SMART? symbicort maintenance and reliever therapy

chronic hypersensitive airway - bronchial asthma

hypersensitive airway aka bronchial asthma prevalence increasing worldwide especially amongst children.

environment vs genetic factors blamed for the rise.

various stimuli (allergen) can trigger bronchospasm of the hypersensitive airway.

May 5 annually is World Asthma Day

This year theme is " YOU CAN CONTROL YOUR ASTHMA"

lastest GINA guidelines 2008 showed the following:-

replacing the following, found in their GINA 2002 guidelines

reference:-

1) http://en.wikipedia.org/wiki/Asthma

2) http://www.who.int/respiratory/asthma/en/

3) http://www.nhlbi.nih.gov/health/public/lung/index.htm#asthma

4) http://www.nationalasthma.org.au/cms/index.php

5) http://www.nationalasthma.org.au/content/view/249/639/

6) http://www.asthma.org.uk/

7) http://www.ginasthma.com/Guidelineitem.asp??l1=2&l2=1&intId=60

8) http://www.patient.co.uk/showdoc/40000622/

Curable infectious disease on the rise - tuberculosis

- 20mil active cases worldwide

- 50 to 100 mil children

- mortality 3mil annually

- 80% in developing countries

- since 1989 Malaysia detected average 11 to 12 thousand cases annually

- diagnosis: clinical + radiological + / - bacteriological

The tuberculin or Mantoux test has some role in the diagnosis of tuberculosis especially in paediatric cases and cases of extra-pulmonary tuberculosis.

The Mantoux test is used in Malaysia using the strength of 10 IU PPD. The result is read after 72 hours.

THE AIMS OF TREATMENT ARE:

1. To cure patients and render them non-infectious

2. To reduce morbidity and mortality

3. To prevent relapse and emergence of resistant tubercle bacilli.

Basic investigations:-

1.Sputum D/S x 3,

2.sputum culture AFB if D/S negative,

3.renal profile,

4.liver functions,

5.visual test (if ethambutol is used ),

6.blood sugar,

7.HIV test when indicated.

Treatment:-

isoniazid (H) 100mg / tab

rifampicin (R) /cap

pyrazinamide (Z) 250mg or 500mg/tab

streptomycin (S) im

ethambutol (E) 400mg/tab

1. daily intensive phase (at least 2/12) SHRZ or EHRZ

INH 5mg/kg/day (max 300mg daily)

rifampicin 10mg/kg/day (max 600mg daily)

pyrazinamide 25mg/kg/day (max 2000mg daily)

+/-

streptomycin 15mg/kg/day (max 1000mg daily; omit in elderly)

ethambutol 15 to 25 mg/kg/day (max 1200mg daily)

2. biweekly phase (4/12) eg S2H2R2

INH ] max 1000mg biweekly

rifampicin ] 15mg/kg/ biweekly max 600mg biweekly

streptomycin ] max 1000mg biweekly

reference:-

1) CPG on Management if Tuberculosis. Ministry of Health Malaysia.