Number 1. Asthma attacks usually have an early (blank) (blank) phase and a (blank) (blank) phase .

Number 2. selective beta2 agonists // bronchodilate the lungs and inhibit leukocytes from releasing inflammatory mediators // asthma, COPD, premature labor to relax uterine contractions(tocolytic), sometimes used in patients in traction to prevent muscle wasting by increasing blood flow to the muscles.

Number 3. steriods to reduce inflammation in the lung when inhaled or given orally or intravenously // decreases expression phospholipase A2 that makes prostaglandins that are bronchoconstrictor, and decreases the number of white cells contributing inflammatory mediators. // used in inhaled form for moderate to severe asthma, intravenously and orally, these steroids are used for many inflammatory conditions, autoimmune diseases and transplant rejection.

Number 4. methylxanthines // inhibit adenosine receptors to cause bronchodilation and inhibit release of inflammatory mediators from white cells, it also inhibits phosphodiesterase to increase cAMP to bronchodilate and inhibit white cell release of mediators. // asthma, reversal of bronchoconstriction to do beta2 agonist overdose, COPD, decreased fatigue of respiratory muscles and alertness to face emergency, increased renal blood flow to reduce pulmonary edema, reduce migraine due to cerebral vasoconstriction, dysmenorrhea uterine relaxation

Number 5. antimuscarinics given by inhaler that reduce bronchoconstriction activated by irritant receptors (muscarinic). More effective in COPD than in asthma. Ipratropium is used in combination with albuterol in an inhaler called combivent. Athough in theory these drugs should dry mucus secretions, in practice these drugs are not observed to cause bothersome thickening of mucus to the point of obstruction unlike antihistamines.

Number 6. leukotriene receptor antagonist (singulair (once per day) and accolade (twice per day) // inhibit leukotriene receptors on bronchiole smooth muscle to prevent their constrictive actions //oral drugs used for asthma prevention. These drugs do not work quickly enough to treat an asthma attack in progress but they are valuable to reduce the numbers of attacks and reduce the use of beta2 agonists. They reduce the ability to fight infection but are safer than the steroids.

Number 7. leukotriene synthase inhibitors // inhibit the synthesis of several leukotrienes and reduces chemotaxis (recruitment) of eosinophiles into the inflammed lung and reduces the actions of leukotrienes to cause bronchoconstriction and capillary leak // Used to treat asthma but less compliance due to 4 times a day dosing (reformulated to twice a day dosing more recently). It effectively reduces asthma caused by NSAIDS which block the cycloxygenase pathway and shift arachidonic acid metabolism to leukotrienes.

Number 8. mast cell stabilizer drugs // thought to inhibit IgE stimulated mast cell release by an unknown mechanism// They are used for allergic asthma. These drugs only work in 40% of patients with asthma.

Number 9. anti IgE antibody inhibits the binding of IgE to mast cells and blocks mast cell degranulation. It may inhibit IgE synthesis by B lymphocytes too. The antibody is a chimera of human antibody body to the mouse recognition ends and therefore is recognized as self within humans and does not cause hypersensitivity when given to humans. Expensive drug valuable in moderate to severe asthma in patients with elevated IgE levels.

Number 10. H1 antihistamines - 1st generation - used to treat allergic rhinitis and motion sickness - marked sedation

Number 11. H1 antihistamines - used for allergic rhinitis - do not cross the blood brain barrier as much and therefore nondrowsy or less drowsy but a little less effective too for blocking nasal symptoms. Soporific antihistamines should not be given to patients with night time asthma or prone to sleep apnea.

Number 12. alpha1 agonists, nasal vasoconstriction - OTC - decreases nasal drip but cause hypertension and coronary vasospasm and should not be used in hypertensive patients or those with angina. Nasal sprays should not be used for longer than 3 days or they cause rebound vasodliation and severe nasal stuffiness.

Number 13. NMDA receptor agonist or opioid agonists are cough suppressants (antitussives) used to reduce cough. Cough should not be suppressed if it is productive since leaving fluids in the lung can cause severe hypoxia and these need to be raised and cleared.