Beruflich Dokumente
Kultur Dokumente
http://health.allrefer.com/health/asthma-normal-versus-asthmatic-bronchiole.html
Asthmatic Inflammation
Normal Early Asthmatic Late Asthmatic Subacute/Chronic
Airway Response Response Inflammation
Inhaled trigger
chemotactic factors
cytokines
No Response
Check PCo2 and pH Response
1-Aminophylline
Oral predinsolone
2- IV Hydrocortisone
2mg/kg/day
3- +/-nebulized Ipratropium
Divided for 3-5 days
bromide
4-Nebulized SABA every
1-2 hour should be cont. ß2-agonists and O2
5-adequate hydration Improved As required
6- +/- Antibiotics
No improvement
Discharge plan
Artificial Respiration
Inhaled Corticosteroid
• Preferred treatment alone or in combination
for all persistent categories of asthma
• Safe when use is monitored
• Reduces asthma symptoms, bronchial
hyperreactivity, exacerbations and
hospitalizations, need for rescue
medications
• Improves lung function, quality of life
• May prevent airway remodeling….!!
Role of ICS in Asthma
• Trials show that among children with asthma (or at risk for
asthma), controller therapy with ICS is efficacious in
controlling asthma symptoms
• However, ICS, do not change the natural clinical course of
the disease.
• PEAK trial 285 children aged 2 to 3 years at high risk for
asthma were randomized to therapy with either an ICS
(fluticasone, 88 μg twice daily for 2 years) or placebo
• Results showed significantly better clinical outcomes and
lung function outcomes in children treated with fluticasone
than in those treated with placebo
• However, clinical differences between groups rapidly
disappeared a few weeks after discontinuation of regular
treatments.
Guilbert et al. Long-term inhaled corticosteroids in preschool children at high risk
for asthma, N Engl J Med 354 (2006), pp. 1985–1997
Asthma Prevention
• There has been remarkable progress in
pharmacotherapy, education and environmental
measures in treating asthma
• However, no single action has been demonstrated
to decrease the risk of developing asthma
• Genetic and environmental influences
• Prevention will depend on factors influencing the
development and progression of asthma
Is Environmental Control Helpful?
• Single allergen reduction not
effective
• “…Treatment by means of
allergen avoidance requires the
definition of what patients are
allergic to, and additional
measures beyond the use of
mattress covers and education”
Thomas Platts-Mills
http://health.allrefer.com/health/asth
ma-common-asthma-triggers.html
Tailored Environmental
Intervention