Asthma - ECARF

Allergisches Asthma Tritt Normalerweise in Schüben

The indoor environment and its effects on childhood asthma. In children, inhaled corticosteroid therapy has been shown to slow the rate of growth, but this effect appears to be transient: Asthma itself delays puberty, and there is no evidence that inhaled corticosteroid therapy in childhood influences adult height. 21. Mutius E, Vercelli D. Farm living: effects on childhood asthma and allergy. • Aerosol treatment is the most effective way to avoid the systemic adverse effects of corticosteroid therapy. Heavy use most often indicates that the patient should be receiving more effective prophylactic therapy with corticosteroids. 25. • Urgent treatment is often begun with an oral dose of 30-60 mg prednisone per day or an intravenous dose of 1 mg/kg methylprednisolone every 6 hours; the daily dose is decreased after airway obstruction has improved. • Clinical Use of Corticosteroids • Clinical studies of corticosteroids consistently show them to be effective in improving all indices of asthma control- severity of symptoms, tests of airway caliber and bronchial reactivity, frequency of exacerbations, and quality of life. • Several are now in advanced stages of clinical development, (eg, roflumilast, cilomilast, tofimilast), but at the time of writing, none has been approved for clinical use by the FDA.

30. • This simplistic idea has been overturned in part by the finding that cromolyn and nedocromil inhibit the function of cells other than mast cells and in part by the finding that nedocromil inhibits appearance of the late response even when given after the early response to antigen challenge, ie, after mast cell degranulation has occurred. The inhibitory effect on mast cells appears to be specific for cell type, since cromolyn has little inhibitory effect on mediator spiriva https://asthma-medikamente.com release from human basophils. 29. • Cromolyn is poorly absorbed from the gastrointestinal tract and must be inhaled as a microfine powder or aerosolized solution. Because the particles generated by a nebulizer are much larger than those from a metered-dose inhaler, much higher doses must be given (2.5-5.0 mg vs 100-400 mcg) but are no more effective. • Ipratropium can be delivered in high doses by this route because it is poorly absorbed into the circulation and does not readily enter the central nervous system. They are not recommended as the sole therapy for asthma.

• For oral therapy with the prompt-release formulation, the usual dose is 3-4 mg/kg of theophylline every 6 hours. Nebulized therapy should thus be reserved for patients unable to coordinate inhalation from a metered-dose inhaler. Because epinephrine and isoproterenol increase the rate and force of cardiac contraction (mediated mainly by B1 receptors), they are reserved for special situations • In general, adrenoceptor agonists are best delivered by inhalation because this results in the greatest local effect on airway smooth muscle with the least systemic toxicity. • The best-characterized action of the adrenoceptor agonists in the airways is relaxation of airway smooth muscle. They are effective after inhaled or oral administration and have a long duration of action. • However, these drugs have no effect on airway smooth muscle tone and are ineffective in reversing asthmatic bronchospasm; they are only of value when taken prophylactically. In the airways, acetylcholine is released from efferent endings of the vagus nerves, and muscarinic antagonists block the contraction of airway smooth muscle and the increase in secretion of mucus that occurs in response to vagal activity . 18. • EFFECTS ON SKELETAL MUSCLE • The respiratory actions of the methylxanthines may not be confined to the airways, for they also strengthen the contractions of isolated skeletal muscle in vitro and improve contractility and reverse fatigue of the diaphragm in patients with COPD.

This effect on diaphragmatic performance- rather than an effect on the respiratory center-may account for theophylline's ability to improve the ventilatory response to hypoxia and to diminish dyspnea even in patients with irreversible airflow obstruction. These drugs appear to interact with inhaled corticosteroids to improve asthma control. The mechanism of this action is not well defined, https://asthma-medikamente.com/theo-24 but the effect is exploited in the treatment of intermittent claudication with pentoxifylline, a dimethylxanthine agent. 24. • CORTICOSTEROIDS • Mechanism of Action • Corticosteroids have been used to treat asthma since 1950 and are presumed to act by their broad anti-inflammatory efficacy, mediated in part by inhibition of production of inflammatory cytokines . Reports of Churg-Strauss syndrome (a systemic vasculitis accompanied by worsening asthma, pulmonary infiltrates, and eosinophilia) appear to have been coincidental, with the syndrome unmasked by the reduction in prednisone dosage made possible by the addition of zafirlukast or montelukast. Such use also reduces or eliminates the need for oral corticosteroids in patients with more severe disease.

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