Asthma drug therapy

Leath TM, Singla M, Peters SP (2005) Novel and emerging therapies for asthma. Drug Discov Today 10 1647-1655... 

Inform the primary health care provider if asthma symptoms do not improve within 4 weeks of initiating treatment. The primary health care provider may discontinue the drug therapy. 

Patients who may benefit from allergen immunotherapy include those who do not tolerate traditional drug therapy (e.g., nosebleeds with intranasal steroids or sedation with antihistamines), suffer from severe symptoms, have comorbid conditions (e.g., asthma or sinusitis), fail drug therapy, or prefer not to take long-term medication. 

Epidural/Intrathecal- Presence of infection at the injection microinfusion site concomitant anticoagulant therapy uncontrolled bleeding diathesis parenterally administered corticosteroids within a 2-week period, other concomitant drug therapy or medical condition that would contraindicate the technique of epidural or intrathecal analgesia acute bronchial asthma upper airway obstruction. 

Three factors contribute to airway obstruction in asthma (1) contraction of the smooth muscle that surrounds the airways (2) excessive secretion of mucus and in some, secretion of thick, tenacious mucus that adheres to the walls of the airways and (3) edema of the respiratory mucosa. Spasm of the bronchial smooth muscle can occur rapidly in response to a provocative stimulus and likewise can be reversed rapidly by drug therapy. In contrast, respiratory mucus accumulation and edema formation are likely to require more time to develop and are only slowly reversible. 

Drazen, J.M., Israel, E., O Byrne, P.M. (1999) Drug therapy treatment of asthma with drugs modifying the leukotriene pathway. New Engl. J. Med. 340, 197-206. 

The efficacy of subcutaneous SIT has been clearly shown in a metaanalysis of 43 double-blind placebo-controlled trials in allergic rhinitis as well as another meta-analysis of 16 double-blind placebo-controlled studies in asthma patients [13]. The mean clinical improvement was 45% reduction in symptoms and medication compared with placebo in rhinitis and 40% in asthma patients, which exceeds the effects of drug therapy. A recent meta-analysis also confirmed that asthma responds favorably to SIT [14], However, recently it could also be demonstrated that SIT is effective in patients with house dust mite allergy, allergic rhinitis and asthma [15]. Immunotherapy in these patients not only reduced rhinitis and asthma symptoms as well as rescue medication, but also had an impact on bronchial hyperreactivity over the 3-year follow-up period. 

Inhaled glucocorticoids are therefore the cornerstone of drug therapy for patients with asthma. Leukotriene inhibitors, beta agonists, and theophylline can be used to supplement glucocorticoids as needed, with the specific drug regimen determined on... 

The Easyhaler (by Orion Pharma, Finland) and the Clickhaler (by Innovata pic, United Kingdom) are available at present in some European markets. Unlike the DPIs described earlier, these two reservoir-type inhalers meter the dose when the patient presses the top of the device similar to actuation of a pressurized metered-dose inhaler. Both devices contain a dose indicator, which is standard for reservoir multidose DPIs. Recently, Innovata presented the Twinhaler for asthma combination therapy, a new development based on the Clickhaler. This device does not require the combined drugs to be formulated in one powder blend but delivers two powder formulations from two reservoirs into one airflow path. 

Drug Therapy for Asthma Research and Clinical Practice, edited by J. W. Jenne and S. Murphy... 

The pharmacists of Care-Rite Pharmacy also developed patient educational tools to be used during the patient assessment and patient education components of the Pharmacy Check-up Service. Because many of the targeted patients have similar medical conditions, education materials were developed for specific disease states, including hypertension, ischemic heart disease, diabetes, asthma, chronic obstructive pulmonary disease (COPD), etc. Also, educational materials were developed for certain therapeutic classes of medications. The Care-Rite pharmacists also determined that many patients needed individualized education materials, so they implemented a drug information/educational service as part of the MTM service. With this service, patients can ask questions regarding their medical conditions and/or drug therapies. The pharmacists will research and provide an individualized written response for each patient. 

Herborg H, Sondergaard B, Froekjaer B, et al. 2001. Improving drug therapy for patients with asthma 2. 

The first MDI products were developed by Riker Laboratories and marketed in 1956, using a newly patented design of metering valve. In most countries the MDI is now established as the principal dosage form of inhalation drug therapy for bronchial asthma and chronic obstructive pulmonary disease (COPD). Since its introduction, MDI technology has evolved steadily. However, with the phase-out in the commercial use of chlorofluorocarbon (CFC) propellants, which have been the mainstay of pharmaceutical MDIs, the pace of MDI technology development has accelerated with the transition to hydrofluorocarbon (HFC) propellants. ... 

Like halothane, isoflurane is useful in cases of life-threatening acute severe asthma refractory to drug therapy. 

A 66-year-old man who has been taking furosemide, atenolol, and loratadine for 5 months, ran out of his medication for 1 week. The patient s blood pressure is 173/96 mm Hg compared with 155/90 mm Hg 5 months ago before drug therapy. PMH includes HTN, asthma, and diabetes. What is the most likely reason for the increased BP ... 

Jenne JW, Murphy S, eds. Drug Therapy for Asthma. New York Marcel Dekker,... 

Pharmacists are providing DSM services to help patients manage such chronic diseases as asthma, diabetes, and dyslipidemia, and drug therapies such as anticoagulation. Hundreds of pharmacists, including those serv-... 

While only steroids against asthma come high on the above lists, the chemical class as a whole plays an unusual role, being the active component of oral contraceptives some anti-asthma drugs some anti-inflammatories and conjugated estrogenic hormone, taken as hormone replacement therapy by meno-pansal women. Some other chemical classes resemble steroids in being therapentically active in a nnmber of areas, and the most important of these are shown in Table 45.3. 

Asthma may be exacerbated by work involving exercise or exposure to cold, dusts, or irritants, to which hyperresponsive airways react. For example, people with asthma react with airway narrowing to sulphur dioxide at concentrations below the recommended occupational standards [1]. Such individuals have a prior history of asthma, no latent interval of symptom-free exposure, and symptoms are improved by avoiding heavy exposure to the provoking agent, and by appropriate drug therapy. 

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