Asthma is a respiratory disease in which intermittent narrowing of the airway causing shortness of breath and wheezing.various triggering factors are there.

1. ASTHMA
PREPARED BY
ANUSREE V
AL SHIFA COLLEGE OF
PHARMACY

2. ASTHMA
Asthma means intermittent narrowing of the
airway causing shortness of breath and
wheezing.

4. CLINICAL MANIFESTATIONS
 Rapid breathing
 Shortness of breath
 Severe wheezing
 Spasmodic cough
 Pale and sweaty face
 Tightness in chest
 Blue lips and / or finger nails
 Tightness in neck muscles
 Chocking sensation
 Difficulty in talking
 Anxiousness

5. PATHOPHYSIOLOGY
dExposure to stimuli/allergens/specific conditions
Production of antibody, IgE
Release of vasoconstrictor & inflammatory
substances by mast cells
Inflammation and vasoconstriction

6. Inflammation and vasoconstriction
Enhanced mucus secretion
Airway narrowing and obstruction
Migration of phagocytic cell
Phagocytosis
Release of basic lytic enzyme
Further inflammation
Precipitation of asthma

8. DIAGNOSIS
Liver function test
Chest X ray
Evaluation for heart burn and GERD (Gastro oesophageal
reflux disease)
Evaluation of sinuses
Spirometry tests

9. DRUGS USED FOR ASTHMA
1. Sympathomimetics
Mechanism of action:
ᵝ2 receptors
in bronchus
Activation Bronchodilation
Inhibit the release of mediators
Promote mucociliary clearance
Eg: 1. Salbutamol (2-4mg oral/ 100-200μg inhalation)
2.Formoterol (12-24μg inhalation)
3.Salmetrol (50-100μg inhalation)
ADR:
 Cardio toxicity
 Tachycardia
 Palpitation
 Tremor

10. 2. Methyl xanthines:
Mechanism of action:
cAMP/cGMP 5-AMP/5-GMP
Theophylline
cAMP/cGMP
Bronchodilation
Inhibit the release of
mediators
Promote mucociliary
clearance
Phosphodiesterase
s
(-)

11. Methyl xanthines
1. Theophylline
2. Acebrophylline
13-20mg oral
0.4mg iv
Eg:
ADR:
 Headache
 Tremor
 Convulsions
 Arrhythmias

12. Anticholinergics
3. Anticholinergics:
Mechanism of action
Block cholinergic receptor, M3
Bronchodilation

13. Eg:
Anticholinergics
1. Ipratropium bromide
2. Tiotropium bromide
40-80μg inhalation
18μg inhalation
ADR:
 Dry mouth
 Dizziness
 Constipation
 Urinary outflow obstruction

14. 4. Leukotriene antagonist
Mechanism of action
Leukotriene antagonist
Inhibit the leukotrienes
(LTC4 &LTD4)
Bronchodilation
Decrease hyperactivity

15. Eg:
Leukotriene antagonist
1. Montelukast
2. Zafirlukast
10mg OD
20mg BD
ADR
 Abdominal pain
 Head ache
 Diarrhoea

16. 5. Mast cell stabilizers
Mechanism of action:
Have no bronchodilatory effect
Mast cell stabilize
Allergic mediators are
not released
Sodium
cromoglycolate

17. Eg:
Mast cell stabilizers
Sodium
cromoglycolate
5mg/ puff
ADR:
 Bronchospasm
 Throat irritation
 Cough
 Sedation
 Dry mouth

18. 6. Corticosteroids
Mechanism of action:
No direct bronchodilatory effect
Corticosteroids
Induce synthesis of lipocortin
Inhibit phospholipase A2
Prevent formation of various mediators

19. Eg:
Corticosteroids
1. Prednisolone
2. Budesonide
1. Diproprionate
2. Fluticasone
3. Propionate
4. Beclamethasone
30mg oral
200-400μg inhalation

20. ADR:
 Peptic ulcer
 Cushing syndrome
 Osteoporosis
 Hyperglycemia

21. TREATMENT ALGORITHM
STEP 1: Mild intermittent therapy
Inhaled short acting ᵝ2 agonist as required
STEP 2: Regular prevention therapy
Start a dose of inhaled steroid appropriate to severity of asthma

22. STEP 3: Add on therapy
1. Add inhaled long acting ᵝ2 agonist LABA
2. Assess control of asthma:- good response to LABA
3. Benefit from LABA, but control still inadequate:- continue LABA and
increase inhaled steroid dose
4. No response to LABA:- Stop LABA and increases inhaled steroid dose
5. If control still inadequate: trial of other therapies eg: leukotriene
receptor antagonist
STEP 4: Persistent poor control
 Increased inhaled steroid dose
 Consider addition of a fourth drug eg: Leukotriene receptor antagonist