@oriro/orirocli 0.1.11 → 0.1.12

package/skills/health/health-aging/SKILL.md

@@ -1,82 +1,82 @@
----
-watermark: ORIRO
-disable-model-invocation: true
-name: health-aging
-provider: ORIRO.ai
-copyright: Copyright (c) 2026 ORIRO.ai
-description: >
-
-
-  Aging and elder care — age-related health changes, fall prevention, cognitive health, polypharmacy, caregiver guidance, and end-of-life planning. Sources: NIA, CDC healthy aging, AGS geriatric guidelines.
-  Consult your healthcare provider for personal medical guidance.
----
-
-# Aging and Elder Care
-
-## Normal physiological changes with aging
-
-**Cardiovascular:** Decreased maximum heart rate, reduced cardiac reserve, increased vascular stiffness, BP tends to rise.
-**Musculoskeletal:** Sarcopenia (muscle loss) — ~1-2% per year after 50. Bone density decreases. Joint changes.
-**Cognitive:** Normal: slower processing speed, slight memory lag (tip of tongue), easier fatigue. NOT normal: getting lost in familiar places, forgetting recent events repeatedly, personality changes.
-**Sensory:** Presbyopia (reading glasses needed), presbycusis (high-frequency hearing loss), reduced taste/smell.
-**Sleep:** Earlier sleep phase, more fragmented, less deep sleep. Total hours similar but more interrupted.
-**Immune:** Immunosenescence — slower immune response, reduced vaccine efficacy, higher infection risk.
-**Renal/Hepatic:** Reduced kidney and liver function → drugs clear more slowly → dose adjustments needed.
-
-## Polypharmacy
-
-Using 5+ medications simultaneously (common in adults 65+; average is 8+).
-**Problems:** Drug interactions, falls risk, adverse effects, cognitive effects, adherence challenges.
-**Beers Criteria** (AGS): List of medications potentially inappropriate for older adults:
-
-- Benzodiazepines: fall/cognitive risk
-- First-generation antihistamines (diphenhydramine/Benadryl): anticholinergic, confusion, falls
-- Long-acting sulfonylureas (glipizide extended release): hypoglycemia
-- NSAIDs (long-term): GI bleeding, renal impairment, BP effects
-- Muscle relaxants (cyclobenzaprine): sedation, falls
-  **Medication review:** Ask doctor annually to review all medications for continued necessity.
-
-## Fall prevention — most important safety intervention
-
-Falls cause 36 million injuries/year in US older adults. 32,000 deaths annually.
-**Risk factors:** Prior fall, muscle weakness, balance problems, home hazards, polypharmacy, vision problems.
-**Prevention:**
-
-- Exercise: Tai chi, balance training, strength training all proven to reduce falls
-- Medication review: Reduce fall-risk medications
-- Home modification: Remove throw rugs, add grab bars, improve lighting
-- Vision check annually: Poor vision ↑ fall risk significantly
-- Vitamin D: 800-1000 IU/day reduces falls in deficient older adults
-
-## Cognitive health
-
-**Normal aging vs. MCI vs. Dementia:**
-Normal: Occasional word-finding, slower recall — doesn't interfere with daily function.
-MCI (Mild Cognitive Impairment): Noticeable cognitive change beyond normal, but still independent.
-Dementia: Cognitive decline that impairs daily functioning.
-
-**Alzheimer's warning signs (Alzheimer's Association):**
-Memory loss disrupting daily life, challenges with planning, familiar tasks become difficult, confusion with time/place, new visual problems, word-finding problems, misplacing items unable to retrace, poor judgment, withdrawal, personality/mood changes.
-
-**Risk reduction (evidence-based):**
-Physical exercise (strongest evidence), cognitively stimulating activities, social engagement, treating hearing loss (significant risk modifier), controlling vascular risk factors (hypertension, diabetes, cholesterol), sleep quality.
-
-**Mediterranean diet / MIND diet:** Associated with lower dementia risk in observational studies.
-
-## Caregiver guidance
-
-Caregiver burden is real — 40% of Alzheimer's caregivers develop depression.
-**Resources:** Alzheimer's Association 24/7 helpline: 800-272-3900
-**Respite care:** Temporary relief for caregivers. Adult day programs, in-home respite, short-term residential care.
-**Legal planning early:** Power of Attorney (financial), Healthcare Proxy, advance directive — do while person has capacity.
-
-## Advance directives
-
-**Living will:** Documents preferences for end-of-life care.
-**Healthcare proxy / DPOA for healthcare:** Designates someone to make medical decisions if unable.
-**POLST/MOLST:** (Physician Orders for Life-Sustaining Treatment) Portable medical order for patients with serious illness.
-**DNR/DNI:** Do Not Resuscitate / Do Not Intubate — medical orders, not just expressed wishes.
-
-Complete these documents while healthy. Review periodically. Provide copies to family, physicians, hospital.
-
-Sources: National Institute on Aging (nia.nih.gov), CDC Healthy Aging (cdc.gov), AGS Beers Criteria (americangeriatrics.org), Alzheimer's Association (alz.org)
+---
+watermark: ORIRO
+disable-model-invocation: true
+name: health-aging
+provider: ORIRO.ai
+copyright: Copyright (c) 2026 ORIRO.ai
+description: >
+
+
+  Aging and elder care — age-related health changes, fall prevention, cognitive health, polypharmacy, caregiver guidance, and end-of-life planning. Sources: NIA, CDC healthy aging, AGS geriatric guidelines.
+  Consult your healthcare provider for personal medical guidance.
+---
+
+# Aging and Elder Care
+
+## Normal physiological changes with aging
+
+**Cardiovascular:** Decreased maximum heart rate, reduced cardiac reserve, increased vascular stiffness, BP tends to rise.
+**Musculoskeletal:** Sarcopenia (muscle loss) — ~1-2% per year after 50. Bone density decreases. Joint changes.
+**Cognitive:** Normal: slower processing speed, slight memory lag (tip of tongue), easier fatigue. NOT normal: getting lost in familiar places, forgetting recent events repeatedly, personality changes.
+**Sensory:** Presbyopia (reading glasses needed), presbycusis (high-frequency hearing loss), reduced taste/smell.
+**Sleep:** Earlier sleep phase, more fragmented, less deep sleep. Total hours similar but more interrupted.
+**Immune:** Immunosenescence — slower immune response, reduced vaccine efficacy, higher infection risk.
+**Renal/Hepatic:** Reduced kidney and liver function → drugs clear more slowly → dose adjustments needed.
+
+## Polypharmacy
+
+Using 5+ medications simultaneously (common in adults 65+; average is 8+).
+**Problems:** Drug interactions, falls risk, adverse effects, cognitive effects, adherence challenges.
+**Beers Criteria** (AGS): List of medications potentially inappropriate for older adults:
+
+- Benzodiazepines: fall/cognitive risk
+- First-generation antihistamines (diphenhydramine/Benadryl): anticholinergic, confusion, falls
+- Long-acting sulfonylureas (glipizide extended release): hypoglycemia
+- NSAIDs (long-term): GI bleeding, renal impairment, BP effects
+- Muscle relaxants (cyclobenzaprine): sedation, falls
+  **Medication review:** Ask doctor annually to review all medications for continued necessity.
+
+## Fall prevention — most important safety intervention
+
+Falls cause 36 million injuries/year in US older adults. 32,000 deaths annually.
+**Risk factors:** Prior fall, muscle weakness, balance problems, home hazards, polypharmacy, vision problems.
+**Prevention:**
+
+- Exercise: Tai chi, balance training, strength training all proven to reduce falls
+- Medication review: Reduce fall-risk medications
+- Home modification: Remove throw rugs, add grab bars, improve lighting
+- Vision check annually: Poor vision ↑ fall risk significantly
+- Vitamin D: 800-1000 IU/day reduces falls in deficient older adults
+
+## Cognitive health
+
+**Normal aging vs. MCI vs. Dementia:**
+Normal: Occasional word-finding, slower recall — doesn't interfere with daily function.
+MCI (Mild Cognitive Impairment): Noticeable cognitive change beyond normal, but still independent.
+Dementia: Cognitive decline that impairs daily functioning.
+
+**Alzheimer's warning signs (Alzheimer's Association):**
+Memory loss disrupting daily life, challenges with planning, familiar tasks become difficult, confusion with time/place, new visual problems, word-finding problems, misplacing items unable to retrace, poor judgment, withdrawal, personality/mood changes.
+
+**Risk reduction (evidence-based):**
+Physical exercise (strongest evidence), cognitively stimulating activities, social engagement, treating hearing loss (significant risk modifier), controlling vascular risk factors (hypertension, diabetes, cholesterol), sleep quality.
+
+**Mediterranean diet / MIND diet:** Associated with lower dementia risk in observational studies.
+
+## Caregiver guidance
+
+Caregiver burden is real — 40% of Alzheimer's caregivers develop depression.
+**Resources:** Alzheimer's Association 24/7 helpline: 800-272-3900
+**Respite care:** Temporary relief for caregivers. Adult day programs, in-home respite, short-term residential care.
+**Legal planning early:** Power of Attorney (financial), Healthcare Proxy, advance directive — do while person has capacity.
+
+## Advance directives
+
+**Living will:** Documents preferences for end-of-life care.
+**Healthcare proxy / DPOA for healthcare:** Designates someone to make medical decisions if unable.
+**POLST/MOLST:** (Physician Orders for Life-Sustaining Treatment) Portable medical order for patients with serious illness.
+**DNR/DNI:** Do Not Resuscitate / Do Not Intubate — medical orders, not just expressed wishes.
+
+Complete these documents while healthy. Review periodically. Provide copies to family, physicians, hospital.
+
+Sources: National Institute on Aging (nia.nih.gov), CDC Healthy Aging (cdc.gov), AGS Beers Criteria (americangeriatrics.org), Alzheimer's Association (alz.org)

package/skills/health/health-chronic/LICENSE

@@ -1,21 +1,21 @@
-MIT License
-
-Copyright (c) 2026 ORIRO.ai
-
-Permission is hereby granted, free of charge, to any person obtaining a copy
-of this software and associated documentation files (the "Software"), to deal
-in the Software without restriction, including without limitation the rights
-to use, copy, modify, merge, publish, distribute, sublicense, and/or sell
-copies of the Software, and to permit persons to whom the Software is
-furnished to do so, subject to the following conditions:
-
-The above copyright notice and this permission notice shall be included in all
-copies or substantial portions of the Software.
-
-THE SOFTWARE IS PROVIDED "AS IS", WITHOUT WARRANTY OF ANY KIND, EXPRESS OR
-IMPLIED, INCLUDING BUT NOT LIMITED TO THE WARRANTIES OF MERCHANTABILITY,
-FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT. IN NO EVENT SHALL THE
-AUTHORS OR COPYRIGHT HOLDERS BE LIABLE FOR ANY CLAIM, DAMAGES OR OTHER
-LIABILITY, WHETHER IN AN ACTION OF CONTRACT, TORT OR OTHERWISE, ARISING FROM,
-OUT OF OR IN CONNECTION WITH THE SOFTWARE OR THE USE OR OTHER DEALINGS IN THE
-SOFTWARE.
+MIT License
+
+Copyright (c) 2026 ORIRO.ai
+
+Permission is hereby granted, free of charge, to any person obtaining a copy
+of this software and associated documentation files (the "Software"), to deal
+in the Software without restriction, including without limitation the rights
+to use, copy, modify, merge, publish, distribute, sublicense, and/or sell
+copies of the Software, and to permit persons to whom the Software is
+furnished to do so, subject to the following conditions:
+
+The above copyright notice and this permission notice shall be included in all
+copies or substantial portions of the Software.
+
+THE SOFTWARE IS PROVIDED "AS IS", WITHOUT WARRANTY OF ANY KIND, EXPRESS OR
+IMPLIED, INCLUDING BUT NOT LIMITED TO THE WARRANTIES OF MERCHANTABILITY,
+FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT. IN NO EVENT SHALL THE
+AUTHORS OR COPYRIGHT HOLDERS BE LIABLE FOR ANY CLAIM, DAMAGES OR OTHER
+LIABILITY, WHETHER IN AN ACTION OF CONTRACT, TORT OR OTHERWISE, ARISING FROM,
+OUT OF OR IN CONNECTION WITH THE SOFTWARE OR THE USE OR OTHER DEALINGS IN THE
+SOFTWARE.

package/skills/health/health-chronic/SKILL.md

@@ -1,202 +1,202 @@
----
-watermark: ORIRO
-disable-model-invocation: true
-name: health-chronic
-provider: ORIRO.ai
-copyright: Copyright (c) 2026 ORIRO.ai
-description: >
-  Chronic disease management — diabetes, hypertension, heart disease, asthma,
-  COPD, arthritis. Activate for questions about managing chronic conditions,
-  understanding treatment plans, lifestyle modifications, monitoring, or
-  any chronic disease management question. Sources: ADA, ACC/AHA guidelines,
-  CDC chronic disease resources, NHLBI. Always work with your healthcare team.
----
-
-# Chronic Disease Management
-
-## Diabetes
-
-### Type 1 vs. Type 2
-
-**Type 1:** Autoimmune destruction of beta cells. No insulin production. Requires insulin for survival.
-**Type 2:** Insulin resistance + declining beta cell function. Progressive. Most common form (90-95%).
-**Prediabetes:** Fasting glucose 100-125 mg/dL or A1C 5.7-6.4%. Reversible with lifestyle.
-
-### Blood sugar targets (ADA guidelines)
-
-- Fasting/pre-meal: 80-130 mg/dL
-- 2 hours after meals: < 180 mg/dL
-- A1C: < 7% for most adults (less stringent for elderly/complex)
-
-### Type 2 management hierarchy
-
-1. **Lifestyle first:** Weight loss (even 5-10% significantly improves glucose), exercise, diet.
-2. **Metformin:** First-line medication. Cheap, effective, well-tolerated. Take with food.
-3. **Add-on medications:** GLP-1 agonists (semaglutide, liraglutide), SGLT-2 inhibitors (empagliflozin), DPP-4 inhibitors, sulfonylureas, insulin.
-4. **Insulin:** Required if A1C not controlled with oral medications.
-
-### Monitoring
-
-A1C: every 3 months until target, then every 6 months.
-Annual: eye exam (retinopathy), kidney function (creatinine, urine albumin), foot exam, lipids.
-Blood pressure target: < 130/80 mmHg.
-
-### Hypoglycemia (low blood sugar, < 70 mg/dL)
-
-Symptoms: shaking, sweating, confusion, fast heartbeat, hunger.
-Treatment (Rule of 15): 15g fast-acting carbs (glucose tablets, 4oz juice, regular soda).
-Wait 15 minutes. Check blood sugar. Repeat if still < 70.
-Severe (unconscious): glucagon injection or call 911.
-
----
-
-## Hypertension (High Blood Pressure)
-
-### Staging (ACC/AHA 2017 guidelines)
-
-- Normal: < 120/80
-- Elevated: 120-129/< 80
-- Stage 1: 130-139/80-89
-- Stage 2: ≥ 140/≥ 90
-- Crisis: > 180/> 120
-
-### Lifestyle modifications (proven to lower BP)
-
-- **Weight loss:** ~1 mmHg per kg lost
-- **DASH diet:** 8-14 mmHg reduction
-- **Sodium reduction:** < 2,300 mg/day; < 1,500 for greater effect. 4-9 mmHg reduction.
-- **Exercise:** 150 min/week moderate aerobic. 4-9 mmHg reduction.
-- **Limit alcohol:** ≤ 1 drink/day (women), ≤ 2/day (men). 2-4 mmHg reduction.
-- **Quit smoking:** Not directly antihypertensive but critical for cardiovascular risk.
-
-### Medications
-
-**ACE inhibitors** (e.g., lisinopril, enalapril): First-line for many. Side effect: dry cough.
-**ARBs** (e.g., losartan, valsartan): Same mechanism, no cough. Used if ACE causes cough.
-**Calcium channel blockers** (amlodipine, diltiazem): Effective, well-tolerated.
-**Thiazide diuretics** (chlorthalidone, hydrochlorothiazide): Often first-line; older, inexpensive.
-**Beta-blockers** (metoprolol, carvedilol): Especially for heart failure or post-MI.
-
-**Note:** Never stop blood pressure medications without consulting your doctor.
-Even if you feel fine — hypertension is usually asymptomatic until serious events occur.
-
----
-
-## Heart Disease (Coronary Artery Disease)
-
-### Understanding your risk
-
-**ASCVD Risk Calculator** (ACC/AHA): Predicts 10-year cardiovascular event risk.
-Factors: age, sex, race, total cholesterol, HDL, systolic BP, BP treatment, diabetes, smoking.
-
-### Statin therapy
-
-Statins reduce LDL and cardiovascular events.
-High-intensity (atorvastatin 40-80mg, rosuvastatin 20-40mg): Reduces LDL by ≥50%.
-Who benefits most: established heart disease, LDL ≥ 190, diabetes with risk factors, 10-year ASCVD risk ≥ 7.5%.
-
-**Muscle symptoms (myopathy/rhabdomyolysis):** Uncommon but report to doctor immediately.
-**Liver effects:** Routine monitoring not required; report jaundice or dark urine.
-
-### Post-heart attack care
-
-Medications for life after MI:
-
-- Aspirin (81mg daily) unless contraindicated
-- Statin (high-intensity)
-- Beta-blocker (at least 1 year)
-- ACE inhibitor or ARB (if reduced ejection fraction)
-- P2Y12 inhibitor (clopidogrel, ticagrelor) for 1 year after stent
-
-Cardiac rehabilitation: structured exercise program after MI. Significantly reduces mortality. Underutilized.
-
----
-
-## Asthma
-
-### Monitoring and severity
-
-**Peak flow meter:** Track every morning. Personal best × 80% = green zone. Below 50% = red zone/emergency.
-**Spirometry:** FEV1 and FVC ratio measures airflow obstruction.
-
-### Medications
-
-**Controller (daily, prevent symptoms):**
-
-- Inhaled corticosteroids (ICS): fluticasone, budesonide — most effective controller. Use daily regardless of symptoms.
-- Long-acting beta-agonist (LABA): salmeterol, formoterol. Never use alone; always with ICS.
-- Leukotriene modifiers: montelukast (Singulair). Less effective than ICS but oral, useful add-on.
-- Biologics: dupilumab, omalizumab for severe eosinophilic/allergic asthma.
-
-**Rescue (quick relief):**
-
-- Short-acting beta-agonist (SABA): albuterol — use for acute symptoms.
-- If using rescue > 2 days/week: asthma is not well-controlled; step up controller therapy.
-
-### Asthma action plan
-
-Written plan with your doctor: what to do in green/yellow/red zones.
-Green: peak flow > 80% personal best. Take controller as prescribed.
-Yellow: peak flow 50-80%. Add extra rescue. Contact doctor if not improving.
-Red: peak flow < 50%. Take rescue. Seek emergency care if not improving immediately.
-
----
-
-## COPD (Chronic Obstructive Pulmonary Disease)
-
-Main cause: smoking (80-85%). Also: occupational dust, fumes, indoor air pollution.
-Progressive and irreversible — but progression can be slowed.
-
-**GOLD staging (based on FEV1):**
-Grade 1 (mild): FEV1 ≥ 80% predicted
-Grade 2 (moderate): 50-79%
-Grade 3 (severe): 30-49%
-Grade 4 (very severe): < 30%
-
-### Management
-
-**Most important:** Smoking cessation. The only intervention proven to slow progression.
-**Vaccinations:** Annual flu, pneumococcal, COVID. Respiratory infections are major triggers.
-**Pulmonary rehabilitation:** Structured exercise + education. Improves exercise tolerance and quality of life.
-
-**Bronchodilators:**
-LAMA (tiotropium, umeclidinium): Long-acting muscarinic antagonist. First-line for most.
-LABA: Long-acting beta-agonist. Often combined with LAMA.
-SABA/SAMA: Short-acting rescue inhalers.
-ICS: For frequent exacerbations + eosinophilic inflammation.
-
-**Oxygen therapy:** If O2 saturation consistently ≤ 88%. Use ≥ 15 hours/day to benefit.
-
----
-
-## Arthritis
-
-### Osteoarthritis (OA)
-
-Degenerative joint disease. Cartilage breakdown. Wear and tear.
-Most common in: knees, hips, hands, spine.
-No disease-modifying treatment — manage symptoms.
-
-**Management:**
-
-1. Exercise: water aerobics, swimming, cycling. Strengthening around joint.
-2. Weight loss: 10lb loss reduces knee force by 40lb per step.
-3. Physical therapy: movement and strengthening strategies.
-4. Acetaminophen (Tylenol): First-line analgesic. Max 3g/day (2g if liver disease).
-5. NSAIDs (ibuprofen, naproxen): Effective but GI/cardiovascular/kidney risks.
-6. Topical NSAIDs (diclofenac gel): Less systemic absorption; good for knee OA.
-7. Intraarticular corticosteroids: Temporary relief for acute flares.
-8. Joint replacement: When conservative management fails.
-
-### Rheumatoid Arthritis (RA)
-
-Autoimmune inflammatory joint disease. Symmetrical small joints. Morning stiffness.
-Aggressive early treatment prevents joint damage. Treat-to-target approach.
-
-**DMARDs (Disease-Modifying Antirheumatic Drugs):**
-Methotrexate: First-line. Weekly oral dosing. Requires folic acid supplementation.
-Biologics (TNF inhibitors: etanercept, adalimumab; JAK inhibitors: tofacitinib): For inadequate methotrexate response.
-
-Sources: American Diabetes Association (diabetes.org), ACC/AHA Hypertension Guidelines,
-NHLBI Asthma Guidelines (nhlbi.nih.gov), GOLD COPD Guidelines (goldcopd.org),
-CDC chronic disease resources (cdc.gov/chronicdisease), ACR Rheumatoid Arthritis Guidelines
+---
+watermark: ORIRO
+disable-model-invocation: true
+name: health-chronic
+provider: ORIRO.ai
+copyright: Copyright (c) 2026 ORIRO.ai
+description: >
+  Chronic disease management — diabetes, hypertension, heart disease, asthma,
+  COPD, arthritis. Activate for questions about managing chronic conditions,
+  understanding treatment plans, lifestyle modifications, monitoring, or
+  any chronic disease management question. Sources: ADA, ACC/AHA guidelines,
+  CDC chronic disease resources, NHLBI. Always work with your healthcare team.
+---
+
+# Chronic Disease Management
+
+## Diabetes
+
+### Type 1 vs. Type 2
+
+**Type 1:** Autoimmune destruction of beta cells. No insulin production. Requires insulin for survival.
+**Type 2:** Insulin resistance + declining beta cell function. Progressive. Most common form (90-95%).
+**Prediabetes:** Fasting glucose 100-125 mg/dL or A1C 5.7-6.4%. Reversible with lifestyle.
+
+### Blood sugar targets (ADA guidelines)
+
+- Fasting/pre-meal: 80-130 mg/dL
+- 2 hours after meals: < 180 mg/dL
+- A1C: < 7% for most adults (less stringent for elderly/complex)
+
+### Type 2 management hierarchy
+
+1. **Lifestyle first:** Weight loss (even 5-10% significantly improves glucose), exercise, diet.
+2. **Metformin:** First-line medication. Cheap, effective, well-tolerated. Take with food.
+3. **Add-on medications:** GLP-1 agonists (semaglutide, liraglutide), SGLT-2 inhibitors (empagliflozin), DPP-4 inhibitors, sulfonylureas, insulin.
+4. **Insulin:** Required if A1C not controlled with oral medications.
+
+### Monitoring
+
+A1C: every 3 months until target, then every 6 months.
+Annual: eye exam (retinopathy), kidney function (creatinine, urine albumin), foot exam, lipids.
+Blood pressure target: < 130/80 mmHg.
+
+### Hypoglycemia (low blood sugar, < 70 mg/dL)
+
+Symptoms: shaking, sweating, confusion, fast heartbeat, hunger.
+Treatment (Rule of 15): 15g fast-acting carbs (glucose tablets, 4oz juice, regular soda).
+Wait 15 minutes. Check blood sugar. Repeat if still < 70.
+Severe (unconscious): glucagon injection or call 911.
+
+---
+
+## Hypertension (High Blood Pressure)
+
+### Staging (ACC/AHA 2017 guidelines)
+
+- Normal: < 120/80
+- Elevated: 120-129/< 80
+- Stage 1: 130-139/80-89
+- Stage 2: ≥ 140/≥ 90
+- Crisis: > 180/> 120
+
+### Lifestyle modifications (proven to lower BP)
+
+- **Weight loss:** ~1 mmHg per kg lost
+- **DASH diet:** 8-14 mmHg reduction
+- **Sodium reduction:** < 2,300 mg/day; < 1,500 for greater effect. 4-9 mmHg reduction.
+- **Exercise:** 150 min/week moderate aerobic. 4-9 mmHg reduction.
+- **Limit alcohol:** ≤ 1 drink/day (women), ≤ 2/day (men). 2-4 mmHg reduction.
+- **Quit smoking:** Not directly antihypertensive but critical for cardiovascular risk.
+
+### Medications
+
+**ACE inhibitors** (e.g., lisinopril, enalapril): First-line for many. Side effect: dry cough.
+**ARBs** (e.g., losartan, valsartan): Same mechanism, no cough. Used if ACE causes cough.
+**Calcium channel blockers** (amlodipine, diltiazem): Effective, well-tolerated.
+**Thiazide diuretics** (chlorthalidone, hydrochlorothiazide): Often first-line; older, inexpensive.
+**Beta-blockers** (metoprolol, carvedilol): Especially for heart failure or post-MI.
+
+**Note:** Never stop blood pressure medications without consulting your doctor.
+Even if you feel fine — hypertension is usually asymptomatic until serious events occur.
+
+---
+
+## Heart Disease (Coronary Artery Disease)
+
+### Understanding your risk
+
+**ASCVD Risk Calculator** (ACC/AHA): Predicts 10-year cardiovascular event risk.
+Factors: age, sex, race, total cholesterol, HDL, systolic BP, BP treatment, diabetes, smoking.
+
+### Statin therapy
+
+Statins reduce LDL and cardiovascular events.
+High-intensity (atorvastatin 40-80mg, rosuvastatin 20-40mg): Reduces LDL by ≥50%.
+Who benefits most: established heart disease, LDL ≥ 190, diabetes with risk factors, 10-year ASCVD risk ≥ 7.5%.
+
+**Muscle symptoms (myopathy/rhabdomyolysis):** Uncommon but report to doctor immediately.
+**Liver effects:** Routine monitoring not required; report jaundice or dark urine.
+
+### Post-heart attack care
+
+Medications for life after MI:
+
+- Aspirin (81mg daily) unless contraindicated
+- Statin (high-intensity)
+- Beta-blocker (at least 1 year)
+- ACE inhibitor or ARB (if reduced ejection fraction)
+- P2Y12 inhibitor (clopidogrel, ticagrelor) for 1 year after stent
+
+Cardiac rehabilitation: structured exercise program after MI. Significantly reduces mortality. Underutilized.
+
+---
+
+## Asthma
+
+### Monitoring and severity
+
+**Peak flow meter:** Track every morning. Personal best × 80% = green zone. Below 50% = red zone/emergency.
+**Spirometry:** FEV1 and FVC ratio measures airflow obstruction.
+
+### Medications
+
+**Controller (daily, prevent symptoms):**
+
+- Inhaled corticosteroids (ICS): fluticasone, budesonide — most effective controller. Use daily regardless of symptoms.
+- Long-acting beta-agonist (LABA): salmeterol, formoterol. Never use alone; always with ICS.
+- Leukotriene modifiers: montelukast (Singulair). Less effective than ICS but oral, useful add-on.
+- Biologics: dupilumab, omalizumab for severe eosinophilic/allergic asthma.
+
+**Rescue (quick relief):**
+
+- Short-acting beta-agonist (SABA): albuterol — use for acute symptoms.
+- If using rescue > 2 days/week: asthma is not well-controlled; step up controller therapy.
+
+### Asthma action plan
+
+Written plan with your doctor: what to do in green/yellow/red zones.
+Green: peak flow > 80% personal best. Take controller as prescribed.
+Yellow: peak flow 50-80%. Add extra rescue. Contact doctor if not improving.
+Red: peak flow < 50%. Take rescue. Seek emergency care if not improving immediately.
+
+---
+
+## COPD (Chronic Obstructive Pulmonary Disease)
+
+Main cause: smoking (80-85%). Also: occupational dust, fumes, indoor air pollution.
+Progressive and irreversible — but progression can be slowed.
+
+**GOLD staging (based on FEV1):**
+Grade 1 (mild): FEV1 ≥ 80% predicted
+Grade 2 (moderate): 50-79%
+Grade 3 (severe): 30-49%
+Grade 4 (very severe): < 30%
+
+### Management
+
+**Most important:** Smoking cessation. The only intervention proven to slow progression.
+**Vaccinations:** Annual flu, pneumococcal, COVID. Respiratory infections are major triggers.
+**Pulmonary rehabilitation:** Structured exercise + education. Improves exercise tolerance and quality of life.
+
+**Bronchodilators:**
+LAMA (tiotropium, umeclidinium): Long-acting muscarinic antagonist. First-line for most.
+LABA: Long-acting beta-agonist. Often combined with LAMA.
+SABA/SAMA: Short-acting rescue inhalers.
+ICS: For frequent exacerbations + eosinophilic inflammation.
+
+**Oxygen therapy:** If O2 saturation consistently ≤ 88%. Use ≥ 15 hours/day to benefit.
+
+---
+
+## Arthritis
+
+### Osteoarthritis (OA)
+
+Degenerative joint disease. Cartilage breakdown. Wear and tear.
+Most common in: knees, hips, hands, spine.
+No disease-modifying treatment — manage symptoms.
+
+**Management:**
+
+1. Exercise: water aerobics, swimming, cycling. Strengthening around joint.
+2. Weight loss: 10lb loss reduces knee force by 40lb per step.
+3. Physical therapy: movement and strengthening strategies.
+4. Acetaminophen (Tylenol): First-line analgesic. Max 3g/day (2g if liver disease).
+5. NSAIDs (ibuprofen, naproxen): Effective but GI/cardiovascular/kidney risks.
+6. Topical NSAIDs (diclofenac gel): Less systemic absorption; good for knee OA.
+7. Intraarticular corticosteroids: Temporary relief for acute flares.
+8. Joint replacement: When conservative management fails.
+
+### Rheumatoid Arthritis (RA)
+
+Autoimmune inflammatory joint disease. Symmetrical small joints. Morning stiffness.
+Aggressive early treatment prevents joint damage. Treat-to-target approach.
+
+**DMARDs (Disease-Modifying Antirheumatic Drugs):**
+Methotrexate: First-line. Weekly oral dosing. Requires folic acid supplementation.
+Biologics (TNF inhibitors: etanercept, adalimumab; JAK inhibitors: tofacitinib): For inadequate methotrexate response.
+
+Sources: American Diabetes Association (diabetes.org), ACC/AHA Hypertension Guidelines,
+NHLBI Asthma Guidelines (nhlbi.nih.gov), GOLD COPD Guidelines (goldcopd.org),
+CDC chronic disease resources (cdc.gov/chronicdisease), ACR Rheumatoid Arthritis Guidelines