User talk:Ahmedkho

Using of analgesics with bronchial asthma patients
Using of analgesics with bronchial asthma patients

Prepared by: Ahmed Khottary oraby, 2nd year pharmacy student

Bronchial asthma is a disease caused by increased responsiveness of the tracheobronchial tree to various stimuli. The result is paroxysmal constriction of the bronchial airways. Bronchial asthma is the more correct name for the common form of asthma. The term 'bronchial' is used to differentiate it from 'cardiac' asthma, which is a separate condition that is caused by heart failure. Although the two types of asthma have similar symptoms, including wheezing (a whistling sound in the chest) and shortness of breath, they have quite different causes.

The symptoms of asthma include labored breathing, constriction of the chest, coughing and gasping usually brought on by allergies.

Some members of NSAIDs group are used as analgesic for bronchial asthma patients such as "acetaminophen"(Paracetamol) but in low dose (<1000 mg).

NSAIDs have produced a wide range of hypersensitivity reactions in susceptible individuals; the most common include skin rashes, urticaria, rhinitis, angioedema, bronchoconstriction, and anaphylactic shock. Hypersensitivity to NSAIDs appears to occur more frequently in patients with asthma or allergic disorders but other risk factors have been identified. The occurrence of aspirin sensitivity in patients with asthma and nasal polyps has been referred to as the 'aspirin triad'. There is considerable cross-reactivity between aspirin and other NSAIDs and it is generally recommended that patients who have had a hypersensitivity reaction to aspirin or any other NSAID should avoid all NSAIDs. Some persons, especially those with asthma, chronic urticaria, or chronic rhinitis, exhibit notable hypersensitivity to aspirin), which may provoke reactions including urticaria and other skin eruptions, angioedema, rhinitis, and severe, even fatal, paroxysmal bronchospasm and dyspnoea. Persons sensitive to aspirin often exhibit cross-sensitivity to other NSAIDs.    The main clinical features of patients who have aspirin hypersensitivity include middle-age, female sex, diagnoses of asthma or rhinitis, a personal or family history of atopy, and a history of nasal polyps, Aspirin sensitivity occurring with asthma and nasal polyps has been referred to in some reports as the 'aspirin triad'. Other sensitivities often found concomitantly include allergy to food dyes such as tartrazine and to drugs such as other NSAIDs.   The prevalence of aspirin-induced asthma can vary according to the method used to measure it, A systematic review calculated the prevalence of aspirin-induced asthma to be 21% in the general adult asthma population and 5% in children when determined by oral provocation testing. However, when based on medical history alone it was only 2.7% in adults and 2% in children. In another study using data from patient questionnaires the prevalence of aspirin-induced asthma was 10 to 11% in patients with asthma and 2.5% in non-asthmatics. There is considerable cross-reactivity between aspirin and other NSAIDs and it is generally recommended that patients who have had a hypersensitivity reaction to aspirin or any other NSAID should avoid all NSAIDs. In a systematic review cross-sensitivity to other NSAIDs (ibuprofen, diclofenac, and naproxen) occurred in over 90% of those patients with aspirin-induced asthma. Paracetamol is usually safe in patients sensitive to aspirin and cross-sensitivity to paracetamol has been calculated as about 7%. Based on these figures, it is considered that less than 2% of asthmatic patients would be likely to react to both paracetamol and aspirin. Paracetamol and NSAIDs are the first choice analgesics for treating mild to moderate pain and are also used in moderate to severe pain to potentiate the effects of opioids. They are suitable for use in acute or chronic pain. Effective relief of acute pain can be achieved with oral NSAIDs, including selective inhibitors of cyclo-oxygenase-2 (COX-2) such as the coxibs, and with paracetamol (particularly in combination with an opioid—see below). Dependence and tolerance are not a problem with non-opioid analgesics but as the dose is increased, their efficacy reaches a ceiling. Aspirin and other non-selective NSAIDs inhibit blood platelet function, adversely affect the gastrointestinal tract, and can precipitate hypersensitivity reactions including asthma. The risk of severe upper gastrointestinal adverse effects may be less with the COX-2 inhibitors; however, their use has been limited by increasing evidence of serious cardiovascular effects. Paracetamol does not have the haematological or gastrointestinal adverse effects of aspirin but large doses can produce severe or sometimes fatal hepatotoxicity. Montelukast is only partially effective in inhibiting aspirin responses in aspirin-sensitive asthmatics Pretreatment with montelukast allowed only one patient to proceed through all challenge doses of ASA without any reactions. The remaining nine patients enjoyed only partial protection from respiratory reactions. Montelukast pretreatment was generally not effective in altering upper airway reactions and only partly effective in altering lower airway reactions. Aspirin and the older nonsteroidal anti-inflammatory drugs (NSAIDs) that block cyclo-oxygenase-1 (COX-1) induce asthma attacks in patients with aspirin-exacerbated respiratory disease and urticaria in patients with chronic idiopathic urticaria. Weak inhibitors of COX-1, such as acetaminophen and salsalate, crossreact also but only with high doses of the drugs. Partial inhibitors of both COX-1 and COX-2, such as nimesulide and meloxicam, also cross-react but only at high drug doses. COX-2 inhibitors do not cross-react; however, all NSAIDs, including the selective COX-2 inhibitors, can sensitize patients and induce urticaria or anaphylaxis on next exposure to the drug. This information is provided on the pathogenesis of aspirin hypersensitivity, cross-sensitivity, and cross-tolerance of different NSAIDs in patients with respiratory types of reactions. Hypersensitivity to aspirin may affect 5-20% of patients with chronic asthma and an unknown fraction of patients with chronic urticaria-angioedema. These patients develop cross-reactions to other, chemically non-related, NSAIDs with strong inhibitory activity towards cyclo-oxygenase (COX)-1 (e.g. indomethacin, naproxen, ketoprofen). Avoidance of aspirin and all cross-reacting NSAIDs as well as education of patients are crucial. As an alternative antipyretic or analgesic drug, aspirin-sensitive asthmatic patients may take acetaminophen (paracetamol) in low or moderate doses (<1000mg). Preferential COX-2 inhibitors (nimesulide, meloxicam) are tolerated by the majority but not all hypersensitive patients. Selective COX-2 inhibitors (celecoxib and rofecoxib [withdrawn from the market]) are well tolerated by almost all aspirin-sensitive asthmatic patients. In patients with coronary artery disease requiring treatment with aspirin, desensitization to aspirin may be an alternative approach. Thus, for the majority of patients with asthma and hypersensitivity to aspirin or other NSAIDs, an alternative anti-inflammatory drug can be found. However, in each individual case physicians must consider the choice of an alternative NSAID carefully. Conclusion: 	With bronchial asthma patients we can use Montelukast & Zafirlukast (Their commercial name is Singular®) because they inhibit aspirin response in aspirin sensitive patients. 	Paracetamol may be taken in low or moderate doses (<1000mg) as analgesic, Because cross-sensitivity to paracetamol has been calculated as about 7% .So, on this figure, it is considered that less than 2% of asthmatic patients would be likely to react to both paracetamol and aspirin. 	Celecoxib ( Celebrex®) is tolerated by almost all aspirin-sensitive asthmatic patients.

Gene Therapy...The Future is coming
Gene therapy