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Antiasthmatics
 

Antiasthmatics

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    Antiasthmatics Antiasthmatics Presentation Transcript

    • WELCOME
    • ANTIASTHMATICS
      Presented by
      P.Pavani
      10T22SO112
      Under The Guidence of
      Mr. J. Anoop
    • ..
      Definition:
      Asthma is a chronic inflammatory disorder of the
      airways that is characterized by increased responsiveness
      of the tracheobranchial tree to a variety of stimuli resulting
      in widespread spasmodic narrowing of the air passages
      which may be relieved spontaneously or therapy.
      • Asthma literally meaning ‘Panting’
    • Characteristics of Asthma:
      • Inflammation of airways
      • Bronchial hyper-reactivity/hyper-responsivness
      • Reversible airway obstruction
    • CLASSIFICATION OF ASTHMA:
      Based on the stimuli initiating bronchial asthma,broad etiologic types are described:
      Extrinsic(allergic, atopic) asthma
      Intrinsic(idiosyncratic,non-atopic) asthma
      Mixed type
    • PATHOPHYSIOLOGY:
    • MORPHOLOGICAL FEATURES:
      1.The mucus plugs contain normal or degenerated respiratory epithelium forming twisted strips called “Curschmann’ssprials”.
      2.The sputum usually contains numerous eosinophils and diamond-shaped crystals derived from eosinophils called “Charcot-Leyden crystals”.
      3. Airway remodeling.
    • Symptoms:
      • Early Warning Signs
      Breathing changes
      Sneezing
      Runny/stuffy nose
      Coughing
      Chin or throat itches
      Feeling tired
      Dark circles under eyes
      Trouble sleeping
      • Asthma Episode Symptoms
      Wheezing
      Shortness of breath
      Tightness in the chest
    •  
      Severe Asthma Episode Symptoms
      personal Severe coughing, wheezing,
      Shortness of breath or tightness in the chest
      Difficulty talking or concentrating
      Walking causes shortness of breath
      Breathing may be shallow and fast or slower than usual
      Hunched shoulders (posturing)
      Nasal flaring
      Retractions
      Cyanosis
      .
    • Asthma Diagnosis:
      The diagnosis of asthma is based on:
      • History
      • Physical examination
      • Supportive diagnostic tests:
      *Pulmonary funcion tests
      Spirometery
      Peak flow meter
      Methacholine challenge test
      *Allergic test
      *Chest x-ray
      *GERD assesment test
    • APPROACHES TO TREATMENT:
      1.Prevention of AG:AB reactions
      2.Neutralisation of IgE antibody
      eg: Omalizumab
      3.Suppresssion of inflamation and bronchial hyperreactivity
      eg: cotricosteriods
      4.Prevention of realease of mediators
      eg: mast cell stabilisers
      5.Antagonism of realeased mediators
      eg: leukotrieneantagonists
      6.Blocked of constictor neurotransmitters
      eg:anticholinergics
      7.Mimicking dilator neurotransmitter
      eg:sympathomimetics.
      8.Directly acting bronchodilators
      eg:methylxanthines
    • CLASSIFICATION:
      • Bronchodilators
      ß2 sympathomimetics : Salbutamol, Terbutaline,Salmetrol
      Methylxanthines : Theophylline, Aminophylline
      Anticholinergics : Ipratropium bromide
      Leukotriene antagonists : Montelukast, Zafirlukast
      • Anti-inflammatory agents
      Mast cell stabilisers : sodium cromoglycate, Nedocromil
      Corticosteriods
      Inhalational : Beclomethasone, fluticasone
      Systemic : Hydrocortisone, Prednisolone
      Anti-IgE antibody : Omlizumab
    • STEPWISE MANAGEMENT OF ASTHMA:
      Mild intermittent asthma

      Regular preventer therapy

      Add -on therapy

      Persistent poor control

      Continuous or frequent use of oral steriod
    • SHORT -ACTING ß2 AGONISTS:
      Eg: Salbutamol, T erbutaline
      These are mainstay of asthma management
      M.O.A:
      ß2 Receptor stimulation ->↑edcAMP in bronchial muscle cell -> relaxation
      Route of administration:
      By inhalation of aerosol, powder.
      Salbutamol is given as intravenous infusion in status asthmaticus.
      Adverse reactions:
      Down regulation of bronchial ß2 receptors
      Tachycardia , palpitations
    • CORTICOSTEROIDS:
      Corticosteriods afford more complete and sustained symptomatic relief than bronchodialators and others
      M.O.A:
      Decrease formation of cytokines(Th2), that recruit and activate eosinophils and are responsible for promoting the production of IgE and expression of IgE receptors.
      INHALED CORTICOSTERIODS:
      Eg: Beclomethasone, fluticasone, ciclesonide
      1ST choice in patients with any degree of persistent asthma
    • ROUTE OF ADMINISTRATION:
      Inhalation by MDI
      SLOWLY and DEEPLY inhalation for solution type inhalers
      QUICKLY and DEEPLY inhalation for dry powdet inhalers
      ADVERSE REACTIONS:
      Hoarseness
      Oral or pharyngeal candidiasis
      Adrenal suppression
      ICS directly targets underlying airway inflammation
    • .
      SYSTEMIC STERIODS
      EG: Hydrocortisone, prednisolone These are oral steriods
      Used in status asthmaticus.
      ADVERSE REACTIONS:
      Adrenal suppression
      Cushing syndrome
      Growth suppression in children
    • ANTI-IgE ANTIBODY:
      Eg: Omalizumab
      M.O.A:
      This drug leads to ↓ed binding of IgE to high affinity IgE receptors on surface of mast cells and basophils and limits realease of mediators of allergic response
      USES:
      ◦In moderate to severe asthma patients who are poorly controlled with conventional therapy.
      ◦Reduces steriod requirements
    • Status Asthmaticus:
      • In which the smooth muscles of the bronchi suddenly contract and narrow the airways.
      • Status asthmaticus can vary from a mild form to a severe form with bronchospasm.
      • Status asthmaticus is an acute episode of asthma that remains unresponsive to standard treatment with bronchodilators.
      symptoms:
      • extreme difficulty with breathing, which causes restlessness
      • coughing and wheezing are not common, because there is not enough airflow
      • advanced symptoms include little or no breath sounds
      • inability to speak
      • skin becomes bluish
      • heavy sweating
      • unconsciousness and even cardiopulmonary arrest, which can be fatal
      TREATMENT:
      • Hospitalisation is necessary
      • The initial treatment starts with supplemental oxygen to increase blood oxygen levels.
      • Inhaled or intravenous bronchodilator to open the airways.
      • large doses of corticosteroids drugs and bronchodilators to reduce inflammation
      .
    • Conclusion:
      Asthma is a curable disease, so it is needed to take proper medication and there is a need to follow the medication therapy systematically.