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M. Hafiizh Alfarrisi, 0606065831
 Medical care
‡ Global Strategy for Asthma Management and
Prevention" include:
± Achieve and maintain control of asthma symptoms
± Maintain normal activity levels, including exercise
± Maintain pulmonary function as close to normal as
possible
± Prevent asthma exacerbations
± Avoid adverse effects from asthma medications
± Prevent asthma mortality
 _he long-term outpatient
management of asthma
‡ Objective measures of lung function
‡ Environmental control measures and
avoidance of risk factors
‡ Comprehensive pharmacologic therapy
‡ Patient education
 asthma treatment strategies
‡ _he functions of asthma assessment and
monitoring are closely linked to the concepts of
severity, control, and responsiveness to
treatment.
‡ Asthma severity is measured most easily and
directly in a patient
‡ Asthma control is the degree to which the
manifestations of asthma are minimized and the
goals of therapy
‡ Asthma responsiveness is the ease with which
asthma control is achieved by therapy.
 Èiet
‡ from prospective cohort studies,
association between asthma and obesity
‡ relationship between body mass index and
the risk of developing asthma.
 Activity
‡ Activity is generally limited by patients' ability to
exercise and their response to medications.
‡ No specific limitations are recommended for
patients with asthma, although they should avoid
exposure to agents that may exacerbate their
disease.
‡ A significant number of patients with asthma
also have exercise-induced bronchospasm
  
 
‡ Asthma medications are generally divided
into 2 categories:
± quick relief (also called reliever medications)
± long-term control (also called controller
medications)
 Ëuick relief medications
‡ are used to relieve acute asthma
exacerbations and to prevent exercise-
induced asthma (EIA), or exercise-induced
bronchospasm (EIB) symptoms.
‡ _hese medications include:
± short-acting beta-agonists (SABAs),
± anticholinergics,
± and systemic corticosteroids.
 Šong-term control medications
‡ inhaled corticosteroids (ICSs),
‡ cromolyn sodium,
‡ nedocromil,
‡ long-acting beta-agonists (ŠABAs),
‡ combination inhaled corticosteroids and
long-acting beta-agonists,
‡ Methylxanthines
‡ leukotriene antagonists
_he newest asthma medication
‡ omalizumab (Xolair)
± a recombinant ÈNA-derived humanized Ig G
monoclonal antibody that binds selectively to
human Ig E on the surface of mast cells and
basophils.
± _he drug reduces mediator release, which
promotes an allergic response.
± It is indicated for moderate-to-severe
persistent asthma, in whom symptoms are not
controlled by inhaled corticosteroids.
Ò
 





‡ _hese agents relieve reversible
bronchospasm by relaxing the smooth
muscles of the bronchi.
± Ševalbuterol
± Salmeterol
± Albuterol
 ' 

 
‡ _hese are highly potent agents that are
the primary ÈOC for treatment of chronic
asthma and prevention of acute asthma
exacerbations.
± _riamcinolone
± Beclomethasone
± Prednisone
 Ò  

‡ Bronchodilators provide symptomatic relief
of bronchospasm due to acute asthma
exacerbation (short-acting agents) or long-
term control of symptoms (long-acting
agents). Also used as the primary
medication for prophylaxis of exercise-
induced asthma.
± Ipratropium
± _heophylline
 


‡ Mast cell stabilizers prevent the release of
mediators from mast cells that cause
airway inflammation and bronchospasm.
_hey are indicated for maintenance
therapy of mild-to-moderate asthma or
prophylaxis for exercise-induced
bronchospasm.
± Cromolyn
    
 
‡ _hese recombinant ÈNA-derived
humanized immunoglobulin G monoclonal
antibodies bind selectively to human
immunoglobulin E on the surface of mast
cells and basophils. _hey reduce mediator
release, which promotes an allergic
response. _hey are indicated for
moderate-to-severe persistent asthma
± Omalizumab
Š





‡ _hese drugs are direct antagonists of
mediators responsible for airway
inflammation in asthma. _hey are used for
prophylaxis of exercise-induced
bronchospasm and long-term treatment of
asthma as alternative to low doses of
inhaled corticosteroids.
± Montelukast
 
 
‡ Exposure to irritants or allergens has been
shown to increase asthma symptoms and
cause exacerbations.
‡ evaluate patients with persistent asthma
for allergen exposures and sensitivity to
seasonal allergens.
‡ Skin testing
 avoid exposure to:
‡ Environmental tobacco smoke
‡ Exertion during high levels of air pollution
‡ Use of beta-blockers
‡ Avoidance of aspirin and other nonsteroidal anti-
inflammatory drugs if the patient is sensitive
‡ Avoidance of sulfites or other food
items/additives to which the patient may be
sensitive
‡ Occupational exposures
 ' 
 
‡ _he most common complications of
asthma include:
± pneumonia,
± pneumothorax or pneumomediastinum,
± and respiratory failure requiring intubation in
severe exacerbations.
ýisk factors for death from asthma:
‡ Previous severe asthma exacerbation (eg, intubation or
ICU admission for asthma)
‡ _wo or more hospitalizations for asthma in the past year
‡ _hree or more emergency department visits for asthma
in the past year
‡ Hospitalization or emergency department visit for asthma
in the past month
‡ Using more than 2 canisters of short-acting beta-
agonists per month
‡ Èifficulty perceiving asthma symptoms or severity of
exacerbations
ï Comorbidities - Cardiovascular disease, other chronic
lung disease, chronic psychiatric disease
 
 
‡ Approximately half the children diagnosed with
asthma in childhood outgrow their disease by
late adolescence or early adulthood and require
no further treatment.
‡ Patients with poorly controlled asthma develop
long-term changes over time (ie, with airway
remodeling). _his can lead to chronic symptoms
and a significant irreversible component to their
disease.
‡ Many patients who develop asthma at an older
age also tend to have chronic symptoms.
 

 
 
‡ Integrate patient education into every aspect of
asthma care.
‡ All members of the health care team, including
nurses, pharmacists, and respiratory therapists,
provide education.
‡ Clinicians teach patients asthma self-
management based on basic asthma facts, self-
monitoring techniques, the role of medications,
inhaler use, and environmental control
measures.
 

 
 
‡ Èevelop treatment goals for the patient
and family.
‡ Èevelop a written, individualized, daily
self-management plan.
‡ Several well-validated asthma action plans
are now available and are key in the
management of asthma.
 _hank you
‡ http://emedicine.medscape.com/article/29
6301-followup