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This invention relates to a method for diagnosing and treating bronchial asthma and more particularly to a method and treatment based on categorizing bronchial asthma into three types and optimizing treatment based on the type of asthma encountered.
It has been reported that asthma is the number one chronic illness for children and is a significant cause of infants' deaths. It has also been reported that over twenty million Americans have asthma. It addition, it is well known that asthma is adversely affected by pollution. For this reason, there has been a significant increase in asthma cases in Kuwait since the Gulf War and the fire set in the Kuwait oil fields by the retreating Iraqi troops.
Bronchial Asthma typically causes decreased lung function, bronchial inflammation, coughing, wheezing and tightness in the chest. These problems are often exasperated by air born irritants such as smoke, exercise, viral infections etc. When a patient encounters such problems, it means that the individual's airway is obstructed and the lungs are not receiving sufficient air. Typically, the airways become obstructed due to the lining of the airways becoming irritated and swollen and because the airways tighten causing them to narrow.
With modern medicine, there are many treatments for asthma. However, most of the drugs prescribed have the potential for negative side effects. For example, asthma treatment can cause depression, dizziness, fatigue, impotence, liver damage etc. In addition, some medications are effective for some patients but less effective with others. Therefore, it is highly desirable to select the right treatment for the right patient.
The main idea of the new invention is to categorize the patient with Bronchial Asthma so you can give the right medication to the right patient thereby reducing side effects of the medication.
In essence the present invention contemplates a method for diagnosing and treating a patient with Bronchial Asthma. The method includes the step of classifying a patient's asthma into three types, namely Type I (a wet type), Type II (a dry type) and Type III (a mixed type). The Type I asthma is characterized by more production of mucus than bronco constriction while the dry type has more bronco spasm than mucus production. The mixed type is a mixture of the two i.e. Type I and Type II. A patient is then diagnosed as Type I, Type II or Type III based on an examination of the patient. For Type I, a patient is treated with a mucolyptic more than a bronco dilator or with a bronco dilator if Type II or some combination of the two if Type III.
In a preferred embodiment of the invention, the diagnosis is based on the onset of symptoms, severity of symptoms at the onset of the symptoms, chest findings, other allergy symptoms, X-ray findings, trigger factors and to a degree response to treatment and age of the patient. The treatment for the Type I asthma includes more use of a mucolyptic than a broncho dilator, and if a nebulizer is used it should include Bisolvon®, a bromhexine that is a synthetic derivative of vasicine. In essence the Bisolvon® is an expectorant i.e. mucus or phlem dissolving preparation. Small doses of a bronco dilator may also be used to open the passages to let the mucus pass. Cortisone is seldom used for such patients.
For those patients with the Type II asthma, they are treated with a bronco dilator and/or nebulizer with the addition of Atrovert, adrenaline and pulmicort if needed in measured amounts. This combination has given relatively quick response and is often effective in decreasing the use of a nebulizer. The treatment for Type III includes a combination of the treatments for Types I and II and is derived based on the physician's experience.
FIG. 1 a block diagram illustrating a method for categorizing different types of asthma in accordance with the present invention;
FIG. 2 is a block diagram illustrating a method for treating different types of asthma in accordance with the present invention;
FIG. 3 is a block diagram illustrating a method for diagnosing and treating asthma in accordance with the present invention; and
FIG. 4 is a block diagram illustrating the method for diagnosing and treating asthma in accordance with the present invention.
A diagnostic method and method for treating patients with Bronchial Asthma will now be described in connection with FIGS. 1-3. As illustrated in FIG. 1, a diagnostic method 20 includes a step 22 of dividing or categorizing asthma into three types i.e. Type I (wet type) as indicated by box 24, Type II (dry type) as indicated by box 26 and Type III (mixed type) as indicated by box 28. The division of the three types is based on differences in symptoms.
The criteria for diagnosing the different types of asthma were developed based on the examination and treatment of numerous patients. The criteria are based on the age of the patient, the age at initial attack (onset of the presentation) or the severity of the initial attack(s), chest findings, evidence of other symptoms as well as the results of any previous treatments tried and used.
Differences in chest findings for the different types of Bronchial Asthma are described as follows: Type I (wet type)—chest examination will reveal a bubbled sound,
Type II (dry type)—there will be flaring of alae nasi, and using accessory muscles of respiration, prolonged expiratory phase and wheezes and in Type III (mixed type), we could find the mixture of symptoms of both types.
Evidences of other symptoms are likewise outlined here. In Wet Type I, the baby will usually present with a blocked nose, less likely to have allergic symptoms and cough throughout the day. In Dry Type II, the child will be very distress, manifesting allergic symptoms like allergic rhinitis, eczema which may precede or come later and continuous cough throughout the day but usually more severe during the night.
To expound further on the result of any previous treatment tried and used, it is understood that Bronchial Asthma was not recognized before as a heterogenous disease thus it was treated as only one disease using cough syrup and a bronchodilator. Although some authors were against giving mucolytics, some others were giving mucolytics because it was not clear to them that Bronchial Asthma is not just one disease. As some were against, others may be giving mucolytic with a bronchodilator. Most of available medications for treatment of Bronchial Asthma is recategorize according to the types of Bronchial Asthma and this gives good results because the right treatment id given to the right patient.
Before the new invention, all kinds of bronchial asthma were treated the same and it is divided into its Acute Stages:
During Acute Stage:
As Prophylaxis:
This is decided according to severity, age of patient and available medication
These were what were used to be given before for all children with Bronchial Asthma but with the new invention:
The Wet Type:
During Acute Stage:
In addition to the above X-ray findings, trigger factors and responses to further treatment are considered. The following are the usual x-ray findings:
The Type I asthma sometimes referred to as the Wet Type and is typically characterized by the following symptoms as indicated by box 32. The symptoms include the age of the patient. For example, Type I asthma is typically found in younger patients from 0 to 1 year old. The type I asthma is also characterized by less distress during an attack (presentation) and chest findings that show bubbled lungs, few wheezes during an attack and lack of allergic symptoms. Additional symptoms include the finding that the patient rarely need prophylactics like Singular (11) if needed and their x-rays show a hazy white lung field. Further, there are no clear triggering factors and the patient usually shows a relatively quick response to proper treatment for Type I asthma.
The symptoms for Type II asthma are typically found in an older age group i.e. those are usually from 1 to 5 years of age but can also occur later on and are further characterized by prolonged expiratory phases and lots of wheezes. Additional symptoms of the Type II asthma relate to the use of accessory muscles for breathing and evidence of other allergies.
A number of patients that exhibit evidence of both Type I and Type II asthma are categorized as Type III i.e. a Mixed Type of asthma. Unless patients' symptoms that are predominantly categorized as Type I or Type II they are classified as a Type III or mixed type asthmatic. Usually the following symptoms occur for the Dry Type II patients; severe distress on presentation, flaring alae nasi, using accessory muscles of respiration, with or without cyanosis, inability to continue the sentences spoken, cough mainly at night, runny nose and could be preceded by a viral infection, exercise and they could also have eczema.
Having characterized the types of asthma and the symptoms of each type, a physician is better prepared to examine and treat a patient, which is defined as a treatment method 40. In the treatment method 40, a physician reviews a patient's medical history and examines the patient and conducts a conventional examination of the patient in step 42. After examining the patient, the physician characterizes the patient's asthma as Type I in box 44, Type II in box 46 or Type III as indicated by box 48. After characterizing the type of asthma experienced by the patient in boxes 44, 46 and 48, the physician considers the appropriate treatment as set forth in boxes 50, 52 and 54 and prescribes an appropriate regime for the patient as indicated by box 56.
The treatment for Type I Asthma includes the use of mucolytic such as Mucosolvan (12), Prospan (13), Bisolvon (1) and Tuscalman (14) more so than bronchodilators. Bronchodilators which acts as mainstay on nebulization are Ventolin (6) and Atrovent (3). In those cases where a nebulizer is called for, an addition of Bisolvon (I) (bromhexine or its equivalent) to dissolve the mucus may be added based on the physician's experience. The physician may also add small doses of a bronchodilator such as Atrovent (3) and Ventolin (6) to let the mildly constricted airways open up and let the mucus pass. In Type I asthma, cortisone is rarely used as re prophylactics.
Hypothetical Patient Type I
| Mouth: | oral trash | |
| Ear: | no abnormality detected | |
| Nose: | blocked | |
| Chest: | bubbled lung, no wheezes | |
| Abdomen: | intact | |
| CVS: | intact | |
| CNS: | intact | |
Baby was diagnosed to have Bronchial Asthma Type I. She was given the following treatment:
The treatment of Type II asthma typically includes the use of a bronchodilator as a cornerstone of treatment. Such bronchodilators may be administered orally but mostly by nebulizers particularly in an acute stage. These bronchodilators are given either thru nebulization such as Atrovent (3), Ventolin (6) or Adrenalin (4) or as orally using Bricanyl (8), Berotec (9) or Ventolin (6). Cortisones may also be used through inhalation using Pulmicort (5) and oral steroid such as Decadron (2). Prophylactics used for this type are inhaled steroid and Singular (11).
An example of a Hypothetical patient having Type II asthma and their treatment follows:
Hypothetical Case, Type II
Mosa is a 5 year old boy, he was presented to my clinic with distress, severe cough that he could not sleep last night after he was exposed to a sandstorm. Last night, the child is restless with flaring alae nasi, using his accessory muscles or respiration, mildly cyanotic, afebrile, HR (100/min), high RR and a congested throat
Chest
Others
He was given hydrocortisone injection with a dose of 50 mg new nebulization are Atrovent (3) and Pulmicort (5) with Adrenalin (4). He was diagnosed to have attacks of Bronchial Asthma, Type II (Dry Type) he was given cough syrup.
Bronchodilator in nebulization for 2-3 days followed by oral Bronchodilator like Bricanyl (8) or Berotec (9) and cortisone (Decadron) (2). This boy used to have a frequent attacks of Bronchial Asthma. Last attack was before 2 weeks so he needs to take prophylaxis like Singular (11) tablets or Pulmicort (5) nebulization solution according to the discussion with the mother.
The treatment of Type III asthma presents a greater challenge to the physician. With symptoms of Type I and Type II asthma present, it is necessary to use a balance treatments from each type and find a treatment that fits the need of a specific patient. For example, a treatment of a hypothetical patient based on a compilation of studies of patients with Type III asthma is as follows:
Hypothetical Case Type III
Mohesen is 1.2 month old boy who was presented with a cough and running nose for one week. Clinical presentation mild to moderate distress, afebrile, chest findings is a mix of bubble lung and wheezes. He took 2 doses of nebulization (Atrovent (3), Ventolin (6)) and continued a bronchodilator and cough syrup like Sinecod (15).
The practice of a preferred embodiment of the present invention will now be described in connection with FIG. 3. As shown in FIG. 3, a physician characterizes the three types of asthma as indicated in box 60 based on the symptoms for each of the three types as indicated in box 62. The physician also identifies the treatment which were generally most effective for each of the three types of asthma as indicated by box 64. As indicated by box 66, with the above mental background, the physician conducts a conventional examination of a patient including review of the patient's medical history and prescribes an appropriate treatment as indicated by box 68. Following this, the physician follows up on the results of the treatment as indicated in box 70 and if necessary modifies the treatment.
5. Pulmicort nebulizer solution (budesonide)
| Suitable Doses: (Kg) | Dosage | |
| 4 | 1 ml × 3 | |
| 6 | 1.5 ml × 3 | |
| 8 | 2 ml × 3 | |
| 10 | 2.5 ml × 3 | |
| 12 | 3 ml × 3 | |
| 14 | 3.5 ml × 3 | |
| 16 | 4 ml × 3 | |
| 18 | 4.5 ml × 3 | |
| 20 | 5 ml × 3 | |
| 24 | 6 ml × 3 | |
| 28 | 7 ml × 3 | |
| 32 | 8 ml × 3 | |
| 36 | 9 ml × 3 | |
| 40 | 10 ml × 3 | |
If an adequate response is not obtained with this dose, the dose may be doubled, provided adverse reactions are not pronounced
The dose should be titrated to the lowest dose t which effective control of asthma is maintained
It should be taken regularly even when asymptomatic. Onset of therapeutic effect is within 4 to 7 days
While the invention has been described in connection with its preferred embodiment it should be recognized that changes and modifications can be made therein without departing from the scope of the appended claims.