Asthma pharmacotherapy

There are four major classes of asthma pharmacotherapy currently in widespread use [22, 23] ... 

Sorkness CA. Leukotriene receptor antagonists in the treatment of asthma. Pharmacotherapy 2001 21 34S-37S. 

Blake KV. Drug treatment of airway inflammation in asthma. Pharmacotherapy 2001 21 3S-20S. 

Kelly HW. Asthma pharmacotherapy Current practices and outlook. Pharmacotherapy 1997 17 13S-21S. 

WUliams DM. Clinical considerations in the use of inhaled corticosteroids for asthma. Pharmacotherapy 2001 21 38S 8S. 

Cordina M, McElnay JC, Hughes CM. 2001. Assessment of a community pharmacy-based program for patients with asthma. Pharmacotherapy 21 1196—203. 

In clinical practice, pulmonary function testing is the primary measurement used to assess disease and monitor asthma pharmacotherapy. Pulmonary function testing methods vary. The two most common measures of lung function include forced expiratory volume exhaled in one second (FEVi) and peak expiratory flow rate (PEE). FEV], measured in milliliters, represents the amount of air that patients can forcibly blow out in 1 second. 

Theophylline, a methylxanthine, still is commonly used for asthma pharmacotherapy in many countries. In developed countries, the advent of inhaled glucocorticoids, fi adrenergic receptor agonists, and leukotriene-modifying drugs has diminished theophylhne use significantly, and it has been relegated to a third- or fourth-line treatment in patients whose asthma is otherwise difficult to control. 

Therapy for chronic asthma is directed at suppressing the underlying inflammatory response and normalizing pulmonary function. The goals of treatment for chronic asthma are to (1) prevent chronic and troublesome symptoms (2) maintain normal or near normal pulmonary function (3) maintain normal activity levels, including exercise and other physical activities (4) prevent recurrent exacerbations of asthma and minimize the need for emergency department visits or hospitalizations (5) provide optimal pharmacotherapy with minimal or no adverse effects and (6) meet patients and families expectations of and satisfaction with asthma care.1... 

Because of the significance of the event, patients may be more open to education about asthma after resolution of the exacerbation. Health care professionals should use this opportunity to provide information to help prevent future episodes, including recognition of early indicators of an exacerbation and a process to appropriately intensify pharmacotherapy during the early stages of future exacerbations, including an individualized written asthma action plan. 

FIGURE 11-1. Steps for using your inhaler. (From Kelly HW, Sorkness CA. Asthma. In DiPiro JT, Talbert RL, Yee GC, et al, (eds.) Pharmacotherapy A Pathophysiologic Approach. 6th ed. New York McGraw-Hill 2005 515, with permission.)... 

From Kelly HW, Sorkness CA. Asthma. In DiPiro JT, Talbert RF, Yee GC, et al, (eds.) Pharmacotherapy A Pathophysiologic Approach. 

Nelson HS, Weiss ST, Bleecker ER, Yancey SW, Dorinsky PM. (2006) The Salmeterol Multicenter Asthma Research Trial a comparison of usual pharmacotherapy for asthma or usual pharmacotherapy plus salmeterol. Chest. 129,15-26. 

Pharmacotherapy of Chronic Obstructive Puimonary Disease and Asthma... 

Pharmacotherapy of asthma is managed in a stepwise fashion according to the severity of the disease. Recommendations for the stepwise treatment of asthma in adults and children older than 5 years of age are shown in Table 39.1. 

Theophylline is a bronchodilator that is commonly used to treat the symptoms of chronic asthma. The principal enzyme involved in the biotransformation of theophylline is CYPl A2 (126). In a case report, Nebel et al. described an individual who required theophylline dosage adjustment following the initiation and cessation of St. John s wort pharmacotherapy (127). The dose... 

Knoell DL, Pierson JF, Marsh CB, etal. 1998. Measurement of outcomes in adults receiving pharmaceutical care in a comprehensive asthma outpatient clinic. Pharmacotherapy 18 1365. 

Kelly HW. Asthma. In Carter B, Angaran D, Sisca T, eds. Pharmacotherapy self-assessment program, 1st edition. Kansas City American College of Clinical Pharmacy, 1992 3-16. 

In step one, pharmacotherapy for mild, intermittent asthma involves a quick-relief drug only for acute symptom control. All other steps also recommend quick-relief drugs in addition to further therapy. Step two includes an additional controller, such as a low-dose ICS, for mild persistent asthma therapy. In step three, either increasing ICS dose or adding one more controller medication, such as an LABA, to the low-to-medium-dose ICS is recommended for moderate persistent asthma. Finally, in step four, high-dose ICS and a LABA are recommended for treating severe persistent asthma. Asthma control should be monitored every 6 months to decide whether to step-up or step-down the pharmacotherapy based on level of symptom control. 

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