Supplemental Reading

Bisgaard H. Pathophysiology of the cysteinyl leukotrienes and effects of leukotriene receptor antagonists in asthma. Allergy 2001;56 Suppl 66:7-11.

Bryan SA, Leckie MJ, Hansel TT, and Barnes PJ. Novel therapy for asthma. Expert Opin Invest Drugs 2000;9:25-42.

Fahy JV, Corry DB, and Boushey HA. Airway inflammation and remodeling in asthma. Curr Opin Pulmon Med 2000;6:15-20.

Hall IP. Genetics and pulmonary medicine. 8: Asthma. Thorax 1999;54:65-69.

Kelly HW. Asthma pharmacotherapy: Current practices and outlook. Pharmacotherapy 1997;17:13S-21S.

Kips JC and Pauwels RA. Long-acting inhaled beta2-agonist therapy in asthma. Am J Respir Crit Care Med 2001;64:923-932.

Kips JC, Peleman RA, and Pauwels RA. The role of theophylline in asthma management. Current Opin Pulmon Med 1999;5:88-92.

Levy BD, Kitch B, and Fanta CH. Medical and ventila-tory management of status asthmaticus. Intensive Care Med 1998;24:105-117.

Second Expert Panel on Management of Asthma. Guidelines for the diagnosis and management of asthma. Bethesda, MD: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung and Blood Institute, 1997.

Williams DM. Clinical considerations in the use of inhaled corticosteroids for asthma. Pharmacotherapy 2001;21:38S-48S.

Case Study Drug Interactions

A 67-year-old man arrives at the emergency department complaining of excessive bleeding from minor shaving cuts and bruising for no apparent reason. Although the signs are alarming to the patient, the intern on duty does not view them as particularly serious. Upon taking the patient's history, the intern learns that for the last 5 years the patient has been taking warfarin for atrial fibrillation. In addition, the patient has had asthma since childhood. About 3 weeks ago the asthma symptoms were increasing in frequency and severity, prompting his pulmonologist to prescribe oral theo-phylline on top of the inhaled corticosteroid and (3-adrenoceptor agonist that the patient was already taking. This new regimen seems to be controlling the asthma well. What is the most appropriate treatment for this patient?

Answer: The key event in this patient's recent history is the addition of theophylline to his asthma regimen. Theophylline interferes with the metabolism of warfarin, and elevated warfarin levels can cause bleeding. Moreover, orally administered theo-phylline is notorious for producing widely variable plasma concentrations. Warfarin levels should be monitored in this patient, and his warfarin dosages should be adjusted accordingly. Withdrawing warfarin completely or administering vitamin K is not necessary, as the bleeding complications are not severe. Moreover, these actions could precipitate adverse clotting events (e.g., transient ischemic attack). Withdrawing asthma medication could impair asthma control. Pulmonary function tests are not necessary, as the patient's asthma symptoms are adequately controlled.

Coping with Asthma

Coping with Asthma

If you suffer with asthma, you will no doubt be familiar with the uncomfortable sensations as your bronchial tubes begin to narrow and your muscles around them start to tighten. A sticky mucus known as phlegm begins to produce and increase within your bronchial tubes and you begin to wheeze, cough and struggle to breathe.

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