Performance Comparison of Microfluidic and Immunomagnetic Platforms for Pancreatic CTC Enrichment
November 15, 2025
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Background
Asthma is a long-term disease that affects the human body’s respiratory system. Asthma can be described as mild-intermittent, where one gets occasional wheezing, or moderate-severe, persistent, where one experiences sudden complete airway obstruction. Asthma in children is one of the prevalent medical conditions that lead to many hospitalizations and increased expenses. The main characteristic is airway inflammation, which increases their sensitivity to provocation stimuli. Asthma is among the diseases that can be fatal if not well managed.
Epidemiology
Asthma is prevalent in 15% to 20% of the population within developed countries and between 2 to 4% in developing countries. Children are commonly affected. Asthma is seen to be more common in older people because of reduced lung capacity and irritability to substances that cause inflammation of the airways.
Asthma is highly prevalent in children; approximately two-thirds of all people with Asthma are first diagnosed before the age of 18 years. The symptoms of asthmatic children clear out almost entirely when they reach early adulthood, by approximately 50%.
Anatomy
Pathophysiology
The inflammation of the airway usually manifests in many patients soon after exposure to an environmental precipitant and is often reversible. The pathogenic process can be initiated by inhaling an allergen or irritant which leads to airway inflammation and increase the formation of mucus due to hypersensitivity of the bronchi. There is a marked increase of the airway resistance, and this is extremely pronounced during expiration.
Blockage of the airway is reached by infiltration with inflammatory cells, hypersecretion with mucus plug, and constriction with smooth muscles. If asthma is not treated soon, it will worsen because the inhaled drug cannot reach the mucus due to mucus formation. This is an inflammation and therefore the swelling increases.
Etiology
The disease asthma is characterized by various comprehensive and several different phenotypes. Specifically, the tendency inherited from one’s parents and relatives concerning allergy is usually found in the form of hay fever, eczema, and other factors noted above about Asthma.
Though, the cause of Asthma involves genetic predisposition and exposure to environmental factors even if the overall cause of Asthma is complex and still unidentified, especially when it comes to the asthmatic children and their probability of having Asthma in their adulthood.
The following factors usually trigger Asthma:
Genetics
Prognostic Factors
Asthma became fatal as it claimed one person per 100000 of the population. Asthma leads to school or work absenteeism and multiple hospitalizations, thus, a high cost of medical care. Several reviews reveal that poor asthma control can result in the worsening of the functioning and decreased the quality of life.
Clinical History
Symptoms: Coughing, wheezing, breathlessness, and chest constriction.
Triggers: Dust, pollen, animal dander, colds, pollution, smog, smoke, strong smells, etc.
Diagnosis: This is usually evidenced by spirometry (lung function) and may be backed up by peak flow measurement or allergy skin tests.
Medications: For immediate management one will be prescribed bronchodilators such as albuterol while for maintenance of the condition the patient may be required to take other medications like inhaled corticosteroids.
Age group
Asthma is a common disease which can entail anyone regardless of his or her age, starting from infants and up to elderly people. It is a long-term illness that results to inflammation and constriction of the airways and common symptoms include wheezing, coughing, chest constriction and finding difficulty in breathing.
Physical Examination
Checking Oxygen Levels
Assessing Respiratory Rate
Measuring Peak Expiratory Flow (PEF)
Assessment of Allergic Symptoms
Assessment of Triggers
Age group
Associated comorbidity
Allergies
Obesity
Gastroesophageal Reflux Disease (GERD)
Sinusitis
Obstructive Sleep Apnea
Associated activity
Acuity of presentation
The intensity or the degree of Asthma is called the acuity of asthma presentation. Its severity ranges from the mildest cases where just simple shortness of breath or wheezing is exhibited to the most severe where one is unable to breathe properly, can hardly get rid of the wheezing despite having taken the necessary medication or even cases of life-threatening.
Differential Diagnoses
Chronic Obstructive Pulmonary Disease (COPD)
Allergic Rhinitis
Pulmonary Embolism
Heart Failure
Bronchiectasis
Vocal Cord Dysfunction
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Treatment Paradigm Â
Assessment and Diagnosis: Diagnosing Asthma through the patient’s history, physical examination and spirometry or other pulmonary function tests.
Environmental Control: Staying away from some of the known factors that may cause exposure to environmental allergies or even exposure to chemicals that cause irritation.
Regular Monitoring: Supervising activity of the lungs, as well as signs, to control the dosage of drugs.
by Stage
by Modality
Chemotherapy
Radiation Therapy
Surgical Interventions
Hormone Therapy
Immunotherapy
Hyperthermia
Photodynamic Therapy
Stem Cell Transplant
Targeted Therapy
Palliative Care
use-of-non-pharmacological-approach-for-asthma
Allergen Control: Minimize the allergens in your environment, which include dust mites, pet hair or fur, mold, and cockroach droppings.
Wash bedsheets, curtains, and other textile home products frequently with hot water.
Smoke and Air Quality: Tobacco smoke should also be uncontrollably avoided since it triggers asthma symptoms. Establish a smoke-free environment.
Environmental Irritants: Avoid the outdoors on days when pollution rates are high by remaining indoors for as long as possible.
Perform Pest Control: Avoid preparing food that would attract pests for example storing foods in opened plastic bags.
Practical measures of pest control to avoid excessive contact with allergens like cockroach feces.
Physical Activity: Promote exercise because its benefits include enhanced fitness for the asthmatic person.
Regular Cleaning: It is imperative to clean and dust the homes daily by using vacuum cleaners that are fitted with hepa filters.
Role of Beta2-adrenergic agonist agents
Albuterol Sulfate: Albuterol is a short acting bronchodilator that belongs to the category of beta-2 adrenergic agonist which gets attached to the beta-2 receptors found in the smooth muscles of the bronchi.
Levalbuterol: Levalbuterol is the pure R-enantiomer of abuterol, and like its counterpart, levalbuterol acts as short acting beta-2 adrenergic agonist contributing to bronchodilation.
Role of Anticholinergic Agents
Ipratropium: Ipratropium is a short acting, selective, anticholinergic bronchodilator with minimal sedative effect that works to antagonise the bronchoconstrictor effects of acetylcholine through competitively binding to the muscarinic receptors.
Tiotropium: Tiotropium is a long-acting selective anticholinergic bronchodilator which cause long term inhibition of muscarinic receptors.
Role of Long-acting beta-2 agonists
Salmeterol: Salmeterol is a long-acting beta-2 adrenergic agonist that encounters beta-2 receptors in the smooth muscles for airways producing bronchodilation.
Formoterol: Formoterol is another to long-acting beta2-agonist with rapid onset of action It is used in combination with other medicines for asthma management.
Role of Nonselective Phosphodiesterase Enzyme Inhibitors
Theophylline: This tends to affect the phosphodiesterase enzymes so that there is an enhancement in the intracellular cyclic AMP (cAMP).
Theophylline is also found to have a modest anti-inflammatory property, particularly, on the inhibition of the functional activities of inflammatory cells.
Role of Mast cells stabilization
Cromolyn sodium: The action is based on suppression of release of the chemical mediators from the mast cells including histamine. Thus, it helps prevent the onset of the inflammatory cascade in the airways by stabilizing mast cells.
It is taken daily as a preventative treatment to minimize the occurrence and intensity of symptoms in Asthma brought about by allergens.
Role of Leukotriene Receptor Antagonist
Montelukast: This drug leads to better functioning of the lungs and hence a change in the lifestyle of patients with Asthma since their symptoms improve.
Montelukast belongs to the leukotriene-receptor category and is prescribed for use as a long-term asthmatic airways’ treatment in adults and children, for the prevention of daytime and nighttime symptoms, and exercise-induced constriction.
use-of-intervention-with-a-procedure-in-treating-asthma
Bronchial Thermoplasty: During bronchoscopy, a regulated, therapeutic radiofrequency radiation is delivered to the airway walls as part of this non-pharmacologic treatment.
Bronchoscopy: A bronchoscope is a thin and flexible optical instrument that is used to pass through the nasal cavity or the oral cavity then into the respiratory tracts with a view of inspecting the lungs.
use-of-phases-in-managing-asthma
Assessment and Diagnosis: Consider the patient’s case as an asthma case through assessment of the medical history, physical assessment, and spirometry test results.
Monitoring and Control: To ensure that asthma control is well received and sustained to reduce episodes of the disease and boost the quality of life.
Stable Phase: Use the least dose of medicine necessary to maintain long-term asthma control.
Acute Phase: Strive to rapidly and efficiently stabilize the patient and reverse the worsening by improving lung function and avoiding side effects.
Medication
Initial:
6 - 12
mcg
via dry powder inhaler every 12 hours. (Do not exceed 24 mcg/day)
Maintenance: 1 capsule inhaled every 12 hours. (Do not exceed 2 capsules/day)
Metered-dose inhaler: 2 to 4 oral inhalations (45 mcg/actuation) with spacer every 20 minutes for 3 doses
Nebulization solution: 1.25mg to 2.5mg oral inhalation every 20 minutes for 3 doses
Asthma with intermittent symptoms:
Metered-dose inhaler: 2 oral inhalations with a spacer every 4 to 6 hours as needed.
Nebulization solution: 0.63 mg to 1.25 mg oral inhalation every 6 to 8 hours as needed up to 3 doses per 24 hours
for immediate release:
600
mg
Orally 
4 times a day
1200 mg twice a day for extended release
40 - 60
mg
Orally 
once a day
3 - 10
days
40-60 mg/day orally for 3-10 days 
10
mg
Orally 
qPM
severe asthma:
3
mg/kg
over 20 to 50 minutes
4
weeks
100
mg
Subcutaneous (SC)
4
weeks
30
mg
Subcutaneous (SC)
4
weeks
first three doses, following every eight weeks thenafter
initial:
2
actuation
of 100 mcg/5 mcg inhaled two times a day and may increase to a higher dose after two weeks; following with 2 actuation of 200 mcg/5 mcg inhaled two times a day
If treatment fails, continue with a Maximum daily dose of 800 mcg/20 mcg
fluticasone furoate and vilanterol
Initial dose:
1 inhalation 100mcg/25mcg or 200mcg/25mcg (fluticasone furoate/vilanterol) once daily
Maximum dose: 1 inhalation 200mcg/ 25mcg (fluticasone furoate/vilanterol) once daily
fluticasone furoate umeclidinium and vilanterol
Initial dose:
1 inhalation of 100 mcg/62.5 mcg/25 mcg or 200 mcg/62.5 mcg/25 mcg (fluticasone/umeclidinium/vilanterol) orally once a day
Maximum dose: 1 inhalation of 200 mcg/62.5 mcg/25 mcg (fluticasone/umeclidinium/vilanterol) once a day
Prophylaxis:
Receiving Bronchodilators: 80 mcg inhaled orally two times a day; may increase to 160 mcg
Receiving Oral Corticosteroids: 80 mcg inhaled orally two times a day; may increase up to 320 mcg
Asthma guidelines: Global Initiative for Asthma guidelines (GINA 2020): HFA inhaler: Metered-dose inhaler:
80-160 mcg required as low dose treatment once a day or in divided doses two times a day
>160-320 mcg required as medium-dose therapy once a day or in divided doses two times a day
>320 mcg required as high-dose therapy once a day or in divided doses two times a day
210
mg
Subcutaneous (SC)
4
weeks
150 - 375
mg
Subcutaneous (SC)
every 2-4 weeks
Mild/moderate/severe:
875
mg
every 12 hrs or 500mg every 8hrs
12.5 - 200
mg
ephedrine/guaifenesin: 1-2 tablets orally 6 times a day as required
Do not exceed 12 tablets a day
25mg/400mg -ephedrine/guaifenesin: 1tablet orally 6 times a day as required
Do not exceed 6 tablets a day
Indicated for Bronchospasm:
20
mg
Tablet
Orally 
3 to 4 times a day
Oral inhalation
Solution for nebulization:
Moderate symptoms
0.5 to 1.25mg every 4 hours when needed
Maximum dose-8 inhalations/day
Severe symptoms
2.5 to 5mg inhaled through nebulization of 3 doses for 20 mins maximum
Oral tablets
2.5mg thrice daily
10
mg
Powder
as Spinhaler inhalator
In the case of mild/moderate infections: 500 mg orally every 12 hours or 400 mg intravenously every 12 hours for 7-14 days
In the case of severe/complicated infections: 750 mg orally every 12 hours or 400 mg intravenously every 8 hours for 7-14 days
Limitations for usage: Reserve the fluoroquinolones for patients who are voided of available treatment options for chronic bronchitis
Indicated for Bronchial Asthma
:
Asthmanefrin- whenever needed, take 0.5ml nebulizer solution of 1 to 3 inhalations using the EZ breath atomizer
S2- 0.5 mL of a 2.25 percent solution mixed in 3 millilitres of normal saline via jet nebulizer every three to four hours as needed
For long-term indication, use once daily, as the maintenance of asthma in people more than 12 years
Spiriva Respimat- 2 actuation of 1.25 mcg each, inhaled orally daily
Dose Modifications
In the case of CrCl<50ml/min, use the drug only when the benefits are more than the potential risks
Indicated for Asthma or Reversible Bronchospasm
Nearly 15 mg/kg orally four times a day as needed
Note:
Renal impairment
Sr CrCl >50 ml/min: Reduce 25% of an actual dose
Sr CrCl 10-50 ml/min: Reduce 50% of an actual dose
Sr CrCl <10 ml/min: Reduce 75% of an actual dose
Indicated for mild asthma:
1 to 2 inhalations orally every 4 hours whenever needed.
After the first inhalation, wait for a minute before giving the second puff.
Do not exceed 8 puffs for 24 hours.
Inhalation powder (generic or Advair Diskus): one actuation Orally every 2 times a day; should not exceed more than one actuation, about 50mcg salmeterol /500mcg fluticasone every 2 times a day; should not use with the spacer
Inhalation powder (AirDuo Digihaler, AirDuo RespiClick): One actuation orally every 2 times a day; should not exceed more than one actuation, about 14mcg salmeterol /232mcg fluticasone every 2 times a day; should not use with the spacer or the volume holding chamber.
Inhalation aerosol (Advair HFA): Two actuations Orally every 2 times a day; should not exceed more than two actuations of about 21mcg salmeterol /230mcg fluticasone every 2 times a day
Indicated for the maintenance of asthma
1-2 actuations every 4-6 hours as required
Do not exceed more than 12 actuations each day
Metered dose inhalers propelling chlorofluorocarbons are out of phase
(Discontinued)
Inhaled powder (Treatment for maintenance)
Administer 360 mcg every 12 hours orally.
Some people may start with 180 mcg every 12 hours. Do not exceed 720 mcg every 12 hours.
Patients who require low-dose inhaled corticosteroids: Inhaled once a day, the contents of 1 capsule contain indacaterol 150 mcg and mometasone 80 mcg.
Do not exceed one capsule in a day.
Patients requiring a medium or high dose of inhaled corticosteroid: Inhaled once a day, the contents of 1 capsule contain indacaterol 150 mcg/mometasone 160 mcg or indacaterol 150 mcg/mometasone 320 mcg.
Do not exceed 1 capsule in a day.
Cardiac Glycosides
Take a dose of 600 mg orally daily
Tincture: take a dose of 6 g daily orally divided three times a day
Liquid extract: take a dose of 600 mg daily orally divided three times a day
Dried extract: take a dose 150 mg orally daily
Administer 5 to 10g orally thrice a day
mometasone/glycopyrrolate (glycopyrronium)/ indacaterolÂ
One capsule inhaled orally one time a day
Maximum dose not more than one capsule a day
Dosing modification
Renal Impairment
Dose modification not required
Hepatic impairment
Dose modification not required
The recommended dose is 225 mg twice a day
Take a maintenance dose orally of 4.7 mg/kg in each 8 hours
ciclesonide/formoterol/tiotropiumÂ
Indicated for Asthma, chronic obstructive pulmonary disease
160 mcg of ciclesonide/12 mcg of formoterol/18 mcg of tiotropium of one puff one time a day
Indicated for Asthma
Two inhalations four times in a day at the regular interval
Inhaled a dose of 20 mcg up to 4 times daily
Take a dose of 600 to 1800 mg daily in 2 to 3 divided doses
Indicated for Acute bronchospasm
10 mg to 20 mg orally three times a day
Or
One-two inhalations of 500 mcg/inhalations, repeat it for every three-six hours as necessary
Status asthmaticus
90 mcg slow intravenous injection; if necessary may repeat it after 10 min
aminophylline, ephedrine and phenobarbitoneÂ
1 to 2 tablets taken orally every 3 times a day
100 mg daily
off-label:
Take 62.5 mcg two times a day
Note: A daily regimen of vilanterol therapy were best tolerated & enhancements in pulmonary function was observed
take 1.5 gms daily with a glass of water
Administer 1 to 2 g once or twice a day intramuscularly or intravenous infusion.
Maximum dose-4 g/day.
Renal impairment
CrCl 10 to 30ml/min-Administer 1 to 2 g every day.
CrCl<10ml/min- Administer 0.5 to 1 g every day.
In vivo, data suggests taking one tablet of 200 mg two times daily after the morning meal & prior to sleep
Take a dose of 100 mg orally two times daily
Administer 20 mg as an inhaler through nebulization four times a day
The dose may be reduced to twice/thrice a day when the condition is stable
Take one tablet/capsule after the breakfast with a glass of water. Dose can be repeated every six hours, should not exceed more than four capsules daily
Off-label dosing
:
300
mg
Tablet
Orally 
twice a day
15
days
starting dose: 10-20mg is given once a day at bedtime. Following the dose to 20mg after one to two weeks
Dose Adjustments
Dosing modifications
Renal impairment
5 mg is given as a starting dose. Following it to 10 mg after one to two weeks
0.005 - 0.090 mg/k is inhaled by mouth every 4 times a day
Administer 2 inhaled aerosols dose at an interval of minimum 1 to 3 minutes followed by a third inhalation
375
mg
Tablets
Orally 
twice a day
2
weeks
Dose Adjustments
Off-label
0.2 - 0.6
ml
Aerosol
1-3 inhalations, 0.5ml of 2.25% solution using a breathe atomizer
Max. dose: 12 inhalations per day
Off-label
In vivo, the study suggests that
0.12mg/kg to be taken orally
(Or)
0.008% as an aerosol
Indications: it is indicated for use in asthma and bronchoconstriction
budesonide and formoterol (inhalation)Â
160 mcg/9 mcg (2 divided doses of 80 mcg/4.5 mcg) every 12hr
severe asthma: 320 mcg/9 mcg (2 divided doses of 160 mcg/4.5 mcg) every 12hr
Should not exceed more than 320 mcg/9 mcg every 12hr
It is used to treat obstructive lung illnesses like COPD and asthma
It is used to treat the symptoms of lung problems, such as wheezing, dyspnea, and tightness in the chest
The recommended usual dose per day is 400 mg two or three times with a maximum permissible limit is 1200 mg per day
Dose Adjustments
Limited data is available
It is mostly recommended for respiratory tract infections, chronic bronchitis, and urinary tract infections
The usual recommended single dose per week only once is 2 g via oral administration
Dose Adjustments
Reduction in dosage is needed depending upon the condition
Administer a dose of 360 mcg through inhalation twice daily
Liquid Extract
Administer 0.3ml to 1.0 ml orally thrice a day;60% ethanol
Topical Mouthwash
Administer 6g dried herb with 150 ml water. Rinse thrice or twice a day
Rhizome/Dried root/Tea
Administer 0.5 to 1g orally thrice a day
Tincture
Administer 2 to 4 ml orally thrice a day;60% ethanol
For mild/moderate: 90 to 720 mcg (Pulmicort Flexhaler) orally inhaled twice a day (Do not exceed 1000 mcg/day)
or 200 to 2,400 mcg/day (Pulmicort Turbuhaler)
or
1 to 2 mg twice a day (Pulmicort Nebuamp)
Children >6 years and adolescents <16 years:
12 mcg oral inhalation every 12 hours (Do not exceed 24 mcg/day)
Adolescents >17 years:
Moderate cases: 12 mcg oral inhalation every 12 hours
Severe cases: 24 mcg oral inhalation every 12 hours
Metered-dose inhaler: Children >4 years and Adolescents:
2 oral inhalations every 4 to 6 hours as needed
Nebulization:
Infants and Children <4 years: 0.31 to 1.25 mg oral inhalation every 4 to 6 hours as needed
Children 5 to <12 years: 0.31 to 0.63 mg oral inhalation every 8 hours as needed
Children >12 years and adolescents: 0.63 to 1.25mg oral inhalation every 6 to 8 hours as needed
refer to adult dose
Age: <12 years
1-2 mg/kg orally daily or divided every 12 hours 3-10 days
Age: ≥12 years
40-60 mg/kg orally daily or divided every 12 hours 3-10 days
acute:
0.6
mg/kg
once a day
oral/IV/IM
Age: 6-12 years
40 mg subcutaneous (SC) every 4 weeks
Age: >12 years
100 mg subcutaneous (SC) every 4 weeks
Age: >12 years
30 mg SC 4 weeks for the first three doses, following every eight weeks thenafter
Age: >12 years
Initial: 2 actuation of 100 mcg/5 mcg inhaled two times a day and may increase to a higher dose after two weeks. Continue with 2 actuation of 200 mcg/5 mcg inhaled 2 times a day
If treatment fails, continue with a Maximum daily dose of 800 mcg/20 mcg
Age: >12 years
210 mg SC 4Weeks
<6 years: Safety and efficacy not established
6 to <12 years: 75-375mg subcutaneous every 2-4 weeks
≥12 years: 150-375mg subcutaneous every 2-4 weeks
Mild/moderate/severe :
45 mg/kg daily divided in doses for every 12hrs or 40 mg/kg per day in divided doses for every 8hrs
Community-acquired pneumonia (Off-label use)
<3 months: Safety and effectiveness have not been established
Age: ≥3 months
immediate release (IR):
Empirical treatment:
90 mg/kg/day orally, divided 2 times a day 10 days
maximum daily dose should not exceed 4,000 mg
Group A Streptococcus:
50-75 mg/kg/day orally, divided 2 times a day 10 days
maximum daily dose should not exceed 4,000 mg
H. influenza:
75-100 mg/kg/day orally, divided 3 times a day 10 days
maximum daily dose should not exceed 4,000 mg
S. pneumoniae:
90 mg/kg/day orally, divided 2 times a day 10 days or 45 mg/kg/day divided 2 times a day 10 days
maximum daily dose should not exceed 4,000 mg
Age >12 years:
12.5mg/200mg-ephedrine/guaifenesin: 1-2 tablets orally 6 times a day as required
Do not exceed 12 tablets a day
25mg/400mg -ephedrine/guaifenesin: 1tablet orally 6 times a day as required
Do not exceed 6 tablets a day
Indicated for Bronchospasm:
<2 years:0.4mg/kg orally every 8 to 12 hours
2-6 years:1-3.5mg/kg/day divided orally every 6 to 8 hours. Do not exceed 10mg/dose
6-9 hours: 10mg orally 3-4 times daily
>12 years:20mg orally daily thrice
Indicated for bronchial asthma
:
Asthmanefrin:
<4 years: Safety and efficacy not established
≥4 years: whenever needed, take 0.5ml nebulizer solution of 1 to 3 inhalations using the EZ breath atomizer
S2:
<4 years:0.5 mL maximum per dosage, given every 12 hours using a jet nebulizer at 0.05 mL/kg (diluted to 3 mL with NS) over 15 minutes.
≥4 years: 0.5 mL of a 2.25 percent solution mixed in 3 millilitres of normal saline via jet nebulizer every three to four hours as needed
For long-term indication, use once daily, as the maintenance of asthma in people more than 6 years
Spiriva Respimat- 2 actuations of 1.25 mcg each, inhaled orally daily
Less than 2 years old: 0.4 mg/kg orally each 8 to 12 hours
2 to 6 years old: 1 to 3.5 mg/kg daily divided each 6 to 8 hours orally and for each dose maximum dose up to 10 mg
6 to 9 years old: take 10 mg orally three or four times a day
More than 12 years old: take 20 mg orally three times a day
Indicated for the maintenance of asthma
Safety and efficacy are not seen in children below 12 years
For more than 12 years-
1-2 actuation every 4-6 hours as required
Do not exceed more than 12 actuations each day
Metered dose inhalers propelling chlorofluorocarbons are out of phase
(Discontinued)
Inhaled powder (Treatment for maintenance)
<6 years: Safety and efficacy not established
>6 years: Administer 180 mcg every 12 hours orally.
Some people may start with 360 mcg every 12 hours. Do not exceed 360 mcg every 12 hours.
Nebulized suspension
<1 year: Safety and efficacy not established
1 to 8 years (prior treatment with only bronchodilators): Administer 0.5 mg once a day or divided every 12 hours; no more than 0.5 mg per day
1 to 8 years (prior treatment with corticosteroids inhaled): Administer 0.5 mg once a day or divided every 12 hours; no more than 1 mg per day
1 to 8 years (prior treatment with corticosteroids oral): Administer 1 mg once a day or divided every 12 hours; no more than 1 mg per day
Children with symptoms who do not respond to nonsteroidal therapy: Start with 0.25 mg every 12 hours.
Inhaled powder (Treatment for maintenance)
<6 years: Safety and efficacy not established
>6 years: Administer 180 mcg every 12 hours orally.
Some people may start with 360 mcg every 12 hours. Do not exceed 360 mcg every 12 hours.
Nebulized suspension
<1 year: Safety and efficacy not established
1 to 8 years (prior treatment with only bronchodilators): Administer 0.5 mg once a day or divided every 12 hours; no more than 0.5 mg per day
1 to 8 years (prior treatment with corticosteroids inhaled): Administer 0.5 mg once a day or divided every 12 hours; no more than 1 mg per day
1 to 8 years (prior treatment with corticosteroids oral): Administer 1 mg once a day or divided every 12 hours; no more than 1 mg per day
Children with symptoms who do not respond to nonsteroidal therapy: Start with 0.25 mg every 12 hours.
Maintenance therapy
Adolescents and children ≥12 years:
Patients that require a low-dose inhaled corticosteroid with a long-acting beta-agonist:
Inhalation capsule with indacaterol 150 mcg and mometasone 80 mcg:
One capsule's contents should be inhaled once daily;
The daily dose should not exceed: mometasone 320 mcg/150 mcg indacaterol daily.
Patients that require a high-dose inhaled corticosteroid with a long-acting beta-agonist:
Inhalation capsule with indacaterol 150 mcg and mometasone 160 mcg or mometasone 320 mcg/150 mcg indacaterol per day
One capsule's contents should be inhaled once daily;
The daily dose should not exceed: mometasone 320 mcg/150 mcg indacaterol daily.
Indicated for Atopic asthma
Age 6 months-3 years
Initial dose: 0.05 mg/kg orally one to two times a day for five days
Maintenance dose: 0.05 mg/kg orally two times a day
It should not exceed 1 mg two times a day
Age >3 years
Initial dose:1 mg orally one to two times a day for five days
Maintenance dose: 1 mg orally two times a day
for 1 to 9 years old:
Take a maintenance dose orally of 6.2 mg/kg in each 6 hours
for 9 to 16 years old:
Take a maintenance dose orally of 4.7 mg/kg in each 6 hours
Indicated for Asthma
Age >6 years
Two inhalations four times in a day at the regular interval
Indicated for Acute bronchospasm
Age 6-12 years
One inhalations of 500 mcg/inhalations for every three-six hours
For children who are between 1 and 6 years of age, the recommended dose is 1.25 ml to 5 ml every 3 to 5 hours but should not exceed a maximum of 3 doses in a day, and for children who are between 6 and 12 doses is2.5 ml to 5 ml every 3 to 5 hours but should not exceed 15 ml in a day
For children who are between 1 and 6 years of age, the recommended dose is 1.25 ml to 5 ml every 3 to 5 hours but should not exceed a maximum of 3 doses in a day, and for children who are between 6 and 12 doses is2.5 ml to 5 ml every 3 to 5 hours but should not exceed 15 ml in a day
Age ≥2 years:
Administer 20 mg as an inhaler through nebulization four times a day
The dose may be reduced to twice/thrice a day when the condition is stable
6-12 years: 5 mg is given as starting dose. Following it to 10 mg after one to two weeks
2-5 years: 5 mg is given as normal dose. Above 10 mg is usually not recommended
for >12 years old:
Administer 2 inhaled aerosols dose at an interval of minimum 1 to 3 minutes followed by a third inhalation
Safety and efficacy study for children under four years of age is not established
For children of 4 years and above:
1-3 inhalations, 0.5ml of 2.25% solution using a jet nebulizer
Max. dose: 12 inhalations per day
budesonide and formoterol (inhalation)Â
Children below 6 years: safety and efficacy not established
6-12 years: 160mcg/9mcg (2 divided doses of 80 mcg/4.5mcg) every 12 hrs
above 12 years: 160 mcg/9 mcg (2 divided doses of 80 mcg/4.5 mcg) every 12hr
severe asthma: 320 mcg/9 mcg (2 divided doses of 160 mcg/4.5 mcg) every 12hr
Should not exceed more than 320 mcg/9 mcg every 12hr
80 mcg/4.5mcg should be given if response is inadequate after 1-2 weeks
For additional control can switch to 160 mcg/9 mcg
It is used to treat obstructive lung illnesses like COPD and asthma
It is used to treat the symptoms of lung problems, such as wheezing, dyspnea, and tightness in the chest
The recommended usual dose per day is 400 mg two or three times with a maximum permissible limit is 1200 mg per day
It is used to treat obstructive lung illnesses like COPD and asthma
It is used to treat the symptoms of lung problems, such as wheezing, dyspnea, and tightness in the chest
Lower the dosage compared to the adult dosage to 200 mg twice a day
Dose Adjustments
Limited data is available
Future Trends
Asthma is a long-term disease that affects the human body’s respiratory system. Asthma can be described as mild-intermittent, where one gets occasional wheezing, or moderate-severe, persistent, where one experiences sudden complete airway obstruction. Asthma in children is one of the prevalent medical conditions that lead to many hospitalizations and increased expenses. The main characteristic is airway inflammation, which increases their sensitivity to provocation stimuli. Asthma is among the diseases that can be fatal if not well managed.
Asthma is prevalent in 15% to 20% of the population within developed countries and between 2 to 4% in developing countries. Children are commonly affected. Asthma is seen to be more common in older people because of reduced lung capacity and irritability to substances that cause inflammation of the airways.
Asthma is highly prevalent in children; approximately two-thirds of all people with Asthma are first diagnosed before the age of 18 years. The symptoms of asthmatic children clear out almost entirely when they reach early adulthood, by approximately 50%.
The inflammation of the airway usually manifests in many patients soon after exposure to an environmental precipitant and is often reversible. The pathogenic process can be initiated by inhaling an allergen or irritant which leads to airway inflammation and increase the formation of mucus due to hypersensitivity of the bronchi. There is a marked increase of the airway resistance, and this is extremely pronounced during expiration.
Blockage of the airway is reached by infiltration with inflammatory cells, hypersecretion with mucus plug, and constriction with smooth muscles. If asthma is not treated soon, it will worsen because the inhaled drug cannot reach the mucus due to mucus formation. This is an inflammation and therefore the swelling increases.
The disease asthma is characterized by various comprehensive and several different phenotypes. Specifically, the tendency inherited from one’s parents and relatives concerning allergy is usually found in the form of hay fever, eczema, and other factors noted above about Asthma.
Though, the cause of Asthma involves genetic predisposition and exposure to environmental factors even if the overall cause of Asthma is complex and still unidentified, especially when it comes to the asthmatic children and their probability of having Asthma in their adulthood.
The following factors usually trigger Asthma:
Asthma became fatal as it claimed one person per 100000 of the population. Asthma leads to school or work absenteeism and multiple hospitalizations, thus, a high cost of medical care. Several reviews reveal that poor asthma control can result in the worsening of the functioning and decreased the quality of life.
Symptoms: Coughing, wheezing, breathlessness, and chest constriction.
Triggers: Dust, pollen, animal dander, colds, pollution, smog, smoke, strong smells, etc.
Diagnosis: This is usually evidenced by spirometry (lung function) and may be backed up by peak flow measurement or allergy skin tests.
Medications: For immediate management one will be prescribed bronchodilators such as albuterol while for maintenance of the condition the patient may be required to take other medications like inhaled corticosteroids.
Age group
Asthma is a common disease which can entail anyone regardless of his or her age, starting from infants and up to elderly people. It is a long-term illness that results to inflammation and constriction of the airways and common symptoms include wheezing, coughing, chest constriction and finding difficulty in breathing.
Checking Oxygen Levels
Assessing Respiratory Rate
Measuring Peak Expiratory Flow (PEF)
Assessment of Allergic Symptoms
Assessment of Triggers
Allergies
Obesity
Gastroesophageal Reflux Disease (GERD)
Sinusitis
Obstructive Sleep Apnea
The intensity or the degree of Asthma is called the acuity of asthma presentation. Its severity ranges from the mildest cases where just simple shortness of breath or wheezing is exhibited to the most severe where one is unable to breathe properly, can hardly get rid of the wheezing despite having taken the necessary medication or even cases of life-threatening.
Chronic Obstructive Pulmonary Disease (COPD)
Allergic Rhinitis
Pulmonary Embolism
Heart Failure
Bronchiectasis
Vocal Cord Dysfunction
Treatment Paradigm Â
Assessment and Diagnosis: Diagnosing Asthma through the patient’s history, physical examination and spirometry or other pulmonary function tests.
Environmental Control: Staying away from some of the known factors that may cause exposure to environmental allergies or even exposure to chemicals that cause irritation.
Regular Monitoring: Supervising activity of the lungs, as well as signs, to control the dosage of drugs.
Allergy and Immunology
Pulmonary Medicine
Allergen Control: Minimize the allergens in your environment, which include dust mites, pet hair or fur, mold, and cockroach droppings.
Wash bedsheets, curtains, and other textile home products frequently with hot water.
Smoke and Air Quality: Tobacco smoke should also be uncontrollably avoided since it triggers asthma symptoms. Establish a smoke-free environment.
Environmental Irritants: Avoid the outdoors on days when pollution rates are high by remaining indoors for as long as possible.
Perform Pest Control: Avoid preparing food that would attract pests for example storing foods in opened plastic bags.
Practical measures of pest control to avoid excessive contact with allergens like cockroach feces.
Physical Activity: Promote exercise because its benefits include enhanced fitness for the asthmatic person.
Regular Cleaning: It is imperative to clean and dust the homes daily by using vacuum cleaners that are fitted with hepa filters.
Allergy and Immunology
Pulmonary Medicine
Albuterol Sulfate: Albuterol is a short acting bronchodilator that belongs to the category of beta-2 adrenergic agonist which gets attached to the beta-2 receptors found in the smooth muscles of the bronchi.
Levalbuterol: Levalbuterol is the pure R-enantiomer of abuterol, and like its counterpart, levalbuterol acts as short acting beta-2 adrenergic agonist contributing to bronchodilation.
Allergy and Immunology
Pulmonary Medicine
Ipratropium: Ipratropium is a short acting, selective, anticholinergic bronchodilator with minimal sedative effect that works to antagonise the bronchoconstrictor effects of acetylcholine through competitively binding to the muscarinic receptors.
Tiotropium: Tiotropium is a long-acting selective anticholinergic bronchodilator which cause long term inhibition of muscarinic receptors.
Pulmonary Medicine
Salmeterol: Salmeterol is a long-acting beta-2 adrenergic agonist that encounters beta-2 receptors in the smooth muscles for airways producing bronchodilation.
Formoterol: Formoterol is another to long-acting beta2-agonist with rapid onset of action It is used in combination with other medicines for asthma management.
Allergy and Immunology
Pulmonary Medicine
Theophylline: This tends to affect the phosphodiesterase enzymes so that there is an enhancement in the intracellular cyclic AMP (cAMP).
Theophylline is also found to have a modest anti-inflammatory property, particularly, on the inhibition of the functional activities of inflammatory cells.
Allergy and Immunology
Pulmonary Medicine
Cromolyn sodium: The action is based on suppression of release of the chemical mediators from the mast cells including histamine. Thus, it helps prevent the onset of the inflammatory cascade in the airways by stabilizing mast cells.
It is taken daily as a preventative treatment to minimize the occurrence and intensity of symptoms in Asthma brought about by allergens.
Allergy and Immunology
Pulmonary Medicine
Montelukast: This drug leads to better functioning of the lungs and hence a change in the lifestyle of patients with Asthma since their symptoms improve.
Montelukast belongs to the leukotriene-receptor category and is prescribed for use as a long-term asthmatic airways’ treatment in adults and children, for the prevention of daytime and nighttime symptoms, and exercise-induced constriction.
Allergy and Immunology
Pulmonary Medicine
Bronchial Thermoplasty: During bronchoscopy, a regulated, therapeutic radiofrequency radiation is delivered to the airway walls as part of this non-pharmacologic treatment.
Bronchoscopy: A bronchoscope is a thin and flexible optical instrument that is used to pass through the nasal cavity or the oral cavity then into the respiratory tracts with a view of inspecting the lungs.
Allergy and Immunology
Physical Medicine and Rehabilitation
Pulmonary Medicine
Assessment and Diagnosis: Consider the patient’s case as an asthma case through assessment of the medical history, physical assessment, and spirometry test results.
Monitoring and Control: To ensure that asthma control is well received and sustained to reduce episodes of the disease and boost the quality of life.
Stable Phase: Use the least dose of medicine necessary to maintain long-term asthma control.
Acute Phase: Strive to rapidly and efficiently stabilize the patient and reverse the worsening by improving lung function and avoiding side effects.
Asthma is a long-term disease that affects the human body’s respiratory system. Asthma can be described as mild-intermittent, where one gets occasional wheezing, or moderate-severe, persistent, where one experiences sudden complete airway obstruction. Asthma in children is one of the prevalent medical conditions that lead to many hospitalizations and increased expenses. The main characteristic is airway inflammation, which increases their sensitivity to provocation stimuli. Asthma is among the diseases that can be fatal if not well managed.
Asthma is prevalent in 15% to 20% of the population within developed countries and between 2 to 4% in developing countries. Children are commonly affected. Asthma is seen to be more common in older people because of reduced lung capacity and irritability to substances that cause inflammation of the airways.
Asthma is highly prevalent in children; approximately two-thirds of all people with Asthma are first diagnosed before the age of 18 years. The symptoms of asthmatic children clear out almost entirely when they reach early adulthood, by approximately 50%.
The inflammation of the airway usually manifests in many patients soon after exposure to an environmental precipitant and is often reversible. The pathogenic process can be initiated by inhaling an allergen or irritant which leads to airway inflammation and increase the formation of mucus due to hypersensitivity of the bronchi. There is a marked increase of the airway resistance, and this is extremely pronounced during expiration.
Blockage of the airway is reached by infiltration with inflammatory cells, hypersecretion with mucus plug, and constriction with smooth muscles. If asthma is not treated soon, it will worsen because the inhaled drug cannot reach the mucus due to mucus formation. This is an inflammation and therefore the swelling increases.
The disease asthma is characterized by various comprehensive and several different phenotypes. Specifically, the tendency inherited from one’s parents and relatives concerning allergy is usually found in the form of hay fever, eczema, and other factors noted above about Asthma.
Though, the cause of Asthma involves genetic predisposition and exposure to environmental factors even if the overall cause of Asthma is complex and still unidentified, especially when it comes to the asthmatic children and their probability of having Asthma in their adulthood.
The following factors usually trigger Asthma:
Asthma became fatal as it claimed one person per 100000 of the population. Asthma leads to school or work absenteeism and multiple hospitalizations, thus, a high cost of medical care. Several reviews reveal that poor asthma control can result in the worsening of the functioning and decreased the quality of life.
Symptoms: Coughing, wheezing, breathlessness, and chest constriction.
Triggers: Dust, pollen, animal dander, colds, pollution, smog, smoke, strong smells, etc.
Diagnosis: This is usually evidenced by spirometry (lung function) and may be backed up by peak flow measurement or allergy skin tests.
Medications: For immediate management one will be prescribed bronchodilators such as albuterol while for maintenance of the condition the patient may be required to take other medications like inhaled corticosteroids.
Age group
Asthma is a common disease which can entail anyone regardless of his or her age, starting from infants and up to elderly people. It is a long-term illness that results to inflammation and constriction of the airways and common symptoms include wheezing, coughing, chest constriction and finding difficulty in breathing.
Checking Oxygen Levels
Assessing Respiratory Rate
Measuring Peak Expiratory Flow (PEF)
Assessment of Allergic Symptoms
Assessment of Triggers
Allergies
Obesity
Gastroesophageal Reflux Disease (GERD)
Sinusitis
Obstructive Sleep Apnea
The intensity or the degree of Asthma is called the acuity of asthma presentation. Its severity ranges from the mildest cases where just simple shortness of breath or wheezing is exhibited to the most severe where one is unable to breathe properly, can hardly get rid of the wheezing despite having taken the necessary medication or even cases of life-threatening.
Chronic Obstructive Pulmonary Disease (COPD)
Allergic Rhinitis
Pulmonary Embolism
Heart Failure
Bronchiectasis
Vocal Cord Dysfunction
Treatment Paradigm Â
Assessment and Diagnosis: Diagnosing Asthma through the patient’s history, physical examination and spirometry or other pulmonary function tests.
Environmental Control: Staying away from some of the known factors that may cause exposure to environmental allergies or even exposure to chemicals that cause irritation.
Regular Monitoring: Supervising activity of the lungs, as well as signs, to control the dosage of drugs.
Allergy and Immunology
Pulmonary Medicine
Allergen Control: Minimize the allergens in your environment, which include dust mites, pet hair or fur, mold, and cockroach droppings.
Wash bedsheets, curtains, and other textile home products frequently with hot water.
Smoke and Air Quality: Tobacco smoke should also be uncontrollably avoided since it triggers asthma symptoms. Establish a smoke-free environment.
Environmental Irritants: Avoid the outdoors on days when pollution rates are high by remaining indoors for as long as possible.
Perform Pest Control: Avoid preparing food that would attract pests for example storing foods in opened plastic bags.
Practical measures of pest control to avoid excessive contact with allergens like cockroach feces.
Physical Activity: Promote exercise because its benefits include enhanced fitness for the asthmatic person.
Regular Cleaning: It is imperative to clean and dust the homes daily by using vacuum cleaners that are fitted with hepa filters.
Allergy and Immunology
Pulmonary Medicine
Albuterol Sulfate: Albuterol is a short acting bronchodilator that belongs to the category of beta-2 adrenergic agonist which gets attached to the beta-2 receptors found in the smooth muscles of the bronchi.
Levalbuterol: Levalbuterol is the pure R-enantiomer of abuterol, and like its counterpart, levalbuterol acts as short acting beta-2 adrenergic agonist contributing to bronchodilation.
Allergy and Immunology
Pulmonary Medicine
Ipratropium: Ipratropium is a short acting, selective, anticholinergic bronchodilator with minimal sedative effect that works to antagonise the bronchoconstrictor effects of acetylcholine through competitively binding to the muscarinic receptors.
Tiotropium: Tiotropium is a long-acting selective anticholinergic bronchodilator which cause long term inhibition of muscarinic receptors.
Pulmonary Medicine
Salmeterol: Salmeterol is a long-acting beta-2 adrenergic agonist that encounters beta-2 receptors in the smooth muscles for airways producing bronchodilation.
Formoterol: Formoterol is another to long-acting beta2-agonist with rapid onset of action It is used in combination with other medicines for asthma management.
Allergy and Immunology
Pulmonary Medicine
Theophylline: This tends to affect the phosphodiesterase enzymes so that there is an enhancement in the intracellular cyclic AMP (cAMP).
Theophylline is also found to have a modest anti-inflammatory property, particularly, on the inhibition of the functional activities of inflammatory cells.
Allergy and Immunology
Pulmonary Medicine
Cromolyn sodium: The action is based on suppression of release of the chemical mediators from the mast cells including histamine. Thus, it helps prevent the onset of the inflammatory cascade in the airways by stabilizing mast cells.
It is taken daily as a preventative treatment to minimize the occurrence and intensity of symptoms in Asthma brought about by allergens.
Allergy and Immunology
Pulmonary Medicine
Montelukast: This drug leads to better functioning of the lungs and hence a change in the lifestyle of patients with Asthma since their symptoms improve.
Montelukast belongs to the leukotriene-receptor category and is prescribed for use as a long-term asthmatic airways’ treatment in adults and children, for the prevention of daytime and nighttime symptoms, and exercise-induced constriction.
Allergy and Immunology
Pulmonary Medicine
Bronchial Thermoplasty: During bronchoscopy, a regulated, therapeutic radiofrequency radiation is delivered to the airway walls as part of this non-pharmacologic treatment.
Bronchoscopy: A bronchoscope is a thin and flexible optical instrument that is used to pass through the nasal cavity or the oral cavity then into the respiratory tracts with a view of inspecting the lungs.
Allergy and Immunology
Physical Medicine and Rehabilitation
Pulmonary Medicine
Assessment and Diagnosis: Consider the patient’s case as an asthma case through assessment of the medical history, physical assessment, and spirometry test results.
Monitoring and Control: To ensure that asthma control is well received and sustained to reduce episodes of the disease and boost the quality of life.
Stable Phase: Use the least dose of medicine necessary to maintain long-term asthma control.
Acute Phase: Strive to rapidly and efficiently stabilize the patient and reverse the worsening by improving lung function and avoiding side effects.
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