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04/Jul/2022

Do asthma drugs affect pregnancy Asthma control may alter during pregnancy, so it’s important to keep an eye on it.

1/3 – same, 1/3 – deteriorate, 1/3 – improve

Risk to a fetus is more in poorly controlled asthma as compared to the risk of medications. Inhaled glucocorticoids, theophylline, beta-2 agonists, and leukotriene inhibitors are not associated with any fetal anomalies.

Do Asthma Drugs Affect Pregnancy | Can Heartburn be Worse Than Asthma?

Yes in many studies it has been shown that heartburn worsens asthma and proton pump inhibitors have been shown to improve asthma control. In severe GERD, surgery may also be need to control asthma symptoms. However, routine use of PPI in asymptomatic GERD in asthmatics is not of any benefit.

What is difficult asthma?

It was in 1998 that Peter Barnes gave the concept of difficult asthma. Most asthmatics are control with ICS. But 5% are not control. Now BTS & GINA have also defined difficult asthma.

Asthma symptoms not controlled by step 4 medications (reliever + 2 or more controllers)

  1. Recheck diagnosis of asthma
  2. Adherence
  3. Smoking history – present or past
  4. Co-morbidities – GERD, sinusitis, obesity, sleep apnea

 

What is steroid-resistant asthma?

Glucocorticoids (GCs) have potent anti-inflammatory actions and are the most effective agents in the treatment of asthma. Asthmatics have 2 spectrums of disease steroid-responsive at one end and steroid-resistant at the other end. Patients with chronic asthma who are unresponsive to high doses of GCs and are without confounding factors have been termed GC-resistant.

There is no known treatment for glucocorticoid-resistant asthma. Treatment strategies include the use of higher doses of systemic glucocorticoids for a longer duration, nonglucocorticoid agents (eg, beta-adrenergic agonists, anticholinergic agents, anti leukotriene agents, omalizumab, cromolyn) and nonpharmacologic therapies (eg, trigger avoidance, bronchial thermoplasty). Small clinical trials of anti-interleukin (IL)-5 and anti-IL-13 have showed some benefit in GC-resistant asthma patients, but many of these innovative medicines require additional evidence of clinically relevant effects.

What are allergy shots?

Allergy shots are another name for immunotherapy. Subcutaneous or sublingual administration is possible. The ideal patient for IT should be more than 5 yr, with mild to moderate disease, few dominant allergens, seasonal exacerbations, patients on daily prophylactic medicines (wants to take less), and improved QOL. Not appropriate <5yr, >60 yr, h/o anaphylaxis, lack of availability of well-tested allergens.

Long-term effects of IT persist even after IT is discontinue.

SLIT: less effective than SCIT,

Safer but not totally

Shown effective as monotherapy

Dosing issues persist

Not shown to be effective in a mixture of antigens

Not yet approved in our country

Is asthma a lifelong problem or can it be cured?

There are 2 types of asthma. Half of the children who develop asthma in childhood outgrow their symptoms when they reach the age of 14-15 y. However, they may develop symptoms in later life when exposed to heavy trigger factors.

Your message for an asthmatic?

Asthma is a controllable disease and you can lead a trouble-free life with 2 Asthma Treatment strategies. 

1. KEEP PRECAUTIONS OF TRIGGER AVOIDANCE 

2. TAKE YOUR MEDICINES REGULARLY

Intrinsic (non-atopic) asthma and extrinsic (atopic) asthma)

There is no clinical or serological evidence of IgE-mediated allergy to common environmental stimuli in intrinsic asthma. When compared to controls, bronchial biopsies from such patients demonstrate increased expression of Th2-type cytokines, CC chemokines, and I/C, similar to extrinsic asthma. These data show that in this key clinically different type of the disease, there may be local IgE production directed against unknown antigens, presumably of viral origin or even autoantigens.


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