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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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04/Jul/2022

Many cells and cellular factors play a part in this chronic inflammatory condition of the airway. Chronic inflammation is associated with airway hyperresponsiveness which is responsible for chest tightness, wheezing, and coughing, particularly at night or in the early morning. What is asthma, These article are associated with widespread but variable airway obstruction within the lung that is often reversible either spontaneously or with treatment.

What is asthma? How is asthma diagnosed?

Symptomatic asthma – PFT, Asymptomatic – provocation challenge test Symptoms: episodic breathlessness, chest tightness, wheezing, cough – incited with allergen exposure, seasonal variation. There is a family history of asthma and allergy. History of variability in symptoms. Physical examination – wheezing may be present, silent chest in severe asthma

Lung functions – FEV1, FVC, PEFR

PEFR – 1. Confirm diagnosis of asthma (>20% or >60l/min improvement post-bronchodilator or diurnal) 2. For monitoring and control

Methacholine challenge test/ histamine challenge test/ mannitol/exercise challenge test (sensitive test – negative test rules out asthma, false-positive – allergic rhinitis, CF, bronchiectasis, COPD)

Sputum eosinophilia, Feno

Total Ig E – not diagnostic of atopy

SPT – low cost and high sensitivity through false positive is high

Rule out DD –

FOREIGN BODY INHALATION

VOCAL CORD DYSFUNCTION

LVF

COPD

CF/BRONCHIECTASIS

How do u assess the severity

 Controlled
(ALL MEASURES)
Partly controlled
(1-2)
Uncontrolled
Daytime symptoms<2 /week3 OR MORE
Limitation of activityNone
Nocturnal awakeningNone
Need for reliever<2 /week
FEV1N<80%

Assessment of future risk –

  1. Poor control of symptoms
  2. Frequent exacerbations
  3. ICU admissions
  4. Low FEV1
  5. Cigarette smoke exposure
  6. High dose medications

 

Old classification of patients – intermittent, mild persistent, moderate persistent, severe persistent

It is not only the severity of symptoms but its responsiveness to treatment.

What is an asthma attack?

Many patients have stable disease and they are relatively free of symptoms. But whenever they come across trigger factors they develop an increase in their symptoms.

Asthma attack comprises the episode of progressive increase in breathlessness, cough, chest tightness, and wheezing. Treatment comprises repeated doses of rapid-acting bronchodilators, systemic steroids, and oxygen if required. Milder exacerbations can be treated in community settings

What causes these symptoms?

Asthma is an inflammatory disease with the involvement of airway cells (like mast cells, eosinophils, t lymphocytes, and dendritic cells) and structural cells (airway epithelial, endothelial cells, smooth muscle cells). Chemokines, cysteinyl leukotrienes, cytokines, histamine, and NO are mediators that act on these cells.

Airway narrowing is caused due to – smooth muscle contraction, airway edema, mucus hypersecretion, airway remodeling.

What signs tells a person that asthma is worsening ?

1. Breathlessness

2. Talks in 

3. Alertness

4. Wheeze

5. Respiratory rate

6. Accessory muscles of respiration

7. Pulse

8. Pulsus paradoxus

9. PEFR

10. SpO2

11. PaO2

12. PaCO2


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04/Jul/2022

Asthma Symptoms, Causes and Treatments: In asthma, the “invaders” are some causes given in the below section. Triggers differ among people. Since asthma is a sort of allergic response, it is in some cases known as reactive airway disease. Every patient with asthma has his or her own one of a distinctive set of causes. Most triggers cause assaults in a few people with asthma and not in others. Common causes of asthma attack involve:

Asthma Symptoms, Causes and Treatments

  • Exposure to wood or tobacco smoke.
  • Inhaling polluted air.
  • Breathing other respiratory irritants like cleaning products or scents (perfumes).
  • Come in Contact to airway aggravations at the workplace.
  • Inhaling in allergy-causing elements (allergens) such as dust, pollen, animal dander or molds.
  • An upper respiratory disease, such as bronchitis, flu, cool, sinusitis.
  • Come in contact to cold, dry weather
  • Emotional stress or excitement
  • Physical workout or exertion
  • Reflux of stomach acid called as GERD or gastroesophageal reflux ailment.
  • Sulfites, an added substance to a few wine and foods
  • Monthly cycle (In a few, not all, ladies, asthma side effects are firmly fixing to the menstrual cycle.)

Risk factors for developing asthma include

  • Allergic Rhinitis (Hay Fever) and other allergies (This is the most common risk factor.),
  • Eczema (Allergy that affecting on screen), and
  • Genetic predisposition (any family History of Asthma).

What Are Asthma Symptoms and Signs?

At the point when the airways become panic and inflammation, the attack is encounter. Check out the Asthma Symptoms, Causes and Treatments. The asthma attack may come on instantly or grow gradually more than a few days or hours. The fundamental side effects that signal an attack are as per the following:

  • Difficulty in Speaking.
  • Shortness of Breathing,
  • Chest tightness,
  • Wheezing, and
  • Coughing

Side effects may happen amid the day or around night time. If they occur around night time, they may bother your sleep. Check Best Asthma Specialist in jaipur

Are There Home Remedies for Asthma?

Current treatment procedure is intended to reduce inflammation, discomfort, and the area to which you need to confine your exercises. If you honestly follow your treatment procedure, you ought to have the capacity to maintain a strategic distance from or lessen your visits to your doctor or asthma specialist.

  • First you need to know about your causes and what you can do to reduce them.
  • If you are smoking, quit it.
  • Try not to take cough medicine. These medications don’t help asthma and may cause undesirable symptoms.
  • Nonsteroidal mitigating or Aspirin drugs, for example, ibuprofen, can make asthma worsen in specific people. These drugs ought not to be taken without the counsel of your doctor.
  • Try not to utilize nonprescription inhalers. These contain short-acting medications that may not keep going sufficiently long to relieve an asthma attack and may cause undesirable symptoms.
  • Take just the drugs your doctor has recommended for your asthma. Take them as prescribed.

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