Asthma severity

Classify asthma severity based on asthma symptoms. 

Classification of asthma severity is based on daytime and nighttime symptoms, physical activity, lung function, variability in peak expiratory flow (PEF), and use of reliever medications. 

Major factors that may contribute to the severity of asthma include allergens typically associated with atopy chemical exposures in occupational environments and exposure to tobacco smoke, irritants, and indoor and outdoor pollution. Other factors include concurrent disease states or medications that may worsen asthma severity. 

Asthma severity ranges from normal pulmonary function and symptoms only with acute exacerbations to significantly decreased pulmonary function with continuous symptoms. 

How would you classify this patient s asthma severity ... 

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). 

P -Adrenergic receptor R16G Nocturnal asthma/severity Agonist-dependent down- (6,12(258)... 

Kalayci O, Birben E, Sackesen C, et al. (2006) ALOX5 promoter genotype, asthma severity and ETC production by eosinophils. Allergy. 61, 97-103. 

Bronchodilators. Narrowing of bronchioles raises airway resistance, e.g in bronchial or bronchitic asthma Several substances that are employed as bronchodilators are described elsewhere in more detail P2-sympathomimetics (p. 84, given by pulmonary, parenteral, or oral route), the methylxanthine theophylline (p. 326, given parenterally or orally), as well as the parasympatholytic ipratropium (pp. 104, 107, given by inhalation). 

Corticosteroids do not heal illnesses, but they are widely used in various conditions when it is necessary to utilize their anti-inflammatory, immunosuppressant, and mineralo-corticoid properties. In addition, they are used in replacement therapy for patients who have adrenal insufficiency. Corticosteroids can be used in vital situations for asthma, severe allergic reactions, and transplant rejections. They are effective in noninfectious granulomatous diseases such as sarcoidosis, collagen vascular disease, rheumatoid arthritis, and leukemia. Steroids are used as lotions, ointments, etc. in treating a number of dermatological and ophthalmologic diseases. 

Respiratory depression At the usual adult dose of 10 mg/70 kg, nalbuphine causes respiratory depression approximately equal to that produced by equal doses of morphine. However, nalbuphine exhibits a ceiling effect increases in dosage beyond 30 mg produce no further respiratory depression. Respiratory depression induced by nalbuphine can be reversed by naloxone. Administer nalbuphine with caution at low doses to patients with impaired respiration (eg, from other medication, uremia, bronchial asthma, severe infection, cyanosis, or respiratory obstructions). 

Inhaled steroids are effective in most patients with asthma, irrespective of age or asthma severity. ICS... 

Caution [C, ] CrCl <30 Contra Component sensitivity, asthma, severe COPD, sinus bradycardia Disp Soln SE Irritation, bitter taste, superficial keratitis, ocular allergic Rxn EMS Drug is absorbed systemically OD May cause electrolyte disturbances (K), acidosis and bradycardia monitor ECG Doxazosin (Cardura, Cardura XL) [Antihypertensive/Alpha Blocker] Uses HTN symptomatic BPH Action < [-Adrenergic blocker relaxes bladder neck smooth muscle Dose HTN Initial 1 mg/d PO may be T to 16 mg/d PO BPH Initial 1 mg/d PO, may T to 8 mg/d XR 2-8mg qAM Caution [B, ] Use w/ PDE5 inhibitor (eg, sildenafil) can cause 1 BP Contra Component sensitivity Disp Tabs SE Dizziness, HA, drowsiness, sexual dysfxn, doses >4 mg T postural BP risk Interactions T Effects W/ nitrates, antihypertensives, EtOH i effects W/ NSAEDs, butcher s broom -t effects OF clonidine EMS Concurrent EtOH use can T drowsiness syncope may occur w/in 90 min of initial dose OD May cause profound hypotension place pt in supine position, give IV fluids, use pressors if needed... 

Since the discovery of sodium chromoglycate (DSCG), a drug which is useful in the treatment of human asthma, several isosteric or structurally related bisbenzofuran systems have been synthesized. A recent example is 6,6 -[(2-hydroxypropane-l,3-diyl)bis(oxy)]-bis-(3-hydroxy-2-benzofurancarboxylic acid) diethyl ester trisodium salt trihydrate (510) (80JHC1U7). 

The large body of epidemiological studies have clearly shown that allergic rhinitis and asthma are frequent diseases, and that both diseases obviously still increase in prevalence [4, 5]. However, without any doubt, there is a direct link between rhinitis and asthma. Several studies in a large number of patients have clearly shown that rhinitis sufferers have a 3- to 7-fold increased risk to also develop asthma within 7 years compared to normal controls. Most of this development actually lies in the early years of childhood, as was recently shown in the MAS and PAT studies [6, 7], In the first study, 5-year-old children sensitized to pollen with allergic rhinitis symptoms developed asthma within 2 years... 

Studies of omalizumab in asthmatic volunteers showed that its administration over 10 weeks lowered plasma IgE to undetectable levels and significantly reduced the magnitude of both the early and the late bronchospastic responses to antigen challenge. Clinical trials have shown repeated intravenous or subcutaneous injection of anti-IgE MAb to lessen asthma severity and reduce the corticosteroid requirement in patients with moderate to severe disease, especially those with a clear environmental antigen precipitating factor, and to improve nasal and conjunctival symptoms in patients with perennial or seasonal allergic rhinitis. 

Filaggrin null mutations are associated with increased asthma severity in children and young adults. J Allergy Clin Immunol 120, 64-68. 

Delfino RJ, Coate BD, Zieger RS, Seltzer JM, Street DH, Koutrakis P Daily asthma severity in relation to personal ozone exposure and outdoor fungal spores. Am J Respir Crit Care Med 1996 154 633-641. 

Delfino RJ, Zieger RS, Seltzer JM, Street DH, Matteucci RM, Anderson PR, Koutrakis P The effect of outdoor fungal spore concentrations on daily asthma severity. Environm Health Perspect 1997 105 622-635. 

Stafforini, D.M. PAF acetylhydrolase gene polymorphisms and asthma severity. Pharmacogenetics 2001, 2, 163-175. 

In various earlier surveys of conventional ionic contrast media, the incidence of minor reactions was one in 13-30 cases, the incidence of intermediate reactions one in 57-130 cases, and the incidence of severe reactions one in 1000-4000 cases. The figures for the non-ionic media are much more favorable. In 1990, the Japanese Committee on the Safety of Contrast Media surveyed 169 284 patients who had received ionic media and 168 363 who had received non-ionic contrast media (14). In patients with a previous history of reactions to contrast media, the incidence of severe reactions was 0.73% with ionic media and only 0.18% with non-ionic media. Among patients with asthma, severe and very severe reactions occurred in 1.88% with ionic media and 0.23% with non-ionic media. In a Canadian survey of 1992, the overall incidence of adverse effects to contrast media was 3.9% for ionic media and only 0.9% for non-ionic media, despite the fact that the proportion of patients with heart disease as a pre-existing susceptibility factor was much higher in the non-ionic group (SEDA-22, 500). 

An 11-year-old girl with acute asthma, severe CO2 narcosis, and ventricular fibrillation induced by hypoxemia was successfully treated with isoflurane in oxygen for 14 hours. Her recovery may have been due to bronchodilatation and the treatment that was possible because of the low dysrhjrthmogenic effect of isoflurane (6). 

Fowler SJ, Dempsey OJ, Sims EJ, Lip-worth BJ. 2000. Screening for bronchial hyperresponsiveness using methacholine and adenosine monophosphate. Relationship to asthma severity and beta(2)-receptor genotype. Am. J. Respir. Crit. Care Med. 162 1318-22... 

The degree of inflammation in asthma may vary among individuals because of interaction of genetic and environmental factors [6]. Accordingly, asthma severity is classified as mild, moderate, or severe based on symptoms, lung function, frequency of exacerbation, and physical activity (Table 1). 

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