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Objectives 
 What is bronchial asthma? 
 Etiology 
 Pathophysiology of Asthma 
 Approaches to treatment 
 Phamacother...
Bronchial Asthma 
300 million people 
Adult 10-12 % 
Children 15%
Bronchial Asthma 
Definition: It is a syndrome 
characterised by inflammation 
and hyperresponsiveness of 
tracheobronchi...
Etiology
Pathophysiology
Pathophysiology
Signs & Symptoms 
 Dyspnoea 
 Wheezing 
 Cough 
 Limitation of activity
Approaches To Treatment 
Prevention of Ag : Ab reaction 
Neutralisation of IgE 
Suppression of inflammation and hyperre...
Drugs used in Asthma 
Bronchodilators 
• β2 agonists 
• Methylxanthines 
• Anticholinergics 
Anti-inflammatory 
agents 
• ...
Bronchodilators 
β2 
agonists 
SABA: 
• Salbutamol 
• Terbutaline 
LABA: 
• Salmeterol 
• Formeterol 
Methylxanthines 
The...
β2 sympathomimetics 
ACTIONS: 
 Bronchodilatation 
β2 receptor stimulation 
Increased cAMP 
Relaxation of bronchial muscl...
β2 Agonists 
SABA 
• Salbutamol, Terbutaline 
• Maximum effect in 30 min 
• Duration of action 4-6 hrs 
• Used on ‘as need...
β2 agonists 
Muscle 
tremors 
ADRs 
Palpitation, 
restlessness 
Ankle 
edema 
Throat 
irritation
Methylxanthines 
Theophylline 
 Bronchodilatation 
 release of mediators 
 Narrow margin of safety 
 Ideal for night t...
Adverse effects 
Gastric pain, vomiting 
Tremors, palpitation 
Hypotension 
Convulsions 
Insomnia
Drug Interactions 
 agents inducing metabolism 
 smoking 
 phenytoin 
 rifampicin 
 agents inhibiting metabolism 
 e...
Anticholinergics 
Ipratropium bromide, Tiotropium bromide 
ACTIONS: 
 Relaxes bronchial smooth muscle 
 may increase muc...
Mechanism of Action
Anti-inflammatory Agents 
Corticosteroids 
Inhalational: 
• Beclomethasone 
• Flunisolide 
• Budesonide 
Systemic: 
• Hydr...
Anti-inflammatory Agents (cont..) 
5-HT inhibitors & 
Antihistaminic 
Ketotifen 
(Oral ) 
Pizotifen 
Lukasts ( Oral ) 
Zaf...
Corticosteroids 
Prednisolone, Beclomethasone 
ADVANTAGES 
 more complete and sustained relief 
 improve airflow 
Influ...
Mechanism of Action
Inhaled v/s Systemic 
corticosteroids 
INHALED SYSTEMIC 
Beclomethasone, 
Budesonide 
Targeted drug delivery 
Systemic sid...
CHROMONES 
Sod cromoglycate, Nedocromil 
Inhibits degranulation of mast cells 
Restricted release of mediators 
Inhibition...
Chromones contd… 
 Long term treatment - cellular inflammatory 
response 
Ineffective during an attack 
USES 
 prophyla...
CHROMONES 
Bronchospasm 
Cough 
Nasal 
ADRs 
congestion 
Rashes 
Arthralgia
Leukotriene Antagonists 
Montelukast and Zafirlukast 
 Prophylaxis of mild to 
moderate asthma 
 Alternatives to inhaled...
Mechanism of Action
Anti IgE Antibody 
Omalizumab
• Inhalational 
• Oral 
• Parenteral 
Drug Delivery
Inhalational Drug Delivery Systems 
MDI Dischalers Spacer 
Rotahalers Nebulizer 
37 
Green 
[Salmeterol] 
Orange 
[Flutica...
Status Asthmaticus 
Acute severe life threatening form of asthma. 
TREATMENT: 
 Hydrocortisone 100mg iv stat 
 Nebulized...
Bronchial asthma pharmacology
Bronchial asthma pharmacology
Bronchial asthma pharmacology
Bronchial asthma pharmacology
Bronchial asthma pharmacology
Bronchial asthma pharmacology
Bronchial asthma pharmacology
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Bronchial asthma pharmacology

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Bronchial asthma pharmacology

  1. 1. Objectives  What is bronchial asthma?  Etiology  Pathophysiology of Asthma  Approaches to treatment  Phamacotherapy  Treatment plan  Drug delivery  Status Asthmaticus
  2. 2. Bronchial Asthma 300 million people Adult 10-12 % Children 15%
  3. 3. Bronchial Asthma Definition: It is a syndrome characterised by inflammation and hyperresponsiveness of tracheobronchial tree resulting in reversible narrowing of air tubes, mucosal oedema and mucus plugging.
  4. 4. Etiology
  5. 5. Pathophysiology
  6. 6. Pathophysiology
  7. 7. Signs & Symptoms  Dyspnoea  Wheezing  Cough  Limitation of activity
  8. 8. Approaches To Treatment Prevention of Ag : Ab reaction Neutralisation of IgE Suppression of inflammation and hyperreactivity Prevention of release of mediators Antagonism of released mediators Blockade of constrictor neurotransmittor Mimicking dilator neurotransmittor Directly acting bronchodilators
  9. 9. Drugs used in Asthma Bronchodilators • β2 agonists • Methylxanthines • Anticholinergics Anti-inflammatory agents • Corticosteroids • Chromones • Lukasts • 5-LOX inhibitor • Antihistaminics • 5-HT antagonists Miscellaneous • Mucolytics • Antibiotics • Monoclonal antibodies • Desensitization 12
  10. 10. Bronchodilators β2 agonists SABA: • Salbutamol • Terbutaline LABA: • Salmeterol • Formeterol Methylxanthines Theophylline Anticholinergics Tiotropium bromide Ipratropium bromide 13
  11. 11. β2 sympathomimetics ACTIONS:  Bronchodilatation β2 receptor stimulation Increased cAMP Relaxation of bronchial muscle  Inhibits mediator release  Increase mucus clearance
  12. 12. β2 Agonists SABA • Salbutamol, Terbutaline • Maximum effect in 30 min • Duration of action 4-6 hrs • Used on ‘as needed’ basis LABA • Salmeterol, Formoterol • Duration of action 12 hrs • Used regularly
  13. 13. β2 agonists Muscle tremors ADRs Palpitation, restlessness Ankle edema Throat irritation
  14. 14. Methylxanthines Theophylline  Bronchodilatation  release of mediators  Narrow margin of safety  Ideal for night time symptoms OTHER USES COPD Apnoea in premature infants Mechanism of Action ATP adenylylcyclase cAMP Phosphodiesterase Theophylline 5 AMP
  15. 15. Adverse effects Gastric pain, vomiting Tremors, palpitation Hypotension Convulsions Insomnia
  16. 16. Drug Interactions  agents inducing metabolism  smoking  phenytoin  rifampicin  agents inhibiting metabolism  erythromycin  OCPs  ciprofloxacin
  17. 17. Anticholinergics Ipratropium bromide, Tiotropium bromide ACTIONS:  Relaxes bronchial smooth muscle  may increase mucociliary clearance  act in larger airways  less effective than sympathomimetics  suitable for prophylactic use  combination is useful  very few side effects - safe
  18. 18. Mechanism of Action
  19. 19. Anti-inflammatory Agents Corticosteroids Inhalational: • Beclomethasone • Flunisolide • Budesonide Systemic: • Hydrocortisone • Prednisolone • Methyl prednisolone Chromones Cromolyn sodium ( MDI ) Nedocromil 22
  20. 20. Anti-inflammatory Agents (cont..) 5-HT inhibitors & Antihistaminic Ketotifen (Oral ) Pizotifen Lukasts ( Oral ) Zafirlukast Montelukast Pranlukast Acolade 5-LOX inhibitors Zileuton (oral) 23
  21. 21. Corticosteroids Prednisolone, Beclomethasone ADVANTAGES  more complete and sustained relief  improve airflow Influence airway remodeling  retard progression of disease
  22. 22. Mechanism of Action
  23. 23. Inhaled v/s Systemic corticosteroids INHALED SYSTEMIC Beclomethasone, Budesonide Targeted drug delivery Systemic side effects are less Used as a prophylactic drug Cannot be withdrawn abruptly – bronchial hyperreactivity Prednisolone, Hydrocortisone Systemic side effects are marked Used in chronic severe asthma Can be tapered rapidly
  24. 24. CHROMONES Sod cromoglycate, Nedocromil Inhibits degranulation of mast cells Restricted release of mediators Inhibition of chemotaxis
  25. 25. Chromones contd…  Long term treatment - cellular inflammatory response Ineffective during an attack USES  prophylaxis in asthma  allergic rhinitis  allergic conjunctivitis
  26. 26. CHROMONES Bronchospasm Cough Nasal ADRs congestion Rashes Arthralgia
  27. 27. Leukotriene Antagonists Montelukast and Zafirlukast  Prophylaxis of mild to moderate asthma  Alternatives to inhaled Glucocorticoids  Acceptable in children  Effective in aspirin induced asthma  Safe drugs Mode of action Antagonise LTs Inhibit receptors
  28. 28. Mechanism of Action
  29. 29. Anti IgE Antibody Omalizumab
  30. 30. • Inhalational • Oral • Parenteral Drug Delivery
  31. 31. Inhalational Drug Delivery Systems MDI Dischalers Spacer Rotahalers Nebulizer 37 Green [Salmeterol] Orange [Fluticasone] Blue [SABA] Brown [budesonide]
  32. 32. Status Asthmaticus Acute severe life threatening form of asthma. TREATMENT:  Hydrocortisone 100mg iv stat  Nebulized Salbutamol 2.5-5mg +Ipratropium bromide 0.5 mg  High flow O2 inhalation  Salbutamol/ Terbutaline 0.4mg im/sc  Intubation and mechanical ventilation  Antibiotics  Saline + sod. bicarbonate

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