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Tuesday, 26 November 2013

Asthma (Respiratory Disease) Treatments In conventional medicine perspective

Respiratory Disease is defined as medical conditions which affect the breathing organ and tissues including Inflammatory lung disease, Obstructive lung diseases, Restrictive lung diseases, Respiratory tract infections, trachea, bronchi, bronchioles, alveoli, the nerves and  muscles breathing , etc,.
I. Asthma 
Asthma is a chronic inflammatory disease affecting the air way of the lung with recurring symptoms, such as wheezing, chest tightness, shortness of breath, and coughing. The disease affects people of all ages, and mostly starts during childhood. In the study of 463,801 children aged 13-14 years in 155 collaborating centres in 56 countries. Children self-reported, through one-page questionnaires, symptoms of these three atopic disorders. In 99 centres in 42 countries, a video asthma questionnaire was also used for 304,796 children, found that for asthma symptoms, the highest 12-month prevalences were from centres in the UK, Australia, New Zealand, and Republic of Ireland, followed by most centres in North, Central, and South America; the lowest prevalences were from centres in several Eastern European countries, Indonesia, Greece, China, Taiwan, Uzbekistan, India, and Ethiopia(1). In the United States, approximately, asthma affects 25 million people, 7 million of them are children.
F. Treatments
F.1. In conventional medicine perspective
According to the guide line of Asthma society of Canada, Most people with asthma take two kinds of medication.
F.1.1. Controllers
Controllers are medication with an aim to prevent the inflammation of the airway. There are advised that patients aho are taking the cotrollers shoud continue to take them even without symptoms to prevent recurrence.
1. Corticosteroids
Corticosteroids  are most frequent used controllers in preventing inflammatory airways in asthma patients.
a. Inhaled corticosteroids
According to the study by University of Nevada School of Medicine, in the review of review is to compare and contrast the newer inhaled corticosteroid (ICS) ciclesonide with older ICSs, showed that once-daily administration of ICSs is generally not as effective as twice-daily. Continuous administration of ICSs does not change the natural history of asthma in either children or adults. Long-term administration of medium dose ICSs does not increase the risk of cataracts or osteopenia in children and young adults(67). Others in the study of  Dry powder inhaler (DPI) devices to assess the proportion of patients with asthma or chronic obstructive pulmonary disease (COPD) with significant bronchoobstruction who do not have inspiratory flows necessary for the adequate use of dry powder inhaler (DPI) devices Diskus and Turbuhaler. showed that significant proportion of patients with asthma or COPD with significant bronchoobstruction do not exhibit satisfactory inspiratory flows for the use of dry powder inhaler (DPI) devices (Diskus < Turbuhaler)(68).
b. Oral or intravenous corticosteroids
In the study of 47 patients, 30 females, 17 male, 24 received oral prednisolone and 23 received IV hydrocortisone. At baseline the oral and IV groups were similar (mean, SD) in age (38.3, 12.8 vs 37.3, 12.9, P=0.80) and initial percent predicted (PP) PEF (61, 16.7 vs 69, 13.0, P=0.11). After 72 h both groups had similar improvements in PEF (27%, 26 vs 27%, 19, P=0.96), researchers at the Department of Respiratory and Sleep Disorders Medicine, Western Hospital, found that Corticosteroids administered orally and IV had similar efficacy in the treatment of adults hospitalised with acute asthma(69).
c. Side effects
a.1. psychiatric side effects include mania, depression and mood disturbances within the first two weeks of corticosteroid therapy(70).
2. Short side effects include cutaneous effects, electrolyte abnormalities, hypertension, hyperglycemia, pancreatitis, hematologic, immunologic, and neuropsychologic effects. and Long-term corticosteroid use may be associated with more serious sequel, including osteoporosis, aseptic joint necrosis, adrenal insufficiency, gastrointestinal, hepatic, and ophthalmologic effects, hyperlipidemia, growth suppression, and possible congenital malformations(71).
2. Cromolyn sodium and nedocromil
a. The medication are used tr block part of the asthma immune response causes of airway inflammation.
Some researchers found that the asthma drugs cromolyn disodium and nedocromil sodium are potent G-protein-coupled receptor 35 (GPR35) agonists. In the study by Amgen San Francisco, South San Francisco,  unlike zaprinast, a potent phosphodiesterase 5 (PDE5) inhibitor, cromolyn disodium and nedocromil sodium lack inhibitory activity towards PDE5. These findings suggest that GPR35 may play an important role in mast cell biology and be a potential target for the treatment of asthma(72).
b. Side effects are not limit to
  • Bad taste in mouth
  • Cough
  • Itching or sore throat
  • Headache
  • Sneezing or stuffy nose

3. Long-acting beta-2 agonists (LABAs)
a. The medication used with intention for long term control of the symptoms.  Long-acting beta-agonist to an inhaled corticosteroid has been accepted as effective therapy for almost two decades, according to the study by Faculty of Medicine, Gazi University, Ankara, found that evidence supports the use of long-acting beta-2 agonists plus inhaled corticosteroids in a single inhaler device to increase adherence and reduce the potential use of long-acting beta-2 agonists monotherapy(73). Other indicated that in adolescents and adults with sub-optimal control on low dose ICS monotherapy, the combination of LABA and ICS is modestly more effective in reducing the risk of exacerbations requiring oral corticosteroids than a higher dose of ICS. Combination therapy also led to modestly greater improvement in lung function, symptoms and use of rescue ss(2) agonists and to fewer withdrawals due to poor asthma control than with a higher dose of inhaled corticosteroids(74).
b. Side effects are not limit to
LABAs may lead to a worsening of asthma symptoms, heart attack and even death, when used alone over a long period of time, (75).
4. Methylxanthines
a. The medication used to gether with inhaled Corticosteroids to prevent the nightmare symptoms of asthatic patients. The methylxanthine theophylline has demonstrated efficacy in attenuating the three cardinal features of asthma – reversible airflow obstruction, airway hyperresponsiveness, and airway inflammation, according to the study by University of North Carolina(76).
b. Side effects are not limit to Cardiac arrhythmias, CNS excitement, tremors, convulsions, and GI irritation.
5. Leukotriene modifiers including cysteinyl LTs (CysLTs) and LTB(4)
a. The medication may be used as alternative for patient with low dose inhaled corticosteroids. Acording to the study by Catholic University of the Sacred Heart, Rome,, LTB(4) might have a role in severe asthma, asthma exacerbations, and the development of airway hyperresponsiveness. CysLT(1) receptor antagonists can be given orally as monotherapy in patients with mild persistent asthma, but these drugs are generally less effective than inhaled glucocorticoids. Combination of CysLT(1) receptor antagonists and inhaled glucocorticoids in patients with more severe asthma may improve asthma control and enable the dose of inhaled glucocorticoids to be reduced while maintaining similar efficacy(77).
b. Side effects are not limit to headache, stomachache or flu-like.
6. Etc.
F.1.2. Relievers
The aim of the medication are to to alleviate symptoms immediately.
1. Short-acting beta-2 agonists
a. Some researchers indicated that although Inhaled beta-adrenergic agonist bronchodilators are integral components of effective asthma treatment, but long-term use of both long-acting and short-acting inhaled beta-agonists may cause a loss of asthma control in some patients(78). But other found evidence against concerns over regular use of inhaled short-acting beta-2 agonists(79).
b. Side effects are not limit to headache and dizziness. Nausea, Vmiting, Diarhea, Anixety, Nervousness or tremor
2. Anticholinergics
In the study of data from 32 randomised controlled trials (n = 3611 subjects) showed significant reductions in hospital admissions in both children (RR = 0.73; 95% CI 0.63 to 0.85, p = 0.0001) and adults (RR = 0.68; 95% CI 0.53 to 0.86, p = 0.002) treated with inhaled anticholinergic agents,  combined treatment also produced a significant increase in spirometric parameters 60-120 minutes after the last treatment in both children (SMD = -0.54; 95% CI -0.28 to -0.81, p = 0.0001) and adults (SMD = -0.36; 95% CI -0.23 to -0.49, p = 0.00001), conducted by Departamento de Emergencia, Hospital Central de las FF.AA,  suggested that the addition of multiple doses of inhaled ipratropium bromide to beta(2) agonists is indicated as the standard treatment in children, adolescents, and adults with moderate to severe exacerbations of asthma in the emergency setting(80).

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