slide preskas asthma treatment hafiizh

8/6/2019 Slide Preskas Asthma Treatment Hafiizh

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Asthma treatment and

management

M. Hafiizh Alfarrisi, 0606065831


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Medical care

Global Strategy for Asthma Management and

Prevention" include:

Achieve and maintain control of asthma symptoms

Maintain normal activity levels, including exercise

Maintain pulmonary function as close to normal as

possible

Prevent asthma exacerbations

Avoid adverse effects from asthma medications

Prevent asthma mortality


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The long-term outpatient

management of asthma Objective measures of lung function

Environmental control measures and

avoidance of risk factors Comprehensive pharmacologic therapy

Patient education


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asthma treatment strategies

The functions of asthma assessment andmonitoring are closely linked to the concepts ofseverity, control, and responsiveness totreatment.

Asthma severity is measured most easily anddirectly in a patient

Asthma control is the degree to which themanifestations of asthma are minimized and the

goals of therapy Asthma responsiveness is the ease with which

asthma control is achieved by therapy.


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Diet

from prospective cohort studies,

association between asthma and obesity

relationship between body mass index andthe risk of developing asthma.


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Activity

Activity is generally limited by patients' ability to

exercise and their response to medications.

No specific limitations are recommended for

patients with asthma, although they should avoid

exposure to agents that may exacerbate their

disease.

A significant number of patients with asthmaalso have exercise-induced bronchospasm


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Medication

Asthma medications are generally divided

into 2 categories:

quick relief (also called reliever medications) long-term control (also called controller

medications)


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Quick relief medications

are used to relieve acute asthma

exacerbations and to prevent exercise-

induced asthma (EIA), or exercise-induced

bronchospasm (EIB) symptoms.

These medications include:

short-acting beta-agonists (SABAs),

anticholinergics,

and systemic corticosteroids.


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Long-term control medications

inhaled corticosteroids (ICSs),

cromolyn sodium,

nedocromil,

long-acting beta-agonists (LABAs),

combination inhaled corticosteroids andlong-acting beta-agonists,

Methylxanthines

leukotriene antagonists


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The newest asthma medication

omalizumab (Xolair)

a recombinant DNA-derived humanized Ig Gmonoclonal antibody that binds selectively to

human Ig E on the surface of mast cells andbasophils.

The drug reduces mediator release, whichpromotes an allergic response.

It is indicated for moderate-to-severepersistent asthma, in whom symptoms are notcontrolled by inhaled corticosteroids.


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Beta2-adrenergic agonist agents

These agents relieve reversible

bronchospasm by relaxing the smooth

muscles of the bronchi.

Levalbuterol

Salmeterol

Albuterol


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Corticosteroids

These are highly potent agents that are

the primary DOC for treatment of chronic

asthma and prevention of acute asthma

exacerbations.

Triamcinolone

Beclomethasone

Prednisone


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Bronchodilators

Bronchodilators provide symptomatic reliefof bronchospasm due to acute asthmaexacerbation (short-acting agents) or long-

term control of symptoms (long-actingagents). Also used as the primarymedication for prophylaxis of exercise-induced asthma.

Ipratropium

Theophylline


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Mast cell stabilizers

Mast cell stabilizers prevent the release of

mediators from mast cells that cause

airway inflammation and bronchospasm.

They are indicated for maintenance

therapy of mild-to-moderate asthma or

prophylaxis for exercise-induced

bronchospasm. Cromolyn


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Monoclonal antibodies

These recombinant DNA-derived

humanized immunoglobulin G monoclonal

antibodies bind selectively to human

immunoglobulin E on the surface of mast

cells and basophils. They reduce mediator

release, which promotes an allergic

response. They are indicated formoderate-to-severe persistent asthma

Omalizumab


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Prevention

Exposure to irritants or allergens has been

shown to increase asthma symptoms and

cause exacerbations.

evaluate patients with persistent asthma

for allergen exposures and sensitivity to

seasonal allergens.

Skin testing


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avoid exposure to:

Environmental tobacco smoke

Exertion during high levels of air pollution

Use of beta-blockers

Avoidance of aspirin and other nonsteroidal anti-

inflammatory drugs if the patient is sensitive

Avoidance of sulfites or other food

items/additives to which the patient may besensitive

Occupational exposures


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Complications

The most common complications of

asthma include:

pneumonia, pneumothorax or pneumomediastinum,

and respiratory failure requiring intubation in

severe exacerbations.


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Risk factors for death from asthma:

Previous severe asthma exacerbation (eg, intubation orICU admission for asthma)

Two or more hospitalizations for asthma in the past year

Three or more emergency department visits for asthma

in the past year Hospitalization or emergency department visit for asthma

in the past month

Using more than 2 canisters of short-acting beta-agonists per month

Difficulty perceiving asthma symptoms or severity ofexacerbations

y Comorbidities - Cardiovascular disease, other chroniclung disease, chronic psychiatric disease


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Prognosis

Approximately half the children diagnosed withasthma in childhood outgrow their disease bylate adolescence or early adulthood and require

no further treatment. Patients with poorly controlled asthma develop

long-term changes over time (ie, with airwayremodeling). This can lead to chronic symptomsand a significant irreversible component to theirdisease.

Many patients who develop asthma at an olderage also tend to have chronic symptoms.


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Patient Education

Integrate patient education into every aspect ofasthma care.

All members of the health care team, including

nurses, pharmacists, and respiratory therapists,provide education.

Clinicians teach patients asthma self-management based on basic asthma facts, self-

monitoring techniques, the role of medications,inhaler use, and environmental controlmeasures.


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Patient Education

Develop treatment goals for the patient

and family.

Develop a written, individualized, dailyself-management plan.

Several well-validated asthma action plans

are now available and are key in the

management of asthma.


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Thank you

http://emedicine.medscape.com/article/29

6301-followup

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