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Dx Asthma Treatment: Read...


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SUMMARY: The consensus of standard therapy is (1) avoid the trigger, and (2) treatment when necessary with inhaled corticosteroids and beta-angonists, oral leukotrienes and in difficult situations, corticosterids.

A recent JAMA article concluded that giving supplmentary vitamin C to pregnancy women smokers reduced wheezing in offspring for the first year.

There is no consensus on the role of Subcutaneous(SCIT) and sublingual (SLIT) immunotherapy although "a growing body of evidence from double-blind, placebo-controlled studies shows that both SLIT and SCIT are effective in reducing symptom scores and medication use, improving quality of life, and inducing favorable changes in specific immunologic markers".

The Cochrane Database confirmed that "intravenous magnesium safely reduced hospital admissions and improves lung functions in adults with acute asthma who do not respond sufficiently to oxygen, nebulized short-acting beta-2 agonists and IV corticosteroids".

The use of ascorbic acid/(Vitamin C) is not currently indicated although Schrader's study of intravenous ascorbic acid and magnesium was impressive and correctly done. There may be potential uses of inhaled glutathione and inhaled DHEA-s. There may also be a role for over-the-counter oral DHEA.
Warning:
Inhaled glutathione: "Testing for sulfites in the urine is recommended prior to GSH inhalation. Minor side effects such as transient coughing and an unpleasant odor are common with this treatment. Major side effects such as bronchoconstriction have only occurred among asthma patients presumed to be sulfite-sensitive. The potential applications of inhaled GSH are numerous when one considers just how many pulmonary diseases and respiratory-related conditions are affected by deficient antioxidant status or an over production of oxidants, poor oxygenation and/or impaired host defenses."


Asthma

The Merck Manual Home Edition states:
"Asthma is a condition in which the airways narrow—usually reversibly—in response to certain stimuli. Coughing, wheezing, and shortness of breath that occur in response to specific triggers are the most common symptoms. Doctors confirm the diagnosis of asthma by doing pulmonary function tests. To prevent attacks, people should avoid substances that trigger asthma and should take drugs that help keep airways open. During an asthma attack, people need to take a drug that quickly opens the airways. Asthma affects more than 25 million people in the United States, and it is becoming more common. The reason for the increase in asthma is not known. Although it is one of the most common chronic diseases of childhood, adults can also develop asthma, even at an old age. Asthma affects more than 7 million children and occurs more frequently in boys before puberty and in girls after puberty. It also occurs more frequently in non-Hispanic blacks and Puerto Ricans. Although the number of people affected by asthma has increased, the number of deaths has decreased. The most important characteristic of asthma is narrowing of the airways that can be reversed. The airways of the lungs (the bronchi) are basically tubes with muscular walls. Cells lining the bronchi have microscopic structures, called receptors. There are many types of receptors, but two main types of receptors are important in asthma: beta-adrenergic and cholinergic."

Medications Used in Treatment:
1. Corticosteroids: prednisone, Medrol®, Flovent®HFA, etc.
2. Beta Agonists: Proair®HFA, Ventolin®HFA, albuterol, etc.
3. Leukotriene Receptor Antagonists: Singulair®, Accolate®
4. Beta Agonists/Corticosteroid combinations: Advair®Diskus, Symbicort®, Advair®HFA
5. Beta-2 Agonist/Corticosteroids: Dulera®
6. Methylxanthines: Theochron®, Theo®-24, theophylline, etc.
7. Mast Cell Stabilizer: Cromolyn®
8. 5-Lipoxygenase Inhibitors: Zyflo®CR, Zyflo®
9. Anti-IgEs: Xolair®
10. Intravenous infusions: Myer's cocktail (Ascorbic Acid, minerals and magnesium)

Anti-IgE Monoclonal Antibody:
Xolair(TM)is used in allergic asthma accompanied by moderately elevated IgE (30-1000iu/ml,depending on body weight) and sensitization to perennial aero-allergies to decrease affinity receptors on mast cells. Given by subcutaneous injection every 2-4 weeks, little improvement in pulmonary function is observed and measurement of serum IgE levels is not useful. The only measurement per see is asthma exacerbation and symptoms. Cost is $1300 per injection. Mepolizumab reduces exacerbation by almost 50% with little effect on lung function.Injection every 4 weeks. Reslizumab is given by injection every 4 weeks, has been shown to reduce exacerbations by 50% and improves FEV1 by 110mL. Again, elevated eosinophils at 400 Eos/uL are require for entry, but not validated as a biomarker. Both reduce IL-5. Reference: McCracken JL. JAMA 2017:318(3):280-90

National Association
*American Lung Association


*[Editor]  The newest information on treating the cause of asthma is the use of a series of intravenous infusions twice weekly of ascorbic acid, trace minerals and magnesium. An excellent double blind study by Schrader  found excellent results in two-thirds of the moderate to severe asthma patients studied with these 20-minute Myer's intravenous infusions. Results have been confirmatory.

Recent articles have found that asthmatic children consume more anti-oxidants: ascorbic acid, omega-3, zinc, vitamin E and C-enzyme Q10. There are some articles that suggest childhood asthma improves with supplements such as vitamin D3, DHEA-s nebulized and even with gingko biloba. Potential improvement may be offered by glutathione nebulized as well. These studies are not yet accepted as standard of therapy but the concept is interesting; delivering antioxidants directly into the bronchioles.

*[Editor]Recent article in JAMA confirmed that the addition of a LABA (long acting Beta Agonist) did not improve time to asthma exacerbation compared with adding tiotropium to black adults using ICS (inhaled corticosteroids).

*[Editor]  By normalizing bio-identical hormones of testosterone, DHEA and thyroid, others published physician have suggested "monitoring of the serum DHEA-S level is necessary for patients with asthma on inhaled steroid treatment, and at minimum, replacement therapy for patients with a low level of DHEA may be helpful for treating their asthma".

Copyrighted© 2014 Updated November 1, 2015