Transcript Types of asthma

Presented by :
Abdulhadi Burzangi .
Pharm.d
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Key Point..
I.
II.
III.
IV.
V.
VI.
Background of Asthma.
Clinical presentation.
Drug used in asthma.
Stepwise approach for managing asthma.
Steps for using inhaler.
Case.
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I- Background
•Definition :
- Asthma is a chronic inflammatory disease
of airway associated with inflammation,
obstruction and increase airway hyperresponsiveness.
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• Types of asthma :
Intermittent
Persistent
Mild
Moderate
Severe
symptoms
< 2 days/week
> 2 days/week
but not daily
Daily
Through out
the day
Night time
awakening
< 2 days/month
3-4 days/month
> 1 day/week
Often 7 days/w
SABA use for
symptoms
control
< 2 days/week
> 2 days/week
Daily
Several time
per day
Interference
with normal
activity
None
Minor limitation
Some
limitation
Extremely
limited
• Asthma triggers :
1- Allergens.
2- Occupational exposure.
3- Disease.
4- Environmental changes.
5- Emotions.
6- Exercise.
7- Drugs and preservatives.
11- Clinical presentation
- In case of chronic ambulatory asthma :
1- Episode of dyspnea.
2- Chest tightness.
3- Coughing ( particularly at night ).
4- Wheezing or a whistling sound when breathing.
- In case of severe acute asthma :
1- Severe dyspnea.
2- Chest tightness.
3- S.O.B
4- The patient is able only to say a few words with each breath.
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111- Drugs used in asthma
A.
Beta 2 agonist.
1- Short acting beta agonist (SABA).
2- Long acting beta agonist (LABA).
B.
Corticosteroids (CS).
1- Inhaled.
2- Oral.
C.
D.
E.
F.
G.
Leukotrine receptor antagonist.
Mast cell stabilizer.
Phosphodiestrease inhibitor.
Anti IgE.
Anticholinergic.
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A. Beta 2 agonist
• SABA :
- e.g : Albuterol .
- Uses
• LABA :
- e.g : 1-Salmetrol
- Uses
2-Formetrol .
- Side effect of both : 1- Tachycardia. 2- Palpitation.
Hypokalemia.
3- Tremor.
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B. Corticosteroid
• Inhaled CS :
- e.g : 1- Beclomethasone.
• Oral CS :
- e.g : 1-predinsone,
2-predinsolone
2- Budesonide.
3- Flunisolide.
4- Fluticasone.
5- Trimcinolone.
- Uses
3-methylpredinsolone
- Uses
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• Short term and long term side effect :
Short term S.E
-Facial flushing.
-Appetite stimulant.
-GIT irritation.
-Mood change.
-Acne.
-Weight gain.
-Hyperglycemia.
-Leukocytosis.
-Hypocalsemia.
Long term S.E
-HPA axis suppression.
-Growth retardation.
-HTN.
-Osteoporosis.
-Hirsutism.
-Myopathy.
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C. Leukotriene receptor antagonist
- e.g : ( Montelukast, Zafirlukast and Zileuton ).
- Uses
D. Mast cell stabilizer
- e.g : ( Cromolyn Na+ and Nedocromil ).
- Uses
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E. Phosphodiestrase inhibitors
- e.g :
( Theophylline ).
- use
- Factors affecting serum theophylline concentration :
Decrease Theophylline conc.
Increase Theophylline conc.
-High protein diet.
-Smoking.
-Rifampin.
-Phenytoin.
-Phenobarbital.
-Carbamazepine.
-High carbohydrate diet.
-Systemic viral infection.
-Cimetidine.
-Erythromycin.
-Ciprofloxacin.
-Ticlopidine.
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Other Drugs
F. Anti IgE (Omalizumab).
G. Anticholinergic (Ipratropium).
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IV. Stepwise approach for managing asthma.
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V. Steps for using inhaler.
1. Remove the cap and hold inhaler upright.
2. Shake the inhaler.
3. Tilt your head back slightly and breathe out slowly.
4. Position the inhaler in one of the following ways
5. Press down on the inhaler to release medication as
you start to breathe in slowly.
6. Breathe in slowly (3 to 5 seconds).
7. Hold your breath for 10 seconds to allow the
medicine to reach deeply into your lungs.
8. Repeat puff as directed. Waiting 1 minute between
puffs may permit second puff to penetrate your
lungs better.
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VI. Case
K.M is 33years old female , she came to ambulatory
care department at last Saturday . She had been
bronchial asthma X 13 years . She was complaining of
cough, wheezing , chest tightness and drowsiness. The
patient said ( sometimes my family want to take me to
ED when i had asthmatic attack but i didn’t want to
visit ED). She on seretid (Flutacasone/Salmetrol) for her
asthma.
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Subjective :
• Chief complaint:
- wheezing.
- cough.
- chest tightness.
- drowsiness.
• Problem list :
- bronchial asthma X 13 years.
- iron deficiency anemia.
• Social history :
• Allergy :
- single.
- Food > banana … shrimp.
- Drugs > no known drug allergy.
- Others > dust and costs.
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Objective :
• Vital sings : R.R : 20 rate/min
B.P : 130/61
• Weight : 68.6 kg
Temp. : 36.8 ْc
Pulse : 81 beat/min
Height : 150cm.
• Past medication :
- Inhaled beclomethasone 100 mcg puff bid.
- Ventolin (Albuterol).
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Current medication :
- Seretid ( Fluctasone 250mcg + Salmetrol 50mcg )BID.
- Ferrose (100 mg iron as iron III hydroxide polymaltose complex).
Assessment :
- The patient diagnosed with mild persistent asthma.
- She doesn’t response to her medication.
Plan :
- Ventolin solution + Ventolin neublizer.
- Ferrose.
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Recommendation
-Check the patient compliance…..
-Stop gradually…..
-General measure for treating asthma.
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