- so, i've got a nice little chart here that tells us how to categorize how severe somebody's asthma is. basically, these three are persistent, as you can see, more than twice a week. moderate is daily. severe is bad symptoms every day, sometimes twice a day. so, here we've got severity scale,
and this scale i found is actually, we can adapt it verylittle to make this scale for evaluating how wellsomebody is treated. so tx is treatment. the goal in treating asthma,since we can't cure it, is to control the symptoms andreduce the number of times. basically, we're trying to get them towards the intermittent stage. so, basically for someoneto be well controlled,
the definition is very similar to the definition for intermittent. so, well controlled wouldbe less than two a week and never more than once a day. so, less than or equal to one a day, when they do have their attack. so, here you say ithappened once on wednesday, just once, then this person is okay. their medication is working.
so, next level is, we say thispatient is not well controlled. don't let the colors confuse you. i'm using green here justto match with this row here, but not well controlled isnot green, it's not good. so, i'm going to writewc for well controlled, and this one is defined asmore than twice per week, or even if they only have it twice a week, more than once per daywhen they do have it. so, if they have it on monday, tuesday,
thursday, friday, sunday,that's not well controlled. that's five times a week. or even if they only havewednesday and saturday, say it only happened on these two days, if they have it let's saytwo times on wednesday or three times on saturday,that already pushes them, that puts them in the notwell controlled as well. and then, of course, the last two here, that's poorly controlled.
we're not even going todistinguish between them. we're just going to write poor. and if you're the physician, the person who is poorly controlled needs to go way up on their meds. the person who is not well controlled also needs to go up on their meds. so, in terms of treatment,first we've got two modes of delivering the drugs.
let's not worry about the drugs for now. let's talk about how it's delivered. first we have a nebulizer. let's spell it out, nebulizer. now, this needs this big machine here, and it has a hose connected to a mask. so, my very crude drawingof a medical mask. the person basically puts this mask on, and the medication gets evaporated
into mist in this machine, and it's delivered withoxygen to the person. it takes about 10 minutes. they just sit there withtheir mask and breathe it in. now, this machine can be more expensive, and you need electrical wiring for it, and you need to stay in one place, and it takes about 10 minutes. so, those are the drawbacks,but it works very well.
alternatively, i'm sureyou've seen people use this. we have the inhaler, whichis this l-shaped tube here with an opening and a button on top. this person can push this button, and the medicine squirts out here. now, the best way to usethis is with a spacer, because the medicineneeds to travel with air, and then a person puts their head here and inhales this medication.
it takes about 30 seconds, at most. so, this is an inhaler. it is relatively cheap. it's small. it can fit in your pocket. so, it can go with the patient anywhere. so, remember for each of these you can use multiple medications with it. it just depends on what's moreconvenient for the patient.
so, in terms of the drugsthat we actually put in here, there are a couple of categories. so first, i want to talkabout the drugs that decrease the inflammation. inflammation is yourbody's natural reaction to something that's bothering it. unfortunately, with asthma, inflammation gives us all these symptoms. so, we temper down theinflammation with drugs.
so, first we've got steroids. now, steroids in the body,that's naturally produced there, can also fight inflammation, but, obviously, it's not enough, so we give artificial steroids to temper down the inflammation. we've also got leukotriene inhibitors. this is a weird word. it's just a molecule,leukotriene inhibitors.
so, basically it stops the leukotriene from having an effect on the body. now, the reason these twoare related has to do with the way the inflammationstarts in the body. we have something, a trigger. an a leading to b, leadingto c, leading to d, all the way to the end,we make leukotriene. that's the goal of this whole cascade. so, of course, to stop the inflammation
we can either get rid of this,or steroids comes in earlier and gets rid of an earlierstage in the cascade. so, both of these drugshave the same goal, which is to decrease the leukotriene, decrease the whole cascadefrom causing the symptoms. so, that's one big class of drugs. the other one is bronchodilators. now, broncho is airway, and dilator means increase the diameter
or just open it up, because asthma involves the clamping down or closing of the bronchial pathway. now, within here wehave the beta agonists. beta is a type of receptors in the body, and in the lungs, theirjob is to open it up. so, literally we relax the smooth muscle, or if this is asthma right now, with all this smooth muscle clamping down,
the beta agonist is able to turn that into a nice open airway,with the smooth muscle much more relaxed around here. so, we throw this drugat the beta-2 receptors on the airway through all of our lungs, and they do different thingsin different parts of the body, but here, we care about bronchodilation. there are other drugs that also do this. for example, we have theophylline,
which is a drug that canbe toxic to some people, and we have to monitorthe levels very carefully, but it basically does the same thing, of relaxing the smooth muscle and giving us a bigger airway. so, treatment can bekind of trial and error, because our goal is justto go in this direction. so, whatever gets us there, whatever combination of drugs, the amount,
we just keep going upand keep adding drugs until we get to wellcontrolled, and that is the goal of our long-term treatments for asthma.