Tuesday, January 12, 2010

Living With Asthma - 10 Simple Things You Can Do to Prevent Asthma Attacks

Living with asthma may not be a comfortable life after all. You may be bothered about whether you may get an asthma attack in the office or after a game of sports or even just walking around.

Indeed, the triggers of asthma may include the air you breathe, dust at home, molds underneath the sheets, stress and too much exertion physical activities. It doesn't mean you have to be paranoid about all these triggers but you can manage the burden of asthma attack by trying to be healthy and avoiding possible triggers as well.

If you have been living with asthma and you have been striving to lessen its attacks, here are a few things you can do.

1. Know everything you can about asthma and how you can control its symptoms. The more you know about it, the more you know what to do in case you have an asthma attack.

2. Quit smoking. Maintain healthy lungs and airways to make sure that you have clean air passage. Of course, smoking may cause lung damage that can also worsen your asthma attack and may bring other respiratory problems.

3. Find protection from polluted air. Although you may not be able to avoid it totally, you can stay indoors if it is dusty outside or if smog is all over. Wear protection if you need to go out though.

4. Be aware of your triggers and jot them down if you want. Living with asthma should mean avoiding your triggers. Most often, these triggers are about stress at work, dust and pollen, scents and perfumes as well as too much physical activities. Animal fur and feathers may also trigger asthma so make sure you have no pets around the house if this is an asthma trigger for you. Make sure also that you regularly clean you carpet to get rid of accumulated dust and molds as well.

5. Have a regular exercise but also avoid those that may require too long exertion.

6. Switch to a diet of more nutritious foods to help you build a healthy immune system and keep you away from frequent asthma attack. Although there is no particular food to avoid if you have asthma, it helps a lot to have a healthy diet for a stronger immune system.

7. Manage stress at home, at work and in the office. Find ways to get rid of daily stress as this can contribute to weakening the immune system and may put you susceptible to asthma attacks. Have plenty of rest and sleep and free your mind from stressful thoughts as well.

8. Try some relaxation techniques to help you relieve stress and helps you practice deep breathing. Visualization, yoga, meditation, acupuncture - these are great relaxation exercises that will help strengthen your immune system and help you combat asthma attack.

9. Do not self-medicate. Asthma may be accompanied by cough but don't treat it with cough medicine. Take note that cough and asthma are not the same and taking cough medicines may bring about unwanted side effects.

10. Lose weight if you are obese or overweight. There are studies linking obesity to asthma thus, start maintaining a good weight now and shed those extra pounds for a healthier you.

Living with asthma is indeed difficult at times, so try to be informed of what you can do to deal with this disease. Take note also that this disease if left uncontrolled can indeed lead to a life-threatening situation, so better act now.

Tuesday, July 7, 2009

Allergic rhinitis: evidence for impact on asthma.

BMC Pulm Med, January 1, 2006; 6 Suppl 1: S4.
Allergic rhinitis: evidence for impact on asthma.
M Thomas
Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Westburn Road, Aberdeen AB25 2AY, UK. drmike.thomas@btinternet.com

This paper reviews the current evidence indicating that comorbid allergic rhinitis may have clinically relevant effects on asthma.
DISCUSSION: Allergic rhinitis is very common in patients with asthma, with a reported prevalence of up to 100% in those with allergic asthma. While the temporal relation of allergic rhinitis and asthma diagnoses can be variable, the diagnosis of allergic rhinitis often precedes that of asthma. Rhinitis is an independent risk factor for the subsequent development of asthma in both atopic and nonatopic individuals. Controlled studies have provided conflicting results regarding the benefits for asthma symptoms of treating comorbid allergic rhinitis with intranasal corticosteroids. Effects of other treatments for comorbid allergic rhinitis, including antihistamines, allergen immunotherapy, systemic anti-IgE therapy, and antileukotriene agents, have been examined in a limited number of studies; anti-IgE therapy and antileukotriene agents such as the leukotriene receptor antagonists have benefits for treating both allergic rhinitis and asthma. Results of observational studies indicate that treating comorbid allergic rhinitis results in a lowered risk of asthma-related hospitalizations and emergency visits. Results of several retrospective database studies in the United States and in Europe indicate that, for patients with asthma, the presence of comorbid allergic rhinitis is associated with higher total annual medical costs, greater prescribing frequency of asthma-related medications, as well as increased likelihood of asthma-related hospital admissions and emergency visits. There is therefore evidence suggesting that comorbid allergic rhinitis is a marker for more difficult to control asthma and worsened asthma outcomes.
CONCLUSION: These findings highlight the potential for improving asthma outcomes by following a combined therapeutic approach to comorbid allergic rhinitis and asthma rather than targeting each condition separately.

Allergic rhinitis and its impact on asthma: an evidence-based treatment strategy for allergic rhinitis

Asian Pac J Allergy Immunol, March 1, 2002; 20(1): 43-52.
Allergic rhinitis and its impact on asthma: an evidence-based treatment strategy for allergic rhinitis.
R Pawankar
ARIA Asia Pacific Affiliate, Department of Otolaryngology, Nippon Medical School, Tokyo, Japan. Pawankar_Ruby/ent@nms.ac.jp
The overall pathogenic view of respiratory allergy has deeply changed and evolved during the last ten years. Much emphasis has been laid to the relationship between rhinitis and asthma, which is between the upper and the lower respiratory airways. This strict link has been evidenced through clinical observations and epidemiological studies and also on the basis of immunological observations and outcomes of therapy. Furthermore, the frequent co-existence of rhinitis and asthma (up to 80 percent of asthmatic patients have co-existing allergic rhinitis, while up to 40 percent of allergic rhinitis patients have asthma, the coexistence of sinusitis and asthma, the presence of rhinitis as a risk factor for developing asthma, further emphasize this link and together lead to the operative definition of Allergic Rhinobronchitis or, United Airways Disease (UAD). The strict link existing between upper and lower respiratory tract can be also regarded from the viewpoint of therapeutical outcomes. The more detailed knowledge of the intricate mechanisms sustaining allergic inflammation in the respiratory tract (i.e. antigen presentation, cytokines, chemokines and adhesion molecules) has clarified the functional relationships between nose and lung. Thus allergic rhinitis or asthma is not a disease confined to a specific target organ, but rather a disorder of the whole respiratory tract, with a range of clinical manifestations, leading to relevant diagnostic and therapeutic implications as indicated in the WHO Initiative ARIA, the first evidence-based guideline emphasizing the impact of allergic rhinitis on asthma and where a step-wise treatment strategy targeting both the upper and lower airway effectively has been proposed.
Moreover, the use of novel potential therapies that target both rhinitis and asthma like antileukotrienes or anti-IgE are indeed a future strategy.
Erratum in Asian Pac J Allergy Immunol. 2002 Jun;20(2):139

levasma (Montelukast 10mg + Levocetirizine 5 mg tablets): diagram of allergic rhinitis

levasma (Montelukast 10mg + Levocetirizine 5 mg tablets): diagram of allergic rhinitis

diagram of allergic rhinitis

Tuesday, April 28, 2009

Recent updates

Quality of Life in Patients With Persistent Allergic Rhinitis Treated With Montelukast Alone or in Combination With Levocetirizine or Desloratadine

M Ciebiada,M Gorska Ciebiada,T Kmiecik,LM DuBuske,P Gorski
Medical University of Lodz, Department of Pneumology and Allergy, Lodz, Poland.
Immunology Research Institute of New England, Gardner, Massachusetts, USA.

■ Abstract

Background: Persistent allergic rhinitis often impairs quality of life.

Objective: We assessed the extent to which treating persistent allergic rhinitis with montelukast, desloratadine, and levocetirizine alone or in combination improved quality of life.

Methods: A 32-week randomized, double-blind, placebo-controlled, crossover study was performed in 2 arms: 20 patients received montelukast 10 mg/d and/or desloratadine 5 mg/d or placebo; 20 patients received montelukast 10 mg/d and/or levocetirizine 5 mg/d or placebo.The treatment periods were separated by 2-week washout periods.

Quality of life was assessed on the day before starting treatment and on the last day of each treatment period using the Rhinoconjunctivitis

Quality of Life Questionnaire. Sleep problems were also assessed.

Results: In the desloratadine plus montelukast arm, the mean (SEM) quality of life score before treatment was 3.1 (0.41). After placebo, this score was 2.16 (0.43), after desloratadine it was 1.79 (0.38), after montelukast it was 1.48 (0.37), and after montelukast plus
desloratadine it was 1.59 (0.37). In the montelukast plus levocetirizine arm, the mean quality of life score before treatment was 2.58 (0.49).After placebo it was 1.78 (0.46),after levocetirizine it was 1.38 (0.42),after montelukast it was 1.36 (0.37),and after montelukast plus levocetirizine it was 1.26 (0.39).

Conclusions: Placebo,montelukast,desloratadine and levocetirizine significantly improved quality of life. Combining montelukast with either levocetirizine or desloratadine gave additional benefits in comparison to each agent alone and could be considered for patients whose
quality of life is impaired by persistent allergic rhinitis.

Wednesday, April 22, 2009

product monograph of Levasma

Each tablet contains:
Montelukast sodium equivalent to montelukast 10 mg and Levocetirizine dihydrochloride 5 mg Product Description
Montelukast sodium is a selective and orally active leukotriene receptor antagonist that inhibits the cysteinyl leukotriene (CysLT 1 ), receptor. Levocetirizine is the R-enantiomer of cetirizine. Levocetirizine is an orally active, potent, selective and long acting H 1 -histamine receptor antagonist with no anticholinergic activity.
After administration of the 10-mg film-coated tablet to fasted adults, the mean peak montelukast plasma concentration (C max ) is achieved in 3 to 4 hours (T max ). The mean oral bioavailability is 64%. The oral bioavailability and C max are not influenced by a standard meal in the morning.
Montelukast is more than 99% bound to plasma proteins. The steady-state volume of distribution of montelukast averages 8 to 11 liters.
Montelukast is extensively metabolized. In studies with therapeutic doses, plasma concentrations of metabolites of montelukast are undetectable at steady state in adults and pediatric patients.
The plasma clearance of montelukast averages 45 mL/min in healthy adults. Following an oral dose of radiolabeled montelukast, 86% of the radioactivity was recovered in 5-day fecal collections and 0.2% was recovered in urine . Coupled with estimates of montelukast oral bioavailability , this indicates that montelukast and its metabolites are excreted almost exclusively via the bile.In several studies, the mean plasma half- life of montelukast ranged from 2.7 to 5.5 hours in healthy young adults. The pharmacokinetics of montelukast are nearly linear for oral doses up to 50 mg. During once daily dosing with 10-mg montelukast, there is little accumulation of the parent drug in plasma (~14%).
Pharmacodynamic properties
Pharmacotherapeutic group:
antihistamine for systemic use, piperazine derivative, Levocetirizine, the (R) enantiomer of cetirizine, is a potent and selective antagonist of peripheral H 1 -receptors.Binding studies revealed that levocetirizine has high affinity for human H 1 -receptors. Levocetirizine has an affinity 2-fold higher than that of cetirizine. Levocetirizine dissociates from H 1 -receptors with a half-life of 115 ± 38 min.
Pharmacodynamic studies in healthy volunteers demonstrate that, at half the dose, levocetirizine has comparable activity to cetirizine, both in the skin and in the nose.
Pharmacokinetic / pharmacodynamic relationship
5 mg levocetirizine provide a similar pattern of inhibition of histamine-induced wheal and flare than 10 mg cetirizine. As for cetirizine, the action on histamine-induced skin reactions was out of phase with the plasma concentrations. ECGs did not show relevant effects of levocetirizine on QT interval
Montelukast causes inhibition of airway cysteinyl leukotriene receptors as demonstrated by the ability to inhibit bronchoconstriction due to inhaled LTD 4 in asthmatics. Doses as low as 5 mg cause substantial blockage of LTD 4 -induced bronchoconstriction.
Pharmacokinetic properties
The pharmacokinetics of levocetirizine are linear with dose and time-independent with low inter-subject variability. The pharmacokinetic profile is the same when given as the single enantiomer or when given as cetirizine. No chiral inversion occurs during the process of absorption and elimination.
Levocetirizine is rapidly and extensively absorbed following oral administration. Peak plasma concentrations are achieved 0.9 g h after dosing. Steady state is achieved after two days. Peak concentrations are typically 270 ng/ml and 308 ng/ml following a single and a repeated 5 mg o.d. dose, respectively. The extent of absorption is dose-independent and is not altered by food, but the peak concentration is reduced and delayed.
No tissue distribution data are available in humans. Levocetirizine is 90% bound to plasma proteins. The distribution of levocetirizine is restrictive, as the volume of distribution is 0.4 l/kg.

The extent of metabolism of levocetirizine in humans is less than 14% of the dose and therefore differences resulting from genetic polymorphism or concomitant intake of enzyme inhibitors are expected to be negligible. Metabolic pathways include aromatic oxidation, N- and O-dealkylation and taurine conjugation.Dealkylation pathways are primarily mediated by CYP 3A4 while aromatic oxidation involved multiple and/or unidentified CYP isoforms. Levocetirizine had no effect on the activities of CYP isoenzymes 1A2, 2C9, 2C19, 2D6, 2E1 and 3A4 at concentrations well above peak concentrations achieved following a 5 mg oral dose.Due to its low metabolism and absence of metabolic inhibition potential, the interaction of levocetirizine with other substances, or vice-versa, is unlikely.The plasma half-life in adults is 7.9 + 1.9 hours. The mean apparent total body clearance is 0.63 ml/min kg. The major route of excretion of levocetirizine and metabolites is via urine, accounting for a mean of 85.4% of the dose. Excretion via faeces accounts for only 12.9% of the dose. Levocetirizine is excreted both by glomerular filtration and active tubular secretion
For Chronic Allergic conditions like seasonal allergic rhinitis , perennial allergic rhinitis, Rhinitis associated with Asthma.
Dosage and Administration
Adults1 tablet once daily
Patients who are hypersensitive to any component of this product or to montelukast sodium, levocetirizine or cetirizine. Patients with completely impaired renal function (anuria).
Use in special populations
The combination should be used in pregnancy only if clearly needed but should not be continued.LactationSince levocetirizine is excreted in breast-milk the combination is not recommended during breast-feeding.
The combination should be used with caution in patients with impaired hepatic and renal function and patients having closed-angle glaucoma.Patients on concurrent administration of CNS depressants should also administer caution
Warnings and Precautions
Montelukast is not indicated for use in the reversal of bronchospasm in acute asthma attacks, including status asthmaticus. Patients should be advised to have appropriate rescue medication available. Therapy with Montelukast can be continued during acute exacerbations of asthma . While the dose of inhaled corticosteroid may be reduced gradually under medical supervision, Montelukast should not be abruptly substituted for inhaled or oral corticosteroids. Montelukast should not be used as monotherapy for the treatment and management of exercise -induced bronchospasm . Patients who have exacerbations of asthma after exercise should continue to use their usual regimen of inhaled (beta)-agonists as prophylaxis and have available for rescue a short-acting inhaled (beta)- agonist . Patients with known aspirin sensitivity should continue avoidance of aspirin or non-steroidal anti-inflammatory agents while taking Montelukast Eosinophilic Conditions
In rare cases, patients on therapy with Montelukast may present with systemic eosinophilia, sometimes presenting with clinical features of vasculitis consistent with Churg-Strauss syndrome, a condition, which is often treated with systemic corticosteroid therapy. These events usually, but not always, have been associated with the reduction of oral corticosteroid therapy. Levocetirizine
Precaution is recommended with intake of alcohol.Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.
Drug Interactions
The individual drugs are not known to have any interactions so far. Hence, no interactions would be expected with the combination
Undesirable effects
Montelukast & Levocetirizine are generally well tolerated. Common side effects, which might be seen with the combination, are dyspepsia, abdominal pain, rash, dizziness, headache, fatigue, and somnolence. Sometimes, hypersensitivity, irritability, restlessness, insomnia, vomiting and diarrhoea may occur. In rare cases, patients may present with systemic eosinophilia, sometimes presenting with clinical features of consistent with Churg-Strauss Syndrome.