Die Struktur von Tadalafil erlaubt eine selektive Bindung an die Bindungsstelle der PDE5 und minimiert gleichzeitig die Interaktion mit PDE6, was visuelle Nebenwirkungen einschränkt. Seine Verteilung im Organismus erfolgt breit, wobei das Verteilungsvolumen etwa 63 Liter beträgt. Über 90 % des Wirkstoffs sind an Plasmaproteine gebunden. Die Wirkung bleibt unabhängig von der Nahrungsaufnahme konstant. Der Abbauweg über CYP3A4 kann durch Hemmer wie Ritonavir oder Ketoconazol verlangsamt werden, was die Plasmakonzentrationen deutlich erhöht. In diesem Kontext wird cialis 20mg preis häufig in Bezug auf pharmakokinetische Wechselwirkungen erwähnt.

Asthma

Asthma may develop at any age, although the majority of people are diagnosed in
childhood. There is often a strong family history of asthma or allergies. Asthma can be
very mild in some people, and vary to the extreme of severe and life-threatening (and
even death) in some people.

Definition - a reversible inflammatory disorder of the airways, often triggered by
allergen exposure, exercise, and cold air

Diagnosis - is based on 2 key elements
1. History or presence of respiratory symptoms consistent with asthma - wheeze, cough
(typically worse at night), and/or shortness of breath (that are better with a bronchodilator
like albuterol)
2. The demonstration of variable airflow obstruction (by formal pulmonary function
testing or in office or at home peak expiratory flow measurement=peak flow).

Other conditions which may simulate asthma - post nasal drip syndrome (can cause
upper airway wheeze-like sounds), gastroesophageal reflux disease (GERD), post-viral
cough, habitual/psychological cough, vocal cord dysfunction, panic disorder, cough from
ACE inhibitor blood pressure medicines, COPD (emphysema), and congestive heart
failure

Treatment & Management

1. Monitoring of patients with asthma - symptom assessment and office/home
monitoring with peak flow meters
2. Patient Education - learn how to monitor their symptoms and pulmonary function,
and use their medicines
3. Controlling triggers - this can help decrease need for medications, and patients need
to be aware and decrease trigger exposure - like allergens at home, workplace, daycare,
or school, indoor allergens (dust mites, animal dander, molds, cockroaches) and
respiratory irritants (tobacco smoke, wood smoke, cleaning products, perfumes, air
pollutants) - consider formal allergy testing
--be aware of conditions that can worsen asthma - like sleep apnea, GERD, obesity,
rhinitis/sinusitis, vocal cord dysfunction, and depression/chronic stress, and medicines
that can worsen asthma (like blood pressure beta blockers and aspirin in some people)
4. Medicine Treatment - the goal is to minimize symptoms, reduce the chance of bad
outcomes (hospitalizations or loss of lung function), and minimize adverse effects from
medicines
-inhaled medicines can be taken in metered dose inhalers (some can be used with a spacer
for younger children) and in aerosolized nebulizer breathing treatments

Treatment depends upon the asthma severity- from intermittent asthma (symptoms
less than 2 days/week, and usually just needing a rescue inhaler=short acting
bronchodilator as needed), mild persistent asthma (symptoms greater than 2 days/week-
usually treated with a low dose inhaled cortisone or Singulair), moderate persistent
asthma (symptoms daily-usually treated with a medium dose inhaled cortisone and long
acting bronchodilator or Singulair), and severe persistent asthma (symptoms throughout
the day - usually treated with a high dose inhaled cortisone with long acting
bronchodilator and Singulair, and often additional medicines)

Rescue Inhalers - short acting bronchodilators
- all asthma patients need to have one available when/if needed for
cough/wheeze/shortness of breath flares, and can be used a maximum of 4x/day for not
longer than 1 week, and if needed 4x/day for more than 1 day you must see your
physician
- only brand name metered dose inhalers are now available in the U.S. because of
regulations that they need to be ozone friendly - Proventil HFA, Ventolin HFA, ProAir
HFA, and Xopenex HFA, the least expensive available is a small size Ventolin HFA
which you can get only at Walmart and Target pharmacies, and if needed due to cost, you

- generic albuterol solution is available for nebulizers (and brand name Xopenex is also
available for nebulizers)

Daily Controller Medicines

Inhaled Glucocorticoid (cortisone)-the most potent anti-inflammatory agents available
for asthma treatment, and rinsing the mouth is required after using to avoid developing
thrush/yeast infections
-Flovent
-Pulmicort
-Qvar
-Asmanex
-Azmacort and AeroBid
Inhaled Glucocorticoids with Long Acting Bronchodilators
-Advair (available in a powder round inhaler, or HFA inhaler)
-Symbicort
Long Acting Bronchodilators-must be used only along with a cortisone inhaler
-Serevent
-Foradil
Leukotriene Receptor Antagonists-these decrease infammation and
bronchoconstriction
-Singulair
-Accolate
Chromones-decrease the early stages of asthmatic response/infammation
-Cromolyn (availabe in inhaler and nebulizer)
Theophylline-has both bronchodilatory and antiinflammatory properties, but can have
irritating and serious side effects, and requires blood tests to keep the blood level
adequate (want 5-15mcg/ml)
Oral Glucocorticoids(cortisone) - a short 7-10 day course can be required for asthma
flares, or rarely for long term asthma control

Source: http://www.excellforlife.com/wp-content/uploads/Resources/Asthma.pdf