Asthma acute attack

Montelukast—Take once daily in the evening, even when free of symptoms. Contact physician if the asthma is not well controlled. This drug is not for the treatment of an acute attack. Avoid taking aspirin and the NSAIDs while taking montelukast. 

Corticosteroids (e.g., beclomethazone, flunisolide, triamcinolone) have anti-inflammatory and immunosuppressant actions. These drugs are used prophylactically to prevent the occurrence of asthma in patients with frequent attacks. Because they are not useful during an acute attack, corticosteroids are prescribed along with maintenance bronchodilators. These drugs are also administered by inhalation. Cromolyn is another anti-inflammatory agent used prophylactically to prevent an asthmatic attack. The exact mechanism of action of cromolyn is not fully understood however, it is likely to involve the stabilization of mast cells. This prevents the release of the inflammatory mast cell mediators involved in inducing an asthmatic attack. Cromolyn has proven effective in patients with exercise-induced asthma. 

Asthma prophylaxis 600 mg qid, not for acute attacks inhibition of theophylline and warfarin metabolism. Hepatotoxic. 

Salbutamol is a selective beta2-receptor agonist indicated in the management of asthma as a bronchodilator relieving acute attacks. It may be used in combination with inhaled corticosteroids such as beclometasone. Salbutamol acts within a few minutes and tends to be short-acting, unlike salmeterol. Side-effects of salbutamol include tachycardia and palpitations. It does not cause drowsiness and does not precipitate oral candidiasis. Inhaled corticosteroids may precipitate oral candidiasis. 

Asthma is managed by the use of an inhaled bronchodilator prescribed on an as-required (p.r.n.) basis to relieve acute attacks and administration of an inhaled corticosteroid as maintenance therapy. Budesonide is available as inhaled corticosteroid. Amoxicillin or another antibacterial agent may be required for short-term periods. Codeine, being an antitussive, should be used with caution in asthmatics and certainly not routinely. 

Beclometasone is a corticosteroid. Corticosteroids are used as prophylaxis in patients with asthma and therefore have no use in an acute attack. Bronchodilators acting as relievers are indicated for an acute attack. In asthma, patients are advised first to administer the bronchodilator, which acts very fast and then apply the corticosteroid, which has anti-inflammatory properties. 

Metered dose Inhaler-2 to 3 inhalations every 3 to 4 hours. Do not exceed 12 inhalations/day. Not recommended for children younger than 12 years of age. Inhalant solutions - Usually, treatment need not be repeated more often than every 4 hours to relieve acute bronchospasm attacks. In chronic bronchospastic pulmonary diseases, give 3 to 4 times/day. A single dose of nebulized metaproterenol in the treatment of an acute attack of asthma may not completely abort an attack. Not recommended for children younger than 12 years of age. 

Epinephrine is used in a variety of clinical situations, and although concern has been expressed about the use of epinephrine in asthma, it is still used extensively for the management of acute attacks. 

Disodium cromoglycate (724), marketed as Intal or Cromolyn Sodium, bears some structural resemblance to khellin (457), the spasmolytic component of seeds of Ammi visnaga. Intal is one of the more successful drugs for the prevention of asthmatic attacks, though it is not effective in the treatment of an acute attack of asthma. It appears to prevent the release of histamine and other substances which mediate hypersensitivity reactions but is ineffective once these substances have been released. The chemistry and pharmacology of Intal have been reviewed (B-70MI22402). 

Meperidine is available in the form of tablets (50 mg) for oral use or in solution (50 mg/ml) for intramuscular administration. It is administered in doses of 50 to 100 mg at 3- to 4-h intervals. Because of its antispasmodic effects, it is particularly useful in pain due to colic. It is also used prior to anesthesia, particularly cyclopropane. Meperidine is used in asthma, but its tendency to addiction limits its use in this condition to acute attacks. 

The treatment of acute attacks of asthma in patients reporting to the hospital requires more continuous assessment and repeated objective measurement of lung function. For patients with mild attacks, inhalation of a -receptor agonist is as effective as subcutaneous injection of epinephrine. Both of these treatments are more effective than intravenous administration of aminophylline. 

The asthma market is thought to be worth some 6 billion worldwide, and consists mainly of inhaled products—bronchodilators and corticosteroids. It is a growing market because the incidence of asthma is increasing, especially in developed countries. It has been postulated that this increase is partly related to overuse of inhaled bronchodilators, which can mask progression of the underlying inflammatory disease process. Current recommendations specify the routine use of anti-inflammatory therapy (e g. inhaled steroids) for mild asthma, with bronchodilators used to relieve acute attacks in more serious cases. 

In a retrospective study of the case notes of patients who had been admitted to hospital with acute attacks of asthma, there was a high prevalence of heroin use—15 % had used only heroin and another 16% had used both heroin and cocaine (9). Heroin users had been intubated more often than non-drug users (17% versus 2.3%). Similarly, more heroin users were admitted to ICU than non-users (21% versus 12%). However, they did not spend more time receiving mechanical ventilation or being in hospital. These findings suggest that heroin induced some degree of bronchoconstriction and respiratory depression, which worsened the initial presentation of asthma. 

Five cases of adverse drug reactions have been attributed to oral Echinacea extracts (26). Two of the patients had anaphylaxis and one had an acute attack of asthma. The authors also tested 100 atopic subjects and found that 20 of them, who had never before taken Echinacea, had positive reactions to skin prick tests. 

Salmeterol is a selective beta2-adrenoceptor agonist that is more potent and has a significantly longer duration of action than salbutamol (SEDA-21, 184). It is used as a supplement to inhaled glucocorticoids for sustained bronchodUatation. It has a much slower onset of effect than salbutamol and is not effective in acute attacks of asthma. It is available as a multidose-pressurized aerosol 0.025 mg/puff, and as a dry powder, Diskhaler or Accuhaler 0.05 mg per dose. The adverse effects profile of salmeterol is the same as that of salbutamol and other betaz-agonists (SEDA-21, 185). 

ANTIASTHMATIC AGENTS relieve the symptoms of bronchial asthma or prevent recurrent attacks. The symptoms of asthma include bronchoconstriction (obstructive airways disease), often with over-secretion of fluid within the bronchioles and other breathing difFiculties. Two main types of drugs are used the first to treat acute attacks and the second as prophylactics to prevent attacks... 

Answer C. Inhaled beta2 selective agonists are preferred in most cases of acute asthma. IV steroids are also helpful, but inhaled steroids should be avoided because they may cause bronchospasm. Despite anxiety and agitation that frequently accompany acute attacks of asthma, sedatives are not generally recommended because they exert respiratory depressant actions. Zafirlukast, a leukotriene receptor antagonist, is of minimal value in acute asthma. Always avoid answers with the word always. 

Corticosteroids are anti-inflammatory drugs that can be used in asthma to reduce airway hyper-responsiveness and to decrease bronchial oedema and mucus secretion. They are effective in the late phase reaction and reduce the intensity of allergic reactions. They are used in emergency treatment of severe acute attacks, for the treatment of mild to moderate attacks and prophylactically to prevent attacks. Corticosteroids can be useful in reducing acute exacerbations of chronic bronchitis. 

Although asthma is considered to be a reversible condition, severe acute attacks can cause obstruction that can take days to reverse and in some cases is not reversible at all. Such attacks need to be treated as a medical emergency requiring hospital treatment. Treatment includes oxygen, inhalation of salbutamol in oxygen, intravenous hydrocortisone and oral prednisolone. Sometimes inhaled antimuscarinics are also used and intravenous salbutamol and aminophylline plus antibiotics if there is infection as well. 

Next, the effects of heparin on acute attacks of asthma were studied. Ten male and 14 female patients were treated with 100-200 mg of intravenous heparin within the first 24 hr of an attack. The wheezing was markedly relieved in 17 cases, moderately in 6, and poorly in one. Coughing was helped in about the same manner, 15 being helped markedly, 8 moderately, and only one poorly. In 23 of the 24 cases the breathing was eased both subjectively and objectively, and all of the patients mentioned a feeling of warmth and relaxation. ... 

The heparinoids have actions as antihistamines. Selected cases of acute hay fever and asthma were helped by intravenous heparin, particularly for the acute attacks. Sufficient clinical improvement was observed to warrant further studies that heparin may provide protection against endogenous histamine. The combination of basic antibiotic and heparin is valuable , possibly due to reduction of toxicity of the antibiotic. While heparin has no effect on the action of histamine on the cat blood pressure, it suppresses histamine-induced gastric acid secretion in Heidenhain pouch dogs - . Chondroitin sulphate reduces the number of gastric ulcers in the Shay rat but polyethylene sulphonates of molecular weights between 15,000 and... 

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