Archive for the ‘Asthma’ Category

Asthma Medications

Asthma Medications

Today asthma is one of the most burning/pressing problems. From 4 to 10 percent of the planet population suffers from this disease. The etiology of asthma is quite individual, but general criteria are ecological situation decline and low-active way of life. In the list of symptoms of the disease there are: cough, sibilant rale, feeling of obstruction in the chest, breathlessness. Asthma can be defined as an inflammatory disease of airways which consists of (make itself prominent in) bronchial tubes narrowing and, as the result, the asthma sufferer literally cannot breathe. It is a chronic disease but GPs learned to deal with the asthma attacks successfully. Many asthma inhalers have been produced in the form of inhalers that have long-term, rapid and immediate effect. The latter should always be at one’s fingertips in view of sudden, unexpected asthma attack. This group of asthma medications includes Proventil, Atrovent and others. These inhalers have rapid effect and release/ relieve the asthma symptoms when one is taken aback by the attack. As for long-acting asthma medications, they work in slightly other way. Having a slow but considerable influence, these medicaments are used as part of patient’s usual treatment plan. Drugs of this group are prescribed by personal doctor in accordance with one’s specific nature.

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Isoflurane Therapy for Status Asthmaticus in Children and Adults: DISCUSSION part2

We installed two waste gas scavenging systems into the operating room. This was simple and inexpensive, as the ICU is contiguous with the operating room.

An adequate scavenging device can be made by connecting the exhaust port of the ventilator to a T- piece that is attached to a 3-L reservoir bag. Wall suction is applied to the remaining limb of the T-piece until the reservoir bag partially fills with each breath, but never fully collapses. Leaks are readily detectable, since isoflurane has a characteristic pungent odor.

Since this is a nonrebreathing system, a great deal of isoflurane is vaporized hourly. The cost for 24 h of continuous use is high, but it is partially offset by decreased use of other sedatives and muscle relaxants.

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Isoflurane Therapy for Status Asthmaticus in Children and Adults: DISCUSSION

Status Asthmaticus

Isoflurane produces bronchodilation through (3-ad- renergic receptor stimulation, direct relaxation of bronchial smooth muscle, antagonism of the action of acetylcholine and histamine, and interference with hypocapnic bronchoconstriction. Thus, a patient who is already receiving maximum doses of standard bron- chodilators may show an additional response. As our case reports suggest, isoflurane acts rapidly and may be lifesaving while high-dose corticosteroids take effect. In contrast, ketamine, an intravenous anes­thetic agent that has also been used in asthma, acts by adrenergic stimulation. Little response is seen in patients receiving large doses of P-agonists and theo­phylline.

There are several advantages of isoflurane over other inhalational anesthetic agents. Historically, diethyl ether and cyclopropane were used, but their extreme flammability precluded their use in electrically active environments. Isoflurane is the least fat soluble of the anesthetic vapors and has the lowest blood gas solu­bility coefficient. Consequently, depth of anesthesia can be most rapidly adjusted with isoflurane, and time to recovery of consciousness is short, despite pro­longed use.

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Isoflurane Therapy for Status Asthmaticus in Children and Adults: CASE REPORTS part2

Case 3

A 27 month-old-boy was admitted to the pediatric ICU for the third time suffering from an exacerbation of asthma. The day prior to hospital admission he had been exposed to grass and pollen on a farm. At a rural hospital he was given albuterol, prednisone, and oral theophylline and transferred to our hospital. En route, he received hydrocortisone 125 mg IV and albuterol inhalations. The ABG values on admission were a pH of 6.94, Pco2 of 132 mm Hg, and Po2 of 79 mm Hg. Heart rate was 168 beats per minute and RR was 22 breaths per minute. Chest roentgenogram showed marked hyperinflation with no consolidation or pneumothorax. Following sedation with fentanyl and paralysis with pancuronium bromide, he was intubated. Subsequent ABG values were pH of 7.01, Pco2 of 122 mm Hg, and Po2 of 106 mm Hg (FIo2 of 0.7). The PIP was 44 cm H20. Positive end-expiratory pressure of 4 cm H20 was added. Drug therapy included methylprednisolone 15 mg IV every eight hours, albuterol 2 jig/kg/min IY atropine 0.6-mg inhalations, and aminophylline 10 mg/h IV (theophylline levels maintained at 16 to 20 mg/L).

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Isoflurane Therapy for Status Asthmaticus in Children and Adults: CASE REPORTS

Case 1

A 20-vear-old woman with a seven-year history of asthma was admitted to the hospital with a history of worsening bronchospasm for one week following a flu-like illness. She had l>een using albuterol, ipratropium, and l>eclomethasone inhalers without im­provement. She was transferred to our Intensive Care Unit (ICU) owing to increasing respiratory distress. On admission to the ICU, her heart rate (HR) was 120 lieats per minute, respiratory rate (RR) was 18 breaths per minute, and Mood pressure (BP) was 150/80 mm Hg. Initial arterial blood gas (ABC) determinations were a pH of 7.30, Pco, of 35 mm Hg, and P<>2 of 45 mm Hg. Complete blood cell count (CBC), electrolytes, and liver function test results were normal.

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Isoflurane Therapy for Status Asthmaticus in Children and Adults

Isoflurane Therapy

Tnhalational anesthetic agents have been sporadically used for status asthmaticus unresponsive to maxi­mal standard therapy. Unfortunately, many agents have serious side effects and the delivery systems have been difficult to use outside the operating room, particularly in patients with high airway pressures.

Isoflurane, a halogenated ether, is an anesthetic agent that produces bronchodilation through a number of mechanisms. Recent technologic developments allow isoflurane to be easily and safely administered for prolonged periods of time to patients with severe bronchospasm.

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Continuous Nebulization of Albuterol (Salbutamol) in Acute Asthma: DISCUSSION part 2

These considerations have prompted others to investigate simpler techniques of aerosol delivery in acute asthma. Recently, it has been suggested that p- agonist delivered by metered dose inhaler with a spacer device is simpler and as effective as В N in this setting. However, some acutely ill patients are unable to use these devices properly while others are psychologically not prepared to accept a form of therapy that they perceive as already having failed at home. Continuous nebulization may achieve the goal of simplifying treatment while introducing a new mode of bronchodilator delivery in patients with acute airway obstruction.

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