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Current time:0:00Total duration:6:41

Video transcript

so I've got a nice little chart here that tells us how to categorize how severe somebody's asthma is basically these three are persistent as you can see more than twice a week moderate is daily and severe is bad symptoms every day sometimes twice a day so here we've got severity scale and this scale I found is actually we can adapt it very little to make the scale for evaluating how well somebody is treated so TX is treatment the goal in treating asthma since we can't cure it is to control the symptoms and reduce the number of times basically we're trying to get them towards the intermittent stage so basically for someone to be well controlled the definition is very similar to the definition for intermittent so well-controlled would be less than two a week and ever more than once a day so less than or equal to one a day when they do have their attack so here you say happened once on Wednesday just once this person is okay their medication is working so next level is we say this patient is not well controlled don't let the colors confuse you I'm using green here just to match with this row here but not well controlled is not green it's not good so I'm going to write WC for well controlled and this one is defined as more than twice per week or even if they only have it twice a week more than once per day when they do have it so if they have it on Monday Tuesday Thursday Friday Sunday that's not well controlled that's five times a week or even if they only have Wednesday and Saturday said it only happened on these two days if they have it say two times on Wednesday or three times on Saturday that already pushes them that puts them in though not well controlled as well and then of course the last two here that's poorly controlled we're not even going to distinguish between them which is going to write poor and if you're the physician the person who's poorly controlled needs to go way up on their meds the prison was not well controlled also needs to go up on their meds soon terms of treatment first we've got two modes of delivering the drugs let's not worry about the drugs for an ounce talk about how it's delivered first we have a nebulizer we'll spell it out nebulizer now this needs this big machine here and it has a hose connected to a mask it's my very crude drawing of a medical mask person basically puts this mask on and the medication gets evaporated into mist in this machine and it's delivered with oxygen to the person takes about ten minutes they just sit there with their masks and breathe it in now this machine can be more expensive and you need electrical wiring for it and you need to stay in one place and it takes about 10 minutes so those are the drawbacks but it works very well alternatively I'm sure you've seen people use this we have the inhaler which is this l-shaped tube here with an opening and a button on top this person can push this button and the medicine squirts out here now the best way to use this is with a spacer because the medicine used to travel with the air and then a person puts their head here and hails this medication it takes about 30 seconds at most so this is an inhaler it is relatively cheap it's small I can fit in your pocket so it can go with patient anywhere so remember for each of these you can use multiple medications with it it just depends on what's more convenient for the patient so in terms of the drugs that we actually put in here there are a couple categories so first I want to talk about the drugs that decrease the inflammation inflammation is your body's natural reaction to something that's bothering it unfortunately what asthma inflammation gives us all these symptoms so we temper down the inflammation with drugs so first we've got steroids now steroids in the body that's naturally produced there can also fight inflammation but obviously it's not enough so we give artificial steroids to temper down the inflammation we've also got Luke of trying inhibitors this is a weird word it's just a mall gluco try in inhibitors so basically it stops that look of trying from having an effect on the body now the reason these two are related has to do with the way inflammation starts in the body so we have something a trigger in a leading to be leading to see getting to D all the way to the end we make leuco try and that's the goal of this whole cascade so of course to stop the inflammation we can either get rid of this or steroids comes in earlier and gets rid of an earlier stage in the Cascade so both of these drugs have the same goal which is to decrease the look of try and decrease the whole cascade from causing the symptoms that's one big class of drugs the other one is bronchodilators now Bronco is a away and dilator means increase the diameter or just open it up because asthma involves the clamping down or closing of the bronchial pathway now within here we have the beta agonists beta is a type of receptors in the body and in the lungs their job is to open it up so literally we relax the smooth muscle if this is asthma or right now with all this smooth muscle clamping down the beta agonist are is able to turn that into a nice open airway with the smooth muscle much more relaxed around here so we throw this drug at the beta 2 receptors on the airway there all of our lungs and they do different things in different parts of the body but here we care about bronchodilation there are other drugs that also do this for example we have vo Filene which is a drug that can be toxic to some people and we have to monitor the levels very carefully but it basically does the same thing of relaxing the smooth muscle and giving us a bigger airway so treatment can be kind of trial and error because our goal is just to go in this direction so whatever gets is there whatever combination of drugs the amount we just keep going up and keep adding drugs until we get to well controlled and that is the goal of our long term treatments for as