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  1. 1. WELCOME<br />
  2. 2. ANTIASTHMATICS<br />Presented by<br />P.Pavani<br />10T22SO112<br /> Under The Guidence of<br /> Mr. J. Anoop<br />
  3. 3. ..<br />Definition:<br />Asthma is a chronic inflammatory disorder of the <br /> airways that is characterized by increased responsiveness <br />of the tracheobranchial tree to a variety of stimuli resulting <br />in widespread spasmodic narrowing of the air passages <br />which may be relieved spontaneously or therapy.<br /><ul><li> Asthma literally meaning ‘Panting’</li></li></ul><li>Characteristics of Asthma:<br /><ul><li>Inflammation of airways
  4. 4. Bronchial hyper-reactivity/hyper-responsivness
  5. 5. Reversible airway obstruction</li></li></ul><li>CLASSIFICATION OF ASTHMA:<br />Based on the stimuli initiating bronchial asthma,broad etiologic types are described:<br />Extrinsic(allergic, atopic) asthma<br /> Intrinsic(idiosyncratic,non-atopic) asthma<br /> Mixed type<br />
  6. 6. PATHOPHYSIOLOGY:<br />
  7. 7. MORPHOLOGICAL FEATURES:<br /> 1.The mucus plugs contain normal or degenerated respiratory epithelium forming twisted strips called “Curschmann’ssprials”.<br /> 2.The sputum usually contains numerous eosinophils and diamond-shaped crystals derived from eosinophils called “Charcot-Leyden crystals”.<br /> 3. Airway remodeling.<br />
  8. 8. Symptoms:<br /><ul><li> Early Warning Signs</li></ul>Breathing changes<br /> Sneezing<br /> Runny/stuffy nose<br /> Coughing<br /> Chin or throat itches<br /> Feeling tired<br /> Dark circles under eyes<br /> Trouble sleeping<br /><ul><li> Asthma Episode Symptoms</li></ul>Wheezing<br /> Shortness of breath<br /> Tightness in the chest<br />
  9. 9.  <br />Severe Asthma Episode Symptoms<br /> personal Severe coughing, wheezing, <br /> Shortness of breath or tightness in the chest<br /> Difficulty talking or concentrating<br /> Walking causes shortness of breath<br /> Breathing may be shallow and fast or slower than usual<br /> Hunched shoulders (posturing)<br /> Nasal flaring <br /> Retractions<br /> Cyanosis<br />.<br />
  10. 10. Asthma Diagnosis:<br />The diagnosis of asthma is based on:<br /><ul><li>History
  11. 11. Physical examination
  12. 12. Supportive diagnostic tests:</li></ul>*Pulmonary funcion tests<br />Spirometery<br /> Peak flow meter<br />Methacholine challenge test<br />*Allergic test<br /> *Chest x-ray <br /> *GERD assesment test<br />
  13. 13. APPROACHES TO TREATMENT:<br />1.Prevention of AG:AB reactions<br />2.Neutralisation of IgE antibody<br />eg: Omalizumab<br />3.Suppresssion of inflamation and bronchial hyperreactivity<br />eg: cotricosteriods<br />4.Prevention of realease of mediators<br />eg: mast cell stabilisers<br />5.Antagonism of realeased mediators<br />eg: leukotrieneantagonists<br />6.Blocked of constictor neurotransmitters<br />eg:anticholinergics<br />7.Mimicking dilator neurotransmitter<br />eg:sympathomimetics.<br />8.Directly acting bronchodilators<br />eg:methylxanthines<br />
  14. 14. CLASSIFICATION:<br /><ul><li>Bronchodilators</li></ul>ß2 sympathomimetics : Salbutamol, Terbutaline,Salmetrol<br />Methylxanthines : Theophylline, Aminophylline<br />Anticholinergics : Ipratropium bromide<br />Leukotriene antagonists : Montelukast, Zafirlukast<br /><ul><li>Anti-inflammatory agents</li></ul>Mast cell stabilisers : sodium cromoglycate, Nedocromil<br />Corticosteriods<br />Inhalational : Beclomethasone, fluticasone<br /> Systemic : Hydrocortisone, Prednisolone<br />Anti-IgE antibody : Omlizumab<br />
  15. 15. STEPWISE MANAGEMENT OF ASTHMA:<br />Mild intermittent asthma<br /> ↓<br /> Regular preventer therapy<br /> ↓<br /> Add -on therapy <br /> ↓ <br /> Persistent poor control<br /> ↓<br /> Continuous or frequent use of oral steriod<br />
  16. 16. SHORT -ACTING ß2 AGONISTS:<br />Eg: Salbutamol, T erbutaline<br />These are mainstay of asthma management<br />M.O.A:<br />ß2 Receptor stimulation ->↑edcAMP in bronchial muscle cell -> relaxation<br />Route of administration:<br />By inhalation of aerosol, powder.<br />Salbutamol is given as intravenous infusion in status asthmaticus.<br />Adverse reactions:<br />Down regulation of bronchial ß2 receptors<br /> Tachycardia , palpitations<br />
  17. 17. CORTICOSTEROIDS:<br />Corticosteriods afford more complete and sustained symptomatic relief than bronchodialators and others<br />M.O.A:<br /> Decrease formation of cytokines(Th2), that recruit and activate eosinophils and are responsible for promoting the production of IgE and expression of IgE receptors.<br />INHALED CORTICOSTERIODS:<br />Eg: Beclomethasone, fluticasone, ciclesonide<br />1ST choice in patients with any degree of persistent asthma<br />
  18. 18. ROUTE OF ADMINISTRATION:<br />Inhalation by MDI<br /> SLOWLY and DEEPLY inhalation for solution type inhalers<br /> QUICKLY and DEEPLY inhalation for dry powdet inhalers<br />ADVERSE REACTIONS:<br />Hoarseness <br /> Oral or pharyngeal candidiasis<br /> Adrenal suppression<br />ICS directly targets underlying airway inflammation<br />
  19. 19. .<br />SYSTEMIC STERIODS<br />EG: Hydrocortisone, prednisolone These are oral steriods<br />Used in status asthmaticus. <br />ADVERSE REACTIONS:<br />Adrenal suppression<br /> Cushing syndrome<br /> Growth suppression in children<br />
  20. 20. ANTI-IgE ANTIBODY:<br />Eg: Omalizumab<br />M.O.A:<br />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<br />USES:<br /> ◦In moderate to severe asthma patients who are poorly controlled with conventional therapy.<br /> ◦Reduces steriod requirements<br />
  21. 21. Status Asthmaticus:<br /><ul><li>In which the smooth muscles of the bronchi suddenly contract and narrow the airways.
  22. 22. Status asthmaticus can vary from a mild form to a severe form with bronchospasm.
  23. 23. Status asthmaticus is an acute episode of asthma that remains unresponsive to standard treatment with bronchodilators.</li></ul> symptoms: <br /><ul><li>extreme difficulty with breathing, which causes restlessness
  24. 24. coughing and wheezing are not common, because there is not enough airflow
  25. 25. advanced symptoms include little or no breath sounds
  26. 26. inability to speak </li></li></ul><li><ul><li>skin becomes bluish
  27. 27. heavy sweating
  28. 28. unconsciousness and even cardiopulmonary arrest, which can be fatal</li></ul>TREATMENT:<br /><ul><li>Hospitalisation is necessary
  29. 29. The initial treatment starts with supplemental oxygen to increase blood oxygen levels.
  30. 30. Inhaled or intravenous bronchodilator to open the airways.
  31. 31. large doses of corticosteroids drugs and bronchodilators to reduce inflammation</li></ul>. <br />
  32. 32.
  33. 33. Conclusion:<br />Asthma is a curable disease, so it is needed to take proper medication and there is a need to follow the medication therapy systematically.<br />