Asthma

What is it?

Asthma is a chronic inflammatory condition of the lungs characterized by episodes of wheezing, breathlessness, chest tightness, and coughing. These episodes can be triggered by a variety of factors such as exercise, allergens (such as dust or pollen), pollution, and respiratory infections.

 

Symptoms

  • Difficulty breathing or shortness of breath
  • Chest tightness or pain
  • Wheezing (a whistling sound when breathing). 
  • Coughing (especially at night or early morning)
  • Rapid breathing. 
  • During an asthma attack, the airways become narrowed due to inflammation and the muscles surrounding the airways tighten, making it harder to breathe.
  • Diminished breath sounds = airways nearly closed.
Beware of diminished breath sounds

Treatment

  • Priority is to avoid triggers
  • Inhaled corticosteroids
  • Leukotriene modifiers
  • Long-acting beta-agonists
  • Immunomodulators
  • Quick-relief medications, also known as rescue medications:  short-acting beta-agonists and anticholinergics.


Medications

  • Short-acting beta agonist: Albuterol. Used as a rescue inhaler during as asthma attack
  • Leukotriene modifiers: Montelukast (Singulair). Works by blocking the action of leukotrienes, which are chemicals in the body that cause inflammation and swelling in the airways.
  • Long-acting beta agonist: Salmeterol. Taken daily to prevent attacks
  • Inhaled corticosteroids work by reducing inflammation in the airways, which helps to prevent asthma attacks. Examples: fluticasone, budesonide and beclomethasone. Note that they end in -sone or -sonide.
  • Immunomodulators: benralizumab, mepolizumab, reslizumab. Notice the ending of these medications.  These medications are used for severe asthma.

Severity of Asthma

1. Mild intermittent asthma: Symptoms occur less than twice a week and only last for a few hours or days. Nighttime symptoms < 2x/month
2. Mild persistent asthma: Symptoms occur at least twice a week, but not every day, and may affect daily activities.  Nighttime symptoms > 2x/month
3. Moderate persistent asthma: Symptoms occur daily and may affect daily activities, including exercise.  Nighttime symptoms > weekly.
4. Severe persistent asthma: Symptoms occur frequently and may be disabling, affecting daily activities and quality of life.  Frequent nighttime symptoms. Treatment may require the use of high-dose medication and/or oral corticosteroids.

Albuterol

Short-acting beta agonist: Use as a rescue inhaler for asthma attacks

Fluticasone

Inhaled corticosteroids: work by reducing inflammation in the airways, which helps to prevent asthma attacks.

Montelukast

Leukotriene modifiers: Works by blocking the action of leukotrienes, chemicals that cause inflammation in airways.

Benralizumab

Immunomodulators: mepolizumab.  Used for severe asthma. Note the ending of these meds.

Salmeterol

Long-acting beta agonist: Taken daily to prevent attacks

Prednisone

Oral steroids: For asthma attacks

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