Therapeutics Pulmonary Lubsch Flashcard

Pathogenesis of Asthma

1.  Host Factors

  • Innate immunity (Th1/Th2 phenotype, “Hygeine Hypothesis)
  • Genetics
  • Sex

2.  Environmental Factors

  • Airborne allergens
  • Viral respiratory infections (RSV, non-RSV bronchiolitis, Parainfluenza virus)
  • Tobacco smoke
  • Air pollution

Clinical Presentation of Asthma

1.  Symptoms

  • Recurrent cough/Nighttime cough
  • Wheezing
  • SOB
  • Chest tightness
  • Decreased exercise tolerance
  • Sputum production

2.  FH/SH

  • Asthma
  • Atopic disease (allergic rhinitis, dermatitis, conjunctivitis)
  • Home characteristics (cockroaches, mites, pets)
  • Smoking
  • Workplace or school characteristics
  • Educational level
  • Employment
  • Social support

3.  Physical Exam

  • Tachypnea, tachycardia
  • Atopy, diaphoresis
  • Wheezes, accessory muscle use

 

Nonpharmacological Therapy for Asthma

  • Environmental Control
  • Manage comorbid conditions
  • Self-Management Skills
  • Education

Exercise-Induced Bronchospasm is diagnosed as:

  • 10-15% decrease in PEF or FEV1
  • No limit in participation/success in activities

Pharmacologic Control: Long Term Therapy

1.  Anti-Inflammatory

  • inhaled corticosteroids
  • mast cell stabilizers
  • leukotriene modifiers
  • immunomodulators

2.  Bronchodilators

  • long-acting beta2 agonist
  • theophylline

Pharmacologic Control: Quick Relief Therapy

  • short-acting beta2 agonists
  • systemic corticosteroids
  • anticholinergic agents

First-Line Therapy for Acute Relief of Asthma and Exercise-Induced Bronchospasm
Short-Acting Beta2 Agonists
Duration of Action for Short-Acting Beta2 Agonists
4 hrs
Examples of Short-Acting Beta2 Agonists

  • Albuterol
  • Levalbuterol
  • Pirbuterol
  • Terbutaline

Preferred Therapy for Moderate-Severe Asthma along with ICS
Long-Acting Beta2 Agonists
Long-Acting Beta2 Agonists are monotherapy or combo-therapy?

NOT indicated for monotherapy

 

Long-Acting Beta2 Agonists: Duration of Action
12 hrs
Long-Acting Beta2 Agonists: Examples

Salmeterol

Formoterol

Theophylline: ADR

  • Hypotension
  • Cardiac arrhythmias
  • Seizures

Leukotrienes Modifiers: ADRs

  • Hepatic dysfunction
  • Headache
  • Abdominal pain

When should Omalizumab be considered for asthma treatment?
Severe persistent allergic asthma in patients > 12 yrs

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