warfarin and Asthma

To administer optimal and safe pharmacotherapy, development of stratified and personalized therapy is imperative. Pharmacogenomics (PGx) is useful in elucidating factors causing individual differences in drug efficacy and the emergence of adverse effects. It also helps design accurate drug administration methods by evaluating the effects of patient-related factors, such as genetic factors, that influence pharmacokinetics (PK) and pharmacodynamics (PD). In addition, selection of appropriate therapeutic agents requires the implementation of precision medicine allowing accurate disease diagnosis. To establish precision medicine, it is necessary to uncover the association of pathophysiological factors, which are represented as endotype or genotype, with the pathology of several phenotypes. This review describes two aspects related to realization of individualized medicine, namely the effectiveness of PK/PD/PGx studies and the stratification of pathological conditions. First, we conducted a PK/PD/PGx study with the aim to individualize warfarin treatment. In this study, we elucidated the effect of CYP4F2 polymorphisms associated with vitamin K metabolism by measuring the blood concentrations of warfarin and vitamin K. Then, to develop precision medicine for asthma and chronic obstructive pulmonary disease (COPD), we analyzed not only clinical symptoms but also pathological biomarkers and genes associated with inflammation. The findings may contribute toward better understanding of the pathological conditions of asthma, COPD, and asthma-COPD overlap.

Topics: Asthma; Cytochrome P450 Family 4; Drug Therapy; Humans; Inflammation; Pharmacogenomic Testing; Pharmacokinetics; Polymorphism, Genetic; Precision Medicine; Pulmonary Disease, Chronic Obstructive; Vitamin K; Warfarin

Topics: Anticoagulants; Asthma; Humans; Leukotriene Antagonists; Lung Diseases, Obstructive; Osteoporosis; Smoking Cessation; Smoking Prevention; Steroids; Warfarin

Topics: Anticoagulants; Asthma; Color; Color Vision Defects; Drug Labeling; Humans; Medication Errors; Self Administration; Warfarin

Topics: Adrenergic beta-Agonists; Adrenergic beta-Antagonists; Analgesia, Obstetrical; Analgesics, Opioid; Anesthesiology; Anesthetics, General; Anticoagulants; Asthma; Drug-Related Side Effects and Adverse Reactions; Genetic Variation; Humans; Malignant Hyperthermia; Myocardial Infarction; Neuromuscular Depolarizing Agents; Pain, Postoperative; Perioperative Care; Pharmacogenetics; Practice Patterns, Physicians'; Succinylcholine; Warfarin

Topics: Adolescent; Adult; Asthma; Child; Chronic Disease; Clinical Trials as Topic; Double-Blind Method; Drug Interactions; Humans; Hydroxyurea; Intestinal Absorption; Leukotrienes; Lipoxygenase Inhibitors; Propranolol; Theophylline; Warfarin

Topics: Anti-Asthmatic Agents; Asthma; Chronic Disease; Clinical Trials as Topic; Dose-Response Relationship, Drug; Drug Interactions; Humans; Indoles; Leukotriene Antagonists; Phenylcarbamates; Sulfonamides; Tosyl Compounds; Warfarin

A 31-yr-old parturient with myotonic dystrophy and asthma presented for elective Caesarean section. The patient was receiving warfarin having had two previous episodes of thromboembolism. Anticoagulation was subsequently provided by heparin in the weeks prior to delivery. The combination of the patient's medical conditions and the continuing need for anticoagulation presented a considerable anaesthetic problem in planning anaesthesia and analgesia for both elective and emergency delivery. Heparin was discontinued on the day prior to surgery and restarted immediately after surgery. During surgery flowtron anti-embolitic boots were used. Warfarin therapy was recommenced on the seventh postoperative day. Anaesthesia for Caesarean section was provided using a combined spinal epidural technique using a separate needle, separate interspace method. Postoperative pain was relieved by using a continuous epidural infusion, transcutaneous nerve stimulation and diclofenac. No new neurological problems arose despite the use of epidural analgesia in the presence of heparin anticoagulation. This method of providing anaesthesia and postoperative analgesia without the use of opioids in an anticoagulated, asthmatic, myotonic parturient has not been described elsewhere.

Topics: Adult; Analgesia, Epidural; Analgesia, Obstetrical; Anesthesia, Epidural; Anesthesia, Obstetrical; Anesthesia, Spinal; Asthma; Cesarean Section; Diclofenac; Elective Surgical Procedures; Female; Gravity Suits; Heparin; Humans; Myotonic Dystrophy; Pain, Postoperative; Pregnancy; Transcutaneous Electric Nerve Stimulation; Warfarin