ASTHMA Created by : Ahmad Nasereddin & Rshad Dabash Dr. olaa ayesh
Transcript
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What Is Asthma? Asthma is a chronic (long-term) lung disease
that inflames and narrows the airways. Asthma causes recurring
periods of wheezing (a whistling sound when you breathe), chest
tightness, shortness of breath, and coughing. The coughing often
occurs at night or early in the morning.
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Asthma affects people of all ages, but it most often starts
during childhood. In the United States, more than 22 million people
are known to have asthma. Nearly 6 million of these people are
children.
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Figure A shows the location of the lungs and airways in the
body. Figure B shows a cross-section of a normal airway. Figure C
shows a cross-section of an airway during asthma symptoms.
Sometimes, asthma symptoms are mild and go away on their own or
after minimal treatment with an asthma medicine. Other times,
symptoms continue to get worse.
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Types of Asthma: Inflamed airways asthma: Airways narrowed as a
result of the inflammatory response cause wheezing.
Bronchoconstriction: During an asthma episode, inflamed airways
react to environmental triggers such as smoke, dust, or pollen. The
airways narrow and produce excess mucus, making it difficult to
breathe. In essence, asthma is the result of an immune response in
the bronchial airways.
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Stimuli: The airways of asthmatics are "hypersensitive" to
certain triggers, known as stimuli. In response to exposure to
these triggers, the bronchi (large airways) contract into spasm (an
"asthma attack"). Inflammation soon follows, leading to a further
narrowing of the airways and excessive mucus production, which
leads to coughing and other breathing difficulties.
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Occupational asthma: That's asthma caused by exposure to
allergens present in the average office - and a new study says it's
on the rise. Exposure to wood dust, paint fumes, solvents, latex
and baking flour - all workplace allergens - cause thousands of
cases of asthma every year, according to a report released on May
12, 2008 by the Australian Institute of Health and Welfare (AIHW).
The study shows that anywhere from 9-15 % of adult-onset asthma
cases can be attributed to exposure to agents at the workplace,
Science Alert reported.
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Occupations with the greatest risk for occupational asthma
include farming, painting, cleaning, baking, animal handling and
chemical work. Other at-risk occupations include nursing, welding,
food processing, dentistry, timber and forestry industries, and
industries that produce metals, plastics, electronics and
rubber.
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New study on Asthma: Tree-lined streets lower asthma risk :
Columbia University scientists on May 10, 2008 have suggested that
tree-lined streets can reduce the risk of developing asthma in
young children. While it is commonly believed that the pollen
released by trees can contribute to asthma attacks.
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the present study shows trees cut asthma risk by cleaning the
air and encouraging kids to play outdoors. According to the study
published in the Journal of Epidemiology and Community Health, an
increase of 343 trees per square kilometer lowers the prevalence of
asthma by 29%.
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What Causes Asthma? The exact cause of asthma isn't known.
Researchers think some genetic and environmental factors interact
to cause asthma, most often early in life. These factors include:
a)An inherited tendency to develop allergies, called atopy. b)
Parents who have asthma c) Certain respiratory infections during
childhood
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d) Contact with some airborne allergens or exposure to some
viral infections in infancy or in early childhood when the immune
system is developing. If asthma or atopy runs in your family,
exposure to irritants (for example, tobacco smoke) may make your
airways more reactive to substances in the air. Some factors may be
more likely to cause asthma in some people than in others.
Researchers continue to explore what causes asthma.
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What Are the Signs and Symptoms of Asthma? Common signs and
symptoms of asthma include: Coughing: Coughing from asthma often is
worse at night or early in the morning, making it hard to sleep.
Wheezing: Wheezing is a whistling or squeaky sound that occurs when
you breathe.
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Chest tightness: This may feel like something is squeezing or
sitting on your chest. Shortness of breath: Some people who have
asthma say they can't catch their breath or they feel out of
breath. You may feel like you can't get air out of your lungs.
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Not all people who have asthma have these symptoms. Likewise,
having these symptoms doesn't always mean that you have asthma. The
best way to diagnose asthma for certain is to use a lung function
test, a medical history (including type and frequency of symptoms),
and a physical exam. The types of asthma symptoms you have, how
often they occur, and how severe they are may vary over time.
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Severe symptoms can be fatal. It's important to treat symptoms
when you first notice them so they don't become severe. With proper
treatment, most people who have asthma can expect to have few, if
any, symptoms either during the day or at night.
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Prevention methods: Inhaled glucocorticoids are the most widely
used of the prevention medications and normally come as inhaler
devices. Long-term use of corticosteroids can have many side
effects including a redistribution of fat, increased appetite,
blood glucose problems and weight gain.
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To control bronchitis and asthma some suggestions: Quit
smoking: If you smoke, quit. Bronchitis will ease dramatically and
may even be cured within a few years when you quit smoking. Walk
away from people who smoke. Drink hot fluids: Have hot clear soups,
hot milk laced with honey and haldi, hot water through the day.
Keep a thermos handy for soothing sips whenever possible
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Use expectorants sparingly: Some expectorants are addictive -
avoid them. Have a safe expectorant only if you have dry cough. If
youre coughing up phlegm, avoid expectorants, stick to hot water.
Walk, dont run: If jogging makes you cough, walk daily for 30-45
minutes at a speed you can manage. Carry your thermos of hot water
with you. You could also swim as swimming is ideal for asthma. Keep
active play tennis, cricket, golf.
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Fresh and nourished meal: Avoid oily or fatty food and be
selective for fresh and nutritious vegetable food. For example,
have only plain steamed rice, salad, yoghurt, bread, cheese,
fruits, cornflakes, digestive biscuits, roast channa, jam, baked
beans, pickles etc. You can also have them with warm milk. Eat
light: Overeating presses on your insides and causes wheezing. Stop
when youre on top - that is when you are comfortable, not full or
heavy. Asthmatics should avoid taking water with meals and should
always eat less then their capacity to make stomach fire stronger
and thereby hardly leaving any chance to form phlegm.
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Sleep elevated: Sleep with two pillows. Keeping your head
slightly elevated prevents stomach reflux. Sometimes, if the
stomach acid drips into your throat, it causes coughing and asthma.
Learn deep breathing: Correct deep breathing regularly. Learn the
correct technique from an experienced Yoga teacher. Practicing
yoga-pranayam to permit proper assimilation of food and strengthen
lungs, digestive system and circulatory system.
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Asthma medication: If you are on asthma medication, you can
have it 15 minutes before you exercise. Lose weight: Lose your
excess weight and it will dramatically improve your health and
level of confidence. You will lose weight when you follow the
lifestyle of an athlete. No depression: Never allow yourself to be
depressed. Be always cheerful and do all the positive things
gladly, joyfully.
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Treatments and drugs Long-term control medications. In most
cases, these medications need to be taken every day. Types of
long-term control medications include: Inhaled corticosteroids.
These medications include fluticasone, budesonide, mometasone,
flunisolide, beclomethasone and others. Leukotriene modifiers.
These oral medications include montelukast (Singulair), zafirlukast
and zileuton.
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Long-acting beta agonists (LABAs). These inhaled medications
include salmeterol and formoterol. Theophylline. This is a daily
pill that helps keep the airways open (bronchodilator).
Theophylline relaxes the muscles around the airways to make
breathing easier. Short-acting beta agonists. These inhaled,
quick-relief bronchodilators can rapidly ease symptoms during an
asthma attack. They include albuterol (ventolin) and others.
Ipratropium (Atrovent). Oral and intravenous corticosteroids.
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When symptoms get more intense and/or more symptoms occur,
you're having an asthma attack. It's important to treat symptoms
when you first notice them. This will help prevent the symptoms
from worsening and causing a severe asthma attack. Severe asthma
attacks may require emergency care, and they can be fatal.
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SINGULAIR(R) (Montelukast Sodium) Tablets, Chewable Tablets,
and Oral Granules
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DESCRIPTION Montelukast sodium, the active ingredient in
SINGULAIR*,it is selective and orally active leukotriene receptor
antagonist that inhibits the cysteinyl leukotriene CysLT1
receptor.
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Mechanism of Action The cysteinyl leukotrienes (LTC4, LTD4,
LTE4) are product of arachidonic acid metabolism and are released
from various cells, including mast cells and eosinophils. These
eicosanoids bind to cysteinyl leukotriene (CysLT) receptors. The
CysLT type-1 (CysLT1) receptor is found in the human airway
(including airway smooth muscle cells and airway macrophages) and
on other pro-inflammatory cells (including eosinophils and certain
myeloid stem cells). CysLTs have been correlated with the
pathophysiology of asthma and allergic rhinitis.
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Montelukast is an orally active compound that binds with high
affinity and selectivity to the CysLT1 receptor (in preference to
other pharmacologically important airway receptors, such as the
prostanoid, cholinergic, or (beta)-adrenergic receptor).
Montelukast inhibits physiologic actions of LTD4 at the CysLT1
receptor without any agonist activity.
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COMMON side effects persist or become bothersome when using
Montelukast: Cough Dizziness Headache Indigestion Nausea Stomach
upset or pain Stuffy nose Tiredness Trouble sleeping Weakness.
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Side Effects by Body System : Nervous system: Nervous system
side effects have included headache (18% to 20%) and dizziness
(2%). Isolated and rare reports of somnolence have been associated
with the use of higher than recommended doses. Seizures have been
reported very rarely. Paresthesias, hypoesthesia, and drowsiness
and have been reported in post marketing experiences.
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Respiratory: Respiratory system side effects have included
influenza (4%), cough (3%), and nasal congestion (2%). In some
studies, upper respiratory tract infection (28%) and worsened
asthma (4% to 11%) were associated with the use of this drug.
However, many patients with asthma have some or all of these
symptoms, and a causal relationship has not been proven.
Rhinorrhea, sinusitis, otitis, influenza, epistaxis, and pneumonia
have also been reported.
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Gastrointestinal: Gastrointestinal side effects have included
abdominal pain, dyspepsia, or infectious gastroenteritis in up to
3% of patients. Diarrhea has been associated with the use of higher
than recommended doses. Musculoskeletal Musculoskeletal side
effects have included myalgia, muscle cramps, and muscle aches.
Post marketing experience has reported arthralgia.
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General: In general, montelukast is well-tolerated. Asthenia,
fatigue, or fever has been associated with the use of this drug in
approximately 2% of patients. Varicella has also been reported.
Dermatologic: Dermatologic side effects have included rash, eczema,
urticaria, and dermatitis.
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Hepatic Post marketing experience has reported rare cases of
cholestatic hepatitis, hepatocellular liver injury and
mixed-pattern liver injury. Hepatic side effects have included
elevated hepatic serum transaminases in approximately 2% of
patients. Pancreatitis has been reported very rarely. Jaundice with
elevated liver enzymes are described in a 42-year-old man several
months after starting montelukast therapy. Serum enzymes completely
normalized 4 months after drug withdrawal.
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Absorption Montelukast is rapidly absorbed following oral
administration.After administration of the 10-mg film- coated
tablet to fasted adults,the mean peak montelukast plasma
concentration (Cmax) is achieved in 3 to 4 hours (Tmax). The mean
oral bioavailability is 64%. The oral bioavailability and Cmax are
not influenced by a standard meal in the morning.
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Distribution Montelukast is more than 99% bound to plasma
proteins. The steady state volume of distribution of montelukast
averages 8 to 11 liters. Studies in rats with radiolabeled
montelukast indicate minimal distribution across the blood- brain
barrier. In addition,concentrations of radiolabeled material at 24
hours postdose were minimal in all other tissues.
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Metabolism Montelukast is extensively metabolized. In studies
with therapeutic doses, plasma concentrations of metabolites of
montelukast are undetectable at steady state in adults and
pediatric patients. In vitro studies using human liver microsomes
indicate that cytochromes P450 3A4 and 2C9 are involved in the
metabolism of montelukast
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Elimination: The plasma clearance of montelukast averages 45
mL/min in healthy adults. Special Populations: Gender: The
pharmacokinetics of montelukast are similar in males and
females.
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Hepatic Insufficiency: Patients with mild-to-moderate hepatic
insufficiency and clinical evidence of cirrhosis had evidence of
decreased metabolism of montelukast resulting in 41% No dosage
adjustment is required in patients with mild-to-moderate hepatic
insufficiency. The pharmacokinetics of SINGULAIR in patients with
more severe hepatic impairment or with hepatitis have not been
evaluated.
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Renal Insufficiency: Since montelukast and its metabolites are
not excreted in the urine, the pharmacokinetics of montelukast were
not evaluated in patients with renal insufficiency. No dosage
adjustment is recommended in these patients.
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Drug Interactions Montelukast at a dose of 10 mg once daily
dosed to pharmacokinetic steady state: did not cause clinically
significant changes in the kinetics of a single intravenous dose of
theophylline
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did not change the pharmacokinetic profile of warfarin. did not
change the pharmacokinetic profile or urinary excretion of
immunoreactive digoxin. did not change the plasma concentration
profile of terfenadine or fexofenadine.
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Pregnancy Category B: No teratogenicity was observed in rats at
oral doses up to 400 mg/kg/day. During worldwide marketing
experience, congenital limb defects have been rarely reported in
the offspring of women being treated with SINGULAIR during
pregnancy. Most of these women were also taking other asthma
medications during their pregnancy. A causal relationship between
these events and SINGULAIR has not been established.
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Nursing Mothers: Studies in rats have shown that montelukast is
excreted in milk. It is not known if montelukast is excreted in
human milk. Because many drugs are excreted in human milk, caution
should be exercised when SINGULAIR is given to a nursing mother.
Pediatric Use: Safety and efficacy of SINGULAIR have been
established in adequate and well-controlled studies in pediatric
patients with asthma 6 to 14 years of age.
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INDICATIONS AND USAGE SINGULAIR is indicated for the
prophylaxis and chronic treatment of asthma in adults and pediatric
patients 12 months of age and older. SINGULAIR is indicated for
prevention of exercise- induced bronchoconstriction in patients 15
years of age and older.
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SINGULAIR is indicated for the relief of symptoms of allergic
rhinitis (seasonal allergic rhinitis in adults and pediatric
patients 2 years of age and older, and perennial allergic rhinitis
in adults and pediatric patients 6 months of age and older)
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CONTRAINDICATIONS: Hypersensitivity to any component of this
product. PRECAUTIONS: SINGULAIR is not indicated for use in the
reversal of bronchospasm in acute asthma attacks, including status
asthmatics. Information for Patients: Patients should be advised to
take SINGULAIR daily as prescribed, even when they are
asymptomatic, as well as during periods of worsening asthma.
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Patients should be advised that oral SINGULAIR is not for the
treatment of acute asthma attacks. They should have appropriate
short-acting inhaled (beta)-agonist medication available to treat
asthma exacerbations. Patients with known aspirin sensitivity
should be advised to continue avoidance of aspirin or non-
steroidal anti-inflammatory agents while taking SINGULAIR.