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Asthma is one of the most common diseases in the world especially in children it’s an obstructive pulmonary condition which affects airways such as the bronchial tubes.
Asthma can be triggered by various factors such as allergies, smoke, weather and many other factors. These triggers could result in a reaction in the airways which could damage them depending on the sensitivity, lifestyle and the genetic history of the person who is at risk of asthma. These triggers cause the muscles around the wall of the airway to become more narrower which could result in the linings of the airway to become inflamed which would lead to swelling. The narrowed airways can result in the goblet cells producing and secreting more mucus whilst damaging the cilia and airways. This build up of mucus results in persistent coughing which makes the lungs more vulnerable to infection due to the bacteria present in the mucus. These reactions caused by the triggers results in symptoms of shortness of breath, wheezing, chest tightness.
DIAGNOSIS
Before determining a treatment plan for the patient preliminary tests are conducted to find out how significant the asthma is and if there are any other possible conditions such as chronic obstructive pulmonary disease (COPD) or a respiratory infection. Some of the tests that are done are the spirometry test which involves how much air you can exhale after a deep breath and how quick the patient can breathe out using a spirometer machine. Or a peak flow test can be done to measure how hard the patient breathes out to determine their peak expiratory flow rate. if these two specific tests cannot give a clearer view on how obstructed the patient’s airways is additional tests can be done such as a nitro oxide test or allergy test. All these tests are done before or after taking bronchildators to open your airways to give clearer view on if the drug had an effect.
TREATMENT
There are various ways in which asthma can be treated and some of them are by using an inhaler or taking short term or long-term medication depending on how serious the condition is. One of the main drugs in the treatment of asthma is the use of bronchodilator medicine specifically β2-adrenergic receptor agonists and these can be used in a short term to treat acute exacerbations or can be used in the long term to treat bronchoconstriction depending on the classification of the patient’s asthma.
β2-adrenergic receptor agonists involve the activation of β adrenergic receptors this allows the airways to become more wider and reduce the stress on the smooth muscle. The mechanism on how it works involves the β2-adrenergic receptor activating the enzyme adenylyl cyclase. This activation lead to the production of cyclic adenosine monophosphate (cAMP) which also involves the activation of protein kinase A (PKA). The activation of these enzyme causes a change in calcium concentration whilst also affecting the potassium channels by increasing their levels through a different mechanism. These actions lead to inactivation of myosin light chain kinase which is a protein kinase found in the smooth muscle. This inactivation of this kinase promotes relaxation in this smooth muscle. Also from the activation of cAMP and protein kinase A. The activation of myosin light chain phosphate also occurs which causes the rapid relaxation of smooth muscle allowing inflamed areas of the airway to become alleviated. So overall from the combination of the decrease levels of calcium and increased levels of potassium as well as the activation and inactivion of certain protein kinases the smooth muscle cells in the airways become hyperpolarized allowing the airways to widen and recover from the use of the β2-adrenergic receptor agonists.
β2-adrenergic receptor agonists can come mainly in 3 different forms which are the short acting agonists the long-lasting agonists and the ultra-long acting beta agonist. The short acting agonist (SABAs) is the primary line of acute treatment of asthma Some examples of this type of drug is salbutamol albuterol and fenoterol and these drugs are mainly administered via inhalation using dry powder and the time taken for onset action can be lower than 5 minutes with the maximum effect the drug occurring within 30 minutes. These types of short β2-adrenergic can be used in conjunction with long lasting agonists and can have a therapeutic effect for a duration between 3-6 hours.
Long lasting agonists (LABAS) can also be used for patients with COPD as well as asthma they are taken when the first line of treatment (SABAs) have failed to have an effect and they are usually taken in combination with inhaled corticosteroids due to recent research suggesting a superior efficacy with dual therapy versus monotherapy as well as preventing reduced swelling in the airway. Some common examples of (LABAS) are Serevent® (salmeterol)and Foradil® (formoterol). These types of LABAS are mainly given to patients that require long term medication due to the increased severity of their classification of asthma this means the asthma sufferer would be taking these drugs every day to control their symptoms of asthma. Like the (SABAs) these drugs are also taken via inhalation and have a duration for at least 12 hours reducing the chances of symptoms occurring at night whilst sleeping.
The final type of β2-adrenergic agonists is Ultra-LABAs and this has the greatest duration of effect that lasts up to 24 hours. Some examples are Indacaterol, Olodaerol and Vilanterol and these are taken via inhalation mainly by dry powders. The administrative route of inhalation is the most recommended due to the concentrating effect on the airways and reduced chance of interference by systematic circulation.
CONCLUSION
To conclude these β2-adrenergic agonists have a great effective in the treatment of asthma specifically SABAs due to their rapid reversal of airflow obstruction and alleviation of asthmatic symptoms. However there can be adversary effects involving the cardiac and metabolic systems.
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