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ASTHMA
PREPARED BY
ANUSREE V
AL SHIFA COLLEGE OF
PHARMACY
ASTHMA
Asthma means intermittent narrowing of the
airway causing shortness of breath and
wheezing.
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
PATHOPHYSIOLOGY
dExposure to stimuli/allergens/specific conditions
Production of antibody, IgE
Release of vasoconstrictor & inflammatory
substances by mast cells
Inflammation and vasoconstriction
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
DIAGNOSIS
Liver function test
Chest X ray
Evaluation for heart burn and GERD (Gastro oesophageal
reflux disease)
Evaluation of sinuses
Spirometry tests
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
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
(-)
Methyl xanthines
1. Theophylline
2. Acebrophylline
13-20mg oral
0.4mg iv
Eg:
ADR:
 Headache
 Tremor
 Convulsions
 Arrhythmias
Anticholinergics
3. Anticholinergics:
Mechanism of action
Block cholinergic receptor, M3
Bronchodilation
Eg:
Anticholinergics
1. Ipratropium bromide
2. Tiotropium bromide
40-80μg inhalation
18μg inhalation
ADR:
 Dry mouth
 Dizziness
 Constipation
 Urinary outflow obstruction
4. Leukotriene antagonist
Mechanism of action
Leukotriene antagonist
Inhibit the leukotrienes
(LTC4 &LTD4)
Bronchodilation
Decrease hyperactivity
Eg:
Leukotriene antagonist
1. Montelukast
2. Zafirlukast
10mg OD
20mg BD
ADR
 Abdominal pain
 Head ache
 Diarrhoea
5. Mast cell stabilizers
Mechanism of action:
Have no bronchodilatory effect
Mast cell stabilize
Allergic mediators are
not released
Sodium
cromoglycolate
Eg:
Mast cell stabilizers
Sodium
cromoglycolate
5mg/ puff
ADR:
 Bronchospasm
 Throat irritation
 Cough
 Sedation
 Dry mouth
6. Corticosteroids
Mechanism of action:
No direct bronchodilatory effect
Corticosteroids
Induce synthesis of lipocortin
Inhibit phospholipase A2
Prevent formation of various mediators
Eg:
Corticosteroids
1. Prednisolone
2. Budesonide
1. Diproprionate
2. Fluticasone
3. Propionate
4. Beclamethasone
30mg oral
200-400μg inhalation
ADR:
 Peptic ulcer
 Cushing syndrome
 Osteoporosis
 Hyperglycemia
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
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
Asthma
Asthma

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Asthma

  • 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.
  • 3.
  • 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
  • 7.
  • 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

Editor's Notes

  1. ADR: