Asthma, worsening

An 11-year-old girl with asthma was stable for 2 months taking theophylline, and phenobarbital until the phenobarbital was replaced by carbamazepine. The asthma worsened, her theophylline serum levels be-eame subtherapeutie and the half-life of the theophylline was reduced from 5.25 to 2.75 hours. Asthmatic control was restored, and the half-life returned to pre-treatment levels 3 weeks after the carbamazepine was re-plaeed by ethotoin. The elearance of theophylline in an adult patient was doubled by carbamazepine 600 mg daily. ... 

Improvements in asthma treatment include the development of more effective, safer formulations of known dmgs. The aerosol adrninistration of P2-agonists or corticosteroids results in a decrease in side effects. Also, the use of reUable sustained release formulations has revolutionized the use of oral xanthines which have a very narrow therapeutic index (see Controlled release technology). For many individuals, asthma symptoms tend to worsen at night and the inhaled bronchodilatots do not usually last through an entire night s sleep (26,27). 

ZANAMIVIR There is a risk for bronchospasm in patients with asthma or COPD. A fast-acting bron-chodilator should be on hand in case bronchospasm occurs. Zanamivir use should be discontinued and the primary health care provider notified promptly if respiratory symptoms worsen. 

The mast cell stabilizers are contraindicated in patients with known hypersensitivity to the drugp. The mast cell stabilizers are contraindicated in patients during attacks of acute astiima because they may worsen bron-chospasm during tiie acute asthma attack. 

There is evidence that some people are sensitive to free glutamates. These people get headaches or other symptoms if they ingest too much. This may be related to pyridoxine (vitamin B6) deficiencies, as this vitamin is necessary for glutamate metabolism. People with uncontrolled severe asthma may find that glutamates complicate or worsen their symptoms. 

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. 

The ingestion of sulfites can also worsen asthma. These agents are often found in processed potatoes, shrimp, dried foods, beer, and wines. Patients sensitive to sulfites should be warned not to ingest these products, as they have been known to cause severe exacerbations, particularly in severe asthmatics. 

There is little evidence for other food allergies as a routine cause of worsening asthma symptoms.1,3... 

Worsening or acute asthma can be a life-threatening situation, and appropriate outcomes require rapid assessment and appropriate intensification of therapy. Mortality associated with asthma exacerbations is usually related to an inappropriate assessment of the severity of the exacerbation resulting in insufficient treatment or referral for medical care.12 The goals... 

Although both formoterol and salmeterol are effective as add-on therapy for moderate persistent asthma, neither agent should be used as monotherapy for chronic asthma. Patients treated with salmeterol alone are at greater risk of worsening asthma than those treated with inhaled corticosteroids.25,26... 

Obtain a thorough medical history focusing on disease states that may worsen the severity of asthma. 

Restart the patient on maintenance therapy. Instruct the patient on what to do if asthma should worsen and to follow-up with his/her health care provider in 3 to 5 days. 

Workers afflicted with OA, may suffer multiple hardships including lower wages due to transfer to other jobs, reduction in job responsibility, lost work days, lack of productivity, and long term unemployment. Quality and satisfaction of life can also be affected if there is development and/or worsening of ongoing asthma, exacerbation... 

In work-aggravated asthma, a worker with preexisting asthma has worsening of asthma symptoms due to exposures in the workplace. These exposures may be irritant chemicals, cold air, or allergens to which the worker was sensitized prior to hire. The diagnosis is made if the asthma was not active within 2 years before the hire date and there is (1) worsening of asthma symptoms on workdays and (2) serial spirometry tests and /or repeat PEER measurements suggesting a work-related pattern. 

MSG (monosodium- glutamate) flavour enhancer for foods may cause allergic reaction known as MSG symptom complex, with symptoms such as nausea and headache may worsen already severe asthma... 

The side effects of beta blockers include decreased blood pressure, dizziness, and sedation. They are also believed by some to worsen symptoms of depression in vulnerable individuals, though how beta blockers such as atenolol that do not enter the brain might do so is not readily understandable. In addition, beta blockers should be avoided in diabetic patients because they may dangerously mask the symptoms of hypoglycemia. Finally, beta blockers should not be taken by patients with emphysema (COPD) or asthma. 

The beta blocker propranolol (Inderal) has been studied in the treatment of impulsivity and appears to provide a slight benefit to some patients. It can be started at a dose of 10 mg taken three times per day and increased gradually to a maximum of 200mg/day. Side effects of propranolol include depression, fatigue, lowered blood pressure, impotence, and a worsening of symptoms in patients with asthma. 

Blocking the beta receptor can lower blood pressure, slow heart rate, trigger erectile dysfunction (impotence), or worsen breathing difficulties in patients with asthma or emphysema. The best way to manage these side effects is to use the lowest effective dose. If the side effects remain intolerable at the least effective dose, then it s probably necessary to switch to an alternative medication. 

The usual frequency of treatments is 3 times/day. Treatments may be increased up to 4 times/day however, the interval between treatments should be at least 4 hours. For some patients, 2 treatments a day may be adequate. Seek medical advice immediately if the previously effective dosage regimen fails to provide the usual relief, as this is often a sign of seriously worsening asthma that would require reassessment of therapy. 

If previously effective dosage regimen fails to provide the usual relief, seek medical advice immediately, as this is often a sign of seriously worsening asthma that would require reassessment of therapy. 

Stages in severity of asthma are mentioned in Table 9. Older smdies have already shown that addition of low doses of theophylline in worsening asthma (giving serum concentrations < 10 mg/1) was more effective than doubling the dose of the inhaled corticosteroid. Similar data are now emerging with anti-leukotrienes. The reason why a combination ther-... 

Do not initiate therapy in patients with significantly worsening or acutely deteriorating asthma... 

Notify the physician if abdominal pain, nausea, flu-like symptoms, jaundice, or worsening of asthma occurs... 

Research shows that repeated exposure to air pollution can cause or worsen asthma in children. 

Propranolol Block 3i and 32 receptors Lower HR and BP reduce renin Hypertension angina pectoris arrhythmias migraine hyperthyroidism Oral, parenteral Toxicity Bradycardia worsened asthma fatigue vivid dreams cold hands... 

Contraindications to the use of 3 blockers are asthma and other bronchospastic conditions, severe bradycardia, atrioventricular blockade, bradycardia-tachycardia syndrome, and severe unstable left ventricular failure. Potential complications include fatigue, impaired exercise tolerance, insomnia, unpleasant dreams, worsening of claudication, and erectile dysfunction. 

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