For asthma

The modern usage of P2" go Asts for the treatment of asthma dates to 1903 when the effect of injected epinephrine [51-43-4] (adrenaline) C2H23NO2, (1 R = CH3) was investigated (see Epinephrine and norepinephrine) (33). As in some other modem treatments, eg, xanthines and anticholinergics, the roots of P2" go Ast therapy for asthma can be found in historical records which document the use of herbal extracts containing ephedrine [299-42-3] C qH NO, (2) as bronchodilators. Epinephrine and ephedrine are stmcturaHy related to the catecholamine norepinephrine [51-41-2] CgH NO, (1, R = H), a neurotransmitter of the adrenergic nervous system (see Neuroregulators). 

For many years oral xanthines, shown in Table 2, were the preferred first-line treatment for asthma in the United States, and if the aerosol and oral formulations of P2" go sts are considered separately, as they are in Table 1, this was still the case in 1989. Within this class of compounds theophylline (8), or one of its various salt forms, such as aminophylline [317-34-0] (theophylline ethylenediamine 2 l), have been the predominant agents. Theophylline, 1,3-dimethylxanthine [58-55-9], is but one member of a class of naturally occurring alkaloids. Two more common alkaloids are theobromine (9), isomeric with theophylline and the principal alkaloid in cacao beans, and caffeine, (10), 1,3,7-Trimethylxanthine [58-08-2], found in coffee and tea. 

The bronchodilating effect of caffeine has been recognized for hundreds of years. In the western world the first description of a caffeine preparation for asthma was made in 1859 (59) by a Scottish physician who recommended strong black coffee as a bronchodilator. In many parts of the world, however, use of xanthines is less frequent than in the United States. 

Corticosteroids are the most efficacious treatment available for the long-term treatment of asthma, and inhaled corticosteroids are considered to be a first-line therapy for asthma (247). In the early 1950s, cortisone (31) and cortisol (29) were used to treat asthma. However, dmgs with fewer side effects and with... 

The crude drug, Adhatoda vasica, is used in India as a remedy for asthma. According to Chopra, vasicine produces broncho-dilation and might be used clinically as an expectorant. A detailed pharmacological examination of peganine in comparison with harmine has been made by Tutaev and Makarova. ... 

According to the Global Initiative for Asthma (GINA, http //www.ginasthma.org), asthma affects about 300 million people worldwide. Men of all ages are affected by this chronic airway disorder that, without appropriate treatment, limits quality of life and is sometimes fatal. 

Asthma is a chronic inflammatory disease. Therefore steroids represent the most important and most frequently used medication. Already after the fust treatment, steroids reduce cellular infiltration, inflammation, and the LAR, whereas changes in the EAR require prolonged treatment to lower the existent IgE levels. The mechanisms of steroid actions are complex and only incompletely understood. Besides their general antiinflammatory properties (see chapter glucocorticoids), the reduction of IL-4 and IL-5 production from T-lymphocytes is particularly important for asthma therapy. The introduction of inhaled steroids, which have dramatically limited side effects of steroids, is considered one of the most important advancements in asthma therapy. Inhaled steroids (beclomethasone, budesonide, fluticasone, triamcinolone, momethasone) are used in mild, moderate, and partially also in severe asthma oral steroids are used only in severe asthma and the treatment of status asthmaticus. Minor side effects of most inhaled steroids are hoarseness and candidasis, which are avoided by the prodrug steroid ciclesonide. 

Leath TM, Singla M, Peters SP (2005) Novel and emerging therapies for asthma. Drug Discov Today 10 1647-1655... 

CA C1 C01.073 Peptidase 1 (mite) Potential drug target for asthma... 

PA S1 S01.143 Tryptase alpha Drug target for asthma and antigen-induced bronchoconstriction... 

Maintenance and prophylactic treatment of asthma for asthma patients who require systemic corticosteroid administration when adding an inhaled corticosteroid may reduce or eliminate the need for systemic corticosteroids... 

Discuss what to include in a teaching plan for a patient taking montelukast for asthma. 

An enprofylline-sensitive mechanism with implications for asthma. J Clin Invest 1995 96 1979-1986. 77... 

Other therapeutic uses of cannabinoid agonists have been reported. The potential of cannabinoids as a treatment for asthma is supported experimentally. A CBi agonist, (i )-methanandamide (21), inhibited nerve growth factor (NGF)-induced airway hyperresponsiveness in vivo [251]. The antipruritic effect of cannabinoids has been reported, the action being mediated by both CBi and CB2 pathways [252]. Treatment with cannabis extract improved urinary tract symptoms of multiple sclerosis patients significantly in an open-label pilot study [253]. 

Up to 80% of asthmatics have symptoms of rhinitis, and inflammation of the upper airways may increase AHR.1,3 Treatment of rhinitis with intranasal corticosteroids may improve asthma symptoms and is recommended for asthma patients with rhinitis. 

Increased serum concentrations of IgE or eosinophils may help confirm the diagnosis of asthma but are not diagnostic for asthma. 

Assessment of diurnal variation of PEF may be useful in patients who have asthma symptoms and normal spirometry. When spirometry is equivocal, a 20% or greater decrease in FEV after the administration of methacholine is diagnostic for asthma. A negative bronchoprovocation test with methacholine may help rule out asthma. 

A positive allergen test may help guide nonpharmacologic therapy but is not diagnostic for asthma. 

Because of the varying presentation of asthma, treatment guidelines for asthma therapy should serve as a guide for therapy with the therapeutic plan individualized for each patient to achieve these goals. 

Patients should play an active role in their therapy. The development of a health care provider-patient partnership is vital to the success of any treatment plan. Goals for asthma treatment should be shared with the patient and family, and the patient and health care provider should jointly agree on the patient s personal treatment goals. 

Patients sensitive to specific allergens should be educated on ways to avoid them. Environmental controls to reduce the allergen load in the patient s home may reduce asthma symptoms, school absences because of asthma, and unscheduled clinic and emergency visits for asthma.13 Patients allergic to warm-blooded pets should remove them from the home if possible or at least keep them out of the bedroom. However, allergens may remain in the home for months after the pet is removed.1... 

Leukotriene modifiers either inhibit 5-lipoxygenase (zileuton) or competitively antagonize the effects of leukotriene D4 (montelukast and zafirlukast). These agents improve FEV, and decrease asthma symptoms, rescue drug use, and exacerbations due to asthma. Although these agents offer the convenience of oral therapy for asthma, they are significantly less effective than low doses of inhaled corticosteroids.2,33... 

FIGURE 11-2. Home management of acute asthma exacerbation. Patients at risk for asthma-related death should receive immediate clinical attention after initial treatment. PEF, peak expiratory flow. 

TABLE 11-5. Dosages of Selected Medications for Asthma Exacerbations in Emergency Medical Care or Hospital... 

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. 

Bertrand CP, Ponath PD. CCR3 blockade as a new therapy for asthma. Expert Opin Invest Drugs 2000 9(l) 43-52. 

Garcia G, Godot V, Humbert M. New chemokine targets for asthma therapy. Cun-Allergy Asthma Rep 2005 5(2) 155-160. 

The first purified and characterized drug substances were administered as aerosols as a topical treatment for asthma approximately 50 years ago. More recently, drugs have been evaluated for systemic delivery. For each category of drug the mechanism of clearance from the airways must be considered. These mechanisms may be listed as mucociliary transport, absorption, and cell-mediated translocation. The composition and residence time of the particle will influence the mechanism of clearance. 

Phenylacetylcarbinol 15 Ephedrine Treatment for asthma Lyase Saccharomyces cerevisiae Single-stage fermentation [9]... 

Smoking is not a recommended treatment for asthma, however, due to the irritant and carcinogenic nature of cannabis smoke. 

Asthma is the most serious of the atopic diseases and has become epidemic, affecting more than 155 million individuals in the developed world. It is the most common chronic childhood disease in developed nations [1], and carries a very substantial direct and indirect economic cost worldwide [2]. A number of pharmacological treatments have been developed for asthma. These treatments have a modest efficacy overall, due in part to widely variable individual responses to asthma drugs. Because of such variability, it is clear that some of the substantial resources expended on asthma medication, estimated to exceed U.S. 3 billion per annum in the U.S. alone [3], would be better spent targeting those patients who... 

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