Management of chronic asthma in childrens

Adult and child over 5 years	Child under 5 years
Step 1: occasional relief broncodilator Inhaled short-acting beta2 agonist as required (up to once daily) Note:Move to step 2 if needed more than twice a week, or if night-time symptoms more than once a week, or if exacerbation in the last 2 years requiring systemic corticosteroid or nebulised bronchodilator.	Step 1: occasional relief bronchodilator Short-acting beta2 agonist as required (not more than once daily) Note Preferably by inhalation (less effective and more side-effects when given by mouth) Move to step 2 if needed more than twice a week, or if night-time symptoms more than once a week, or if exacerbation in the last 2 years
Step 2: regular inhaled preventer therapy Inhaled short-acting beta2 agonist as required plus Regular standard-dose inhaled corticosteroid (alternative are considerably less effective)	Step 2: regular preventer therapy Inhaled short-acting beta2 agonist as required plus Either regular standard-dose  inhaled corticosteroid Or (if inhaled corticosteroid cannot be used) leukotriene receptor antagonist
Step 3: inhaled corticosteroid + long-acting inhaled beta2 agonist Inhaled short-acting beta2 agonist as required plus Regular standard-dose inhaled corticosteroid plus Regular inhaled long-acting beta2 agonist (salmeterol or formoterol) If asthma not controlled Increase dose of inhaled corticosteroid to upper end of standard dose range and Either stop long-acting beta2 agonist if of no benefit Or continue long-acting beta2 agonist if of some benefit If asthma still not controlled and long-acting beta2 agonist stopped, add one of Leukotriene receptor antagonist Modified-release oral theophylline Modified-release oral beta2 agonist	Step 3: add-on therapy Child under 2 years: Refer to respiratory paediatrician Child 2–5 years: Inhaled short-acting beta2 agonist as required plus Regular inhaled corticosteroid in standard dose plus Leukotriene receptor antagonist
	Step 4: persistent poor control Refer to respiratory paediatrician Stepping down Regularly review need for treatment
Step 4: high-dose inhaled corticosteroid + regular bronchodilators Inhaled short-acting beta2 agonist as required with Regular high-dose inhaled corticosteroid plus Inhaled long-acting beta2 agonist plus In adults 6-week sequential therapeutic trial of one or more of ·         Leukotriene receptor antagonist ·         Modified-release oral theophylline ·         Modified-release oral beta2 agonist Step 5: regular corticosteroid tablets Inhaled short-acting beta2 agonist as required with Regular high-dose inhaled corticosteroid and One or more long-acting bronchodilators (see step 4) plus Regular prednisolone tablets (as single daily dose) Note:In addition to regular prednisolone, continue high-dose inhaled corticosteroid (in exceptional cases may exceed licensed doses); these patients should normally be referred to an asthma clinic.	Standard-dose inhaled corticosteroids (given through a metered-dose inhaler and in children a large-volume spacer): Beclometasone dipropionate or budesonide 100–400 micrograms twice daily; child under 12 years 100–200 micrograms twice daily Fluticasone propionate 50–200 micrograms twice daily; child 4–12 years 50–100 micrograms twice daily Mometasone furoate (given through a dry-powder inhaler) 200 micrograms twice daily, Alternatives to inhaled corticosteroid are leukotriene receptor antagonists, theophylline, inhaled cromoglicate, or inhaled nedocromil. High-dose inhaled corticosteroids (given through a metered-dose inhaler and a large-volume spacer): Beclometasone dipropionate or budesonide 0.4–1 mg twice daily; child 5–12 years 200–400 micrograms twice daily Fluticasone propionate 200–500 micrograms twice daily; child 5–12 years 100–200 micrograms twice daily. Mometasone furoate (given through a dry powder inhaler) 200–400 micrograms twice daily. Note. Doses of inhaled corticosteroids here are for CFC-containing metered-dose inhalers; dose adjustments may be required for other inhaler devices. Failure to achieve control with these doses is unusual.Lung-function measurements cannot be used to guide management in those under 5 years

Health and computers

Computer has revolutionized the human’s life and they are used as bio part of the body i.e to control and  synchronize body part and their movements through thoughts.

Scientist has discovered a new technique  that use a skullcap fitted with  sensors that recognized the brain commands and send them through computers to the machines, this technique is further refined by the scientist of Maryland that allow the person to allow the 3D movements of hands, arms, knees and hip joints to be produced.

Sweating and weight loss

Many people think that with increasing perspiration they are losing weight......Yes it is true that when you perspire you lose weight.

It is actually the water that you are losing through perspiration, but remember that your body in healthy state is very good at balancing the amount of water you hold.

When you sweat,  you  lose a lot of water in the form of perspiration, next time you drink water to compensate this lost water. so the water lost through sweating is recovered.

This is not to say that you should not sweat if you are sweating it means that you are exercising, and if you are exercising it means that you are burning calories, and this burning of  calories unlike sweating  would cause permanent weight loss.

Coffee and blood pressure

Many of  us would be unaware of the effect that coffee may be dangerous in hypertensive  people. It is fact that coffee can increase your systolic  and diastolic blood pressure even if you don't have  high blood pressure. Actually coffee contains caffeine that is the main constituent that increase the blood pressure.

Mechanism:
there are many possible mechanisms for  this increase in blood pressure, one is that caffeine block the hormone that  keeps your arteries dilated.Other thinks that is causes release of  epinephrine and nor epinephrine from adrenal glands that cause elevation in blood pressure.

Treatment of gout

Treatment of Gout

• Drug mostly Used are:

1. NSAIDs (Asprin should be avoided as it can increase plasma urate at some conc.)
2. Colchicine
3. Allopurinol
4. Uricosuric Agents
For Acute inflamation
1. Indomethacin
2. Colchicine
3. Cortiosteroid for resistant episodes of gouts
Prophylactic Treatment
1. Allopurinol
2. Uricosuric Agents
Colchicine
Colchicine is an anti-inflamatory drug without anelgesic properties.

Prescription symbol

 

"The symbol "Rx" meaning "prescription" is a transliteration of a symbol resembling a capital R with a cross on the diagonal.

NATIONAL ESSENTIAL DRUGS LIST OF PAKISTAN

i
NATIONAL ESSENTIAL DRUGS LIST OF PAKISTAN
             Ministry of Health
          Government of Pakistan
                   Islamabad
                      2003
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NATIONAL
ESSENTIAL DRUGS
LIST
iii
CONTENTS
PREFACE…………………………………….……………… vii
NATIONAL ESSENTIAL DRUGS LIST
THIRD REVISION