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What Is Asthma? Asthma is a chronic (long-term) lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing (a whistling sound when you breathe), chest tightness, shortness of breath, and coughing. The coughing often occurs at night or early in the morning.

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Asthma affects people of all ages, but it most often starts during childhood. In the United States, more than 22 million people are known to have asthma. Nearly 6 million of these people are children.

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Figure A shows the location of the lungs and airways in the body. Figure B shows a cross-section of a normal airway. Figure C shows a cross-section of an airway during asthma symptoms. Sometimes, asthma symptoms are mild and go away on their own or after minimal treatment with an asthma medicine. Other times, symptoms continue to get worse.

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Types of Asthma: Inflamed airways asthma: Airways narrowed as a result of the inflammatory response cause wheezing. Bronchoconstriction: During an asthma episode, inflamed airways react to environmental triggers such as smoke, dust, or pollen. The airways narrow and produce excess mucus, making it difficult to breathe. In essence, asthma is the result of an immune response in the bronchial airways.

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Stimuli: The airways of asthmatics are "hypersensitive" to certain triggers, known as stimuli. In response to exposure to these triggers, the bronchi (large airways) contract into spasm (an "asthma attack"). Inflammation soon follows, leading to a further narrowing of the airways and excessive mucus production, which leads to coughing and other breathing difficulties.

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Occupational asthma: That's asthma caused by exposure to allergens present in the average office - and a new study says it's on the rise. Exposure to wood dust, paint fumes, solvents, latex and baking flour - all workplace allergens - cause thousands of cases of asthma every year, according to a report released on May 12, 2008 by the Australian Institute of Health and Welfare (AIHW). The study shows that anywhere from 9-15 % of adult-onset asthma cases can be attributed to exposure to agents at the workplace, Science Alert reported.

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Occupations with the greatest risk for occupational asthma include farming, painting, cleaning, baking, animal handling and chemical work. Other at-risk occupations include nursing, welding, food processing, dentistry, timber and forestry industries, and industries that produce metals, plastics, electronics and rubber.

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New study on Asthma: Tree-lined streets lower asthma risk : Columbia University scientists on May 10, 2008 have suggested that tree-lined streets can reduce the risk of developing asthma in young children. While it is commonly believed that the pollen released by trees can contribute to asthma attacks.

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the present study shows trees cut asthma risk by cleaning the air and encouraging kids to play outdoors. According to the study published in the Journal of Epidemiology and Community Health, an increase of 343 trees per square kilometer lowers the prevalence of asthma by 29%.

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What Causes Asthma? The exact cause of asthma isn't known. Researchers think some genetic and environmental factors interact to cause asthma, most often early in life. These factors include: a)An inherited tendency to develop allergies, called atopy. b) Parents who have asthma c) Certain respiratory infections during childhood

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d) Contact with some airborne allergens or exposure to some viral infections in infancy or in early childhood when the immune system is developing. If asthma or atopy runs in your family, exposure to irritants (for example, tobacco smoke) may make your airways more reactive to substances in the air. Some factors may be more likely to cause asthma in some people than in others. Researchers continue to explore what causes asthma.

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What Are the Signs and Symptoms of Asthma? Common signs and symptoms of asthma include: Coughing: Coughing from asthma often is worse at night or early in the morning, making it hard to sleep. Wheezing: Wheezing is a whistling or squeaky sound that occurs when you breathe.

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Chest tightness: This may feel like something is squeezing or sitting on your chest. Shortness of breath: Some people who have asthma say they can't catch their breath or they feel out of breath. You may feel like you can't get air out of your lungs.

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Not all people who have asthma have these symptoms. Likewise, having these symptoms doesn't always mean that you have asthma. The best way to diagnose asthma for certain is to use a lung function test, a medical history (including type and frequency of symptoms), and a physical exam. The types of asthma symptoms you have, how often they occur, and how severe they are may vary over time.

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Severe symptoms can be fatal. It's important to treat symptoms when you first notice them so they don't become severe. With proper treatment, most people who have asthma can expect to have few, if any, symptoms either during the day or at night.

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Prevention methods: Inhaled glucocorticoids are the most widely used of the prevention medications and normally come as inhaler devices. Long-term use of corticosteroids can have many side effects including a redistribution of fat, increased appetite, blood glucose problems and weight gain.

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To control bronchitis and asthma some suggestions: Quit smoking: If you smoke, quit. Bronchitis will ease dramatically and may even be cured within a few years when you quit smoking. Walk away from people who smoke. Drink hot fluids: Have hot clear soups, hot milk laced with honey and haldi, hot water through the day. Keep a thermos handy for soothing sips whenever possible

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Use expectorants sparingly: Some expectorants are addictive - avoid them. Have a safe expectorant only if you have dry cough. If youre coughing up phlegm, avoid expectorants, stick to hot water. Walk, dont run: If jogging makes you cough, walk daily for 30-45 minutes at a speed you can manage. Carry your thermos of hot water with you. You could also swim as swimming is ideal for asthma. Keep active play tennis, cricket, golf.

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Fresh and nourished meal: Avoid oily or fatty food and be selective for fresh and nutritious vegetable food. For example, have only plain steamed rice, salad, yoghurt, bread, cheese, fruits, cornflakes, digestive biscuits, roast channa, jam, baked beans, pickles etc. You can also have them with warm milk. Eat light: Overeating presses on your insides and causes wheezing. Stop when youre on top - that is when you are comfortable, not full or heavy. Asthmatics should avoid taking water with meals and should always eat less then their capacity to make stomach fire stronger and thereby hardly leaving any chance to form phlegm.

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Sleep elevated: Sleep with two pillows. Keeping your head slightly elevated prevents stomach reflux. Sometimes, if the stomach acid drips into your throat, it causes coughing and asthma. Learn deep breathing: Correct deep breathing regularly. Learn the correct technique from an experienced Yoga teacher. Practicing yoga-pranayam to permit proper assimilation of food and strengthen lungs, digestive system and circulatory system.

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Asthma medication: If you are on asthma medication, you can have it 15 minutes before you exercise. Lose weight: Lose your excess weight and it will dramatically improve your health and level of confidence. You will lose weight when you follow the lifestyle of an athlete. No depression: Never allow yourself to be depressed. Be always cheerful and do all the positive things gladly, joyfully.

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Treatments and drugs Long-term control medications. In most cases, these medications need to be taken every day. Types of long-term control medications include: Inhaled corticosteroids. These medications include fluticasone, budesonide, mometasone, flunisolide, beclomethasone and others. Leukotriene modifiers. These oral medications include montelukast (Singulair), zafirlukast and zileuton.

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Long-acting beta agonists (LABAs). These inhaled medications include salmeterol and formoterol. Theophylline. This is a daily pill that helps keep the airways open (bronchodilator). Theophylline relaxes the muscles around the airways to make breathing easier. Short-acting beta agonists. These inhaled, quick-relief bronchodilators can rapidly ease symptoms during an asthma attack. They include albuterol (ventolin) and others. Ipratropium (Atrovent). Oral and intravenous corticosteroids.

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When symptoms get more intense and/or more symptoms occur, you're having an asthma attack. It's important to treat symptoms when you first notice them. This will help prevent the symptoms from worsening and causing a severe asthma attack. Severe asthma attacks may require emergency care, and they can be fatal.

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SINGULAIR(R) (Montelukast Sodium) Tablets, Chewable Tablets, and Oral Granules

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DESCRIPTION Montelukast sodium, the active ingredient in SINGULAIR*,it is selective and orally active leukotriene receptor antagonist that inhibits the cysteinyl leukotriene CysLT1 receptor.

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Mechanism of Action The cysteinyl leukotrienes (LTC4, LTD4, LTE4) are product of arachidonic acid metabolism and are released from various cells, including mast cells and eosinophils. These eicosanoids bind to cysteinyl leukotriene (CysLT) receptors. The CysLT type-1 (CysLT1) receptor is found in the human airway (including airway smooth muscle cells and airway macrophages) and on other pro-inflammatory cells (including eosinophils and certain myeloid stem cells). CysLTs have been correlated with the pathophysiology of asthma and allergic rhinitis.

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Montelukast is an orally active compound that binds with high affinity and selectivity to the CysLT1 receptor (in preference to other pharmacologically important airway receptors, such as the prostanoid, cholinergic, or (beta)-adrenergic receptor). Montelukast inhibits physiologic actions of LTD4 at the CysLT1 receptor without any agonist activity.

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COMMON side effects persist or become bothersome when using Montelukast: Cough Dizziness Headache Indigestion Nausea Stomach upset or pain Stuffy nose Tiredness Trouble sleeping Weakness.

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Side Effects by Body System : Nervous system: Nervous system side effects have included headache (18% to 20%) and dizziness (2%). Isolated and rare reports of somnolence have been associated with the use of higher than recommended doses. Seizures have been reported very rarely. Paresthesias, hypoesthesia, and drowsiness and have been reported in post marketing experiences.

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Respiratory: Respiratory system side effects have included influenza (4%), cough (3%), and nasal congestion (2%). In some studies, upper respiratory tract infection (28%) and worsened asthma (4% to 11%) were associated with the use of this drug. However, many patients with asthma have some or all of these symptoms, and a causal relationship has not been proven. Rhinorrhea, sinusitis, otitis, influenza, epistaxis, and pneumonia have also been reported.

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Gastrointestinal: Gastrointestinal side effects have included abdominal pain, dyspepsia, or infectious gastroenteritis in up to 3% of patients. Diarrhea has been associated with the use of higher than recommended doses. Musculoskeletal Musculoskeletal side effects have included myalgia, muscle cramps, and muscle aches. Post marketing experience has reported arthralgia.

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General: In general, montelukast is well-tolerated. Asthenia, fatigue, or fever has been associated with the use of this drug in approximately 2% of patients. Varicella has also been reported. Dermatologic: Dermatologic side effects have included rash, eczema, urticaria, and dermatitis.

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Hepatic Post marketing experience has reported rare cases of cholestatic hepatitis, hepatocellular liver injury and mixed-pattern liver injury. Hepatic side effects have included elevated hepatic serum transaminases in approximately 2% of patients. Pancreatitis has been reported very rarely. Jaundice with elevated liver enzymes are described in a 42-year-old man several months after starting montelukast therapy. Serum enzymes completely normalized 4 months after drug withdrawal.

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Absorption Montelukast is rapidly absorbed following oral administration.After administration of the 10-mg film- coated tablet to fasted adults,the mean peak montelukast plasma concentration (Cmax) is achieved in 3 to 4 hours (Tmax). The mean oral bioavailability is 64%. The oral bioavailability and Cmax are not influenced by a standard meal in the morning.

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Distribution Montelukast is more than 99% bound to plasma proteins. The steady state volume of distribution of montelukast averages 8 to 11 liters. Studies in rats with radiolabeled montelukast indicate minimal distribution across the blood- brain barrier. In addition,concentrations of radiolabeled material at 24 hours postdose were minimal in all other tissues.

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Metabolism Montelukast is extensively metabolized. In studies with therapeutic doses, plasma concentrations of metabolites of montelukast are undetectable at steady state in adults and pediatric patients. In vitro studies using human liver microsomes indicate that cytochromes P450 3A4 and 2C9 are involved in the metabolism of montelukast

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Elimination: The plasma clearance of montelukast averages 45 mL/min in healthy adults. Special Populations: Gender: The pharmacokinetics of montelukast are similar in males and females.

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Hepatic Insufficiency: Patients with mild-to-moderate hepatic insufficiency and clinical evidence of cirrhosis had evidence of decreased metabolism of montelukast resulting in 41% No dosage adjustment is required in patients with mild-to-moderate hepatic insufficiency. The pharmacokinetics of SINGULAIR in patients with more severe hepatic impairment or with hepatitis have not been evaluated.

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Renal Insufficiency: Since montelukast and its metabolites are not excreted in the urine, the pharmacokinetics of montelukast were not evaluated in patients with renal insufficiency. No dosage adjustment is recommended in these patients.

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Drug Interactions Montelukast at a dose of 10 mg once daily dosed to pharmacokinetic steady state: did not cause clinically significant changes in the kinetics of a single intravenous dose of theophylline

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did not change the pharmacokinetic profile of warfarin. did not change the pharmacokinetic profile or urinary excretion of immunoreactive digoxin. did not change the plasma concentration profile of terfenadine or fexofenadine.

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Pregnancy Category B: No teratogenicity was observed in rats at oral doses up to 400 mg/kg/day. During worldwide marketing experience, congenital limb defects have been rarely reported in the offspring of women being treated with SINGULAIR during pregnancy. Most of these women were also taking other asthma medications during their pregnancy. A causal relationship between these events and SINGULAIR has not been established.

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Nursing Mothers: Studies in rats have shown that montelukast is excreted in milk. It is not known if montelukast is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when SINGULAIR is given to a nursing mother. Pediatric Use: Safety and efficacy of SINGULAIR have been established in adequate and well-controlled studies in pediatric patients with asthma 6 to 14 years of age.

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INDICATIONS AND USAGE SINGULAIR is indicated for the prophylaxis and chronic treatment of asthma in adults and pediatric patients 12 months of age and older. SINGULAIR is indicated for prevention of exercise- induced bronchoconstriction in patients 15 years of age and older.

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SINGULAIR is indicated for the relief of symptoms of allergic rhinitis (seasonal allergic rhinitis in adults and pediatric patients 2 years of age and older, and perennial allergic rhinitis in adults and pediatric patients 6 months of age and older)

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CONTRAINDICATIONS: Hypersensitivity to any component of this product. PRECAUTIONS: SINGULAIR is not indicated for use in the reversal of bronchospasm in acute asthma attacks, including status asthmatics. Information for Patients: Patients should be advised to take SINGULAIR daily as prescribed, even when they are asymptomatic, as well as during periods of worsening asthma.

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Patients should be advised that oral SINGULAIR is not for the treatment of acute asthma attacks. They should have appropriate short-acting inhaled (beta)-agonist medication available to treat asthma exacerbations. Patients with known aspirin sensitivity should be advised to continue avoidance of aspirin or non- steroidal anti-inflammatory agents while taking SINGULAIR.

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Thanks for attention