Asthma evaluation

Taggart VS, Zuckerman AE, Sly RM, Steinmueller C, Newman G, O Brien RW, Schneider S, Bellanti JA You Can Control Asthma Evaluation of an asthma education program for hospitalized inner-city children. Patient Educ Couns 1991 17 35-47. 

Two newer potent selective H -antagonists, terfenadine (23) (132) and astemizole (24) (133), have been developed which have neither the sedative nor the anticholinergic Habilities of the earlier agents. Both of these compounds have proven efficacious in the treatment of hay fever and produce very few side effects, prompting a re-evaluation of the role of antihistamines in asthma treatment. 

Dyspnea Dyspnea is shortness of breath or difficulty in breathing. The victim is usually quite aware of the unusual breathing pattern. Shortness of breath can be an indicator of many physical ailments including simple exertion, a panic attack, a blow to the chest, asthma, cardiac disease, as well as exposure to toxic chemicals. If a person is suffering from shortness of breath, evaluate them for additional symptoms and possible exposures. Keep the victim in a sitting position. Remove the victim to fresh air, if possible, and seek medical attention. 

Given the routine use of mast cell stabilizers in the clinic, for example in the setting of asthma treatment, these preclinical results may stimulate clinical evaluation in humans. 

Berkum Y. Ben-Zvi A. Levy Y. Galili D. Shalit M Evaluation of adverse reactions to local anesthetics experience with 236 patients. Ann Allergy Asthma Immunol 2003 91 342-345. 42... 

Evaluate current asthma therapy and make changes when necessary. 

Airway hyperresponsiveness is defined as the exaggerated ability of the airways to narrow in response to a variety of stimuli. Although AHR exists in patients without asthma, it is a characteristic feature of asthma and appears to be directly related to airway inflammation and the severity of asthma.1,3 Treatment of airway inflammation with inhaled corticosteroids attenuates AHR in asthma but does not eliminate it.1 Clinically, AHR manifests as increased variability of airway function. Although not commonly used to diagnose asthma, AHR can be evaluated clinically using a methacholine or histamine bronchoprovocation test. 

The optimal treatment of acute severe asthma depends on the severity of the exacerbation (Figs. 11-2 and 11-3). The patient s condition usually deteriorates over several hours, days, or weeks however, rapid deterioration can occur in some patients.3 Gradual deterioration may indicate failure of long-term controller therapy. Patients with rapid deterioration usually respond well to bronchodilator therapy.40 Severity at the time of the evaluation can be estimated by signs and symptoms, but patient response 30 minutes after inhalation of a bronchodilator is the best predictor of outcome.12... 

Monitor and maintain PEF above 80% of personal best PEF variability should be less than 20%. Patients with PEF rates consistently greater than 80% over several months should be evaluated for a step down in long-term control therapy. Patients with a PEF less than 80% of personal best should begin to monitor PEF twice daily and consult their asthma action plan. Patients with a PEF less than 50% of personal best should immediately use their short-acting inhaled 32-agonist and consult their asthma action plan. 

Evaluate therapy on a regular basis. Assess the patient s control of asthma by evaluating symptoms, PEF diary entries, and rescue medication use. Step long-term control therapy up or down based on these parameters. Before stepping up therapy, reassess the patient s inhaler technique to assure appropriate drug delivery. 

Refer patients who present with atypical symptoms such as cough, non-allergic asthma, or chest pain to their physician for further diagnostic evaluation. 

The first purified and characterized drug substances were administered as aerosols as a topical treatment for asthma approximately 50 years ago. More recently, drugs have been evaluated for systemic delivery. For each category of drug the mechanism of clearance from the airways must be considered. These mechanisms may be listed as mucociliary transport, absorption, and cell-mediated translocation. The composition and residence time of the particle will influence the mechanism of clearance. 

If you look in the medical literature, you will often see the term placebo defined as a non-specific treatment. What does it mean to say that a treatment is not specific It could mean that the treatment is effective for many different disorders, rather than for only one particular condition. In this sense, placebos are indeed non-specific. Besides depression, placebos have been shown to affect anxiety, pain, ulcers, irritable bowel syndrome, Parkinson s disease, angina, autoimmune diseases, Alzheimer s disease, rheumatoid arthritis, asthma, gastric function, sexual dysfunction and skin conditions. We know this from the thousands of studies in which placebos have been used as control conditions, against which the effects of medication have been evaluated, and from studies that were specifically designed to assess the placebo effect. 

Flunisolide is a fast-acting corticoid designed for the treatment of allergic rhinitis, asthma, and other allied respiratory disorders in humans. As the quantum of drug delivered by inhalation (/. e., the usual route of administration of the drug), is invariably small, the plasma-levels attained can also be fairly small. Hence, there is a dire need for a sensitive method of plasma concentration evaluation which is satisfied by radioimmunoassay. 

Other workers with flavoring-related BO were not appropriately diagnosed, even after reports of flavoring-related BO were published in the scientific literature (Kreiss et ah, 2002a Lockey et ah, 2002 Parmet and von Essen, 2002), public health commimications (CDC, 2002), and the press. Frequent misdiagnoses by physicians included asthma, bronchitis, and emphysema due to a presumptive diagnosis, an incomplete medical evaluation, and/or failure to make a coimection with occupational exposures. 

The initial publication was sharply criticized by other workers [360] who had reached diametrically opposed conclusions from their own studies and these, in turn, were examined and points of difference clarified by the original authors [361 ]. This exchange reveals the clinical evaluation of a new aid to asthma therapy a too complex for easy resolution of differences of approach and view. 

Of course, it is not always necessary to rely on biomarkers for rapid evaluation of dose-response relationships in ED. Thus, efficacy of new drugs is readily demonstrated in terms of the clinical endpoint for diseases, such as migraine, inflammatory pain, asthma, psoriasis, glaucoma and many others. 

It is important to include all age ranges that are of clinical importance. Development of an anti-asthma drug, for example, should include a programme of evaluation in children as well as adults because they will form a significant portion of the database and risk-benefit considerations will be different. Development of an anti-arthritis compound, on the other hand, will be undertaken predominantly in older patients and particularly detailed information on efficacy and safety in the elderly will be required. 

Iloprost has not been evaluated in patients with chronic obstructive pulmonary disease (CORD), severe asthma, or acute pulmonary infections. 

Adults and children 4 years of age and older (12 years of age and older for Proventil) 2 inhalations every 4 to 6 hours. In some patients, 1 inhalation every 4 hours may be sufficient. More frequent administration or a larger number of inhalations is not recommended. If previously effective dosage fails to provide relief, this may be a marker of destabilization of asthma and requires re-evaluation of the patient and treatment regimen. 

Multiple chemical sensitivity (MCS) is characterized by a variety of adverse effects upon multiple organs that result from exposure to levels of common foods, drugs, and chemicals that do not affect most people. Symptoms include headaches, fatigue, lack of concentration, memory loss, asthma, and other often subjective responses following exposure. MCS has remained controversial because standard medical evaluations, such as blood biochemical screens, have failed to identify consistent physical or laboratory test abnormalities that would account for the symptoms. 

---