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Anaphylaxis quizlet
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Title of article is A Study of Safety and Efficacy of CNTO 148 in Patients with Severe Persistent Asthma (ClinicalTrials.gov, 2013). The official title is A Phase 2, Multicenter, Randomized, Double-Blind, Placebo-controlled, Parallel-group, Dose-ranging Study Evaluating the Efficacy and Safety of CNTO 148 Administered Subcutaneously in Symptomatic Subjects with Severe Persistent Asthma.
a. Purpose of the study
The purpose of this study is to evaluate the effectiveness and safety of CNTO 148 (golimumab) in patients with severe persistent asthma. This is a multicenter, randomized (the study medication is assigned by chance), double-blind (neither physician nor patient knows the treatment that the patient receives), placebo-controlled (an inactive
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Patient inclusion criteria
• Physician diagnosis of asthma for greater than or equal to 3 years and a diagnosis of severe persistent asthma forgreater than or equal to 1 year to screening
• Continuous treatment with high dose Inhaled corticosteroids (ICS) and long acting beta-agonist for at least 3 months prior to screening
• Have evidence of at least 1 of the following in the 5 years prior to screening or during screening, reversible airway obstruction greater than or equal to 12 percentage change in forced expiratory volume in 1 second (FEV1) postbronchodilator; Diurnal variation in peak expiratory flow rate (PEFR) greater than or equal to 30 percentage change) and airway hyperresponsiveness
• Estimated frequency of symptoms on more than one-third of days for at least 3 months prior to screening (e.g., wheezing, breathlessness, chest tightness, cough, nocturnal awakening) despite treatment with high dose ICS and long-acting ß2-agonist (LABA) with or without continuous oral
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Disadvantages is anaphylaxis. “Subcutaneous allergen immunotherapy, the oldest biologic agent in current use, has the highest of frequency of the most serious and life-threatening reaction, anaphylaxis. It is also one of the only disease modifying interventions for allergic rhinitis and asthma” (Cox, 2009).
f. Your opinion on the research value of this study to advance patient care.
Golimumab was used on 309 patients with asthma. Monthly SC injections of either placebo or golimumab at 50, 100, or 200 mg doses were administered through week 52. Efficacy was assessed from the change from baseline in the prebronchodilator percent-predicted forced expiratory volume 1 (FEV1) and the number of severe exacerbations at week 24. However, no significant changes were observed in these measures, and the agent was found to have an unfavorable risk-benefit profile in this patient population (Mazumdar & Greenwald,
Asthma is a chronic inflammatory disease of the airways. It is a reversible airway obstruction, occurring 8 to 10% of the population worldwide. According to a study in 2005, asthma affects over 15 million Americans, with more than 2 million annual emergency room visits. Asthma patients have a hyper-responsiveness in their airways and generally and increase in their airway smooth muscle cell mass. This hyperplasia is due to the normal response to the injury and repair to the airway caused by exacerbations. The main choice of therapy for asthma patients is β2- adrenergic agonists. Racemic albuterol has been the drug of choice for a short acting bronchodilator for a long time, but since the development of levalbuterol, there is the question of which drug is a better choice for therapy. Efficacy and cost of treatment must both be taken into consideration in each study of these therapies to determine which is best for the treatment of asthma.
In the article "The Effect of Theophylline and ß2 agonists on Airway Reactivity" it says that more airway responsiveness occurs in asthma, chronic bronchitis, cystic fibrosis, and other diseases. Theophylline and ß2 agonists are used commonly for maintenance therapy for symptoms associated with the increased responsiveness. Both can reduce airway responsiveness to a variety of chemical irritants.. (Ahrens 15S)
Oxygen, inhaled bronchodilators, inhaled steroids, combination inhalers, oral steroids, phosphodiesterase-4 inhibitors and theophylline are effective medications for COPD (Mayo Clinic, 2016). “Patients with COPD have persistent high levels of CO2, their respiratory centers no longer respond to increased levels of CO2 by stimulating breathing. Therefore, COPD patients with more severe hypoxemia are at higher risk of CO2 retention from uncontrolled CO2 administration” (Van Houten, p. 13). For nurses, “It is important to administer the lowest amount of O2 necessary to patients” (Van Houten, p. 13). Some COPD medicines are used with inhaler and nebulizer devices. It is important to teach patients how to use these devices correctly. (Potter & Perry,
Carone M, D. C. ( 2007). Clinical Challenges In COPD[e-book]. (Oxford: Clinical Pub) Retrieved March 24, 2014, from (EBSCOhost).
It is used as a bronchodilator in the treatment of asthma. It is also frequently administered in asthma inhalers as the primary active drug of the inhaler. The use of Clenbuterol as a medication for asthma is primarily a European medical practice while in North America, Clenbuterol’s sister compound “Albuterol”, is utilized instead. The activation of beta-2 receptors in the cell-lining of the bronchial tubes initiates the opening and expansion of the airways (bronchial dilation) in the nose, throat and lungs. Many sympathomimetic stimulants exert this effect however Clenbuterol and Albuterol are better effective in particular for this purpose. Clenbuterol is also used in the treatment of other medical conditions, such as cardiovascular shock, heart arrhythmias, hypertension, allergic reactions and swelling, migraine headaches, anaphylactic shock and histamine
The practical application of healthcare system requires certain type of training and ability of an individual to work in that particular setting; moreover, these training modules, which are available for nurses, are primarily for the purpose of enhancing the quality of work, satisfaction and quality of treatment. The role of a Registered Nurse cannot be neglected in the provision of quality and safe care to patients and adopt procedures adequate for the condition of the patients because they work at the front line level. Registered Nurses have direct dealing with patients and integration of personal and professional skills is necessary. Therefore, there are certain attributes that are necessary to be present in a Registered Nurse for accurately performing various tasks. These include; Workload management, leadership qualities, control of practice, professional development, communication and organizational loyalty (Daly & Carnwell 2003, pp. 158-167). These attributes hold significance in terms of obtaining positive outcome for not only the Registered Nurse but also the organization and the patient. Workload should be managed in such a way that the care process is not affected. Registered Nurse should have leadership qualities to help, motivate and inspire other nurses. Similarly, a Registered nurse should also enable and promote learning opportunities for other nurses. A Registered Nurse has responsibilities towards the subordinates, patients and most importantly to the organization. The code of ethics and principles of practice must be followed and the practice of the nurse should be in the line of the organization’s working principles. The responsibility should be met as accountability f...
CB is a 57-year-old male presents to your clinic for cough for past two months. States he has been having some shortness of breath when going up stairs. Denies any fevers or congestion, denies any chest pain or recent travel outside US. Patient states he does smoke ½ to 1 pack per day for the past 30 years. Patient does have history of HPTN and Hyperlipidemia which are controlled with medication. VS 130/78; rr 18; pulse ox 96%, hr 88.
Asthma is a condition of the bronchial tubes characterized by episodes of constriction and increased mucous production. A person with asthma has bronchial tubes that are super sensitive to various stimuli, or triggers, that can produce asthma symptom.In other words, asthmatics have special sensitivity that causes their lung tissue to react far more than is should to various stimulating factors or triggers. For this reason, people with asthma are said to have "twitchy airways."Some symptoms that people with asthma commonly experience are chest tightenings, difficulty inhaling and exhaling, wheezing, production of large amounts of mucous in their windpipes and coughing.Coughing can be frequent or intermittent, and can be loose-reflecting extra mucous secretion in the airways or dry and deep-reflecting tight bronchospasms. Not all these symptoms occur in every case of asthma.Sometimes people may have coughing without and symptoms for months or even years before it's realized that they are asthmatic. Interestingly enough, asthma symptoms are most severe at night, while we're lying down our airways narrow as a result of gravity changes. Also our lungs do not clear secretions as well at night, which leads to mucous retention, and that can increase the obstruction to air flow.
Asthma is a serious ongoing disease that affects the airways of both adults and children.5 It is a type of inflammatory disease in your lungs with multiple triggers which may include the flu, indoor allergies, pets, dust mites, exercise, and tobacco smoke. Asthma has been recognized since ancient Egyptian times. Researchers found prescriptions written in hieroglyphics. Aretaus of Cappadonia an ancient Greek master clinician wrote the initial clinical description of asthma. Aaezein is the Greek word from which the current medical term Asthma come. The original Greek term mean ' sharp breath'. There are many people who have this chronic disease. Approximately 7.1 million children are diagnosed, and 18.9 million adults; 8.2 percent of the population of the United States.
Asthma is a disease that affects the breathing passages of the lungs (bronchioles). People who have asthma always have difficulty breathing. In the United States alone, over twenty-five million Americans are diagnosed with asthma. According to the Centers for Disease Control and Prevention (CDC), asthma is known to be the third most common disease as well as a leading cause to hospitalization in America. In 2008, one in two people were reported to have asthma attacks which is roughly about twelve million asthma attacks a year. In 2007, the United States spent more than fifty-six million dollars on medical costs, lost school and work days, and early deaths from asthma. Asthma is not visible to the human eye, so it is difficult in an emergency situation for the lay responder to tell whether the victim is having trouble breathing or having an asthma attack. Unlike people who are diabetic and have to wear medical ID bracelets, people with asthma are not required to wear them, but it should be recommended to help the lay responder, the doctors and the paramedics identify the situation they are dealing with at hand. For hours, days or even months a person may be normal but then an attack may suddenly happen out of nowhere.
Most of you may not think of asthma as a killer disease, yet more that 5,000 Americans die of asthma each year. According to the Mayo Clinic web page, asthma also accounts for more that 400,000 hospital discharges annually. As the number of people with asthma increases, the more likely you are to come in contact with a person who has the disease. As far as I can remember, I have had asthma my whole life. My mother and one of my sisters also have asthma, so I have a first hand experience with it. This morning, I will discuss some interesting facts about asthma, I will specifically focus on what it is, warning signs, symptoms, causes, and the treatments that are used.
Chronic obstructive pulmonary disease (COPD) is preventable disease that has a detrimental effects on both the airway and lung parenchyma (Nazir & Erbland, 2009). COPD categorises emphysema and chronic bronchitis, both of which are characterised by a reduced maximum expiratory flow and slow but forced emptying of the lungs (Jeffery 1998). The disease has the one of the highest number of fatalities in the developed world due to the ever increasing amount of tobacco smokers and is associated with significant morbidity and mortality (Marx, Hockberger & Walls, 2014). Signs and symptoms that indicate the presence of the disease include a productive cough, wheezing, dyspnoea and predisposing risk factors (Edelman et al., 1992). The diagnosis of COPD is predominantly based on the results of a lung function assessment (Larsson, 2007). Chronic bronchitis is differentiated from emphysema by it's presentation of a productive cough present for a minimum of three months in two consecutive years that cannot be attributed to other pulmonary or cardiac causes (Marx, Hockberger & Walls, 2014) (Viegi et al., 2007). Whereas emphysema is defined pathologically as as the irreversible destruction without obvious fibrosis of the lung alveoli (Marx, Hockberger & Walls, 2014) (Veigi et al., 2007).It is common for emphysema and chronic bronchitis to be diagnosed concurrently owing to the similarities between the diseases (Marx, Hockberger & Walls, 2014).
The clinical manifestation one may see in patients with chronic bronchitis are chronic cough, weight loss, excessive sputum, and dyspnea. Chronic cough is from the body trying to expel the excessive mucus build up to return breathing back to normal. Dyspnea is from the thickening of the bronchial walls causing constriction, thereby altering the breathing pattern. This causes the body to use other surrounding muscles to help with breathing which can be exhausting. These patients ca...
Nursing Diagnosis I for Patient R.M. is ineffective airway clearance related to retained secretions. This is evidenced by a weak unproductive cough and by both objective and subjective data. Objective data includes diagnosis of pneumonia, functional decline, and dyspnea. Subjective data include the patient’s complaints of feeling short of breath, even with assistance with basic ADLs. This is a crucial nursing diagnosis as pneumonia is a serious condition that is the eighth leading cause of death in the United States and the number one cause of death from infectious diseases (Lemon, & Burke, 2011). It is vital to keep the airway clear of the mucus that may be produced from the inflammatory response of pneumonia. This care plan is increasingly important because of R.M.'s state of functional decline; he is unable to perform ADL and to elicit a strong cough by himself due to his slouched posture. Respiratory infections and in this case, pneumonia, will further impair the airway (Lemon, & Burke, 2011). Because of the combination of pneumonia and R.M's other diagnoses of lifelong asthma, it is imperative that the nursing care plan of ineffective airway clearance be carried out. The first goal of this care plan was to have the patient breathe deeply and cough to remove secretions. It is important that the nurse help the patient deep breathe in an upright position; this is the best position for chest expansion, which promotes expansion and ventilation of all lung fields (Sparks and Taylor, 2011). It is also important the nurse teach the patient an easily performed cough technique and help mobilize the patient with ADL's. This helps the patient learn to cough and clear their airways without fatigue (Sparks a...
Asthma is a disease that currently has no cure and can only be controlled and managed through different treatment methods. If asthma is treated well it can prevent the flare up of symptoms such as coughing, diminish the dependence on quick relief medication, and help to minimize asthma attacks. One of the key factors to successful treatment of asthma is the creation of an asthma action plan with the help of a doctor that outlines medications and other tasks to help control the patient’s asthma ("How Is Asthma Treated and Controlled?"). The amount of treatment changes based on the severity of the asthma when it is first diagnosed and may be the dosage may be increased or decreased depending on how under control the patient’s asthma is. One of the main ways that asthma can be controlled is by becoming aware of the things that trigger attacks. For instance staying away from allergens such as pollen, animal fur, and air pollution can help minimize and manage the symptoms associated with asthma. Also if it is not possible to avoid the allergens that cause a patient’s asthma to flare up, they may need to see an allergist. These health professionals can help diagnosis what may need to be done in other forms of treatment such as allergy shots that can help decrease the severity of the asthma ("How Is Asthma Treated and Controlled?").