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Time on anti-inflammatory treatment

Figure 2 The beneficial effects of anti-inflammatory therapy on frequency, duration and severity of exacerbations in asthma.

Time on anti-inflammatory treatment

Figure 2 The beneficial effects of anti-inflammatory therapy on frequency, duration and severity of exacerbations in asthma.

twice a month, and a resting peak expiratory flow rate (PEFR) of >80% of predicted with less than 20% diurnal variability. Moderate asthma is defined as exacerbations more than twice a week, resulting in urgent care treatment less than three times a year, with periods of minimal symptoms between exacerbations; exercise tolerance in these patients is slightly diminished, nocturnal symptoms may be present 2-3 times a week, and resting PEFR may be 60-80% of predicted with diurnal variability of 20-30%. Severe asthma is characterized by daily symptoms with frequent exacerbations and frequent utilization of urgent care facilities or a history of respiratory failure. Patients with severe asthma have poor exercise tolerance, frequent nocturnal symptoms, resting PEFR <60% of predicted with diurnal variability >30%. Risk factors for fatal asthma include hospital admission for severe asthma within the preceding year, a history of respiratory failure with hypercarbia due to asthma, and a history of barotrauma. Pharmacologic therapy should be targeted to clinical stage, as summarized in Table 1. A synthesis of available studies suggests that immunotherapy for inhalant allergens reduces BHR, frequency and/or severity of exacerbations, and medication usage in all three clinical stages of chronic asthma. Leukotriene antagonists may be useful for all stages of asthma, and particularly effective for aspirin sensitive asthmatics. Agents considered investigational at this time for the treatment of severe asthma include methotrexate, gold, macrolides and cyclosporine.

The treatment of acute asthma should focus on intensification of pharmacologic therapies and maintenance of respiratory function with the use of ventilatory support and neuromuscular paralysis as necessary. Therapeutic BAL may be useful in selected patients. Mucolytic agents and iodides are contra-indicated.

Coping with Asthma

Coping with Asthma

If you suffer with asthma, you will no doubt be familiar with the uncomfortable sensations as your bronchial tubes begin to narrow and your muscles around them start to tighten. A sticky mucus known as phlegm begins to produce and increase within your bronchial tubes and you begin to wheeze, cough and struggle to breathe.

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