Questions and Answers
What is a key advantage of using this treatment method compared to inhaled β2 agonists?
What adverse effect can result from the systemic use of this treatment?
What precaution should be taken to reduce the risk of candidiasis when using inhalation?
Which dietary recommendation is suggested for patients using this treatment?
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What should be continuously checked in patients using this treatment?
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Which of the following is recommended if a patient develops a candida infection?
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What must be done to avoid withdrawal complications?
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What should be administered in cases of acute infection while using this treatment?
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Which drug is given twice daily for asthma management?
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Which mechanism of action is associated with Zileuton?
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What is the primary role of leukotriene inhibitors in asthma management?
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What effect do leukotriene inhibitors have on drug metabolism?
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Which of the following mast cell stabilizers is poorly soluble?
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For what age group is Montelukast approved for asthma management?
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Which option correctly describes dosing frequency for Montelukast?
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What form should Cromylyn and Nedocromil be given to patients?
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What is the primary mechanism of action of Omalizumab?
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In the stepwise approach to asthma management, what is the first line treatment for stable asthma?
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What treatment should be added to the management of asthma if inhaled steroid dose reaches 800 mcg/day and control is still inadequate?
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In the stepwise approach, if step 5 is reached for chronic asthma, what is a recommended action?
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How is acute severe asthma (status asthmaticus) primarily managed?
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What is a role of the medication that inhibits mast cell degranulation?
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Which of the following is true regarding the use of high doses of inhaled steroids in asthma treatment?
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What has largely replaced the use of mast cell inhibitors?
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What is one of the adverse effects that may occur with the use of these medications?
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What is Ketotifen classified as?
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In which condition is Ketotifen commonly used as a prophylactic treatment?
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What mixture is utilized to reduce the work of breathing in obstructed airways?
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What function do expectorants and mucolytics serve in asthma treatment?
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What characteristic of helium contributes to its therapeutic effect in asthma treatment?
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What is one of the mechanisms by which corticosteroids reduce bronchial inflammation?
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In the treatment of acute severe asthma, what is the typical intravenous dosage of hydrocortisone administered?
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Which of the following features is a benefit of inhaled corticosteroids in asthma treatment?
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What is the effect of corticosteroids on mast cells in the context of asthma treatment?
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Which corticosteroid is commonly used in chronic bronchial asthma treatment?
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In the context of cytokine release, what role do corticosteroids play?
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What effect do corticosteroids have on beta-2 receptors?
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Which of the following actions does NOT describe the effects of corticosteroids?
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The efficacy of systemic corticosteroids is equal to that of inhaled β2 agonists.
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Using inhaled corticosteroids can lead to oral thrush, but this can be prevented by using a mouthwash after inhalation.
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Immediate withdrawal of corticosteroids is recommended to avoid acute Addisonian crisis.
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A diet low in carbohydrates is advised for patients using systemic corticosteroids.
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If a patient develops a candida infection, they should stop using corticosteroids entirely.
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Systemic corticosteroids have no systemic side effects.
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Continuous monitoring for weight gain and elevated blood pressure is unnecessary in patients on corticosteroids.
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Patients using inhaled corticosteroids should gargle with antifungal mouthwash after every dose.
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Zafirlukast is administered once daily for asthma management.
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Zileuton inhibits the synthesis of leukotrienes by acting on the lipoxygenase enzyme.
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Mast cell stabilizers such as Cromolyn and Nedocromil should be given in liquid form for better absorption.
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Montelukast has been shown to reduce the frequency of asthma exacerbations similarly to leukotriene receptor antagonists.
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Zafirlukast and Montelukast both work by blocking leukotriene (LTD4) receptors.
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Zileuton is a P450 inhibitor and can affect the metabolism of several other drugs.
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Leukotriene inhibitors have been clinically demonstrated to be superior to corticosteroids in reducing asthma exacerbations.
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Nedocromil is a more soluble compound than Cromolyn and is administered as a solution.
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Omalizumab inhibits the binding of IgE to B cells and prevents mast cell activation.
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In the stepwise approach for chronic asthma, an inhaled long-acting B2 agonist (LABA) is added only when the inhaled steroid dose reaches 800 mcg/day.
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Acute severe asthma, also known as status asthmaticus, is typically treated with immediate outpatient management and oral corticosteroids.
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Mast cell stabilizers primarily function by enhancing the activity of chloride channels in mast cell membranes.
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The maximum inhaled steroid dose in a stepwise approach for chronic asthma can reach up to 2000 mcg/day.
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Ketotifen is a first-generation antihistamine used for treating allergic rhinitis.
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Oxygen treatment for acute severe asthma aims to maintain peripheral capillary O2 saturation between 88-92%.
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Corticosteroids enhance B cell function in the treatment of asthma.
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The use of mast cell stabilizers has been largely replaced by leukotriene inhibitors due to their efficiency.
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The first step in treating chronic asthma involves the use of inhaled long-acting B2 agonists as required.
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Heliox is a mixture of oxygen and helium that helps reduce breathing work by increasing mucus viscosity.
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Inhaled corticosteroids are considered the second choice in newly diagnosed asthma.
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Mast cells release histamine, which corticosteroids help to inhibit.
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The primary adverse effect of mast cell stabilizers is systemic irritation of the throat.
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Corticosteroids are known to stabilize lysosomal membranes in macrophages.
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Mast cell stabilizers are sometimes used for prophylactic treatment in conditions like bronchial asthma.
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Dexamethasone is typically administered intravenously for chronic bronchial asthma.
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Ketotifen can be administered as eye drops for treating allergic conjunctivitis.
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Chloride channels in mast cells play a critical role in the mechanism of action of leukotriene inhibitors.
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Corticosteroids have no effect on the up-regulation of beta-2 receptors.
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Prednisolone is the typical oral corticosteroid prescribed for acute severe asthma management.
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Corticosteroids inhibit phospholipase A2 enzyme activity, reducing the synthesis of prostaglandins and leukotrienes.
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How do agents that inhibit mast cell degranulation likely alter mast cell function?
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For which allergic conditions is Ketotifen used as a prophylactic treatment?
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What has largely replaced the use of mast cell stabilizers in asthma management?
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What are the common adverse effects associated with the administration of mast cell stabilizers?
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What is the primary mechanism of action for expectorants and mucolytics in asthma treatment?
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How does the mixture of 20% oxygen and 80% helium aid in treating obstructed airways?
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What classification does Ketotifen fall into in terms of antihistamines?
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What role do corticosteroids play in reducing bronchial inflammation during asthma treatment?
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How do corticosteroids influence B cell function in the context of bronchial inflammation?
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What intravenous dosage of hydrocortisone is typically administered for acute severe asthma?
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What effect do corticosteroids have on T cell-mediated responses in asthma?
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What is the significance of up-regulation of β2 receptors due to corticosteroid use?
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In chronic bronchial asthma management, what oral corticosteroid dosage is commonly prescribed for prednisolone?
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How do corticosteroids affect macrophage activity in asthma treatment?
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What is the role of phospholipase A2 inhibition by corticosteroids in asthma management?
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Inhaled corticosteroids are considered the first choice for which patient group?
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What type of drug is Zileuton, and what does it inhibit?
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How do leukotriene inhibitors impact asthma management compared to corticosteroids?
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What is the dosing frequency for Zafirlukast?
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What major interaction should be considered when using Zileuton?
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Which agents are classified as mast cell stabilizers?
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How should Cromolyn and Nedocromil be administered to ensure effectiveness?
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Describe the specific receptor that leukotriene inhibitors, such as Montelukast, block.
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What is the significance of Montelukast being approved for children?
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What potential benefit do corticosteroids provide compared to oral medications in asthma management?
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What is a strategy to prevent oropharyngeal candidiasis when using inhaled corticosteroids?
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What dietary modifications are recommended for patients on systemic corticosteroids?
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What is a critical precaution to take when withdrawing corticosteroids?
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How should weight, edema, and blood pressure be monitored in patients using corticosteroids?
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What should be done if a patient using corticosteroids develops an acute infection?
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What is the significance of using antifungal treatment in patients with candidiasis while on inhaled corticosteroids?
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What should be continuously checked in patients receiving corticosteroid therapy?
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How does Omalizumab contribute to the management of asthma exacerbations?
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What is the maximum recommended dose of inhaled steroids in the stepwise management of chronic asthma?
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What should be utilized to maintain adequate oxygen levels in patients experiencing acute severe asthma?
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How is the stepwise approach adjusted if a patient on inhaled LABA still experiences inadequate asthma control?
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What action should be taken if a patient reaches step 5 in the asthma management process?
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Define 'status asthmaticus' in the context of acute severe asthma.
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Corticosteroids can effectively ↓ bronchial ______ and hyperreactivity activity.
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Corticosteroids inhibit ______ cell function → ↓ antigen-antibody reaction.
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Corticosteroids inhibit ______ cell functions → ↓ mediators and cytokine release.
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For acute severe asthma, hydrocortisone 2000 mg is given by ______ injection.
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Chronic bronchial asthma may be treated with oral ______ 20 mg g/d.
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Inhaled corticosteroids, such as ______, should be considered the 1st choice in newly diagnosed asthma.
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Corticosteroids inhibit mast cells → ↓ ______ release.
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Corticosteroids cause up-regulation of ______ receptors.
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Their efficacy is equal to inhaled ______.
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Adverse effects may occur if used ______.
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Candidiasis can be avoided by using mouthwash and ______ after each inhalation.
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Candida infection can be treated by nystatin mouthwash or ______ lozenges.
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Patients must be withdrawn from corticosteroids ______ to avoid acute Addisonian crisis.
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A diet should be rich in potassium and proteins and low in ______.
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Continuous monitoring for weight increase, edema, and ______ in urine is necessary.
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If a patient develops acute infection, adequate ______ must be administered with a decreased steroid dose.
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Zafirlukast and montelukast are types of ______ inhibitors.
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Zileuton inhibits the synthesis of leukotrienes by acting on the ______ enzyme.
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Montelukast is approved to control asthma in ______.
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Cromolyn sodium and nedocromil are ______ soluble drugs.
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Cromolyn and nedocromil should be given as micronized powder through a ______.
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Zafirlukast is taken ______ daily.
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Zileuton is a microsomal P450 ______ and can inhibit the metabolism of many drugs.
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Mast cell stabilizers work by preventing the release of ______ from mast cells.
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Omalizumab is a new drug that inhibits the binding of IgE to ______ cells.
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The stepwise approach for treating chronic asthma includes adding an inhaled ______ at 400 mcg/day.
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In the management of acute severe asthma, oxygen is used to maintain peripheral capillary ______ saturation between 94-98%.
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If control is still inadequate after increasing inhaled steroid dose to 800 mcg/day, the next step is to add an inhaled long-acting ______ agonist (LABA).
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In step 5 of asthma management, patients should be referred for ______ care.
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Mast cell degranulation is influenced by altering the function of chloride ______ in the mast cell membrane.
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Acute severe asthma is a condition in which ______ are poorly effective in relieving the attack.
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Ketotifen is used as an eye drop to treat allergic ______.
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Expectorants and ______ are used to reduce mucus viscosity.
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Heliox is a mixture of oxygen (20%) and ______ (80%).
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The use of certain mast cell stabilizers has become very ______ and has been largely replaced by leukotriene inhibitors.
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Local irritation of the throat and chest tightness are examples of ______ effects at the site of administration.
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Ketotifen is classified as a second-generation ______.
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Helium's low density facilitates O2 diffusion through ______ airways.
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Match the following advantages of corticosteroids with their descriptions:
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Match the recommended dietary considerations for patients on corticosteroids:
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Match the treatment for candidiasis with the recommended method:
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Match the monitoring aspects with their importance in corticosteroid use:
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Match the following corticosteroid uses with their respective dosages:
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Match the required precautions when using corticosteroids:
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Match the mechanisms of action of corticosteroids to their effects:
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Match the type of immune cell with the action suppressed by corticosteroids:
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Match the adverse effects with their corresponding scenarios:
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Match the treatment strategies with their purpose:
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Match the type of corticosteroid administration with the appropriate condition:
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Match the intervention with its expected outcome in corticosteroid therapy:
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Match the inflammatory mediator with the corticosteroid effect:
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Match the statement about corticosteroids with the appropriate description:
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Match the action associated with corticosteroids with its result:
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Match the type of asthma with the appropriate corticosteroid treatment:
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Match the following asthma management steps with their corresponding actions:
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Match the following drugs with their primary mechanisms in asthma treatment:
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Match the stages of acute treatment for severe asthma with their appropriate actions:
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Match the following drug classes with their indicated uses in asthma management:
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Match the stepwise treatment approach for asthma management with the correct drug doses:
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Match the following definitions with their corresponding conditions in asthma management:
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Match the following leukotriene inhibitors with their key characteristics:
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Match the mast cell stabilizers with their properties:
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Match the following statements with the corresponding drug action:
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Match the drug with its dosing schedule:
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Match the following actions of leukotriene inhibitors:
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Match the following drugs with their potential drug interactions:
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Match the following characteristics of mast cell stabilizers:
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Match the following statements about asthma management:
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Match the following drugs with their primary usage:
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Match the side effects with their associated treatments:
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Match the drugs with their classifications:
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Match the drug with the allergic condition it treats:
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Match the following descriptions to the correct drug:
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Match the following therapies with their mechanisms:
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Match the drug with its limitation in use:
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Match the adverse effects to the correct drug category:
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Study Notes
Reduction of Bronchial Inflammation
- Corticosteroids are effective in decreasing bronchial inflammation and hyperreactivity.
- Mechanisms of action include inhibiting B and T cell functions, macrophage activity, mast cells, and phospholipase A2, leading to reduced antigen-antibody reactions, cytokine release, histamine release, and prostaglandins/leukotrienes synthesis.
- Increased regulation of β2 receptors enhances the efficacy of corticosteroids.
Use in Asthma
- Acute severe asthma treated with intravenous hydrocortisone at 2000 mg, repeated every 4 hours if needed.
- Chronic bronchial asthma managed with oral prednisone (20 mg/day) or dexamethasone (4-8 mg/day), or inhaled corticosteroids like beclomethasone.
- Inhaled corticosteroids should be the first-line treatment for newly diagnosed asthma due to their equivalent efficacy to inhaled β2 agonists and minimal systemic side effects.
- Potential side effects include oropharyngeal candidiasis, which can be prevented with mouth rinsing post-inhalation, and treated with antifungal agents.
Precautions for Corticosteroid Use
- Gradual withdrawal is crucial to prevent acute Addisonian crisis.
- Diet should be potassium and protein-rich but low in sodium and carbohydrates.
- Regular monitoring for weight gain, edema, elevated blood sugar, or blood pressure changes is necessary.
- Antibiotics may be required for acute infections with adjusted steroid dosages.
Prophylactic Treatment
- Leukotriene inhibitors (e.g., zafirlukast, montelukast) are used to reduce asthma exacerbation frequency.
- Zafirlukast taken twice daily and montelukast once daily, both blocking leukotriene receptors.
- Zileuton inhibits leukotriene synthesis but can interact with other medications like warfarin and theophylline.
Mast Cell Stabilizers
- Cromolyn sodium and nedocromil are poorly soluble drugs that prevent mast cell degranulation, mainly used in allergic conditions but largely replaced by leukotriene inhibitors due to limited efficacy.
- Ketotifen functions as both an antihistamine and mast cell stabilizer, administered as eye drops or in oral form for allergic conjunctivitis and asthma prophylaxis.
Other Treatments
- Expectorants and mucolytics decrease mucus viscosity.
- Heliox (20% oxygen, 80% helium) facilitates oxygen diffusion in obstructed airways, reducing breathing effort.
- Omalizumab, an anti-IgE monoclonal antibody, prevents IgE binding to mast cells, reducing the severity of asthma attacks and corticosteroid requirements.
Stepwise Approach to Chronic Asthma Management
- Step 1: Use inhaled short-acting β2 agonists (SABA) as needed.
- Step 2: Add inhaled corticosteroids at 400 mcg/day.
- Step 3: Incorporate long-acting β2 agonists (LABA) and increase inhaled steroids to 800 mcg/day if inadequate control.
- Step 4: Further increase inhaled steroids up to 2000 mcg/day and consider adding a fourth drug (e.g., leukotriene antagonist or oral β2 agonists).
- Step 5: Use oral steroids at the lowest effective dose in combination with high-dose inhaled steroids and refer to specialist care if needed.
Management of Acute Severe Asthma (Status Asthmaticus)
- Defined as unresponsive bronchodilator relief during asthma attacks.
- Requires hospitalization, with oxygen supplied to maintain peripheral capillary saturation (SpO2) between 94-98%.
Reduction of Bronchial Inflammation
- Corticosteroids are effective in decreasing bronchial inflammation and hyperreactivity.
- Mechanisms of action include inhibiting B and T cell functions, macrophage activity, mast cells, and phospholipase A2, leading to reduced antigen-antibody reactions, cytokine release, histamine release, and prostaglandins/leukotrienes synthesis.
- Increased regulation of β2 receptors enhances the efficacy of corticosteroids.
Use in Asthma
- Acute severe asthma treated with intravenous hydrocortisone at 2000 mg, repeated every 4 hours if needed.
- Chronic bronchial asthma managed with oral prednisone (20 mg/day) or dexamethasone (4-8 mg/day), or inhaled corticosteroids like beclomethasone.
- Inhaled corticosteroids should be the first-line treatment for newly diagnosed asthma due to their equivalent efficacy to inhaled β2 agonists and minimal systemic side effects.
- Potential side effects include oropharyngeal candidiasis, which can be prevented with mouth rinsing post-inhalation, and treated with antifungal agents.
Precautions for Corticosteroid Use
- Gradual withdrawal is crucial to prevent acute Addisonian crisis.
- Diet should be potassium and protein-rich but low in sodium and carbohydrates.
- Regular monitoring for weight gain, edema, elevated blood sugar, or blood pressure changes is necessary.
- Antibiotics may be required for acute infections with adjusted steroid dosages.
Prophylactic Treatment
- Leukotriene inhibitors (e.g., zafirlukast, montelukast) are used to reduce asthma exacerbation frequency.
- Zafirlukast taken twice daily and montelukast once daily, both blocking leukotriene receptors.
- Zileuton inhibits leukotriene synthesis but can interact with other medications like warfarin and theophylline.
Mast Cell Stabilizers
- Cromolyn sodium and nedocromil are poorly soluble drugs that prevent mast cell degranulation, mainly used in allergic conditions but largely replaced by leukotriene inhibitors due to limited efficacy.
- Ketotifen functions as both an antihistamine and mast cell stabilizer, administered as eye drops or in oral form for allergic conjunctivitis and asthma prophylaxis.
Other Treatments
- Expectorants and mucolytics decrease mucus viscosity.
- Heliox (20% oxygen, 80% helium) facilitates oxygen diffusion in obstructed airways, reducing breathing effort.
- Omalizumab, an anti-IgE monoclonal antibody, prevents IgE binding to mast cells, reducing the severity of asthma attacks and corticosteroid requirements.
Stepwise Approach to Chronic Asthma Management
- Step 1: Use inhaled short-acting β2 agonists (SABA) as needed.
- Step 2: Add inhaled corticosteroids at 400 mcg/day.
- Step 3: Incorporate long-acting β2 agonists (LABA) and increase inhaled steroids to 800 mcg/day if inadequate control.
- Step 4: Further increase inhaled steroids up to 2000 mcg/day and consider adding a fourth drug (e.g., leukotriene antagonist or oral β2 agonists).
- Step 5: Use oral steroids at the lowest effective dose in combination with high-dose inhaled steroids and refer to specialist care if needed.
Management of Acute Severe Asthma (Status Asthmaticus)
- Defined as unresponsive bronchodilator relief during asthma attacks.
- Requires hospitalization, with oxygen supplied to maintain peripheral capillary saturation (SpO2) between 94-98%.
Reduction of Bronchial Inflammation
- Corticosteroids are effective in decreasing bronchial inflammation and hyperreactivity.
- Mechanisms of action include inhibiting B and T cell functions, macrophage activity, mast cells, and phospholipase A2, leading to reduced antigen-antibody reactions, cytokine release, histamine release, and prostaglandins/leukotrienes synthesis.
- Increased regulation of β2 receptors enhances the efficacy of corticosteroids.
Use in Asthma
- Acute severe asthma treated with intravenous hydrocortisone at 2000 mg, repeated every 4 hours if needed.
- Chronic bronchial asthma managed with oral prednisone (20 mg/day) or dexamethasone (4-8 mg/day), or inhaled corticosteroids like beclomethasone.
- Inhaled corticosteroids should be the first-line treatment for newly diagnosed asthma due to their equivalent efficacy to inhaled β2 agonists and minimal systemic side effects.
- Potential side effects include oropharyngeal candidiasis, which can be prevented with mouth rinsing post-inhalation, and treated with antifungal agents.
Precautions for Corticosteroid Use
- Gradual withdrawal is crucial to prevent acute Addisonian crisis.
- Diet should be potassium and protein-rich but low in sodium and carbohydrates.
- Regular monitoring for weight gain, edema, elevated blood sugar, or blood pressure changes is necessary.
- Antibiotics may be required for acute infections with adjusted steroid dosages.
Prophylactic Treatment
- Leukotriene inhibitors (e.g., zafirlukast, montelukast) are used to reduce asthma exacerbation frequency.
- Zafirlukast taken twice daily and montelukast once daily, both blocking leukotriene receptors.
- Zileuton inhibits leukotriene synthesis but can interact with other medications like warfarin and theophylline.
Mast Cell Stabilizers
- Cromolyn sodium and nedocromil are poorly soluble drugs that prevent mast cell degranulation, mainly used in allergic conditions but largely replaced by leukotriene inhibitors due to limited efficacy.
- Ketotifen functions as both an antihistamine and mast cell stabilizer, administered as eye drops or in oral form for allergic conjunctivitis and asthma prophylaxis.
Other Treatments
- Expectorants and mucolytics decrease mucus viscosity.
- Heliox (20% oxygen, 80% helium) facilitates oxygen diffusion in obstructed airways, reducing breathing effort.
- Omalizumab, an anti-IgE monoclonal antibody, prevents IgE binding to mast cells, reducing the severity of asthma attacks and corticosteroid requirements.
Stepwise Approach to Chronic Asthma Management
- Step 1: Use inhaled short-acting β2 agonists (SABA) as needed.
- Step 2: Add inhaled corticosteroids at 400 mcg/day.
- Step 3: Incorporate long-acting β2 agonists (LABA) and increase inhaled steroids to 800 mcg/day if inadequate control.
- Step 4: Further increase inhaled steroids up to 2000 mcg/day and consider adding a fourth drug (e.g., leukotriene antagonist or oral β2 agonists).
- Step 5: Use oral steroids at the lowest effective dose in combination with high-dose inhaled steroids and refer to specialist care if needed.
Management of Acute Severe Asthma (Status Asthmaticus)
- Defined as unresponsive bronchodilator relief during asthma attacks.
- Requires hospitalization, with oxygen supplied to maintain peripheral capillary saturation (SpO2) between 94-98%.
Reduction of Bronchial Inflammation
- Corticosteroids are effective in decreasing bronchial inflammation and hyperreactivity.
- Mechanisms of action include inhibiting B and T cell functions, macrophage activity, mast cells, and phospholipase A2, leading to reduced antigen-antibody reactions, cytokine release, histamine release, and prostaglandins/leukotrienes synthesis.
- Increased regulation of β2 receptors enhances the efficacy of corticosteroids.
Use in Asthma
- Acute severe asthma treated with intravenous hydrocortisone at 2000 mg, repeated every 4 hours if needed.
- Chronic bronchial asthma managed with oral prednisone (20 mg/day) or dexamethasone (4-8 mg/day), or inhaled corticosteroids like beclomethasone.
- Inhaled corticosteroids should be the first-line treatment for newly diagnosed asthma due to their equivalent efficacy to inhaled β2 agonists and minimal systemic side effects.
- Potential side effects include oropharyngeal candidiasis, which can be prevented with mouth rinsing post-inhalation, and treated with antifungal agents.
Precautions for Corticosteroid Use
- Gradual withdrawal is crucial to prevent acute Addisonian crisis.
- Diet should be potassium and protein-rich but low in sodium and carbohydrates.
- Regular monitoring for weight gain, edema, elevated blood sugar, or blood pressure changes is necessary.
- Antibiotics may be required for acute infections with adjusted steroid dosages.
Prophylactic Treatment
- Leukotriene inhibitors (e.g., zafirlukast, montelukast) are used to reduce asthma exacerbation frequency.
- Zafirlukast taken twice daily and montelukast once daily, both blocking leukotriene receptors.
- Zileuton inhibits leukotriene synthesis but can interact with other medications like warfarin and theophylline.
Mast Cell Stabilizers
- Cromolyn sodium and nedocromil are poorly soluble drugs that prevent mast cell degranulation, mainly used in allergic conditions but largely replaced by leukotriene inhibitors due to limited efficacy.
- Ketotifen functions as both an antihistamine and mast cell stabilizer, administered as eye drops or in oral form for allergic conjunctivitis and asthma prophylaxis.
Other Treatments
- Expectorants and mucolytics decrease mucus viscosity.
- Heliox (20% oxygen, 80% helium) facilitates oxygen diffusion in obstructed airways, reducing breathing effort.
- Omalizumab, an anti-IgE monoclonal antibody, prevents IgE binding to mast cells, reducing the severity of asthma attacks and corticosteroid requirements.
Stepwise Approach to Chronic Asthma Management
- Step 1: Use inhaled short-acting β2 agonists (SABA) as needed.
- Step 2: Add inhaled corticosteroids at 400 mcg/day.
- Step 3: Incorporate long-acting β2 agonists (LABA) and increase inhaled steroids to 800 mcg/day if inadequate control.
- Step 4: Further increase inhaled steroids up to 2000 mcg/day and consider adding a fourth drug (e.g., leukotriene antagonist or oral β2 agonists).
- Step 5: Use oral steroids at the lowest effective dose in combination with high-dose inhaled steroids and refer to specialist care if needed.
Management of Acute Severe Asthma (Status Asthmaticus)
- Defined as unresponsive bronchodilator relief during asthma attacks.
- Requires hospitalization, with oxygen supplied to maintain peripheral capillary saturation (SpO2) between 94-98%.
Reduction of Bronchial Inflammation
- Corticosteroids are effective in decreasing bronchial inflammation and hyperreactivity.
- Mechanisms of action include inhibiting B and T cell functions, macrophage activity, mast cells, and phospholipase A2, leading to reduced antigen-antibody reactions, cytokine release, histamine release, and prostaglandins/leukotrienes synthesis.
- Increased regulation of β2 receptors enhances the efficacy of corticosteroids.
Use in Asthma
- Acute severe asthma treated with intravenous hydrocortisone at 2000 mg, repeated every 4 hours if needed.
- Chronic bronchial asthma managed with oral prednisone (20 mg/day) or dexamethasone (4-8 mg/day), or inhaled corticosteroids like beclomethasone.
- Inhaled corticosteroids should be the first-line treatment for newly diagnosed asthma due to their equivalent efficacy to inhaled β2 agonists and minimal systemic side effects.
- Potential side effects include oropharyngeal candidiasis, which can be prevented with mouth rinsing post-inhalation, and treated with antifungal agents.
Precautions for Corticosteroid Use
- Gradual withdrawal is crucial to prevent acute Addisonian crisis.
- Diet should be potassium and protein-rich but low in sodium and carbohydrates.
- Regular monitoring for weight gain, edema, elevated blood sugar, or blood pressure changes is necessary.
- Antibiotics may be required for acute infections with adjusted steroid dosages.
Prophylactic Treatment
- Leukotriene inhibitors (e.g., zafirlukast, montelukast) are used to reduce asthma exacerbation frequency.
- Zafirlukast taken twice daily and montelukast once daily, both blocking leukotriene receptors.
- Zileuton inhibits leukotriene synthesis but can interact with other medications like warfarin and theophylline.
Mast Cell Stabilizers
- Cromolyn sodium and nedocromil are poorly soluble drugs that prevent mast cell degranulation, mainly used in allergic conditions but largely replaced by leukotriene inhibitors due to limited efficacy.
- Ketotifen functions as both an antihistamine and mast cell stabilizer, administered as eye drops or in oral form for allergic conjunctivitis and asthma prophylaxis.
Other Treatments
- Expectorants and mucolytics decrease mucus viscosity.
- Heliox (20% oxygen, 80% helium) facilitates oxygen diffusion in obstructed airways, reducing breathing effort.
- Omalizumab, an anti-IgE monoclonal antibody, prevents IgE binding to mast cells, reducing the severity of asthma attacks and corticosteroid requirements.
Stepwise Approach to Chronic Asthma Management
- Step 1: Use inhaled short-acting β2 agonists (SABA) as needed.
- Step 2: Add inhaled corticosteroids at 400 mcg/day.
- Step 3: Incorporate long-acting β2 agonists (LABA) and increase inhaled steroids to 800 mcg/day if inadequate control.
- Step 4: Further increase inhaled steroids up to 2000 mcg/day and consider adding a fourth drug (e.g., leukotriene antagonist or oral β2 agonists).
- Step 5: Use oral steroids at the lowest effective dose in combination with high-dose inhaled steroids and refer to specialist care if needed.
Management of Acute Severe Asthma (Status Asthmaticus)
- Defined as unresponsive bronchodilator relief during asthma attacks.
- Requires hospitalization, with oxygen supplied to maintain peripheral capillary saturation (SpO2) between 94-98%.
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This quiz focuses on the role of corticosteroids in reducing bronchial inflammation, including their mechanisms of action. Learn how these medications impact B and T cell functions to alleviate symptoms associated with hyperreactive conditions. Test your knowledge on the pharmacological effects of corticosteroids and their clinical applications.