Antiasthmatics
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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.