Asthma treatment

β-agonists in the treatment of asthma
The first line of treatment for relief of asthma is one of the
selective β2-agonists taken by inhalation. β2-agonists
are the most effective bronchodilators in asthma. They start to work
quickly – salbutamol and terbutaline take effect within 15 minutes
and last for 4 to 6 hours. There is no clear threshold for all patients,
but if there has been an exacerbation of asthma in the last 2 years,
inhaled β2-agonists are needed or symptoms present at least three
times a week or asthma disturbs sleep one night a week, then
additional treatment must be considered.

The dose response varies among patients as does the dose that will produce side effects, such as tremor. Patients should be taught to monitor their inhaler use and to understand that if they need it more, or if its effects lessen,these are danger signals. They indicate deterioration in asthmatic control and the need for further treatment.

Side effects of beta agonists:
Some patients worry that β2-agonists may become less effective
with time, particularly if the dose is high. There is little evidence
of clinically significant tachyphylaxis for the airway effects in asthmatics.
If it exists, it is a minor effect that is quickly reversed, either
by stopping the treatment temporarily or by taking corticosteroids.
Tremor, palpitations and muscle cramps may occur, but are rarely troublesome. Some studies found that regular use of β2-agonists was associated wth increased bronchial reactivity, worsening asthma control and accelerated decline of lung function. These have not been confirmed.
However, when the steps in standard guidelines are followed,
β2-agonists are not used regularly unless needed for control of
symptoms and in this way never without a regular preventer
therapy such as inhaled steroids.

The chance of a person developing asthma by the age of 50 is
increased 10 times if there is a first-degree relative with asthma.
The risk is greater the more severe the relative’s asthma is. It
has been suggested that breastfeeding may reduce the risk of
a child developing atopic conditions such as asthma because
it restricts the exposure to ingested foreign protein in the first
few months of life. Conflicting studies have been published and
it may require considerable dietary restriction by the mother
to avoid passing the antigen on to the child during this vulnerable
period. Overall, although infant wheezing may be less
common in breastfed infants, there is no good evidence to show
that asthma is less prevalent in breastfed children. Nevertheless,
many other benefits of breastfeeding indicate that it should be
encouraged.

Maternal smoking in pregnancy interferes with lung function development
and increases the risk of childhood wheezing; exposure
during the first few years of life is also detrimental. It is not clear
that allergic conditions are increased. Studies of paternal smoking
have shown less certain trends in the same direction.

Most asthma develops during childhood and usually varies considerably
with time and treatment. Young asthmatic patients usually have identifiable triggers that provoke wheezing, although there is seldom one single extrinsic cause for all their attacks. This ‘extrinsic’ asthma is often associated with other features of atopy such as rhinitis and eczema. When asthma starts in adult life, the airflow obstruction is often more persistent and many exacerbations have no obvious stimuli other than respiratory

Types of asthma :

Childhood onset asthma :Most asthma starts in childhood, usually on an atopic background. Tends to have significant variability and
identifiable precipitants.

Adult onset asthma : This is most often a relapse of earlier asthma, but may have initial onset at any age. Often more persistent with fewer
obvious precipitants except infection.

Nocturnal asthma : This is Common in all types of asthma, related to poor overall control and increased reactivity.

Occupational asthma : This is often underdiagnosed, needs expert evaluation.

Cough-variant asthma : In this type of asthma cough is a common symptom and may precede airflow obstruction.

Exercise-induced asthma : In this the common precipitant, exercise may be the only significant precipitant in children.

Brittle Type 1 asthma : This is a chaotic uncontrolled asthma with very variable peak flow.

Brittle Type 2 asthma: This results in sudden severe deteriorations from a stable baseline.

Aspirin-sensitive asthma : May be associated with later onset and nasal polyps;2–3% asthmatics on history but 10–20% on formal
testing.

Churg-Strauus syndrome: An uncommon diffuse vasculitis characterised by severe persistent asthma. The initial clue may be high
eosinophilia (>1500/μl) or vasculitic involvement of
another organ.

Obesity is associated with an increased prevalence of asthma. The
associations are complicated with increased airway responsiveness
in obesity together with symptoms of breathlessness related to the
higher mechanical load on the lungs.

Asthma is a common condition that has increased in prevalence
throughout the world over the last 20 years. It is estimated that
around 300 million people are affected across the world. There
is no precise, universally agreed definition of asthma.

The clinical picture of asthma in young adults is recognizable
and reproducible. The difficulties in precise diagnosis arise in the
very young, in older groups and in very mild asthma. Breathlessness
from other causes, such as increased tendency towards obesity, may
be confused with asthma.

In older patients, the commonest dilemma is differentiation
of asthma from chronic obstructive pulmonary disease (COPD)
. Since both conditions are common, some patients will
have both. A degree of increased airway responsiveness is found in
COPD in relation to geometry from the narrower airways. Bronchodilators will be appropriate for both conditions although the
agent may vary. Inhaled corticosteroids are a mainstay of asthma
treatment, when used early, but in COPD, they are less effective and
are used to manage more severe disease or frequent exacerbation.

Mild Asthma:These patients comprise 50 percent of the asthmatic population. They have symptoms only once or twice per year and are generally controlled on as needed bronchodilator medications.

Moderate Asthma: Forty percent of all patients with asthma fall into this category. These people have symptoms roughly once per month and some require daily medication to keep their symptoms from getting worse and interfering with their daily life.

Severe Asthma: These cases make up the remainder of patients with asthma. This is the life-threatening form of this condition. However, it should also be remembered that patients in any of the categories can have a life threatening attack, so please take your condition seriously. The severe types usually require multiple daily medications just to maintain decent control over their breathing. Wheezing and coughing occur most of the time, and these patients usually find it difficult to participate in sporting activities.

Asthma is the number one chronic respiratory disease in America.
It is a disease of the lungs. The term “asthma” comes from the
Greek word for panting. People with asthma pant or gasp for brath because, when they are experiencing an attack, the tubes inside their lungs that deliver air, known as bronchi, become inflamed. When this happens, the muscles of the bronchial walls tighten and extra mucus is produced, causing the airway to narrow. The severity of the attack can vary from slight wheezing to life-threatening.

These obstructive changes leave very
little room for air to get through. Trying to breathe when this is occurring is like trying to breathe with a pillow over your face. To make
matters worse, people with asthma get an airway inflammation that
produces more mucus, which can lead to even more airway obstruction— a vicious cycle that continues, usually until some medication is administered.

Since allergies play such a significant role in lost productivity,
increased healthcare costs, and simply making your life miserable, it
is important to determine which allergens are responsible for specific
diseases, so the proper medical decisions can be made. Allergy testing
has serious limitations, and the diagnosis of an allergy to a specific
allergen cannot be made on the basis of testing alone. Your history is
just as critical to the diagnosis. The basic conventional forms of
allergy testing include percutaneous testing, intradermal testing, in
vitro antibody testing, and delayed hypersensitivity testing.

Percutaneous Testing
This is the skin prick testing most of us are familiar with. The basic
mechanism behind skin testing is the interaction of the injected allergen
with specific IgE antibodies on the surface of your skin mast cells.
This injection will trigger the release of histamine and the formation
of a wheal and flare at the site.

Peanut allergies are increasingly common, and this is especially
important in school-age children because peanuts are in so many
foods. It is not just the peanut itself that can cause the allergy but also
peanut oil, peanut sauce, and anything that contains peanuts. Peanut
oil is so commonly used that it may be one of the ingredients in your
food, so check labels. Peanut allergies are usually so severe that if a
pot had peanut oil in it prior to your use, a reaction may occur. Peanut
allergies are very common, and the reactions tend to be the most
severe. Peanuts are responsible for 63 percent of all food-allergy related
deaths.

The link between allergies and asthma has been well established.
It is very hard to discuss one without the other. Up to 45
percent of patients with allergies have been diagnosed with asthma,
and 80 percent of all those diagnosed with asthma have allergies. The
two are diagnosed simultaneously in about 25 percent of all patients.
Not only do these two diseases coexist, they may even cause each
other due to their underlying mechanisms. This is why it is so important
to find a cure, not just a temporary alleviation of symptoms.

The number of people who suffer from allergies has been increasing
dramatically in the past few decades. It is now to the point where
the majority of us suffer from allergies in some way at some time in
our lives. A total of 40 percent of all adults and 50 percent of children
suffer from hay fever, or allergic rhinitis, as it is officially called,
which is characterized by nasal congestion and itchy eyes.
Allergies can strike at any time, usually without warning. People
may go most of their lives without any allergies and then develop
them, or they may suffer their entire lives. Once one allergy develops,
the person is usually susceptible to more.