The document discusses bronchial asthma, including its definition, causes, triggers, and treatment according to GINA guidelines. It presents the case of a patient with symptoms of breathlessness, wheezing, and cough. Various medications are assessed and justified according to their mechanisms and GINA recommendations. The goals of therapy are to control asthma symptoms, maintain normal activity and lung function, prevent exacerbations, and improve quality of life through therapeutic and toxicity monitoring.

1. BRONCHIAL
ASTHMA
 BY
Ganesha Prakash N S
170608005 M.PHARM

2. What’s Bronchial Asthma?
 DEFINITION :
is a chronic (long-term) lung disease that inflames and narrows the
airways. Asthma causes recurring periods of wheezing (a whistling sound when you
breathe), chest tightness, shortness of breath, and coughing.
The coughing often occurs at night or early in the morning.

3. General Ideas
about B.Asthma

4. Causes for B.ASTHMA?
It isn't clear why some people get asthma and others don't, but it's
probably due to a combination of environmental and genetic (inherited) factors.
 Asthma triggers
 Exposure to various irritants and substances that trigger allergies are :
 Airborne substances, such as pollen, dust mites, mild spores, pet dander or
particles of cockroach waste
 Respiratory infections, such as the common cold
 Physical activity (exercise-induced asthma)

5. Causes Continuation …
 Cold air
 Air pollutants and irritants, such as smoke
 Certain medications, including beta blockers, aspirin, ibuprofen (Advil, Motrin IB,
others) and naproxen (Aleve)
 Strong emotions and stress
 Sulfites and preservatives added to some types of foods and beverages, including
shrimp, dried fruit, processed potatoes, beer and wine
 Gastroesophageal reflux disease (GERD), a condition in which stomach acids back
up into your throat

6. Problems List
BRONCHIAL ASTHMA MYOFASCIAL SYNDROME

7. Subjective Evidence
 Increased Breathlessness *1 week associated with
Wheeze, progressive in nature, graduated onset
 Cough with expectoration* 1 week , Both increases on
exposure to cold and seasonal variation
MEDICAL HISTORY :
 Breathlessness and Cough with expectoration since 1 year

8. Objective Evidence
 Respiratory examination revealed Bilateral diffuse rhonchi
 LAB investigation shows increased level in ESR ( 28mm/hr )and
AEC(absolute eosinophil count )
 Basophil ( 0.5 % )
 MCV ( 82.9 fl )

9. ASSESSMENT…
Diagnosis :
Bronchial asthma
Risk factor :
Cold and seasonal variation and also hereditary causes.

10. Assessment : Bronchial Asthma
IF THERAPY IS REQUIRED OR NOT ?
 Yes , Therapy is indicated in this patient.
 To provide patient relief from severe symptoms such as Breathlessness
associated with wheezing and cough with expectoration .
 Respiratory examination revealed bilateral diffuse rhonchi and increased
level of ESR and AEC shows the problems or infections related to pulmonary
and therapeutic monitoring is required .
 To have a clear respiration with good quality of life.
 To avoid the further complications

11. GINA GUIDELINES :

12. Assessment of current therapy :
 Inj. IVEPRED 125mg ( D1 – D6 ) , TABLET 16mg 1-0-0 ( D7 )
( Methylprednisolone sodium succinate )
 Indication : Severe allergic reaction, Allergic disorders, Asthma
 Category : Corticosteroids
 Dose & Duration : 125mg 4 to 6 hours and 16mg tab once in the
morning.
 MOA : Anti –inflammatory , immunosuppressive

13.  ADRs :
 Electrolyte imbalance, Redistribution/accumulation of body fat, Bone degradation,
Increased risk of infection, Muscle disorders, Increased blood pressure, Increased
glucose level in blood, Skin scar, Altered bone growth, Cataract, Behavioural changes.
 Justification : As per Gina guidelines ,
Systemic glucocorticoids should be used in all patients with severe acute asthma

14. Budecort nebulizer ( D1 – D8 ) (budenoside )
 Indication : Prevention of Breathlessness and wheezing by Asthma
 Category : Corticosteroids
 Dose & duration : 0.5 to 2mg daily
 MOA : Decreased formation, release, and activity of the mediators of
inflammation (eg, kinins, histamine, liposomal enzymes, prostaglandins, and
leukotrienes)

15.  ADRs : Dry/irritated throat, hoarseness, voice changes, bad taste in the
mouth, runny nose, or nosebleeds may occur.
 Justification : As per Gina guidelines, Inhaled budesonide gave a dose-related
reduction in airways obstruction , bronchial reactivity and asthma symptom
severity.

16. T . Spirodin 650 1-0-0 ( D1 – D10 )(doxofyilline)
 Indication : COPD & Asthma
 Category : New generation long-acting oral bronchodilator (methyxanthine derivative.)
 Dose and Duration : 650 mg once in the morning
 MOA : Works by relaxing the muscles in the walls of the airways. This opens the airways
and makes breathing easier.
 ADRs :Nausea, Vomiting, Headache, Abdominal upset, Restlessness.
 Justification : Methyl xanthine continues to be a commonly prescribed drug for management
of asthma,

17. T. Montek –LC 0-0-1 ( D1-D8)
(montelukast,levocetrizine)
 Indication : Allergic disorders, Asthma
 Category : Levocetrizine : Antihistamine (H1-receptor blocker)
Montelukast : Leukotriene receptor antagonist
 Dose and Duration : One tablet once in the night .
 MOA : Levocetrizine : It blocks the action of certain chemical messengers that are
responsible for inflammation, congestion, itching, and other allergic reactions.
Montelukast : It works by blocking the action of leukotriene. It
reduces inflammation in the airways and nasal passages to prevent asthma and relieve
symptoms of allergies.

18.  ADRs :
Sleepiness, Indigestion ,Dizziness ,Abdominal pain ,Rash ,Cough
 Justification : According to Gina guidelines,
since the patient has allergic rhinitis this drug could be given

19. Syp. Ascoril-D (D1 –D10)
(Dextromethorphan)
 Indication : Common cold, Cough, Allergy
 Category : Bronchodilator
 Dose & Duration : 2tsp
 MOA : It does act on the cough centre in the medulla oblongata by elevating the threshold for coughing
affecting the signals in the brain that trigger cough reflex.
 ADRs :Fast heart rate ,Drowsiness ,Dizziness ,Dryness in mouth ,Restlessness ,
Difficulty in passing urine
 Justification : This causes increased resistance to flow, pulmonary hyperinflamation and
ventilation/perfusion and since patient had cough this drug could be given.

20. T. Sompraz 40 1-0-0 B/F (D1- D10 )
(Esomeprazole)
 Indication : Acidity , Heart Burn
 Category : Antacid , Anti-reflux agents ,PPI
 Dose & Duration : 40mg tablet once in the morning before food .
 MOA : lowers the acid production in the stomach.
 ADRs : Nausea, Abdominal pain, Constipation, Diarrhoea, Flatulence.
 Justification : Patients requiring enteral nutrition,
may also be in need of acid-suppressing therapy with proton pump

21. Neb Duolin ( D1 – D8 )
(Salbutamol/ipratropium)
 Indication : Asthma, COPD
 Category : Salbutamol – Short acting b2 agonist
 ipratropium - Anticholinergic
 Dose & Duration : 1-4 times 5-15mins
 MOA : Works by relaxing the muscles in the walls of the airways. This opens the
airways and makes breathing easier.
 ADRs : Dry mouth ,Buccal ulceration ,Paralytic ileus ,Headache ,Nausea
 Justification : According to Gina, Most effective medication for asthma and first-
line therapy . They are anti inflammatory and disease modifying resulting in
improved lung function, reduction of symptoms and exacerbations

22. Cap. Zevit 0-1-0 ( D3 – D7 )(vitamin)
 Indiaction : Covalescence, Old age & associated wth poor diet &prolonged antibiotic
therapy and debilitating diseases
 Category : Vitamin & or Minerals
 Dose & Duration : One capsule in the afternoon
 MoA :The production of fatty acids, strengthens
metabolism and boosts the energy level.
 ADRs : Rashes ,Chest pain , Dry mouth ,Nausea
 Justification : Increase vitamin intakes, promote health
and reduce the risk of disease.

23. T. Seradair 80mg 1-0-0 ( D3 – D10 )
(Seratrodast)
 Indication: To prevent Asthma
 Category : Prostaglandin endoperoxide receptor antagonist
 Dose & Duration : 80mg once in the morning
 MOA : Works by blocking the action of certain chemical messengers (prostaglandin ) that may
cause symptoms of asthma and allergies also decreases inflammation by antagonising the
thromboxane A2 receptor
 ADRs :. Headache ,Dry mouth , Nausea ,Drowsiness , Anemia , Abdominal pain , Stomach
discomfort
 Justification : It improves clinical symptoms and airway hyper responsiveness by reducing
airway inflammations

24. T . Pregaba 0-0-1 ( D4 – D8 )
(Pregaballin)
 Indication : Neuropathic pain
 Category : Antiepileptic
 Dose & Duration : 75mg once at night
 MOA : It decreases pain and seizures by modulating calcium channel activity of
the nerve cells
 ADRs : Sleepiness , Dizziness , Uncoordinated body movement , Fatigue, Chest
tightens
 Justification : Pregabalin is also used for postherpetic neuralgia (pain that
occurs after shingles)

25. Syp . Looz SoS ( D5 – D8 ) (lactulose)
 Indication : Constipation
 Category : Hyperosmotic Laxative
 Dose & Duration : SoS If necessary
 MOA : Works by drawing water into the intestine through osmosis ,
which makes the stool soft and easier to pass.
 ADRs : Dehydration
 Justification : Fiber supplements and simple osmotic laxatives are usually an adequate
approach for constipation in these patients.

26. MDI Formonide 6/200 2puffs via zerostat
( D9 – D10)
 Indication : Asthma , Allergic disorders , COPD
 Category : Long acting b2 agonist
 Dose & Duration : 2puffs via zerostat
 MOA : It works by relaxing the muscles in the walls of the airways this opens the airways
and make breathing easier.
 ADRs : Nausea , Insomnia , Vomiting , Dizziness , Dry mouth Nasopharyngitis
 Justification :According to Gina,low dose inhaled budesonide alone reduced severe
exacerbations and improved asthma control, and in patients already receiving inhaled
corticosteroid, adding formoterol was more effective than doubling the corticosteroid
dose.

27. Planning : Goals of Therapy :
 To monitor the toxicity with the side effects and to give maximum
therapeutic effect
 Achieve and maintain control of asthma symptoms
 Maintain normal activity levels, including exercise
 Maintain pulmonary function as close to normal as possible
 Prevent asthma exacerbations
 Avoid adverse effects from asthma medications
 Prevent asthma mortality
 To improve the quality of life without any obstructions or difficulties in
breathing

28.  Therapeutic monitoring –
 PFTs,
 sputum
 Toxicity monitoring –
 Inflammatory markers
 Blood sugar levels
 candida infections
 potassium levels

29. Points to Physician :
 To conduct Lung function test and Monitor the parameters
 To do the allergic test to determine the risk factors

30. Points to Patient :
 About the Disease :
 it’s the disease which causes inflammation of airways
,bronchoconstriction which results in the difficulty of breathing
 Advice regarding MDI usage , Need for compliance to medications & need for
regular check up
 Contact if Alarming symptoms of Haemoptysis , Breathlessness , Fever .
 Do not stop medications without consulting the doctor which may result in the
addiction .

31. About the Drugs :
 ALL the drugs having the dizziness and sleepiness as a common side effect ,do
not go or dive by taking this medications.
 If T. Pregaballin causes chest tightens , if any symptoms persists stop the
medication and contact physician immediately.
 Do not skip the dosage , if missed don not take double dose of it.
 Complete details about the discharge medication .

32. Discharge medications :
 -MDI FORMONIDE 6/200 2puffs via zerostat ( until next visit )
 -T . Montek LC 0-0-1 (30days )
 -T . Seradair 80mg 1-0-0 (10 days )
 -T .Pregaba 75mg 0-0-1 (30days )
 -Syp . Ascoril –D 2tsp (sos)
 -T. Sompraz 40mg 1-0-0 B/F ( 15days )
 -Cap . Zevit 0-1-0 ( 30days )
 -Syp. Looz 15ml ( sos)
 -T . Spirodin 650mg 1-0-0 ( 10days )
 -T . Ultracet ( sos )

33. Life style Modifications :
 Avoid stress and relax .
 Exercise everyday for at least 30 minutes-walking however, avoid any kind
of excessive physical exertion.
 Do not expose yourself to dust and environmental factors .
 Do not take self medications .
 Do constant check-ups during the seasonal variations

34. Follow up :
TO REVIEW AFTER 1 MONTH IN PUL 001 OPD ON
MONDAY/WEDNESDAY/FRIDAY

35. THANK You

36. References :
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