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What do you use to avoid exercise-induced asthma?
- Short acting B-blocker taken 15 minutes before exercise can have a 2-3 hour effect.
- Long-acting B-blockers can also be used, prefer formoterol, which has a more rapid onset of action than salmeterol.
What are side effects of inhaled corticosteroids?
- dysphonia (in part from myopathy of small muscles of phonation), oral thrush, and cough
The systemic side effects of inhaled corticosteroids are relatively uncommon but do occur in patients on high-dose therapy, particularly long-term, high-dose therapy. These effects include adrenal suppression, reduced growth velocity in children, weight gain, glaucoma, cataracts, osteopenia, and skin thinning. Therefore, the lowest dose consistent with disease control should always be used. For most end points, the effects of inhaled corticosteroids are relatively flat at high doses. Step-down therapy should be considered at regular intervals, perhaps every 3 months, if the disease is adequately controlled.
How is Omalizumab used in asthma treatment?
- Omalizumab, a recombinant monoclonal antibody that binds to the Fc portion of IgE antibody, is approved for use in patients
- with moderate to severe, persistent allergic asthma.
A pt with asthma symptoms, now presenting with infiltrates, striking peripheral blood eosinophilia, and constitutional symptoms, such as fever and weight loss. What is the diagnosis?
Chronic eosinophilic pneumonia
A pt with asthma symptoms, now with eosinophilia, markedly high serum IgE levels, and intermittent pulmonary infiltrates
A pt with asthma symptoms, now with upper airway and sinus disease, difficult-to-treat asthma, and multi-organ dysfunction. What is the diagnosis?
What is Reactive Airways Dysfunction Syndrome?
Exposure to high levels of irritants (for example, chlorine gas, bleach, or ammonia) can result in significant airway injury, which can lead to persistent airway inflammation and dysfunction with airway hyperresponsiveness and obstruction. After a single exposure, typically accidental, the patient may develop chronic and persistent cough, shortness of breath, and chest tightness. This is known as the reactive airways dysfunction syndrome (RADS).
How do you treat virus-induced asthma?
- Infection with rhinovirus, influenza virus, and respiratory syncytial virus has been associated with asthma exacerbation.
- Typically, asthma exacerbations occur 2 to 4 days after the onset of the cold and can range from mild to very severe exacerbations. When mild, these exacerbations can be treated with inhaled corticosteroids and long-acting β2-agonists; however, severe exacerbations require therapy with systemic corticosteroids
What is cough-variant asthma?
- In a subset of patients with asthma, cough can be the predominant or, at times, the only symptom. This syndrome is called cough-variant asthma
- Patients with cough-variant asthma typically have airway hyperresponsiveness on methacholine challenge testing and can show evidence of obstruction on spirometry, with improvement after inhaled bronchodilators
What is Vocal Cord Dysfunction?
- Vocal cord dysfunction (VCD) simulates asthma and manifests as recurrent wheezing and stridor. Symptoms can occur suddenly without a clear cause or in response to irritants, exercise, or stress; VCD can occur in patients with or without asthma.
- The diagnosis can be confirmed by flow volume loops when the patient is symptomatic, which show an inspiratory cut-off, or laryngoscopy, which shows abnormal adduction of the vocal cords.
- Treatment involves speech therapy, behavior modification, and patient education.
- During an acute attack, inhalation of a helium-oxygen mixture and continuous positive airway pressure can relieve the symptoms of VCD.
What are the recommended treatments for asthma in the pregnant pt?
- Short acting B-blocker
- Inhaled corticosteroids
- Long-acting B-blocker with salmeterol if needed
- PO prednisone if needed
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