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Asthma - Coggle Diagram
Asthma
Clinical Presentation
Cough
wheezing
SOB
Chest Pain or tightness
Categories of Severity
Mild Persistent
low-dose inhaled glucocorticoid
Fluticasone
with SABA as needed
albuterol
levalbuterol
Budesonide
Mometasone
Beclomethasone
Ciclesonide
Moderate Persistent
combination low-dose inhaled glucocorticoid and LABA
budesonide-formoterol
Intermittent
Treat with SABA
Albuterol
Levalbuterol
Severe Persistent
medium doses of an inhaled glucocorticoid in combination with a LABA
budesonide-formoterol
Additional therapy with a leukotriene modifier, tiotropium, or biologic agent may be needed,
Montelukast
triple combination inhaler containing an inhaled glucocorticoid, LABA, and LAMA can also be used
fluticasone furoate, vilanterol, and umeclidinium
Treatments
Budesonide/Formoterol
MOA
Formoterol: Relaxes bronchial smooth muscle by beta2 receptor action -
long-acting effect.
Budesonide:Corticosteroid. Prevents/control inflammation
Drug interactions
CYP3A4 inhibitors, corticosteroids, sympathomimetics, beta-2 agonists, beta-blockers, caffeine, QT-prolonging agents, loop diuretics, TCAs
Adverse reactions
Headache
Nasopharyngitis
PK/PD
budesonide
high protein binding, CYP3A4 metabolism, high first-pass effect, renal excretion
formoterol
absorbs rapidly into plasma, hepatic metabolism via glucuronidation, renal excretion
Indication
Asthma (controller/maintenance)
Albuterol
Adverse reactions
Tremor
Asthma Exarcebation
Bronchospasm
Nervousness
PK/PD
onset and duration of action depends on formulation (similar for nebulization and inhalation, longer for oral); hepatic metabolism; renal excretion
MOA
relaxes bronchial smooth muscle cells by acting as an agonist on beta-2 receptors with little effect on heart rate
Drug interactions
beta-blockers, sympathomimetics, QT-prolonging agents, other beta-2 agonists, TCAs
Indication
reliever therapy (as-needed) for maintenance
Montelukast
leukotriene receptor antagonist: decreasing inflammation and signs and symptoms of asthma and allergic rhinitis
BBW: neuropsychiatric events/suicidal ideation
adverse reactions: headache/dizziness, rash/dermatitis/eczema
Metabolism: CYP3A4, 2C8, 2C9
highly protein bound and adjustments required in hepatic impairment
drug interactions: gemfibrozil, loxapine, lumacaftor
indication: allergic rhinitis, asthma maintenance therapy, exercise induced bronchoconstriction prevention
Diagnostics
Check breathing rate
Signs
Wheezing
coughing
chest tightness
Spirometry
Pathophysiology
Airflow Obstruction
Contraction of airway smooth muscle, thickening of airway wall, and plugging of airway with mucus.
Airway Inflammation
Mast cell activation mediated by cytokines and other mediators is a key part of clinical presentation of asthma