CME : Your SA Journal of CPD - Volume 26, Issue 4, 2008
Volume 26, Issue 4, 2008
Source: CME : Your SA Journal of CPD 26 (2008)More Less
This issue of CME is particularly interesting to me. I am asthmatic. I was recognised as an asthmatic as a child, but appeared to grow out of it, until, in my late 20s, the condition once more reared its head. I am now exceptionally well controlled on a combination of high-dose inhaled steroids and a long-acting beta-2 stimulant - and run half marathons with no limitations in my breathing (other than that caused by lack of fitness of course!).
Source: CME : Your SA Journal of CPD 26, pp 180 –182 (2008)More Less
- Anti-inflammatory therapy is the cornerstone of therapy in asthma.
- Corticosteroids are the most effective anti-inflammatory agents.
- Corticosteroids are available in different potencies - more severe disease is best managed with a more potent steroid.
- Clinical therapeutic endpoints (the goals of asthma management) are a useful surrogate of control of airway inflammation and narrowing.
- Inhaled corticosteroids plus long-acting β-antagonist are the most effective agents for uncontrolled asthma.
- Most MDIs contain CFCs - these are being phased out and replaced with HFA/dry-powder devices.
- MDIs are the best way to deliver therapy as small, effective doses can be delivered to the appropriate site, making them cost-effective and limiting systemic side-effects.
- Patient education and reinforcement is crucial - the better patients utilise their MDIs the better the clinical effect.
Author Charles FeldmanSource: CME : Your SA Journal of CPD 26, pp 184 –186 (2008)More Less
- Asthma is an inflammatory condition of the airway.
- The inflammation is responsible for the manifestations of asthma, namely the symptoms, the airflow limitation and the airway hyperresponsiveness.
- The majority of asthmatics are treated with a controller medication of which the inhaled corticosteroids (ICS) are the mainstay of therapy.
- In patients not controlled on ICS alone, it is recommended that an additional controller medication is added, rather than simply increasing the ICS dose, and the long-acting beta-agonists are the preferred option.
- Leukotriene receptor antagonists (LTRAs) are suitable options that are given orally
- LTRAs appear to be particularly useful for the treatment of asthma in children, for asthmatic patients with allergic rhinitis, for the treatment of exercise-induced asthma and for aspirin-induced asthma.
- Sustained release theophylline is an alternative additional controller therapy, which although very cheap, is associated with low efficacy and a high frequency of side-effects.
- Chromones have limited value in the long-term management of asthma.
- Anti-immunoglobulin E therapy is the most recently introduced therapy which is recommended for use as a second-line agent in patients with moderate to severe allergic asthma not controlled on standard recommended therapy.
- For reliever therapy, the primary bronchodilators are the short-acting beta-agonists (SABA), although anticholinergic agents may be suitable for older adults, for those intolerant of SABA, and for patients with nocturnal or intrinsic asthma.
Author Bob MashSource: CME : Your SA Journal of CPD 26, pp 188 –191 (2008)More Less
Source: CME : Your SA Journal of CPD 26, pp 192 –194 (2008)More Less
- In a young child, not all wheezing is asthma.
- Children under the age of 5 need a different approach to the diagnosis and management of asthma to that in adults and older children.
- Transient (limited to a few months or years) wheezing in infancy is more likely to be a function of small airways, and wheezing in the first year of life does not persist as asthma in two-thirds of those afflicted.
- The differential diagnosis of wheezing in a young child includes: gastro-oesophageal reflux, cystic fibrosis, aspiration, immune deficiency, TB, bronchopulmonary dysplasia.
- A clue to the origin of wheeziness in children in South Africa may be failure to thrive or poor weight gain.
- Other history and examination clues are found in the markers of specific diseases, such as stigmata of AIDS, tuberculosis, congenital cardiac disease, cystic fibrosis and gastro-oesophageal reflux.
- It is as important to treat inflammation in the persistent chronic young asthmatic as it is in the older child and adult; however, some special situations exist.
- Viruses play an integral role in early childhood asthma and there is marked interplay between allergy / atopy and viral infections.
- There is mounting evidence from 3 studies that treating asthma in young children with leukotriene receptor antagonists at the time of a viral-induced asthma exacerbation is useful.
- The decision on how to treat a child depends on his / her current level of control, current impairment and individual risk factors.
Author J. O'BrienSource: CME : Your SA Journal of CPD 26, pp 196 –199 (2008)More Less
- Some asthmatics will have persistent symptoms despite apparently adequate treatment.
- Review possible factors, such as treatment adherence, that lead to poor control before labelling a patient as having resistant asthma.
- Poor adherence to treatment and poor inhaler technique are probably the most common reasons why suboptimal control is achieved.
- Chronic sinusitis and upper airways allergy as well as gastro-oesophageal reflux are also associated with poor asthma control.
- Always refer to a specialist when a patient has resistant asthma in order to rule out alternative diagnoses.
- Some patients have persistently low lung function and significant baseline breathlessness which deteriorates at times of exacerbations.
- Other patients may have well-preserved lung function but unstable airways and can deteriorate acutely and severely. They are called brittle asthmatics.
- All patients with difficult asthma require high-dose inhaled corticosteroids and many severe asthmatics will need oral steroids periodically.
Author M.L. WongSource: CME : Your SA Journal of CPD 26 (2008)More Less
Source: CME : Your SA Journal of CPD 26, pp 206 –210 (2008)More Less
Asthma is one of the commonest chronic diseases in the world, with an estimated 300 million asthmatics worldwide. In 2004 South Africa was estimated to have a prevalence of clinical asthma of 8.2%, and although ranked 25th in the world in terms of prevalence, South Africa was ranked 5th for asthma case fatality rates, with an estimated case fatality rate of 18.5 per 100 000.
Author Chris BatemanSource: CME : Your SA Journal of CPD 26, pp 215 –216 (2008)More Less
Kids who live in neighbourhoods with heavy traffic pollution have lower IQs and score worse on other tests of intelligence and memory than children who breathe cleaner air, a new study shows. This raises fresh concern about the smog that often hovers over South African townships.