Asthma monitoring

In the clinical area, the largest share of analytical methods development and publication has centered on the determination of theophylline in various body fluids, since theophylline is used as a bronchodilator in asthma. Monitoring serum theophylline levels is much more helpful than monitoring dosage levels.44 Interest in the assay of other methylxanthines and their metabolites has been on the increase, as evidenced by the citations in the literature with a focus on the analysis of various xanthines and methylxanthines. 

CCBs not for acute asthma monitor for Sxs of hepatic failure (N, RUQ pain, lethargy, hepatomegaly, and jaundice) beware neuropsychiatric events OD Sxs unknown, unlikely... 

Use cautiously in patients with reactive airway disease such as asthma. Monitor for ECG changes (widening QRS complexes, prolonged QT interval). 

Provision and use of appropriate health surveillance, e.g. for signs of dermatitis, asthma, effects of specific solvent exposures. Full use of any spray booth, enclosure, exhaust ventilation or dilution systems, and automatic handling equipment. (The efficiency of all local exhaust ventilation and other control systems should be maintained, and checked by testing.) Where appropriate, atmospheric monitoring of airborne pollution levels. 

Monitor for adverse effects of 3-blockers—heart rate, blood pressure, fatigue, masking of symptoms of hypoglycemia and/or glucose intolerance (in patients with diabetes), wheezing or shortness of breath (in patients with asthma or chronic obstructive pulmonary disease), etc. 

Educate patients on the use of inhaled drug delivery devices, peak flow monitors, and asthma education plans. 

Treatment of severe acute asthma includes the use of oxygen for the rapid reversal of hypoxemia, a short-acting P2-agonist to reverse airway constriction, and a systemic corticosteroid to attenuate the inflammatory response.1 Close monitoring of objective measures such as FEVi or PEF is important to quantify the response to therapy. Because recovery from exacerbations is often gradual, intensified therapy should be continued for several days. 

Monitor symptoms such as wheezing, shortness of breath, chest tightness, cough, and nocturnal awakenings due to asthma symptoms. Daytime symptoms should occur no... 

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. 

Monitor frequency of patient exacerbations. Frequent exacerbations, unscheduled clinic visits, emergency department visits, and hospitalizations due to asthma may indicate a non-adherent patient or the need to step up long-term control medications. 

Monitor patient use of long-term control medications to ensure adherence to the medication plan. Patients not adhering to the long-term control medication regimen should be re-educated on the importance of these medications for asthma control. 

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. 

In patients with severe exacerbations, monitoring of Pco2 should be considered. Patients with acute asthma usually have a respiratory alkalosis, and a normal or increased Pco2 indicates the potential for respiratory failure. 

Prepare a patient-specific self-monitoring plan and review it with the patient. Educate the patient on the signs and symptoms of asthma deterioration and when and how to take rescue actions. 

Local and systemic adverse effects are associated with AIT. Patients may experience pain or subcutaneous nodules at the injection site. In patients who suffer systemic symptoms soon after the injection, the AIT plan should be assessed and may need to be advanced more gradually. Systemic reactions, including anaphylaxis, are most likely to occur during the titration phase. Patients with asthma are at higher risk for systemic and fatal reactions. Patients should be monitored for... 

The most common adverse effect with omalizumab is injection-site reaction, reported in 45% of patients in clinical trials. Other adverse effects include viral and upper respiratory tract infections, sinusitis, headache, and pharyngitis. Rare cases of malignant neoplasms and anaphylaxis were reported during clinical trials of omalizumab in asthma. Patients should be monitored for at least 2 hours following the injection so that anaphylaxis and/or injection-site reactions may be managed.25... 

Patients should also be monitored for the presence of atypical symptoms such as cough, nonallergic asthma, or chest pain. These symptoms require further diagnostic evaluation. 

Objective measurements of airflow obstruction with a home peak flow meter may not necessarily improve patient outcomes. The NAEPP advocates use of PEF monitoring only for patients with severe persistent asthma who have difficulty perceiving airway obstruction. 

Spirometric tests are recommended at initial assessment, after treatment is initiated, and then every 1 to 2 years. Peak flow monitoring is recommended in moderate to severe persistent asthma. 

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