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Pulmonary diseases in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Leah Lande, Abraham Sanders, Dana Zappetti
Airway inflammation is treated with inhaled corticosteroids and bronchial hyper-responsiveness is treated with short- or long-acting bronchodilators. In addition, leukotriene receptor antagonists, theophylline, and cromolyn appear to be safe during pregnancy and may be considered in select patients (21). Most data on the safety of asthma medications in pregnancy are observational, with the most extensively studied being albuterol and inhaled budesonide (21–23). Albuterol appears to be safe based on a review of six published studies including 1599 women and a prospective study including 1828 women, in whom no significant relationship was found between the use of inhaled beta-2 agonists and adverse pregnancy outcomes (21,24). The National Asthma Education and Prevention Program Working Group reviewed 10 studies, including 6113 patients who were treated with inhaled corticosteroids during pregnancy and found no increases in congenital malformations or adverse perinatal outcomes in these patients (24).
The Long-Term Effects of Beta Receptor Agonist Therapy in Relation to Morbidity and Mortality
Published in Richard Beasley, Neil E. Pearce, The Role of Beta Receptor Agonist Therapy in Asthma Mortality, 2020
Colin S. Wong, Anne E. Tattersfield
Beta2 agonists provide rapid symptomatic relief from symptoms of asthma and effective prophylaxis against bronchoconstrictor stimuli, such as cold air and exercise. Regular use of a beta2 agonist may therefore cause the patient to become noncompliant with other medications for asthma. Overreliance on a beta agonist can cause delay in seeking medical attention and may have contributed to some asthma deaths.11,12 It cannot easily explain the gradual increase in mortality seen in several countries over the last two decades as the use of prophylactic treatment has increased progressively over this time. It also fails to explain why New Zealand alone should have had a more recent epidemic. Finally, it clearly does not explain the deterioration in asthma control or increase in reactivity seen with beta agonists in controlled studies.
Asthma
Published in James M. Rippe, Lifestyle Medicine, 2019
David E. Ciccolella, Gilbert E. D’Alonzo
In order to achieve immediate relief of bronchoconstriction and the discomforting symptoms associated with asthma, quick-relief medications, such as fast-acting/short-acting beta-2 agonists and anticholinergics are employed. Short-acting beta-2 agonists relax airway smooth muscle within minutes and improve airflow. These agents are the drugs of choice for treating acute asthma symptoms and exacerbations.2 They are also used for preventing exercise-induced bronchospasm.2 Inhaled anticholinergic therapy, such as ipratropium bromide, can also be used as a bronchodilator in this setting, but a beta agonist should be used first. Ipratropium bromide may provide some additional benefit during a moderate-to-severe asthma exacerbation and it may also be considered as an alternative for those who absolutely cannot tolerate beta agonists.2
Is mild asthma truly mild? The patients’ real-life setting
Published in Expert Review of Respiratory Medicine, 2022
Gabriella Guarnieri, Veronica Batani, Gianenrico Senna, Annarita Dama, Andrea Vianello, Marco Caminati
Within our study population, 50% of the subjects reported to use bronchodilators alone in the case of asthma exacerbation onset. SABAs do represent the cornerstone of asthma patients’ self-management, which is driven by symptoms occurrence and based on drugs providing immediate relief [4,6,7]. Of note, the relevance and opportunity of beta-2 short agonists has been re-discussed even in the context of an acute bronchospasm [9]. In fact, SABAs alone do not address the inflammation spike underlying the clinical manifestations of an asthma attack, thus not definitely solve the acute bronchoconstriction [7,16,17]. The poor impact of SABAs alone on airways inflammation is also supported by data on pH levels in exhaled breath condensate (EBC), which can be considered a biomarker of bronchial flogosis in asthma patients [18]. In fact, differently from inhaled steroid treatments, Beta-2 agonists do not resolve airway acidification, not preventing subsequent asthma attacks. The risk of poor asthma control and bad outcomes in asthma patients overusing SABAs has been reported by several studies [7,16–18].
Pharmacotherapy considerations for morning symptoms in chronic obstructive pulmonary disease
Published in Expert Opinion on Pharmacotherapy, 2022
Morning symptoms significantly impact quality of life and ability to perform daily activities. In a quantitative internet interview with 803 COPD patients from Europe and the United States (US), 37% of the cohort and 46% of those with severe COPD reported that morning was the worst time of the day for symptoms [1]. A majority of those with severe disease were awoken by their symptoms at least 3 days a week [1]. In a cross-sectional study involving 1239 COPD participants in the US, the most commonly reported symptoms were cough (74.5%), shortness of breath (73.9%), and mucus production (69.6%) [2]. Approximately 60% of respondents reported a limitation in their morning activities due to these symptoms [2]. This was also reflected in frequent rescue medication use during this time of the day, with 43% of those with morning symptoms requiring medications on average 5.1 ± 2.4 mornings during the prior week [2]. It should be noted that morning symptoms such as dyspnea are not specific and may reflect pathology and/or disease activity in other organs such as the cardiovascular system (e.g. congestive heart failure, CHF). For example, one study suggested a prevalence of previously undiagnosed CHF of 21% in patients with COPD or asthma [3]. The distinction in diagnosis has important therapeutic implications as short-acting beta-2 agonists can potentially exacerbate cardiac function [3]. Moreover, patients with CHF should be treated with cardiac medications such as diuretics for symptom relief.
Disease burden and treatment adherence among children and adolescent patients with asthma
Published in Journal of Asthma, 2022
Carlyne M. Averell, François Laliberté, Guillaume Germain, David J. Slade, Mei S. Duh, Joseph Spahn
The asthma cohort included 186,868 patients (112,689 children [aged 5–11 years] and 74,179 adolescents [aged 12–17 years]). Baseline characteristics are shown in Table 1 (additional information, Table 1, supplementary material). The mean age was 10.5 years and 40.4% of patients were female (children: 7.9 years and 37.8% were female; adolescents: 14.3 years and 44.3% were female). At baseline, 25.7% of patients used ICS (29.6% children; 19.7% adolescents), 8.8% used ICS/LABA (children: 6.4%; adolescents: 12.4%), 24.0% used OCS (defined as at least one dispensing of OCS during the baseline period; children: 26.6%; adolescents: 19.9%), 19.6% used leukotriene receptor antagonists (LTRA; children: 20.0%; adolescents: 19.0%), and 44.2% used short-acting beta2 agonists (SABA; children: 44.1%; adolescents: 44.4%).