management and treatment of asthma. colombia
TRANSCRIPT
![Page 1: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/1.jpg)
Maria Bea Merscher – Interna en Medicina Interna – Estudiante de Intercambio
GINA – Management and Treatment of Asthma
![Page 2: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/2.jpg)
Publish guidelines
What is GINA?
![Page 3: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/3.jpg)
How does GINA define asthma?
“Asthma is a chronic inflammatory disorder of the airways in which many cells
and cellular elements play a role. The chronic inflammation is associated with
airway hyperresponsiveness that leads to recurrent episodes of wheezing,
breathlessness, chest tightness and coughing particularly at night or in the
early morning. These episodes are usually associated with widespread, but
variable airflow obstruction within the lung that is often reversible either
spontaneously or with treatment.”
![Page 4: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/4.jpg)
What is the aim of GINA?
Guided self-management (1A)
![Page 5: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/5.jpg)
What is the aim of GINA?
Improve
the
Improve
the
patient’s
patient’s
compliance!
!
compliance!
!
Don’t forge
t the
Don’t forge
t the
education of o
thers!
education of o
thers!
![Page 6: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/6.jpg)
Levels of Control Characteristics
Controlled (all of the following)
Partially controlled Not controlled
Daily symptoms No (≤ 2x per week) >2 per week
≥3 characteristics of partially controlled asthma in any week
Limitation of activities
No Any
Nighttime symptoms / patient
is woken by symptoms
No Any
Use of short-acting β2-agonists for
symptom control
No (≤ 2x per week) >2 per week
Pulmonary function (FEV1 or peak flow)
>80% predicted/personal
best
<80% predicted/personal
best
Exacerbations No ≥1 1x per week
Impairment
Risk
![Page 7: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/7.jpg)
Severity
Severity Frequency of
symptomsNighttime symptoms
FEV1Variety of
FEV1
Usage of short-acting β2-agonists
Intermittent ≤ 2x per week≤ 2x per month
≥ 80% < 20%≤ 2 days per
week
Mild persistent
> 2x per week but not daily
3-4 x per month
≥ 80% 20-30%> 2 days per
week but not daily
Moderate persistent
Daily > 1x per week
but not at nighttime
60-80% > 30% Daily
Severe persistent
Throughout the day
Frequent (~7x per week)
< 60% > 30%Several times
a day
![Page 8: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/8.jpg)
Controllers vs Relievers
![Page 9: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/9.jpg)
Management Based on Control
![Page 10: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/10.jpg)
Management Based on Control
![Page 11: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/11.jpg)
Routes of Administration
![Page 12: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/12.jpg)
Inhaled Glucocorticosteroids
![Page 13: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/13.jpg)
Equipotency of Inhaled Glucocorticosteroids
![Page 14: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/14.jpg)
Side effects: Inhaled Glucocorticosteroids
![Page 15: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/15.jpg)
Leukotriene Modifiers
![Page 16: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/16.jpg)
Side effects: Leukotriene Modifiers
![Page 17: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/17.jpg)
Long-acting inhaled β2-agonists
![Page 18: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/18.jpg)
Long-acting inhaled β2-agonists
![Page 19: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/19.jpg)
Theophylline
![Page 20: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/20.jpg)
Theophylline
![Page 21: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/21.jpg)
Theophylline• Xanthin derivative• Competitive nonselective phosphodiesterase inhibitor raises
intracellular cAMP activates PKA inhibits TNF-alpha and inhibits leukotriene synthesis reduces inflammation and innate immunity
• Nonselective adenosine receptor antagonist, antagonizing A1, A2, A3 receptors almost equally explains cardiac side effects
• Inhibits TGF (transforming growth factor)-beta-mediated conversion of pulmonary fibroblasts into myofibroblasts in COPD and asthma via cAMP-PKA pathway which codes for collagen
• Directly activates HDAC2 (histone deacetylase) repackaging of DNA promoter regions of inflammatory genes are unavailable for binding of transcription factors such as NF-kappa-B
• Smoking inhibits the HDAC2-activity theophylline should be considered in smoking asthmatics
![Page 22: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/22.jpg)
Systemic glucocorticosteroids
![Page 23: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/23.jpg)
Systemic glucocorticosteroids
Patients with long-term systemic glucocorticosteroids should receive osteoporosis-profilaxis!
![Page 24: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/24.jpg)
Systemic glucocorticosteroids and osteoporosis
![Page 25: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/25.jpg)
Anti-IgE
![Page 26: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/26.jpg)
Anti-IgE
![Page 27: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/27.jpg)
Severity of Asthma Exacerbations
![Page 28: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/28.jpg)
Rapid-acting inhaled β2-agonists
![Page 29: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/29.jpg)
Rapid-acting inhaled β2-agonists
![Page 30: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/30.jpg)
Systemic glucocorticosteroids
![Page 31: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/31.jpg)
Systemic glucocorticosteroids
![Page 32: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/32.jpg)
Anticholinergics
![Page 33: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/33.jpg)
Anticholinergics
![Page 34: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/34.jpg)
Theophylline
![Page 35: MANAGEMENT AND TREATMENT OF ASTHMA. COLOMBIA](https://reader033.vdocument.in/reader033/viewer/2022060200/5598cda31a28ab99338b4612/html5/thumbnails/35.jpg)
Short-acting oral β2-agonists