Drug therapy for bronchial asthma satya xp


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an informative ppt for medical undergraduates on drugs used in bronchial asthma with jokes and pics..... enjoy reading ..... <3.... satya

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Drug therapy for bronchial asthma satya xp

  3. 3. The surface area of the lungs is roughly the samesize as a tennis court.
  4. 4. The capillaries in the lungs would extend 1,600kilometres if placed end to end.
  5. 5. A person at rest usually breathes between 12 and15 times a minute.
  6. 6. The breathing rate is faster in children andwomen than in men.
  8. 8. BRONCHIAL ASTHMA Hyperresponsiveness of tracheo-bronchial smooth muscle resulting in narrowing of bronchial tree Wheezing attacks polygenic Primarily inflammatory condition
  9. 9. Mediators in Asthma Mediators released are > 100 in number histamine, TNFa - immediate Prostaglandins, leukotrienes, PAF – within min Interleukins, TNFa – /over hrs
  10. 10. Symptoms of Asthma• Wheezing• Cough, especially at night• Chest tightness• Shortness of breath• Characteristically occur or worsen at night, with exercise, with viral infections, or with exposure to dust, animals, or smoke
  11. 11. TYPES EXTRINSIC ASTHMA – Commonest, episodic, allergens involved INTRINSIC ASTHMA – without allergens, Perennial EXERCISE INDUCED ASTHMA ASTHMA ASSO. WITH COPD
  13. 13. APPROACHES TOTREATMENT REDUCTION OF BRONCHIAL INFLAMMATION & HYPERREACTIVITY Glucocorticoids Sodium cromoglicate Nedocromil sodium Ketotifen PAF antagonists
  14. 14. APPROACHES TOTREATMENT DILATATION OF NARROWED BRONCHI BETA2 receptor agonists Methyl xanthines Antimuscarinic bronchodilators Leukotriene receptor antagonists
  15. 15. JOKE WITH ASTHMA Matthew sets up Andrew to go on a blind date with a friend of his. But Andrew is a little worried about going out with someone he has never seen before. “What do I do if she’s ugly?” says Andrew, “I’ll be stuck with her all night.” “Don’t worry.” Matthew says. “Just go up to her door and meet her first. If you like what you see, then everything goes as planned. If you don’t, just shout Aaauuuggghhh! and fake an
  16. 16. JOKE WITH ASTHMA So that night, Andrew knocks at the girl’s door, and when she comes out he is awe-struck at how beautiful and sexy she is. Andrew’s about to speak when the girl suddenly shouts, “Aaauuuggghhh!”
  17. 17. BETA2 AGONISTS Salbutamol (Albuterol ) Terbutaline Bambuterol Salmeterol Formeterol
  18. 18. SALBUTAMOL Beta2 stimulation  inc.cyclic AMP relaxation, decreases mediator release Fastest acting , within 5 min, lasts for 2-4 hrs Relieves symptoms Used to abort acute attacks of asthma ADR – tremors, palpitation, restlessness, ankle edema, hypokalemia Orally in severe asthma Regular use – downregulation of receptors
  19. 19. TERBUTALINE Similar to salbutamol Used only for symptomatic relief
  20. 20. BAMBUTEROL Prodrug Hydrolysed by pseudocholinesterase into active drug Release over 24 hrs Indicated in chronic bronchial asthma Single evening dose 10 -20 mg
  21. 21. SALMETEROL Long acting beta2 agonist Slow onset of action Used by inhalation Twice a day schedule For maintenance therapy and nocturnal asthma
  22. 22. FORMOTEROL Long acting beta2 agonist Acts for 12 hrs when inhaled Fast acting as well Used as a Regular twice a day schedule for round the clock bronchodilatation.
  23. 23. OTHER BETA AGONISTS Adrenaline, ephedrine, isoprenaline Less safe – cause cardiac arrhythmias
  24. 24. Worried Patient Patient: Doctor, when I press my leg it hurts. Then when I press my chest it hurts, when I press my head it hurts, and when I press my stomach it hurts. Im worried doc, whats wrong with me? Doctor: Easy straightforward, you have a sore finger!
  25. 25. THEOPHYLLINE Xanthine alkaloid Good bronchodilator Inhibit phosphodiesterase 5, release Ca, block adenosine receptors CNS stimulant, increases HR, Diuretic, increases acid secretion, dilate bronchi Also used in COPD Has low therapeutic index Use has declined because of safety
  26. 26. THEOPHYLLINE - ADR Insomnia, nervousness, flushing Tremors Vomiting Palpitation Arrhythmias, seizures in high doses
  27. 27. THEOPHYLLINE – DRUGINTERACTIONS Microsomal enzyme inhibitors increases toxicity Enzyme inducers decrease levels Theophylline enhances the effects of furosemide, sympathomimetics, hypoglycemics PK – elimination changes 1st order to 0 order Has low therapeutic index – need monitoring
  28. 28. USES Bronchial asthma COPD Apnoea in premature infant
  29. 29. ANTIMUSCARINICBRONCHODILATORS Ipratropium bromide, oxitropium, tiotropium Block M3 receptors Inhaled  less systemic effects Slower response Better suited for regular prophylactic use Less effective than salbutamol Useful in COPD, refractory asthma
  30. 30. The Specialist What kind of work do you do? a woman passenger enquired of the man travelling in her train compartment. Im a Naval surgeon, he replies. My word! spluttered the woman, How you doctors specialise these days.
  31. 31. CORTICOSTEROIDS Suppress inflammatory response Do not dilate bronchi Afford complete & sustained relief Decrease disease progression Inhaled steroids – only few ADR Long term systemic therapy – more ADR
  32. 32. CORTICOSTEROIDS Prednisolone – given orally Beclomethasone Fluticasone Budesonide all given by inhalation to minimise systemic side effects
  33. 33. Effects of Inhaled Corticosteroids onInflammationCompromisCompromisededEpitheliumEpithelium Intact Intact Thickened BM Epithelium Epithelium Thickened BM Inflammatory Cells Inflammatory Cells ↓ ↓ Inflammatory Inflammatory Cells Cells Laitinen et al. J Allergy Clin Immunol 1992;90:32-
  34. 34. INHALED STEROIDS High topical activity ‘ Step 1’ for all patients Indicated if beta2 agonist required daily ADR – hoarseness of voice, dysphonia, oropharyngeal candidiasis, sore throat Safe during pregnancy > 600 micrograms/day  systemic effects C/I - Infection
  35. 35. MAST CELL STABILIZERS Sodium cromoglycate, nedocromil Alternative to inhaled steroids Inhibit degranulation of mast cells – prevent release of mediators Given by inhalation Prevent bronchospasm induced by allergens, irritants, cold air, exercise Other Uses – allergic rhinitis, conjunctivitis ADR- mild, like cough, throat irritation
  36. 36. KETOTIFEN H1Antihistamine Like cromoglycate Orally given ADR – Sedation, dry mouth, weight gain 1-2 mg BD Also used in other allergic disorders
  37. 37. LEUKOTRIENE RECEPTORANTAGONISTS Montelucast, zafirlucast Similar efficacy like low dose steroids Used in prophylaxis alternate to steroids More acceptable in children Effective in aspirin induced asthma Very safe, few side effects- headache, rash rarely cause churg- strauss syndrome 2nd – 3rd line role
  38. 38. 5-LOinhibitors - zileuton Cysteinyl- LT receptor antagonists - zafirlukast -
  39. 39. ZILUTON 5 Lipoxygenase inhibitor Prevent all LT induced responses Efficacy similar to LT antagonists Limitations – short duration, hepatotoxicity
  40. 40. OMALIZUMAB A monoclonal antbody against IgE Binds to IgE  form a complex make IgE not bind to IgE receptors on mast cells and basophils  inhibition of allergic response Given S.C once in 2-4 weeks ADR – Well tolerated, pain at the site of inj., allergy Caution – a very small% developed cancers Uses – prophylaxis in patients with moderate to severe asthma >12 years
  41. 41. STATUS ASTHMATICUS Also known as refractory asthma , acute severe asthma May be life threatening A medical emergency URI is mostly the precipitant Other triggers – drugs, stress, allergens, abrupt withdrawal of steroids after prolonged use
  42. 42. A JOKE ON SAVING LIFE In a school in Poland the teacher asks, "Has any of you ever saved somebodys life?“ A little boy raises his arm, "Yes, my little nephews.“ "How did it happen? Tell us!" asks the teacher. The little Polack says, "I hid my sisters birth control pills!"
  43. 43. STATUS ASTHMATICUS Nebulized salbutamol (2.5-5 mg )+ ipratropium (0.5 mg ) intermittent inhalation Intermittent high flow humidified Oxygen inhalation Hydrocortisone hemisuccinate 100 mg i.v stat followed by 100 – 200 mg 4-8 hourly infusion Salbutamol/Terbutaline 0.4 mg i.m/s.c may be added Antibiotics i.v fluids + sodium bicarbonate infusion Intubation and mechanical ventilation, if needed NO SEDATION
  44. 44. Can I call you Little Asthma?Cause you take my breathaway……Tweet Share
  45. 45. CHOICE OF TREATMENT – MILDEPISODIC ASTHMA Symptoms < once daily, normal between attacks Inhaled beta2 agonist at onset of episode – step1 Regular Prophylaxis not required
  46. 46. SEASONAL ASTHMA inhaled cromoglycate or low dose inhal.steroids Regularly 3-4 weeks before and after season Individual episodes – short acting inhal. Beta2 agonist
  47. 47. MILD CHRONIC ASTHMAWITH OCCASIONALEXACERBATIONS Symptoms once daily Regular Low dose inhal. Steroids or cromoglicate – step2 Episode treatment with short acting inhal. Beta2 agonist
  48. 48. MODERATE ASTHMA withfrequent exacerbations Attacks affect activity Occur > 1/day Increasing doses of Inhal. Steroids upto 800 micrograms/day + inhal. Long acting beta2 agonist – step3 Or LT antagonist for steroids Theophylline may be used
  49. 49. SEVERE ASTHMA Continuous symptoms, activity limitation, frequent attacks requiring hospitalisation Regular high dose inhaled steroids ( 800 – 2000 micrograms/ day ) with spacer + Inhaled salmeterol BD Leukotriene antagonist/ Oral theophylline S.R/ oral beta2 agonist/ inhaled ipratropium – step4 Not controlled  oral steroids – step5
  50. 50. WARNINGS BETA BLOCKERS even topical or selective may precipitate asthma Can be fatal  so contraindicated Overuse of beta2 agonists  can cause asthma related deaths
  51. 51. NAEPP Guidelines Classification of Asthma Severity 4 Severe Persistent 3 Moderate Persistent 2 Mild Persistent 1 Mild Intermittent
  52. 52. Asthma Treatment SummaryMild Intermittent Use: salbutamol, Asthma Action PlanMild Persistent Use: salbutamol and Controller medications (low dose steroids, nedocromil, cromolyn, montelukast)Moderate Persistent Use: Combination of medications (low to medium dose steroid plus long acting beta agonist, and/or Leukotriene modifiers)Severe Persistent Use: High dose inhaled steroids, long acting beta agonist, and leukotriene modifier. May need oral steroids
  53. 53. PADDY IN THE CONFESSIONBOX Paddy NcNaughty went to confession : "Bless me, Father, for I have sinned.“ Priest asked "And what is it that you have done, my son?" "I made love to one of the girls in the village.“ "My God!" said the priest, "and which of the village girls did you commit sin with?" "Ah, Father, that I cannot tell."
  54. 54. PADDY IN THE CONFESSIONBOX "And if you will not tell me, then I shall not forgive your sins " "Ah dear!" said Paddy. "Was it Molly OFlaherty?" asked the priest. "No, it was not Molly OFlaherty." "Then was it Flora Fitzgibbons?" "Ah no," said Paddy, "it was not Flora Fitzgibbons."
  55. 55. PADDY IN THE CONFESSIONBOX Was it Maggie Muldoon, then?" persisted the priest. "Ah, sure no, it was not Maggie Muldoon." "Then who in heavens name was it?" "Ah, sure, Father -- that I cannot tell.“ "And if you dont tell me I shall not give you absolution."
  56. 56. PADDY IN THE CONFESSIONBOX "Ah, Father, thats too bad!" said Paddy and walked out of the confessional. His friend, Michael, was waiting outside. He asked "Well, Paddy, did you get your sins forgiven?" "No," said Paddy, "but I got the names of few great girls to fun with "
  57. 57. LAUGHTER BOOSTS IMMUNESYSTEM Young children laugh an average of 300 times a day, while adults average somewhere between 15 to 100 times. The saying that ‘Laughter is the best medicine’ may have some truth to it. Laughing helps to boost the immune system.
  58. 58. THANK U…