Asthma intermittent

Patients with mild intermittent asthma may be symptom-free and have normal pulmonary function between exacerbations. 

In chronic asthma, classification of asthma severity is based on daytime and nighttime symptoms, physical activity, lung function (PEF or FEVfi, PEF variability, and reliever medication use. Because lung function is difficult to measure in preschool children (children 5 years of age or younger), it cannot be used to classify disease severity in this age group. Chronic asthma is classified as mild intermittent asthma, or mild, moderate or severe persistent asthma (Table 11-1). 

Use of short-acting 32-agonist greater than 2 times a week in intermittent asthma (daily or increasing use in persistent asthma) may indicate the need to initiate or increase long-term-control therapy... 

In patients with mild intermittent asthma, long-term control medications are not necessary, and patients should use a short-acting inhaled P2-agonist t° prevent or treat symptoms.2 This classification includes patients with exercise-induced asthma, seasonal asthma, or asthma symptoms associated with infrequent trigger exposure. Patients can pre-treat with two puffs of cromolyn or nedocromil prior to exposure to a known trigger. The treatment of choice for exercise-induced asthma is two inhalations of albuterol 5 minutes prior to exercise.1 Cromolyn and nedocromil are less effective than albuterol for prophylaxis of exercise-induced asthma. 

Monitor use of short-acting inhaled P2-agonists. Use of these agents more than twice a week in intermittent asthma may indicate the need to initiate long-term control therapy. Use of more than one canister per a month indicates the need to step up long-term control therapy. 

A 65-year-old African-American female with a history of diabetes, mild intermittent asthma, and hypertension presents to your clinic for her yearly check-up. She states that she is concerned about losing her eyesight because her sister has started losing her vision from glaucoma. She states that she has not noticed any changes in her vision. 

Based on a LOAEL of 2 ppm for respiratory effects—bronchial obstruction (30% change in airway resistance) in 2/10 persons with asthma in the Jappinen et al. (1990) study, an acute inhalation MRL of 0.07 ppm was derived. An uncertainty factor of 30 was applied to the LOAEL 10 for the use of a LOAEL and 3 for human variability. Since persons with severe asthma were excluded from the study, an uncertainty factor of 3 is needed to protect all sensitive individuals including children. Further details on the derivation of this MRL can be found in the MRL worksheets in Appendix A of this profile. Based on aNOAEL of 30.5 ppm for respiratory effects in mice observed in the CUT (1983a) study, an intermediated MRL of 0.03 ppm was derived. The NOAEL is adjusted for intermittent exposure and the NOAEL[hec] is calculated. An uncertainty factor of 30 is then applied 3 for extrapolating from animals to humans and 10 for human variability. Further details on this MRL can be found in the MRL worksheets in Appendix A of this profile. 

Asthma can vary from chronic daily symptoms to only intermittent symptoms. The intervals between symptoms may be days, weeks, months, or years. 

The severity is determined by lung function, symptoms, nighttime awakenings, and interference with normal activity prior to therapy. Patients can present with mild intermittent symptoms that require no medications or only occasional use of short-acting inhaled /f2-agonists to severe chronic asthma symptoms despite receiving multiple medications. 

Albuterol and other inhaled short-acting selective / -agonists are indicated for treatment of intermittent episodes of bronchospasm and are the first treatment of choice for acute severe asthma and EIB. Regular treatment (four times daily) does not improve symptom control over as-needed use. 

Potentiation of the action of acetylcholine, another bronchoconstrictive agent implicated as a mediator in asthma, has also been reported in guinea pigs exposed to ozone at at least 2 ppm for 30 min before inhalation of acetylcholine the effect was observed intermittently for up to 23 h after ozone exposure. 

Many disorders benefit from exercise (Pederson Saltin, 2005). These include asthma, cancer, chronic heart failure, coronary artery disease, chronic obstructive pulmonary disease (COPD), depression, type 1 diabetes melUtus, type 2 diabetes melUtus, hypertension, intermittent claudication, osteoarthritis, osteoporosis, rheumatoid arthritis and obesity. 

Most of the adverse reactions associated with the use of the intravenous barbiturates are predictable and therefore can be controlled or avoided. Some reactions, such as hypersensitivity, are entirely unpredictable. Particularly patients with asthma, urticaria, or an-gioedema may acquire allergic hypersensitivity to the barbiturates. Acute intermittent porphyria is an absolute contraindication to the use of barbiturates. 

Inhibitors) may be involved. A meta-analysis suggested that ginkgo was more effective than placebo and possibly comparable to pentoxifylline (Chapter 20 Drugs Used in Asthma) in relieving symptoms of intermittent claudication. 

Inhaled adrenergic agonists with p2 activity are the drugs of choice for mild asthma, that is, in patients showing only occasional, intermittent symptoms (Figure 22.2). p2-Agonists are potent bron-chodilators that relax airway smooth muscle directly. 

Adults and adolescents with asthma Inhalation 0.12-4 ppm 40 min - 4 h No change in pulmonary function was noted in several studies of adult and adolescent, whether at rest or with intermittent exercise. Koenig et al. 1987 Koenig et al. 1985 Kleinman et al. 1983 Rubinstein et al. 1990 Vagaggini et al. 1996 Utell and Morrow 1989 Mohsenin 1987 Roger et al. 1990 Sackneret al. 1981 Linn and Hackney 1984... 

Suppression of diseases of s5rmptoms is used continuously or intermittently to maintain health without attaining cure (as in h5fpertension, diabetes mellitus, epilepsy, asthma) or to control symptoms (such as pain and cough) whilst awaiting recovery from the causative disease. 

Partial agonists, such as acebutolol, oxprenolol, pindolol, practolol, and xamoterol, produce less resting bradycardia. It has also been claimed that such agents cause a smaller increase in airways resistance in asthmatics, less reduction in cardiac output (and consequently a lower risk of congestive heart failure), and fewer adverse effects in patients with cold hands, Raynaud s phenomenon, or intermittent claudication. However, none of these advantages has been convincingly demonstrated in practice, and patients with bronchial asthma or incipient heart failure must be considered at risk with this type of compound. 

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