drk1980
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UW question
A 19 yr girl presents to her doctor before an annual athletic competition. She c/o wheezing and breathlessness during exercise on various occasions. She is a nonsmoker and does not take any recreational drugs. She also has a h/o allergiic rhinitis. She has been taking Benzoyl peroxide and Erythromycin cream for mild acne. Chest exam unremarkable. What is the most appropriate treatment in this patient?
A) Beta agonists
B) Steroids
C) Zafirlukast
D) Theophylline
E) Ipratropium
F) Cromolyn sodium
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| ssrpk
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F) cromolyn Na+ (ideal for excercise induced asthma)
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| AAAAA
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ssrpk wrote:
F) cromolyn Na+ (ideal for excercise induced asthma)
THE CORRECT ANSWER IS A
DR. SSRPK
PLEASE READ THE DETAIL EXPLANATION BELOW.
THANKS !
CROMOLYN NA IS USELESS IN EXERCISE INDUCED ASTHMA !
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Exercise-induced asthma
Why does it happen? What can you do about it?
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Introduction
A few people seem to get asthma attacks only when they run or take other exercise. Doctors used to think this was a separate form of asthma. But it is very usual for people with asthma to have this happen to them. This 'exercise-induced asthma' is especially a problem for young people. In fact doctors used to puzzle over why children got exercise-induced asthma and why adults did not. Eventually research discovered the reason; adults don't take nearly so much exercise! We now think that people who get asthma attacks only when they take exercise just have asthma which is too mild to show up most of the time, needing the extra provocation from faster breathing to bring it out.
Exercise is just one of many things which show that the air passages are irritable in asthma
If you have asthma, your air passages are irritable. This means things which are harmless to other people may trigger an attack of asthma. So you might get asthma from:
Cold air, if you move from warm indoor air to cold air outdoors.
Tobacco smoke, e.g. in a pub.
Emotional stress. Although there seems to be no really good research on this, people with asthma often say their asthma gets worse if they are upset.
Infections of the lining of the breathing passages, such as colds and 'flu.
Some drugs, especially medicines called beta blockers used for high blood pressure or heart disease.
Laughing. So don't laugh! (Only joking, but it can happen.)
Irritants in asthma inhalers. Strange, but true. Some powder inhalers can cause a small amount of chest tightness. Pressurised aerosol inhalers need to have a lubricant and this can cause worsening of air passage narrowing, occasionally bad enough to be noticeable.
Breathing tests. Just as the faster breathing in exercise can bring on attacks, the faster and deeper breathing you have to do for most breathing tests can bring on quite a noticeable worsening of airway narrowing in a few people.
Sulphur dioxide used as a preservative in soft drinks and wine. This can cause chest tightening within seconds of drinking, or even breathing the air above such a drink.
Indigestion, with stomach acid coming up into your gullet. This is called gastro-oesophageal reflux.
Histamine or methacholine aerosols. In specialised tests doctors use an inhaled mist of these substances to measure how irritable your air passages are. In asthma they are more irritable than normal. During allergic or asthmatic reactions cells in the lungs release histamine . Methacholine mimics the effect of a substance (acetylcholine) released by nerves in the lung during asthma. Both substances cause an asthma attack in anyone who breathes enough of them, but people who have asthma will get an attack from a much smaller amount. In the test, the amount of asthma produced is small and very bearable, and it wears off quickly. The result gives us a measurement which can be very useful.
To some extent people differ in which of these things cause the most asthma. Nevertheless, they all reflect the irritability of the air passages in asthma, even if some of them do so in somewhat different ways.
So exercise is just one of many things which can provoke narrowing of the air passages in asthma. It is just one of many things which reveal the abnormal irritability or 'twitchiness' of the air tubes which is an important feature of asthma. The medical term for this 'twitchiness' is 'hyperreactivity'.
Are some kinds of exercise worse than others?
Yes.
If you take different kinds of exercise so that you use the same amount of oxygen in each one, some will cause more wheeziness or chest tightness than others. Running outdoors will in general be worse than swimming. In fact swimming is one of the best forms of exercise for people with asthma because it usually causes the least amount of chest tightness. Running indoors on a treadmill, or cycling on an indoor exercise bike will come somewhere between outdoor running and swimming.
Other factors influence the amount of worsening of your breathing which you get from a particular form of exercise. Generally for example, if the air you breathe is cold and dry, the asthma will be worse. If it is warm and moist, the asthma will be less bad. This explains why swimming generally causes less asthma than outdoor running.
Some people get worsening of their asthma from the chlorine fumes from swimming baths. This is another factor which can affect the result, and for such people swimming in a chlorinated pool is much worse than running.
The timing of the exercise is important. It takes about six minutes of exercising to bring on exercise-induced asthma, and exercising for quite a bit less than this may not do it.
For a few hours after you have had exercise induced asthma, repeating the same amount of exercise will no longer produce the same amount of asthma symptoms, or may produce none at all.
So you may be able to 'run through' your exercise induced asthma either by warming up with short bursts of exercise, or by continuous exercise which does not bring on a severe attack. Sports and exercises which consist of short bursts of activity with periods of rest in between can be particularly suitable for people with asthma. Examples include relay races, and team sports in which you are not running all the time.
There is also persuasive evidence that gradual athletic training can make you less prone to exercise-induced asthma. At a special school for children with asthma near Oslo in Norway, children ended up being able to do far larger amounts of exercise than they could tolerate before a physical training programme. Although some of this improvement may well have been due to the excellent medical care they received, the doctor in charge thought that the exercise training itself played a vital part in the improvement.
In fact better treatment with medicines can have a powerful effect on exercise-induced asthma. The better your asthma control, the less you will be troubled by exercise-induced asthma.
Exercise-induced asthma is an excellent example of a problem which you can begin to solve once you understand it better.
What is it about exercise that makes asthma worse?
The last time I read this up, the evidence was that increased breathing during exercise causes cooling and drying of the lining of the air passages and that these are necessary for someone to get exercise-induced asthma. This explains why warm moist air protects against exercise-induced asthma.
Nobody knows exactly why the drying and cooling of the airway linings causes the asthma episode.
Exercise-induced asthma can be useful!
Well, of course you would rather not have asthma of any kind, however 'useful'. But seriously, exercise-induced asthma can be useful for diagnosing asthma in a child. Exercising a child for about 6 minutes is a convenient and safe way of provoking a mild asthma attack, and this has led to many children getting early and appropriate advice and treatment. We can exploit this feature of asthma to help defeat asthma.
Exercise-induced asthma has also been useful in asthma research. It can be used for testing medicines which may help asthma.
Athletes and exercise-induced asthma.
A lot of athletes, especially skiers and runners, get exercise-induced asthma. This may be partly because an amount of asthma which does not matter to most people can mean the difference between winning and losing to an athlete. So it may simply be that athletes notice the condition when other people overlook it. The other reason may be that the same underlying disease process goes unnoticed in non-athletes because they simply never exercise to the degree athletes do.
If you are an athlete and have this problem it is worth getting top-level specialist expertise to help you solve it. Just as you train to levels of fitness which ordinary people don't even think about, so it is worth getting the best advice to help you break the barrier which poorly treated exercise asthma can pose. Many Olympic gold medal winners have been asthmatic and have suffered from exercise-induced asthma. With the right help and self-discipline the problem can often be overcome.
Should people with asthma avoid exercise?
No, definitely not. In fact enjoyable exercise is even more important for someone with asthma than for other people.
Children with asthma have in the past often been asked to sit on the sidelines whilst their classmates played games and did sports. This is completely wrong if there is any reasonable way in which the child can be made fit enough to take part. What is true for children is also true for adults.
Asthma attacks are hard work. One of the dangers in an asthma attack is fatigue, which may make you weaken in your fight to breathe. Obviously it is good to have strong breathing muscles, because strong muscles tire less easily. Obviously the way to get strong breathing muscles is to take exercise. Far from being prevented from getting exercise, people with asthma should take as much exercise as they can enjoyably manage. With care and understanding this will be much more than most outsiders think possible. Good medications and intelligent use of the tricks for getting round the problem of exercise-induced asthma can achieve tremendous results.
What can I do about exercise-induced asthma?
You will already have picked up some useful clues. Swimming rather than running, warmer and moister air, warm-up by short periods of exercise, and getting into training can all help.
In Scandinavia cross-country skiers sometimes wear breathing masks which store the heat and moisture from the air they breathe out and then return it to the air they breathe in. This is helpful in avoiding exercise-induced asthma.
Good control of your asthma, whether by breathing in a 'preventer' treatment or by avoiding causes of asthma such as house dust mites and pets can have a tremendously helpful effect on exercise-induced asthma.
Reliever inhalers can be tremendously helpful if you use them just before you exercise. This applies especially to the so-called 'beta-2 stimulants' such as salbutamol (albuterol) or terbutaline. The benefit should last for hours.
Long-acting reliever inhalers are also very helpful; they just work for longer.
If you are a competitive athlete or sportsman, you may be concerned about disqualification because you use drugs. The good news is that all the ordinary asthma medicines, used in the medically recommended way and dosage, are acceptable to sporting bodies provided you use them correctly for asthma. The wise thing is to check with your sports authority or sports doctor.
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ssrpk wrote:
F) cromolyn Na+ (ideal for excercise induced asthma)
wrong answer !
Reliever inhalers can be tremendously helpful if you use them just before you exercise. This applies especially to the so-called 'beta-2 stimulants' such as salbutamol (albuterol) or terbutaline. The benefit should last for hours.
Long-acting reliever inhalers are also very helpful; they just work for longer.
The patient should be advised to use the albuterol or salbutamol before exercise. Avoid excessive use of sterioid which will disqualify the patient.
Armstrong and many athletics used steroid and other drugs for their medical problems so be careful to advise patients to use steroid among very competitive sports
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ssrpk wrote:
F) cromolyn Na+ (ideal for excercise induced asthma)
Cromolyn Na+ is never used as an acute treatment of asthma and how does cromolyn Na+ is ideal for exercise induced asthma, Dr. Ssrpk ????
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| MAZI
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i agree with AAAAA
the correct answer is BETA AGONIST BEFOR EXERCISE
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| drk1980
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This particular Q is from UW...but infact i made one slight change by including a 6th option.
Without this option, the correct answer to this Q is A) beta agonists. Read on...
However, in an explanation to another similar Q, UW makes the following statement:
"For patients who have asthma accompanied by other allergic disorders(rhinitis, eczema etc) mast cell stabilizers are the drugs of choice.
Additionally Kaplan notes have mentioned that esp. in the pediatric patients mast cell stabilizer is first line chronic treatment for exercise and allergic asthma.
So, keeping in line with the above, I would have argued (F) to be the correct answer.
Open to corrections.
A request: Please, lets keep these discussions as courteous as possible to make sure that everyone feels free to add their opinions and thoughts on the possible answers. Thank you very much!
BTW, Asthma Management shows up in a big way on the exam.
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| AAAAA
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American College of Physicians MKSAP 13 (2002) (The lates one just came out in 2006) stated the sources of official guidelines for treatment of asthma and exercise-induced asthma.
The National Asthma Educational and Prevention Program (NAEPP) published clinical practice in 1991 (naepp rEPORT).
The guidelines were updated in 2002 and are now employed around the world.
The guidelines and other useful information aboust asthma are available at the Web of the Global Initiative for Asthma (GINA)
http://www.ginasthma.com
Sources from NIH National Institutes of Health , National Institute of Asthma :
http://www.nhlbisupport.com/asthma/
The correct answer is albuterol.
F is the incorrect answer because the patient does not have more than 2 attacks per month and asymptomatic and normal PEF between exacerbations. Also exacerbated only by exercise.
F would NOT have been a correct answer .
Please refer to the official U.S. Government Health Agency guideliens.
I have mentioned those review books are very dangerous for USMLE !!!
Use American medical societies guideliens !!
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| AAAAA
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The correct answer is albuterol.
The source is Mayo Clinic. They did mentioned F
But A is the first line of treatment then F.
Read very carefully the following article.
Exercise-induced asthma: Avoid it with preventive medication
From MayoClinic.com
Special to CNN.com
Do you regularly cough and feel short of breath about five to 10 minutes into a good, heart-pumping workout? If so, you may have asthma. Your breathing problems during exercise are part of the underlying condition.
People with mild exercise-induced asthma may not realize that their symptoms go beyond the body's normal response to exertion. They blame their difficulty on being out of shape or short on endurance. The good news is that when your asthma is properly recognized and treated, you'll probably be able to exercise as much as you want.
Asthma and exercise: What's the connection?
Many people with asthma have bouts of wheezing and breathlessness when they exercise strenuously. This reaction is known as exercise-induced asthma or exercise-induced bronchospasm.
Exercise-induced asthma is not a distinct type of asthma. Instead, it is likely to occur in anyone who has the airway reactivity that underlies asthma. Your airways — the passages branching off your windpipe to carry air to and from your lungs — are reactive if they tend to narrow under certain circumstances, such as after exposure to an allergen or while you are suffering from a cold. The linings of reactive airways are prone to inflammation and excess mucus secretion as well.
Exercise-induced asthma: Who's at risk?
Because they're more active than adults, children are more likely to wind up at the doctor's to find out why they have trouble catching their breath when they play hard. Exercise-induced symptoms are often the tip-off that a child has asthma. Other triggers may become apparent over time.
At all ages, though, physical activity is a common cause of acute airway constriction — in other words, of asthma attacks. Only colds are more likely to cause asthma symptoms. Aerobic exercise, such as running or playing basketball, hockey or soccer, is more likely to trigger asthma symptoms than is weightlifting, golfing or moderate-paced walking. Swimming is aerobic, but because humidity is higher near water, your airways are more likely to stay open.
Asthma: Steps in diagnosis
Are regular asthma and exercise-induced asthma different conditions?
On a practical level, they're the same. About 90 percent of people with chronic asthma have exercise-induced asthma. And a subgroup of people with exercise-induced asthma — by some estimates, between 5 percent and 10 percent — have symptoms only when they exercise. Allergies, pet hair, respiratory infections — none of these common triggers causes asthma symptoms in this group.
Even so, exercise-induced symptoms are usually no different from those of asthma induced by other triggers. Typically, the symptoms appear during exercise, but they may not start until after. And asthma episodes related to exercise tend not to last as long as other asthma attacks.
Treating exercise-induced asthma
Because exercise-induced asthma has the same symptoms and results from the same airway reaction involved in regular asthma, standard asthma medications can control it. Depending on the severity and frequency of your symptoms, your doctor may prescribe:
A short-acting inhaled bronchodilator, such as albuterol (Proventil, Ventolin) or pirbuterol (Maxair), used 15 minutes before exercise to prevent symptoms for about four hours.
A mast cell stabilizer, such as cromolyn sodium (Intal) or nedocromil sodium (Tilade), used 15 to 60 minutes before exercise to prevent symptoms for about four hours.
A longer acting bronchodilator, such as salmeterol (Serevent Diskus) and formoterol (Foradil), taken 30 minutes before exercise to relieve symptoms for up to 12 hours.
A leukotriene modifier, such as montelukast sodium (Singulair) or zafirlukast (Accolate), for effects lasting up to 24 hours. These drugs are helpful in reducing airway inflammation when exercise-induced symptoms are a feature of chronic asthma.
If you wheeze whenever you exert yourself or if allergies and irritants also trigger your symptoms, your doctor may recommend that you use a corticosteroid inhaler such as triamcinolone (Azmacort) or fluticasone (Flovent) every day. These drugs reduce inflammation. In addition, you may need daily doses of a longer acting bronchodilator.
Medications and immunotherapy for asthma
Self-care for exercise-induced asthma
Make a habit of warming up and cooling down for at least 15 minutes before and after exercise. Avoid exercising outdoors in extremely cold temperatures or when pollen levels are high.
If you feel mild asthma symptoms coming on during a workout, try continuing your activity. Your symptoms may remain mild. Otherwise, if your doctor has prescribed an inhaler with a short-acting bronchodilator, pause and inhale two puffs, even if you have pretreated. You should breathe more easily within a few minutes. If you don't, stop exercising. Recurrent exercise-induced symptoms not relieved by a short-acting bronchodilator may mean you need to change your medication.
Other tips that may help reduce symptoms:
Do your best to stay free of colds and other respiratory infections. Refrain from strenuous exercise when you have a cold.
Choose a humid exercise environment such as a trail alongside a lake or stream or a gym with an indoor pool.
If allergies contribute to your asthma, use allergy medication as directed by your doctor, and avoid exercising anywhere you might be exposed to allergens.
Learn to breathe through your nose or through pursed lips as much as possible while exercising.
Wear a face mask during exercise.
With your doctor's help, you can control exercise-induced asthma. The benefits of regular exercise are too great to let asthma symptoms keep you from activities you enjoy.
November 23, 2005
© 1998-2006 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.com," "Mayo Clinic Health Information," "Reliable information for a healthier life" and the triple-shield Mayo logo are trademarks of Mayo Foundation for Medical Education and Research. Terms of Use.
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| AAAAA
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The Mayo Clinic did mention F but A comes first before F
Treating exercise-induced asthma
Because exercise-induced asthma has the same symptoms and results from the same airway reaction involved in regular asthma, standard asthma medications can control it. Depending on the severity and frequency of your symptoms, your doctor may prescribe:
A short-acting inhaled bronchodilator, such as albuterol (Proventil, Ventolin) or pirbuterol (Maxair), used 15 minutes before exercise to prevent symptoms for about four hours.
A mast cell stabilizer, such as cromolyn sodium (Intal) or nedocromil sodium (Tilade), used 15 to 60 minutes before exercise to prevent symptoms for about four hours.
A longer acting bronchodilator, such as salmeterol (Serevent Diskus) and formoterol (Foradil), taken 30 minutes before exercise to relieve symptoms for up to 12 hours.
A leukotriene modifier, such as montelukast sodium (Singulair) or zafirlukast (Accolate), for effects lasting up to 24 hours. These drugs are helpful in reducing airway inflammation when exercise-induced symptoms are a feature of chronic asthma.
If you wheeze whenever you exert yourself or if allergies and irritants also trigger your symptoms, your doctor may recommend that you use a corticosteroid inhaler such as triamcinolone (Azmacort) or fluticasone (Flovent) every day. These drugs reduce inflammation. In addition, you may need daily doses of a longer acting bronchodilator.
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http://www.mayoclinic.com
A short-acting inhaled bronchodilator, such as albuterol (Proventil, Ventolin) or pirbuterol (Maxair), used 15 minutes before exercise to prevent symptoms for about four hours.
A mast cell stabilizer, such as cromolyn sodium (Intal) or nedocromil sodium (Tilade), used 15 to 60 minutes before exercise to prevent symptoms for about four hours
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This comes from the world authroity on asthma and exercise-induced asthma.
Managing Exercise-Induced Asthma
WebMD Live Events Transcript
Event Date: Wednesday, August 18, 2004
Clifford Bassett, MD
Biography
If I use Proventil to keep airways open wouldn't I breathe in more allergens?
What type of exercise for those of us with a more severe disease?
How long after a major flare should I wait to exercise?
At what point should my kids take maintenance rather than rescue meds?
Experts agree that all but those with the most severe asthma should be able to participate in sports and exercise. The key is to manage your asthma instead of letting it manage you. Asthma expert Clifford Bassett, MD, joined us on Aug. 18, 2004, to discuss creating an asthma management plan that lets you in the game.
If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
MODERATOR:
Welcome, Dr. Bassett. With the emphasis on being active and fit, what challenges are presented by having asthma?
BASSETT:
About 7% of the U.S. population, or about 18 million Americans, are reported to suffer from asthma. With exercise, many individuals can experience asthma symptoms. Approximately 40% of patients with seasonal or indoor allergies may have exercise-induced bronchia spasm, otherwise known as exercise-induced asthma.
About 10% of nonasthmatics may also experience exercise-induced symptoms. These symptoms can include wheezing, chest tightness, coughing, chest pain, and also prolonged shortness of breath after beginning exercise. Other individuals may experience fatigue, as well as a decrease in their exercise performance due to this condition.
If you have asthma it's important to understand how to plan and deal with your breathing issues to allow you to participate in sports. Exercise-induced asthma can affect up to 20% of highly competitive or elite athletes, including many Olympic athletes. In the 1996 Olympic Games it was reported that up to 17% of the athletes had a history of asthma.
I'd like to take just a moment or two and give a couple tips that are quite useful when dealing with asthma and exercise"
If you have exercise-induced asthma, symptoms can be prevented by using a short-acting inhaler about 10 to 15 minutes prior to exercise. This will certainly help to ease any respiratory symptoms that should occur, and this form of treatment may last up to four to six hours.
It's also quite important to have an exercise warm-up from six to 15 minutes before beginning a full exercise program.
Dr. Clifford Basset:
Clifford Bassett, MD
Clifford Bassett, MD, an allergist/immunologist, is medical director of Allergy and Asthma Care of New York. He is also an assistant clinical professor of medicine affiliated with The Long Island College Hospital in Brooklyn and is on the faculty of the NYU School of Medicine.
Bassett is a diplomate of the American Board of Allergy and Immunology and is a fellow of the American Academy of Allergy, Asthma and Immunology (AAAAI). He is a member of the AAAAI Public Education committee and National Allergy Bureau and chairman for the PR Committee of the AAAAI. Bassett serves on the medical advisory board of the Allergy and Asthma Foundation of America. He is also on the executive committee of the NY Allergy & Asthma Society of Greater New York. He was appointed as a police surgeon and peace officer in New York State.
As an investigator in clinical trials, Bassett has published papers in the Journal of Allergy and Clinical Immunology, Annals of Allergy, Pediatrics, and Chest. He has co-authored a chapter in a leading textbook on food allergy.
He is an expert on seasonal/indoor allergies, mold allergies, asthma and air quality/urban air pollution issues, "World Trade Center cough" and health problems, pet allergies, asthma treatments, insect & tick bite prevention, smallpox vaccine risk factors, anthrax, SARS, and food allergy prevention and food labeling issues.
He has contributed to articles in the New York Daily News, New York Newsday, Time, New York Post, Baby Talk, Prevention, Bottom Line Health Newsletter, JAMA, Women’s World, Self, and USA Today. He has frequently contributed to various Internet-based medical information web sites and has been interviewed on local and national radio and television programs as an allergy and respiratory specialist, including NBC’s The Today Show, CBS’ The Early Show and CBS Evening News, World News Tonight, CNBC, Good Day New York, NBC Nightly News, MSNBC, Telemundo, and Bloomberg Radio Network.
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If you have exercise-induced asthma, symptoms can be prevented by using a short-acting inhaler about 10 to 15 minutes prior to exercise. This will certainly help to ease any respiratory symptoms that should occur, and this form of treatment may last up to four to six hours.
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How Is It Treated?
If your child has exercise-induced asthma, the doctor may recommend pretreatment, which means taking medication before exercise or strenuous activity. This medication is often the same fast-acting, short-term medication used during flare-ups, known as rescue medication, although in this case its function is preventative. By taking this medication before exercise, the airway narrowing triggered by exercise can be prevented.
If pretreatment isn't enough to control symptoms, the doctor may recommend that your child also use controller medication, which is usually taken regularly over time to reduce airway inflammation.
If, despite medication, your child still has breathing trouble during exercise, see your child's doctor. Your child's medication dosages may need to be adjusted for better control. Also, let your child's doctor know of any changes in your child's breathing trouble.
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Medical Issues/Complications
Although rare, as with any asthma attack, progression can result in status asthmaticus and even death. Treatment should be provided immediately and the situation taken seriously.
Consultations
Consultation is rarely available and is not needed in the acute attack on the playing field; however, access to the emergency medical system should be readily available.
Other Treatment
Treatment of the athlete experiencing an acute attack of EIA is the same as in any asthma attack. Immediate removal from competition or play is the first step. Immediate administration of a rapid onset, short-acting beta2-agonist (eg, albuterol) has the highest yield. The usual dose is 2 puffs of albuterol via a metered dose inhaler. If response is not satisfactory, transportation to an emergency facility should be initiated, as the attack may escalate. If available, use of any spacer device can help transport the medication to the area of greatest need, especially when an athlete is distracted in the midst of competition or anxious from dyspnea and unable to concentrate.
If initial treatment fails or is unavailable, immediate transfer to an acute care facility should occur. Subcutaneous epinephrine can be administered in such life-threatening situations.
Recovery Phase
Medical Issues/Complications
If the initial response to treatment was adequate, observation and monitoring need to continue for several hours, in case of relapse.
Consultations
If relapse is immediate, transportation to an emergency facility should be initiated.
Other Treatment (Injection, manipulation, etc.)
If mild residual symptoms persist after relief of the acute symptoms, repeat administration of albuterol is advisable. Recommended dosing interval is 4 hours.
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| AAAAA
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A;buterol has the highest yield and is the treatment for acute phase.
mast cell stabilizers are also used.
Have I given mast cells stabilizers ? ALL THE TIME !
But for acute EIA, I always recomment my patient , who are normally 15, 16 years old tomuse albuterol despite they are on a mast cell stabilizer !!!
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Treatment of the athlete experiencing an acute attack of EIA is the same as in any asthma attack. Immediate removal from competition or play is the first step. Immediate administration of a rapid onset, short-acting beta2-agonist (eg, albuterol) has the highest yield. The usual dose is 2 puffs of albuterol via a metered dose inhaler
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Cromolyn Sodium is NOT the incorrect answer in real life but is the wrong answer in the examination. And the effectiveness is only 80-90% !! (still very good)
Drug Category: Mast cell stabilizers
These agents are 70-80% effective in preventing bronchospasm during exercise. An additive effect is noted in combination with albuterol.
Drug Name Cromolyn sodium (Intal, Nasalcrom)
Description First or second-line agent in the prevention of EIA.
Adult Dose 2 puffs via metered dose inhaler 30-45 min preexercise
Pediatric Dose 1-2 puffs via metered dose inhaler 30-45 min preexercise
Contraindications Documented hypersensitivity
Interactions None reported
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Drug Category: Mast cell stabilizers
These agents are 70-80% effective in preventing bronchospasm during exercise. An additive effect is noted in combination with albuterol.
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