Asthma Management and Exacerbation
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A postmenopausal woman with a history of well-controlled asthma begins estrogen replacement therapy. Which of the following is the MOST likely effect of this therapy on her asthma?

  • Improved asthma control due to estrogen's anti-inflammatory properties.
  • Exacerbation of asthma symptoms, potentially requiring an adjustment in asthma management. (correct)
  • No change in asthma control, as estrogen has no significant impact.
  • Reduced need for inhaled corticosteroids due to estrogen's bronchodilatory effects.

A patient with asthma is prescribed a non-selective beta-blocker for hypertension. What is the MOST important consideration regarding the use of this medication in the context of their asthma?

  • The beta-blocker will have no impact on the patient's asthma control or response to asthma medications.
  • The beta-blocker will enhance the effectiveness of the patient's albuterol inhaler.
  • Non-selective beta-blockers can trigger immediate bronchospasm in asthmatic patients.
  • Non-selective beta-blockers can prevent the reversal of bronchospasm by reducing the effects of albuterol. (correct)

A patient experiencing an acute asthma exacerbation is being treated in the emergency department. After initial SABA administration, the patient's symptoms remain severe. Which of the following routes of administration for corticosteroids is MOST appropriate at this stage?

  • Oral
  • Topical
  • Intravenous (correct)
  • Inhaled

A 7-year-old child with chronic asthma is prescribed montelukast. What is the appropriate daily dose of montelukast for this patient?

<p>5 mg (A)</p> Signup and view all the answers

A patient with a known aspirin allergy experiences a mild asthma exacerbation. Which of the following preventative treatments is MOST appropriate to manage their underlying asthma?

<p>Inhaled Corticosteroids (ICSs) (A)</p> Signup and view all the answers

A 14-year-old patient is prescribed budesonide via a dry powder inhaler (DPI) for persistent asthma. What is the MAXIMUM number of inhalations per day that should be recommended for this patient?

<p>11 inhalations (B)</p> Signup and view all the answers

Montelukast is prescribed for a patient with asthma. Which of the following mechanisms of action BEST describes how montelukast helps to manage asthma symptoms?

<p>It blocks the action of leukotrienes, reducing airway edema and smooth muscle contraction. (D)</p> Signup and view all the answers

Advair Diskus is prescribed for a 6-year-old child with asthma. What is the recommended dosage for this patient?

<p>1 inhalation twice daily (B)</p> Signup and view all the answers

A patient presents with acute bacterial rhinosinusitis. Which of the following bacteria is LEAST likely to be the causative agent?

<p>Escherichia coli (D)</p> Signup and view all the answers

An alcoholic patient is diagnosed with pneumonia. Based on the patient's history, which of the following bacterial pathogens is the MOST likely cause of their pneumonia?

<p>Klebsiella pneumoniae (D)</p> Signup and view all the answers

Which statement accurately describes the mechanism of action of neuraminidase inhibitors like oseltamivir and zanamivir?

<p>They interfere with the release of new viral particles by inhibiting the cleavage of sialic acid linkages. (C)</p> Signup and view all the answers

A 3-year-old child is diagnosed with influenza. Which of the following neuraminidase inhibitors is an appropriate treatment option?

<p>Oseltamivir (B)</p> Signup and view all the answers

A 70-year-old patient presents with pneumonia, a respiratory rate of 32 breaths per minute, blood urea nitrogen (BUN) of 25 mg/dL, and confusion. Their blood pressure is 92/62 mmHg. What is their CURB-65 score?

<p>4 (D)</p> Signup and view all the answers

According to GINA guidelines, which factor is MOST important when determining the appropriate step of asthma therapy for a patient?

<p>Severity of their asthma symptoms and frequency. (A)</p> Signup and view all the answers

A patient with asthma is prescribed a new Advair Diskus inhaler. What counseling point is MOST important to emphasize to the patient regarding its use and storage?

<p>Rinse your mouth out of water after each use. (B)</p> Signup and view all the answers

A patient using a SABA inhaler for asthma is experiencing breakthrough symptoms. What is the correct advice regarding the administration of multiple puffs?

<p>Wait 15-30 seconds between each puff. (C)</p> Signup and view all the answers

Which statement accurately describes the use of spacers in asthma management?

<p>Spacers are typically used for children under 6 years old to improve medication delivery. (D)</p> Signup and view all the answers

A COPD patient is prescribed Spiriva Respimat. What key counseling point regarding its use is MOST important to convey?

<p>The inhaler expires 3 months after opening. (B)</p> Signup and view all the answers

In what scenario is it LEAST appropriate to consider stepping down the dose of an inhaled corticosteroid (ICS) in a patient with stable asthma?

<p>The patient is currently pregnant. (A)</p> Signup and view all the answers

Which of the following medications is NOT typically used as a component in the acute treatment of an asthma exacerbation?

<p>Montelukast (A)</p> Signup and view all the answers

Which of the following is a correct statement about the use of inhaled medications?

<p>DPIs requires the patient to breath in on their own. (A)</p> Signup and view all the answers

A patient taking theophylline is also prescribed a fluoroquinolone antibiotic. What is the most likely effect of this drug interaction?

<p>Decreased theophylline clearance, potentially leading to toxic levels. (B)</p> Signup and view all the answers

A patient with COPD is interested in quitting smoking. They have a history of well-controlled hypertension but had a myocardial infarction (MI) 1 week ago. Which smoking cessation aid is contraindicated for this patient?

<p>Nicotine Replacement Therapy (NRT) (C)</p> Signup and view all the answers

Which of the following factors would suggest a patient with Community-Acquired Pneumonia (CAP) should be treated empirically for MRSA?

<p>Severe CAP requiring vasopressors (B)</p> Signup and view all the answers

A 7-year-old child presents with acute otitis media. The parent reports the child has taken amoxicillin in the past month and has purulent conjunctivitis. Which of the following is the MOST appropriate first-line antibiotic choice?

<p>Augmentin (D)</p> Signup and view all the answers

A patient with CAP is treated initially with appropriate antibiotics. After 72 hours, the patient shows no improvement. What is the next appropriate step in managing this patient?

<p>Switch to a different antibiotic regimen. (D)</p> Signup and view all the answers

A patient is diagnosed with CAP and meets the criteria for severe pneumonia. Which of the following CURB-65 criteria would classify the pneumonia as 'severe'?

<p>Septic shock requiring vasopressors, respiratory failure requiring mechanical ventilation (A)</p> Signup and view all the answers

A patient with a known theophylline allergy requires bronchodilation. Which medication would be the MOST appropriate alternative?

<p>Inhaled albuterol (B)</p> Signup and view all the answers

What is the recommended duration of antibiotic treatment for a 5-year-old child with mild-to-moderate acute otitis media?

<p>5-7 days (D)</p> Signup and view all the answers

For a patient experiencing an asthma exacerbation with an initial FEV1 less than 30% of the predicted value, which of the following albuterol administration methods is MOST appropriate?

<p>Continuous nebulization (B)</p> Signup and view all the answers

A 67-year-old patient with a history of COPD is discussing pneumonia vaccinations with their healthcare provider. According to the guidelines, which of the following is the MOST appropriate recommendation?

<p>The patient should receive the pneumococcal vaccine, with shared-decision making involved. (C)</p> Signup and view all the answers

A patient with asthma is prescribed a long-acting beta-agonist (LABA). Which of the following statements is MOST accurate regarding LABA therapy for asthma?

<p>LABA monotherapy is not recommended for asthma. (A)</p> Signup and view all the answers

A child with acute asthma exacerbation is prescribed albuterol. What is the mechanism of action of albuterol in treating asthma symptoms?

<p>Inhibition of immediate hypersensitivity mediators from mast cells (A)</p> Signup and view all the answers

Which of the following inhaled corticosteroids is NOT used to reduce inflammation in asthma?

<p>Tiotropium (C)</p> Signup and view all the answers

A patient with asthma is prescribed ipratropium. What is the mechanism of action of ipratropium?

<p>Competitive inhibition of muscarinic receptors (A)</p> Signup and view all the answers

A patient with asthma is prescribed montelukast. What is the mechanism of action of montelukast?

<p>Reduction of leukotriene action (B)</p> Signup and view all the answers

According to GINA guidelines, which inhaled corticosteroid (ICS) and long-acting beta-agonist (LABA) combination is recommended for Maintenance and Reliever Therapy (MART) in asthma?

<p>Budesonide/Formoterol (D)</p> Signup and view all the answers

A 45-year-old patient with COPD is prescribed Symbicort (budesonide/formoterol) for maintenance therapy. They are using 2 inhalations twice daily of the 160 mcg budesonide strength. During an exacerbation, they use an additional 2 inhalations as needed, up to a maximum of 12 inhalations per day. What is the maximum total daily dose of budesonide this patient could potentially receive?

<p>1920 mcg (A)</p> Signup and view all the answers

A patient with severe allergic asthma is prescribed omalizumab. Which factor is MOST important to consider when determining the appropriate dose of omalizumab?

<p>Patient's weight and IgE levels (D)</p> Signup and view all the answers

A 68-year-old COPD patient, who has experienced 5 exacerbations in the past year, presents with increased dyspnea, cough, and sputum production. Which of the following is the MOST appropriate initial treatment strategy?

<p>Bronchodilator, prednisone 40mg daily for 5-7 days, and levofloxacin (C)</p> Signup and view all the answers

Which administration schedule is correct for omalizumab?

<p>2-4 week interval (A)</p> Signup and view all the answers

Which pneumococcal vaccine is recommended for adults aged 19-50 with COPD?

<p>Pneumococcal Polysaccharide Vaccine (PPSV23) (C)</p> Signup and view all the answers

A patient with COPD is prescribed salmeterol. What is the route of administration for salmeterol?

<p>Dry powder inhaler (DPI) (A)</p> Signup and view all the answers

A COPD patient is prescribed azithromycin for a bacterial infection. What potential adverse effect should the healthcare provider specifically monitor for, considering the patient's COPD?

<p>Increased risk of hearing loss (A)</p> Signup and view all the answers

A patient with COPD is prescribed umeclidinium. What is the mechanism of action of umeclidinium?

<p>Muscarinic antagonist (D)</p> Signup and view all the answers

A patient with COPD is on triple therapy but continues to have persistent symptoms. Which of the following medications might be considered next, according to the guidelines?

<p>Roflumilast (D)</p> Signup and view all the answers

An elderly patient with COPD is prescribed long-term oral corticosteroids. Which potential long-term adverse effect is of particular concern in this geriatric population?

<p>Osteoporosis (B)</p> Signup and view all the answers

A patient with acute COPD exacerbation presents with increased dyspnea and sputum production. They have no fever, but their sputum is purulent. According to current guidelines, what is the MOST appropriate initial treatment?

<p>Inhaled bronchodilators and systemic corticosteroids (B)</p> Signup and view all the answers

A patient with COPD is prescribed azithromycin for long-term management. What is a potential adverse effect of azithromycin that the healthcare provider should monitor?

<p>Hearing loss (B)</p> Signup and view all the answers

Which medication is contraindicated with Theophylline due to similar MOA?

<p>Roflumilast (C)</p> Signup and view all the answers

A patient with a history of frequent COPD exacerbations is prescribed a new medication. After starting the medication, the patient reports experiencing muscle weakness and tremors. Which class of medications is MOST likely responsible for these adverse effects?

<p>Beta-agonists (C)</p> Signup and view all the answers

A patient with end-stage COPD is experiencing severe dyspnea despite optimal bronchodilator therapy. Which of the following medications may be considered for symptomatic relief of dyspnea?

<p>Morphine (A)</p> Signup and view all the answers

Flashcards

Estrogen and asthma

Estrogen may worsen asthma during menopause and PMS; progesterone may mitigate effects.

Non-selective beta blockers

Propranolol does not cause bronchospasm but can reduce albuterol effectiveness.

ICS's for asthma

Inhaled corticosteroids are the primary preventive treatment for asthma.

Acute asthma exacerbation treatment

Start with SABA (albuterol), then assess severity for systemic corticosteroids or other options.

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Montelukast (Singulair)

Leukotriene receptor antagonist reducing inflammation; treats chronic and exercise-induced asthma.

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Doses for Mometasone furoate

Low dose: 110-220 mcg; Medium: 220-240 mcg; High: >440 mcg for chronic asthma.

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Severe asthma treatment

For severe cases, use IV steroids and consider magnesium sulfate; oral for mild/moderate.

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Administer Montelukast timing

Administer Montelukast at night for best effects.

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Asthma Step Therapy

Determining the appropriate treatment step based on GINA guidelines.

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Symbicort

A combination medication containing budesonide for asthma treatment.

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SABA Inhaler Technique

For Short-Acting Beta Agonists, wait 15-30 seconds between puffs.

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Spiriva Respimat

Soft mist inhaler for COPD containing tiotropium, used for long-term control.

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ICS Therapy Dosing

Stepping down ICS doses by 25-50% every 3 months is safe.

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Acute Asthma Exacerbation Medications

Albuterol and corticosteroids are first-line for asthma attacks.

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COPD Expiration Dates

Spiriva Respimat expires 3 months after opening; Handihaler 6 weeks.

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Advair Diskus

DPI containing fluticasone and salmeterol for asthma maintenance.

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S.Pneumonia

Bacterium causing acute bacterial rhinosinusitis and pneumonia.

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Oseltamivir

Neuraminidase inhibitor, preferred for influenza, taken orally, and renally dosed.

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CURB-65

Scoring system for pneumonia severity: Confusion, Uremia, Respiratory rate, Blood pressure, Age.

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Zanamivir

Neuraminidase inhibitor for influenza, delivered via diskhaler, not renally dosed, 7 years and up.

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Klebsiella pneumoniae

Bacterium notably affecting alcoholics, causing pneumonia.

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GINA guidelines MART therapy

Symbicort is recommended as the only inhaler for both maintenance and acute treatment for asthma.

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Doses of Symbicort

Adults can take a maximum of 12 inhalations per day of Symbicort, with lower doses for younger patients.

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Prednisone for COPD

In acute exacerbations with 2 or 3 cardinal symptoms, Prednisone 40 mg is prescribed for 5-7 days along with bronchodilators.

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Cardinal symptoms of COPD

The three cardinal symptoms are dyspnea, cough, and sputum production, used to assess exacerbations.

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Recommended antibiotics for COPD

In uncomplicated acute COPD exacerbations, Azithromycin or Doxycycline may be used, especially for frequent exacerbators.

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Short-term effects of steroids

Steroids can cause side effects including cataracts, skin thinning, and increased osteoporosis risk, especially in geriatrics.

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COPD and pneumonia vaccines

Individuals aged 19-50 should receive a pneumococcal vaccine, while those aged 50 and above require an additional vaccine.

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Theophylline therapeutic index

Theophylline has a narrow therapeutic index of 5-15 mcg/mL.

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Warnings for Theophylline use

Toxic levels (>20 mcg/mL) can cause arrythmias and seizures.

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CYP enzymes and interactions

Theophylline is affected by CYP 1A2 and CYP 3A4 enzyme interactions.

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Smoking effects on Theophylline

Smoking increases Theophylline clearance, reducing its effectiveness.

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Nicotine replacement therapy (NRT) contraindications

NRT is contraindicated in patients with a recent stroke or MI.

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Bupropion SR precautions

Bupropion SR should be avoided in patients with a history of seizures or eating disorders.

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First line treatment for acute otitis media

First line is Amoxicillin 80-90 mg/kg/day BID for ages 6 months to 12 years.

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Augmentin use criteria

Augmentin (90 mg/kg/day BID) is used if there's recent antibiotic use or recurrent infections.

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Continuous Nebulization

Administering nebulized medication continuously for patients with poor lung function response.

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Albuterol

A short-acting beta-agonist used to relieve bronchospasm in asthma or COPD.

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Guidelines for Vaccines

Recommendations for vaccinations like flu annually and others based on age and condition.

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Long-Acting Beta Agonists (LABA)

Medications not recommended alone for asthma due to safety concerns.

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Inhaled Corticosteroids

Medications that reduce inflammation and are used in asthma treatments.

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Leukotriene Modifiers

Drugs that reduce the action of leukotrienes, helping inflammation and bronchoconstriction.

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Tiotropium (Spiriva)

A long-acting muscarinic antagonist (LAMA) used for COPD management.

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Roflumilast

A PDE4 inhibitor that relaxes airway muscles and reduces inflammation in COPD.

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Methylxanthines

A class of drugs including theophylline that relax bronchial muscles.

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Anticholinergics

Medications that block muscarinic receptors, helping to relax airway muscles.

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Biologics in Asthma

Targeted therapy that involves recombinant antibodies to reduce inflammation.

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Azithromycin

An antibiotic sometimes used in COPD, linked to QTC prolongation.

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SABA/SAMA Use in COPD

Short-acting beta agonists (SABA) and short-acting muscarinic antagonists (SAMA) are used in COPD.

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Vaccination Post-50

People over 50 need additional pneumonia vaccination due to COPD concerns.

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Study Notes

Estrogen Effects on Asthma

  • Estrogen replacement during menopause may worsen asthma, especially without progesterone.
  • Estrogen levels during premenstrual syndrome (PMS) may also worsen asthma.
  • Non-selective beta blockers, such as propranolol, reduce the effectiveness of albuterol.
  • Aspirin allergies should be considered when treating asthma.

Acute Asthma Exacerbation

  • Initial treatment involves short-acting beta agonists (SABAs), like albuterol.
  • Severe exacerbations require systemic corticosteroids (e.g., prednisone, methylprednisolone, dexamethasone) in combination with inhaled ipratropium (anticholinergic), intravenous magnesium sulfate, and supplemental oxygen (O2).
  • Moderate to mild cases may benefit from oral corticosteroids.
  • Recommended dosage of inhaled corticosteroids (ICS) varies by age and severity.

Montelukast (Singulair)

  • A leukotriene receptor antagonist (LTRA).
  • Reduces inflammation and smooth muscle contraction in the airways.
  • Improves symptoms of chronic asthma.

Asthma Patient Management

  • Management should follow GINA (Global Initiative for Asthma) guidelines.
  • Appropriate inhalers, such as budesonide, mometasone, or advair, should be considered.
  • Counseling points for asthma patients: prime inhalers, timing between puffs, and proper inhaler techniques (spacing, usage with mouth, etc.).

COPD Products

  • Inhalers for COPD, such as Spiriva Respimat and Combivent, may be used. Important to check expiration dates.
  • Proper use of inhalers: use appropriate techniques and spacers to ensure medication reaches the lungs properly -Turn, Open, Press (soft mist).

ICS Therapy

  • Step-wise approach to manage asthma.
  • Reduce dose by 25-50% every three months, if possible.
  • Avoid dose reduction during pregnancy.

COPD Medications

  • Long-acting beta agonists (LABAs) are not recommended for monotherapy in asthma.
  • Medications for acute exacerbation should include short-acting beta agonists (SABAs)
  • Know the mechanism of action of different classes of asthma medications
  • Consider comorbidities and risks related to particular medications.

Asthma Management Guidelines

  • Follow GINA guidelines for asthma management and treatment strategies.
  • Consider other potential therapies based on severity.
  • Dosage and frequency of medication should be considered carefully based on age and individual needs.

Vaccines and COPD

  • Patients with COPD should receive annual influenza vaccines.
  • Tetanus, diptheria and pertussis (Tdap) vaccines every 10 years.
  • Review other recommended vaccines.

COPD Exacerbation Treatment

  • Consider pneumonia and other bacterial infections when assessing COPD exacerbations.
  • Consider appropriate antibiotics based on possible bacterial pathogens.
  • Ensure proper dosages and treatment duration are considered.

Other Asthma/COPD Considerations

  • Be aware of specific drug interactions and side effects.
  • Patient history, allergies and comorbidities should be considered.
  • Proper dosage should be considered, in relation to age and clinical situation.
  • Review the information and focus on acute exacerbations and treatment strategies, particularly of COPD.
  • Consider appropriate follow up.

Asthma and COPD Medications

  • Thoroughly review each medication's mechanism of action (MOA).

Additional Treatments and Guidelines

  • Review all available information for current treatment guidelines and indications.
  • Review all adverse effects of relevant treatments.

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Description

The lesson covers hormonal influences on asthma, specifically estrogen's potential to worsen symptoms during menopause and PMS. It details acute exacerbation treatments, including SABAs, corticosteroids, and other therapies. It also includes the role of Montelukast in asthma management.

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