This document discusses bronchial asthma, including its definition, pathophysiology, signs and symptoms, and various treatment approaches. It notes that asthma affects 300 million people worldwide and is characterized by inflammation and airway hyperresponsiveness. Treatment involves preventing antigen reactions, suppressing inflammation, blocking mediators, and using bronchodilators such as beta-2 agonists, methylxanthines, corticosteroids, and leukotriene antagonists to relax airway smooth muscle. Status asthmaticus, a severe life-threatening form of asthma, requires aggressive treatment including nebulized bronchodilators, steroids, oxygen, and potentially intubation.

3. Objectives
 What is bronchial asthma?
 Etiology
 Pathophysiology of Asthma
 Approaches to treatment
 Phamacotherapy
 Treatment plan
 Drug delivery
 Status Asthmaticus

4. Bronchial Asthma
300 million people
Adult 10-12 %
Children 15%

5. 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.

6. Etiology

7. Pathophysiology

8. Pathophysiology

10. Signs & Symptoms
 Dyspnoea
 Wheezing
 Cough
 Limitation of activity

11. 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

12. 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
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13. Bronchodilators
β2
agonists
SABA:
• Salbutamol
• Terbutaline
LABA:
• Salmeterol
• Formeterol
Methylxanthines
Theophylline
Anticholinergics
Tiotropium
bromide
Ipratropium
bromide
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14. β2 sympathomimetics
ACTIONS:
 Bronchodilatation
β2 receptor stimulation
Increased cAMP
Relaxation of bronchial muscle
 Inhibits mediator release
 Increase mucus clearance

15. 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

16. β2 agonists
Muscle
tremors
ADRs
Palpitation,
restlessness
Ankle
edema
Throat
irritation

17. 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

18. Adverse effects
Gastric pain, vomiting
Tremors, palpitation
Hypotension
Convulsions
Insomnia

19. Drug Interactions
 agents inducing metabolism
 smoking
 phenytoin
 rifampicin
 agents inhibiting metabolism
 erythromycin
 OCPs
 ciprofloxacin

20. 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

21. Mechanism of Action

22. Anti-inflammatory Agents
Corticosteroids
Inhalational:
• Beclomethasone
• Flunisolide
• Budesonide
Systemic:
• Hydrocortisone
• Prednisolone
• Methyl
prednisolone
Chromones
Cromolyn sodium
( MDI )
Nedocromil
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23. Anti-inflammatory Agents (cont..)
5-HT inhibitors &
Antihistaminic
Ketotifen
(Oral )
Pizotifen
Lukasts ( Oral )
Zafirlukast
Montelukast
Pranlukast
Acolade
5-LOX inhibitors
Zileuton
(oral)
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24. Corticosteroids
Prednisolone, Beclomethasone
ADVANTAGES
 more complete and sustained relief
 improve airflow
Influence airway remodeling
 retard progression of disease

25. Mechanism of Action

26. 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

27. CHROMONES
Sod cromoglycate, Nedocromil
Inhibits degranulation of mast cells
Restricted release of mediators
Inhibition of chemotaxis

28. Chromones contd…
 Long term treatment - cellular inflammatory
response
Ineffective during an attack
USES
 prophylaxis in asthma
 allergic rhinitis
 allergic conjunctivitis

29. CHROMONES
Bronchospasm
Cough
Nasal
ADRs
congestion
Rashes
Arthralgia

30. 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

31. Mechanism of Action

32. Anti IgE Antibody
Omalizumab

35. • Inhalational
• Oral
• Parenteral
Drug Delivery

37. Inhalational Drug Delivery Systems
MDI Dischalers Spacer
Rotahalers Nebulizer
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Green
[Salmeterol]
Orange
[Fluticasone]
Blue
[SABA]
Brown
[budesonide]

38. 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