The interaction of these features of asthma determines the clinical manifestations and severity of
asthma and the response to treatment.
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3. Con’t…
• Asthma is a globally significant non-communicable disease with major public health consequences for
both children and adults, including high morbidity, and mortality in severe cases.
• While asthma incidence and prevalence are higher in children, morbidityand mortality are higher in
adults.
• Childhood asthma is more common in boys while adult asthma is more common in women.
• Asthma is affecting 1–18% of the population in different countries.
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4. Con’t…
• Globally, asthma is ranked 16th among the leading causes of years lived with disability and 28th
among the leading causes of burden of disease, as measured by disability-adjusted life years.
• Around 300 million people have asthma worldwide, and it is likely that by 2025 a further 100
million may be affected.
• There is a large geographical variation in asthma prevalence, severity, and mortality.
While asthma prevalence is higher in high income countries, most asthma-related mortality
occurs in low-middle income countries.
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5. ETIOLOGY AND PATHOPHYSIOLOGY
• The current evidence suggests that asthma is
a complex multifactorial disorder and its
etiology is increasingly attributed to
interactions between genetic susceptibility,
host factors, and environmental exposures.
Environmental factors : air pollution,
pollens, mold and other aeroallergens,
drugs and weather
Host factors : obesity, nutritional factors,
infections, allergic sensitization
Genetic factors : asthma susceptibility loci
on genes
• Although underlying mechanisms of asthma
are not yet fully understood, they may
include airway inflammation, control of
airway tone and reactivity.
• It is also now recognized that asthma may
not be a single disease but a group of
heterogeneous phenotypes with different
etiologies and prognoses.
2/20/2023 5
6. Con’t…
• Most patients do experience 2 clear phases of the asthmatic response when exposed to a particular trigger, the
‘‘early’’ phase and the ‘‘late’’ phase.
• The ‘‘early’’ phase of the asthma response usually occurs 10-30 minutes following exposure to an asthma
trigger and involves the release of inflammatory mediators from IgE-coated mast cells throughout the
respiratory passages.
• These inflammatory mediators include histamine, prostaglandins, leukotrienes, and interleukins.
• These mediators
Induce bronchospasm
Increase permeability of the airways to antigen
Increase vascular permeability and mucus secretion
• Activation of vagal nerves in the airway constricts bronchial smooth muscle and increases secretions from
mucous-producing cells
2/20/2023 6
8. Con’t…
The late-phase inflammatory reaction occurs 6 to 9 hours
after allergen provocation where airway inflammation
becomes more prominent.
Neutrophils, attracted by chemo-taxis to the area of
inflamed airway, leave the more permeable blood vessel
and enter the respiratory tissues.
Neutrophils are joined by other inflammatory immune
cells such as basophils, and eosinophils that escalate the
inflammatory response by releasing their own
inflammatory mediators.
T-lymphocytes may also play an important role in the
asthmatic response since a particular subset of T-
lymphocytes (TH2) responds to environmental allergens
by releasing cytokines that may be a key mechanism of
the late-phase response.
2/20/2023 8
9. Clinical Presentation and Diagnosis
• The following features are typical of asthma and, if present, increase the probability that the patient has asthma.
• Respiratory symptoms of wheeze, shortness of breath, cough and/or chest tightness:
Patients (especially adults) experience more than one of these types of symptoms.
Symptoms are often worse at night or in the early morning.
Symptoms vary over time and in intensity.
Symptoms are triggered by viral infections (colds), exercise, allergen exposure, changes in weather, laughter, or irritants such as car exhaust fumes,
smoke or strong smells
• The symptoms of asthma can be nonspecific and varied, making the diagnosis difficult.
Therefore, a thorough history and physical examination along with spirometry are important for the diagnosis of
asthma.
2/20/2023 9
11. Con’t…
• Airflow obstruction with a FEV1/forced vital capacity ratio <0.7 or less than the lower limit of normal
(LLN) AND airflow reversibility after inhalation of a short-acting beta-2 agonist (SABA) defined as FEV1
improvement by at least 12% AND/OR 200 Ml indicates a diagnosis of asthma.
However, given the variable nature of airflow obstruction asthma patients can present with normal
spirometry results.
In such patients, bronchoprovocation with methacholine or mannitol can be useful in the asthma
diagnosis.
A >20% drop in FEV1 provocation concentration (PC20 <16 mg/mL), and now recently a
provocation dose (PD20) <400 µg, are currently used and recommended for diagnosis.
2/20/2023 11
19. Management
General principles of asthma management
• The long-term goals of asthma management from a clinical perspective are:
To achieve good control of symptoms and maintain normal activity levels
To minimize the risk of asthma-related death, exacerbations, persistent airflow limitation
and side-effects.
• The patient’s own goals regarding their asthma and its treatment should also be identified.
2/20/2023 19
21. Con’t…
Categories of asthma medications
• The pharmacological options for long-term treatment of asthma fall into the following three main
categories:
I. Controller medications
• These medications contain ICS and are used to reduce airway inflammation, control symptoms, and
reduce future risks such as exacerbations and related decline in lung function.
People with more severe asthma use controller medication on a regular basis, not only when they have symptoms.
2/20/2023 21
22. Con’t…
II. Reliever medications
• These are provided to all patients for as-needed relief of breakthrough symptoms, including
during worsening asthma or exacerbations.
Track 1: The reliever is as-needed low dose ICS-formoterol (preferred)
Track 2: The reliever is as-needed SABA
• They are also recommended for short-term prevention of exercise-induced bronchoconstriction.
2/20/2023 22
23. Con’t…
Initial controller treatment
• For the best outcomes, ICS-containing controller treatment should be initiated as soon as possible after
the diagnosis of asthma is made, as the evidence suggests that:
Early initiation of low dose ICS in patients with asthma leads to a greater improvement in lung function than if
symptoms have been present for more than 2–4 years. One study showed that after this time, higher ICS doses
were required, and lower lung function was achieved.
Patients not taking ICS who experience a severe exacerbation have a greater long-term decline in lung function
than those who are taking ICS.
For patients with occupational asthma, early removal from exposure to the sensitizing agent and early controller
treatment increase the probability of resolution of symptoms, and improvement of lung function and airway
hyperresponsiveness.
Starting treatment with SABA alone encourages patients to regard it as their main asthma treatment, and
increases the risk of poor adherence when daily ICS is subsequently prescribed.
2/20/2023 23
30. Box 6-6. Low daily doses of inhaled corticosteroids for children 5 years and younger
Con’t…
2/20/2023 30
31. Management of Worsening Asthma and Exacerbations
• Exacerbations represent an acute worsening in symptoms and lung function from the patient’s usual status, or
in some cases, a patient may present for the first time during an exacerbation.
• Common exacerbation triggers include:
Viral respiratory infections
Allergen exposure e.g. grass pollen, fungal spores
Food allergy
Outdoor air pollution
Seasonal changes and/or returning to school in fall (autumn)
Poor adherence with ICS
• However, a subset of patients present more acutely and without exposure to known risk factors
Severe exacerbations can occur in patients with mild or well-controlled asthma symptoms
2/20/2023 31
32. Con’t…
• The decrease in expiratory airflow can be quantified by lung function measurements such as peak
expiratory flow (PEF) or forced expiratory volume in 1 second (FEV1), compared with the patient’s
previous lung function or predicted values.
In the acute setting, these measurements are more reliable indicators of the severity of the exacerbation than
symptoms.
A minority of patients perceive airflow limitation poorly and can experience a significant decline in lung function without a
change in symptoms.
• The frequency of symptoms may, however, be a more sensitive measure of the onset of an exacerbation
than PEF.
• Severe exacerbations are potentially life threatening and their treatment requires careful assessment and
close monitoring.
2/20/2023 32
33. Con’t…
Treating exacerbations in primary care (adults, adolescents, children 6–11years)
• The main initial therapies include
Repetitive administration of short-acting inhaled bronchodilators
Early introduction of systemic corticosteroids, and
Controlled flow oxygen supplementation.
• The aim is to rapidly relieve airflow obstruction and hypoxemia, address the underlying inflammatory
pathophysiology, and prevent relapse.
• Infection control procedures should be followed.
2/20/2023 33
34. Con’t…
Inhaled short-acting beta2 –agonists
• Currently, inhaled salbutamol (albuterol) is the usual bronchodilator in acute asthma management.
• For mild to moderate exacerbations, repeated administration of inhaled SABA (up to 4–10 puffs every 20
minutes for the first hour) is an effective and efficient way to achieve rapid reversal of airflow limitation.
After the first hour, the dose of SABA required varies from 4–10 puffs every 3–4 hours up to 6–10 puffs every 1–2
hours, or more often.
2/20/2023 34
35. Con’t…
Controlled oxygen therapy
• Oxygen therapy should be titrated against pulse oximetry (if available) to maintain oxygen saturation at
93–95% (94–98% for children 6–11 years).
In hospitalized asthma patients, controlled or titrated oxygen therapy is associated with lower mortality and better
outcomes than high concentration (100%) oxygen therapy.
If supplemental oxygen is administered, oxygen saturation should be maintained no higher than 96% in adults
2/20/2023 35
36. Con’t…
Systemic corticosteroids
• OCS should be given promptly, especially if the patient is deteriorating, or had already increased their
reliever and controller medications before presenting.
• The recommended dose of prednisolone for adults is 1 mg/kg/day or equivalent up to a maximum of 50
mg/day, and 1–2 mg/kg/day for children 6–11 years up to a maximum of 40 mg/day).
• OCS should usually be continued for 5–7 days in adults and 3-5 days in children.
2/20/2023 36
37. Con’t…
Controller medication
• Patients already prescribed controller medication should be provided with advice about increasing the dose
for the next 2–4 weeks.
• Patients not currently taking controller medication should be commenced on regular ICS-containing therapy,
as SABA-only treatment of asthma is no longer recommended.
Antibiotics (not recommended)
• Evidence does not support routine use of antibiotics in the treatment of acute asthma exacerbations unless
there is strong evidence of lung infection.
2/20/2023 37
