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Extrapulmonary – Treatable traits
Published in Vibeke Backer, Peter G. Gibson, Ian D. Pavord, The Asthmas, 2023
Vibeke Backer, Peter G. Gibson, Ian D. Pavord
Few randomised treatment studies have been performed due to several complicating factors. Many studies are performed with an open-label design, and a placebo may not be available. Potential interventions include physiotherapy, psychotherapy, speech therapy, surgery and pharmacological studies, among others, using inhaled ipratropium bromide.
Medicines management
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Kirsty Andrews, Martina O’Brien
Adverse side effects of nebulised medicines can include giddiness, tremor, palpitations, wheeziness and irritable coughing. These may be related to the drugs and then dosage may need adjustment. It is also important that the nebules are not too cold as this would cause bronchoconstriction. Mouth infections (e.g. candidiasis) may occur after prolonged use of steroid-inhaled drugs, so rinsing the mouth after use is beneficial in this case. If a nebulised steroid is being administered, delivery via a mask may cause irritation to the eyes and skin. Ipratropium bromide, a quite commonly prescribed bronchodilator, can also be irritating to the eyes when given via a mask, so washing the face afterwards may help.
Occupational Asthma
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Bill Brashier, Amruta Wankhede
Therapeutically, combination of anti-inflammatory and bronchodilator drugs are advocated (Bardana 2003). The two major categories of asthma medications are quick-relief and long term control medications. Quick-relief medications (a.k.a rescue medications) are used as needed for rapid, short-term symptom relief during an asthma attack. Short-acting beta agonists (albuterol, levalbuterol) act as smooth muscle bronchodilators within minutes to relieve symptoms. Ipratropium bromide is a long-acting M3 muscarinic receptor antagonist that is approved as a bronchodilator for acute COPD exacerbations. Long-term medications including inhaled corticosteroids (ICS), Long-Acting Beta-2-Agonists (LABA), leukotriene modifiers, combination ICS/LABA inhalers, Long-Acting Muscarinic Antagonists (LAMA) and biologics have all been approved for the treatment of asthma and should be used in a similar capacity in OA cases as appropriate. Oral and intravenous corticosteroids (prednisone, methylprednisolone) are reserved to treat more severe OA to aggressively relieve airway inflammation and as adjunctive therapy during an acute asthma exacerbation. Severe or poorly controlled cases of OA might require more frequent or prolonged use of oral corticosteroids to better control symptoms even after removal from the work place exposure (Greiwe and Bernstein 2019).
Respiratory management in the premature neonate
Published in Expert Review of Respiratory Medicine, 2023
Vikramaditya Dumpa, Indirapriya Avulakunta, Vineet Bhandari
Albuterol and Ipratropium are the most frequently prescribed bronchodilators in the NICU. Albuterol is primarily a short acting beta-2 adrenergic agonist with some minor effect on beta-1 adrenergic receptors. Its administration results in bronchial smooth muscle relaxation with some increased myocardial contraction. Ipratropium bromide is a muscarinic antagonist that produces bronchodilation. These drugs are usually prescribed to preterm infants with evolving or established BPD to prevent or treat bronchospasm. There is wide variation in the indication and timing, with two large US retrospective multicenter cohort studies reporting center-to-center variation of 0–59% and 0–81%, respectively, with the use of bronchodilators among the hospitals in the studies [150,151]. Despite small studies showing improved compliance and decreased resistance in preterm infants with chronic lung disease, RCTs did not show any reduction in meaningful long-term outcomes such as BPD with the use of bronchodilators [152–157]. In a post-hoc analysis of the Neonatal European Study of Inhaled Steroids (NEuroSIS) trial, early inhaled bronchodilators started within the first 48 hours of life did not reduce the risk of BPD or death in extremely preterm infants [158]. Based on the available evidence, routine use of inhaled bronchodilators to prevent or manage BPD is not recommended. Their use can be considered in preterm infants with BPD who have a strong component of reversible bronchospasm.
Intravenous methylprednisolone versus intravenous methylprednisolone combined with inhaled budesonide in acute severe pediatric asthma
Published in Journal of Asthma, 2021
Prabhavathi Gummalla, Diana Weaver, Youssef Ahmed, Vikas Shah, Michael Keenaghan, Sule Doymaz
There were no statistical differences in the duration of continuous albuterol nebulization treatment, or in the duration of PICU and hospital LOS between the two groups (Table 2). 58% of the patients enrolled in the trial were treated with noninvasive ventilation. One patient in each group needed invasive mechanical ventilation. The mean duration of respiratory support was higher in Group B, although not statistically significant (median (IQR); 6 (0–19) vs. 9.25 (0–28); p = 0.327). We also noted that the mean fraction of inspired oxygen was similar between the two groups. The use of ipratropium bromide nebulization, IV magnesium sulfate boluses, epinephrine, and parenteral terbutaline were not different between the two groups during the enrollment period. (Table 2). Pediatric asthma severity scores were comparable for the two groups throughout hospital stay. 24 h PASS scores showed a significant difference in favor of group B (median (IQR); 11(9–12) vs 9 (7–11); p = 0.02) (Figure 2). Number of readmissions at six months follow up after discharge was statistically similar between the two groups. (Table 2).
Pharmacotherapeutic strategies for critical asthma syndrome: a look at the state of the art
Published in Expert Opinion on Pharmacotherapy, 2020
Alessandro Vatrella, Angelantonio Maglio, Corrado Pelaia, Girolamo Pelaia, Carolina Vitale
Ipratropium is the short-acting muscarinic receptor antagonist (SAMA) mainly used in acute asthma. There is evidence to suggest that the addition of ipratropium in the initial treatment of severe acute asthma may provide an improvement in lung function and avoid prolonged first aid and hospitalization treatments [36]. Ipratropium is a nonselective antagonist of muscarinic receptors and its use is recommended in the current GINA guidelines for the treatment of moderate to severe acute asthma in addition to SABAs [1,33]. Ipratropium starts to act within 15–30 minutes, but the maximum bronchodilation can take up to 90 minutes and the duration of action is about 6 hours [37]. Latest GINA guidelines recommend addition of ipratropium bromide for both adults and children with moderate-severe exacerbations and a poor response to initial SABA [1]. In children, the dose of 2 puffs of 80 mcg (or 250 mcg by nebulizer) every 20 minutes for 1 hour only is recommended [1,38]. This benefit of combination therapy is greater for patients who have severe acute asthma and are at greater risk of hospitalization [39]. Currently, the use of SAMAs alone or in combination with SABAs is not approved for the treatment of acute asthma by FDA; nevertheless, the use of combined multiple dose of a SABA + SAMA is common in clinical practice and it has been defined the ‘first line’ therapy for acute exacerbation of asthma by some authors [40,41].