Asthma 1. Signs and Symptoms a. Defnition i. Chronic inflammatory disease of the airways b. Symptoms i. Wheezing (breathing out) ii.

Breathlessness iii. Chest tightness iv. Cough (in night and early morning) v. Airway obstruction c. Types i. Childhood asthma 1. Atopy (eczematous skin lesions, allergen sensitivity, allergic shiners) ii. Adult Asthma 1. No atopy 2. Caused by exposure to environmental factors that cause airway inflammation 3. Can lead to bronchoconstruction 2. Drug Types a. Short acting B2 Agonists i. Info 1. 15 minutes to work 2. Last 4-6 hours 3. Given as metered dose inhaler 4. Used as a rescue inhaler 5. NOT ANTI-INFLAMMATORY ii. Drugs 1. Albuterol (ProAir, Ventolin, Proventil) 2. Levalbuterol (Xopenex) iii. Effects 1. Sympathetic Stimulation a. Bronchodialation important 2. Side effects a. Insomnia, hyperactivity, tremors and arrhythmias b. Anticholinergic i. Info 1. Less effective than B2 Agonists 2. Used when patients cant tolerate B2 agonists 3. used as a rescue inhaler

4. NOT ANTI-INFLAMMATORY ii. Drugs 1. Ipratopium (Atrovent) 2. Tiotropium (Spiriva) 3. Albuterol/Ipratropium (combivent) iii. Effects 1. Parasympethtetic Block a. Bronchodialation b. ecrease Mucous secretion 2. Side Effects a. Constipation, Dry mouth, Mydriasis (Pupil dialation), confusion, blurred vision and urine retention. c. Inhaled corticosteroids i. Info 1. Used for long term use to control the onset of asthma symptoms 2. Anti-inflammatory 3. Not a rescue inhaler ii. Drugs 1. Budesonide (Pumicort respules) a. Not Inhaler 2. Beclomethasone (Qvar) 3. Fluticasone (Flovent HFA) iii. Effects 1. Anti-inflammatory 2. Inhibit release of leukotriene 3. Reduce mucosal edema 4. Side effects a. Oropharyngeal Candidiasis (rinse mouth) d. Cromolyn and Nedocromil i. Info 1. Not as effective as inhaled corticosteroids 2. May take as long as 4-6 weeks to determine efficacy 3. Not effective in treating acute asthma ii. Drugs 1. Cromolyn 2. Nedocromil iii. Effects 1. Decrease release of leukotriene and histamine from mast cells 2. Prevents bronchoconstriction due to allergen 3. Side effects

a. Not really any side effects because it is not absorbed to any great extent in the blood. e. Anti-leukotriene i. Info 1. Used to treat chronic allergic rhinitis ii. Drugs 1. Montelukast (singulair) iii. Effects 1. Side effects a. Headache 2. Bronchoconstriction 3. Increase endothelial permeability 4. Promote mucous secretion 5. Attract eosinophils and neutrophils f. Long-acting B2 Agonists i. Info 1. Not for rescue 2. Beneficial when used chronically with inhaled corticosteroids ii. Drugs 1. Salmaterol (Serevent) 2. Formoterol (Foradil) 3. Fluticasone/Salmeterol (Advair) 4. Budesonide/Formoterol (Symbicort) iii. Effects 1. Salmaterol is associated with asthma related death 2. Can Build tolerance to B2 and need to take more 3. Types of asthma and treatment a. Mild-intermittent i. Short acting B2 Agonist ii. Anti-Cholinergic b. Mild-persistent i. Inhaled corticosteroid ii. Cromolyn and nedocromil iii. Leukotriene Blockers c. Moderate-persistent i. Long Acting B2 agonist 1. Combination inhaled corticosteroid and Long acting B2 agonist d. Severe-persistent i. High Dose corticosteroid and Long-acting B2 agonist ii. Oral Corticosteroids (dont work well and lots of side effects)

COPD 1. Signs and Symptoms a. Definition i. Condition characterized by limitations of airflow that is not fully reversible ii. Progressive with bronchial inflammation iii. Emphysema and Chronic Bronchitis b. Emphysema i. Weakened and collapsed air sacs with excess of mucus ii. Not reversible iii. Alveoli inflammation iv. No cough v. Thin and barrel chest vi. No hypoxia (Pink puffer) c. Chronic Bronchitis i. Mucous and inflammation in bronchioles ii. Productive cough iii. Obese patients iv. Hypoxia (blue bloater) 2. Drug types a. Anticholinergic and short acting B2 agonist i. Types 1. Albuterol/ Ipratopium (Combivent) b. Inhale corticosteroids i. Info 1. Used as a last resort 2. Doesnt really work ii. Types 1. Beclomethasone (Qvar) 2. Fluticasone (Flovent HFA) 3. Budesinide (Pulmicort Respules)

Chronic Allergic Rhinitis 1. Signs and symptoms a. Definition i. Inflammation of the mucous membranes of the nose b. Symptoms i. Sneezing, watery rhinorrhea and congestion c. Causes i. Allergens 1. Sensitized mast cells degranulate and release histamine ii. Histamine 1. Histamine can react locally or widespread 2. Produces pruritis, vasodialtaion, bronchoconstriction and increase in vascular permeability 2. Drug types a. Anti-histamines i. Info 1. Sedating 2. Non-sedating ii. Drugs 1. Sedating a. Diphenhydramine (Benadryl) b. Hydroxyzine (Atarax) c. Cetrizine (Zyrtec) d. Chlorpheniramine (ChlorTimeton) 2. Non-sedating Antihistamines a. Loratadine (Claritin) b. Desloratadine (Clarinex) c. Fexofenadine (allegra) b. Oral Decongestants i. Drugs 1. Pseudoephedrine (Sudafed) 2. Phenylephrine (Sudafed PE) ii. Effects 1. Vasoconstriction c. Topical Decongestant i. Info 1. Do not use topical decongestant for more than 3 days in a row ii. Drugs 1. Oxymetazoline (Afrin) 2. Phenylephrine (Neo-synephrine)

3. Naphazoline (Naphcon) iii. Effects 1. Addiction 2. Rebound congestion (cant breathe without medicine) d. Intranasal Corticosteroid i. Info 1. May take up to two weeks to work 2. No rebound congestion 3. Low side effects ii. Drugs 1. Budesonide (Rhinocort Aqua) 2. Fluticasone (Flonase) 3. Mometasone (Nasonex)