Asthma

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Asthma Treatment

Four classifications of asthma based on frequency and duration of symptoms are used to develop a treatment plan: (1) mild intermittent asthma, (2) mild persistent asthma, (3) moderate persistent asthma, and (4) severe persistent asthma. Patients often move from one classification to another, and the treatment is adjusted accordingly. Characteristics for classifying patients are given below:

1. Mild intermittent asthma:
• Symptoms occur, on average, less than twice a week
• No symptoms (asymptomatic) and normal peak expiratory flow (PEF) rate between attacks (exacerbations)
• Brief exacerbations last from a few hours to a few days and vary in intensity
• Nighttime symptoms occur less than twice a month
• FEV1 or PEF greater than 80% of the predicted value
• PEF variability of less than 20%
2. Mild persistent asthma:
• Symptoms occur less than twice a week
• Exacerbations affect activity
• Nighttime symptoms occur more than twice a month
• FEV1 or PEF greater than 80% of the predicted value
• PEF variability of between 20% to 30%
3. Moderate persistent asthma:
• Daily symptoms
• Daily use of a short-acting beta2 agonist
• Exacerbations affect activity
• Exacerbations occur more than twice a week or persist for days
• Nighttime symptoms occur more than once a week
• FEV1 or PEF greater than 60% but less than 80% of the predicted value
• PEF variability greater than 30%
4. Severe persistent asthma:
• Continual symptoms
• Exacerbations limit physical activity
• Frequent exacerbations
• Frequent nighttime symptoms
• FEV1 or PEF less than 60% of the predicted value
• PEF variability greater than 30%

Pharmacological Therapy
Pharmacological (drug) therapy for asthma has several goals: prevention of chronic symptoms, recurrent exacerbations, emergency room visits, and hospitalization; maintenance of normal lung function and normal activity levels; and avoidance of side effects of other medications. There are two broad classes of medications used in the treatment of asthma: quick-relief, or rescue, medications; and long-term control medications.

Quick-relief medications
Quick-relief medications include short-acting inhaled beta2 agonists, oral beta2 agonists, inhaled anticholinergics, and oral corticosteroids.

Long-term control medications
Long-term control medications include oral corticosteroids, inhaled corticosteroids, cromolyn sodium, and nedocromil, long-acting beta2 agonists, leukotriene modifiers, and theophylline.

Long term control medications are divided into two large categories based on their primary mechanism of action: anti-inflammatory drugs and prolonged bronchodilators. These are prescribed when symptoms occur more often than mildly intermittent asthma. With long term control medications, it is essential to use an antiinflammatory and the prolonged bronchodilators as supplemental medications.

Asthma, Asthma Treatment reprinted with permission from pulmonologychannel.com
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