This document provides information about inhalers used for bronchial asthma. It discusses the pathophysiology of asthma involving inflammation and bronchoconstriction. It then covers the history of inhaled therapy, reasons for inhalation therapy, definitions of aerosols, lung deposition of drugs, inhalation devices including metered dose inhalers and dry powder inhalers, asthma medications including bronchodilators and corticosteroids, dosages, and specific inhaler brands such as Ventolin, Flovent, and Aerobid.
Definition and introduction to bronchial asthma - classification of bronchial asthma - pathophysiology and risk factors for bronchial asthma - diagnosis of bronchial asthma - clinical manifestations - investigations - management of bronchial asthma
Most about status asthmaticus, you will find from etiology to treatment and ventilator management. This presentation is made with thanks to medscape and other resources.
Definition and introduction to bronchial asthma - classification of bronchial asthma - pathophysiology and risk factors for bronchial asthma - diagnosis of bronchial asthma - clinical manifestations - investigations - management of bronchial asthma
Most about status asthmaticus, you will find from etiology to treatment and ventilator management. This presentation is made with thanks to medscape and other resources.
Bronchial Asthma: Definition,Pathophysiology and ManagementMarko Makram
Definition and Pathophysiology of Asthma in addition to classification and recent updates in the management of asthma based on GINA-2019 Guidelines, by Dr. Marco Makram.
Anatomy and physiology of lungs
Targeting drug delivery
pulmonary drug delivery
Pulmonary drug delivery is primarily used to treat conditions of the airways, delivering locally acting drugs directly to their site of action.
Delivery of anti-asthmatic and other locally acting drugs directly to their site of action reduces the dose needed to produce a pharmacological effect, while the low concentrations in the systemic circulation may also reduce side-effects.
The drugs which are administered by pulmonary route are not only for lungs delivery but it goes to systemic circulation and produce the effect where it is desired through out the body. For Eg. A product containing ergotamine tartrate is available as an aerosolized dosage inhaler for the treatment of migraine & Volatile anesthetics, including, halothane, are also given via the pulmonary route.
propellant
aerosol
container
A nebuliser is a small portable device that runs electronically, turning liquid medication into a mist.
The patient then needs to breathe in the aerosol thus created through a mouthpiece.
The mist, when inhaled, travels directly to the lungs, ensuring better absorption of the medication and a more
effective outcome of your ongoing treatment.
Metered Dose Inhaler (MDI)
Used for the treatment of respiratory diseases such as as :-
asthma, chronic obstructive pulmonary disease (COPD)
and other respiratory diseases.
Bronchial Asthma: Definition,Pathophysiology and ManagementMarko Makram
Definition and Pathophysiology of Asthma in addition to classification and recent updates in the management of asthma based on GINA-2019 Guidelines, by Dr. Marco Makram.
Anatomy and physiology of lungs
Targeting drug delivery
pulmonary drug delivery
Pulmonary drug delivery is primarily used to treat conditions of the airways, delivering locally acting drugs directly to their site of action.
Delivery of anti-asthmatic and other locally acting drugs directly to their site of action reduces the dose needed to produce a pharmacological effect, while the low concentrations in the systemic circulation may also reduce side-effects.
The drugs which are administered by pulmonary route are not only for lungs delivery but it goes to systemic circulation and produce the effect where it is desired through out the body. For Eg. A product containing ergotamine tartrate is available as an aerosolized dosage inhaler for the treatment of migraine & Volatile anesthetics, including, halothane, are also given via the pulmonary route.
propellant
aerosol
container
A nebuliser is a small portable device that runs electronically, turning liquid medication into a mist.
The patient then needs to breathe in the aerosol thus created through a mouthpiece.
The mist, when inhaled, travels directly to the lungs, ensuring better absorption of the medication and a more
effective outcome of your ongoing treatment.
Metered Dose Inhaler (MDI)
Used for the treatment of respiratory diseases such as as :-
asthma, chronic obstructive pulmonary disease (COPD)
and other respiratory diseases.
Asthma is a chronic inflammatory disorder of the airways causing airflow obstruction
and recurrent episodes of
wheezing,
breathlessness,
chest tightness and
coughing.
Chronic inflammatory airway disease associated with increased airway responsiveness and reversible airway obstruction.
It can present at any age; majority of cases diagnosed in childhood
Most of them become asymptomatic by adolescence
Disease severity rarely progresses; patients with severe asthma have it at the onset.
FACTORS EFFECTING ASTHMA:
The inside lining of the airways becomes red and swollen (inflammation)
Extra mucus (sticky fluid) may be produced
The muscle around the airways tightens
(bronchoconstriction)
DIAGNOSIS:
Pulse oximetry and ABG analysis
Chest Xray
Blood Test
Peak Flow meter + Spirometry- PEFR + FEV1 decrease
PEFR + FEV1 increase >15% after β agonist inhalation
Skin Testing
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
4. Lung function during early and late
phases of allergic response
BEFORE STIMULUS
BRONCHOSPASM
LATE PHASEEARLY PHASE
INFLAMMATION
5.
6. History of Inhaled Therapy
4000 years ago: the smoke of ephedra sinica
was used for asthma therapy
7. Modern age
Metered dose inhaler 1956 Medihaler
Dry powder inhaler 1960
Multidose dry powder inhaler 1970
440 million boxes aerosols per year are
manufactured in the world
8. Why Inhalation Therapy?
Targeted delivery of medication to the lungs
Rapid onset of action
Smaller doses
Less systemic and GI adverse effects
Relatively comfortable
9. Definition of an aerosol
Aero air
Sol solution
Liquid or solid suspensions into gas medium
Particles which are sufficiently small so as to
remain airborne for a considerable period of
time
12. Lung deposition of drug
Particle
size
shape
particle density
solid or liquid phase
Type of inhalation device
Technique
Airway obstruction
Drug molecule
13. Device dependent factors
Device dependent factors Patient dependent factors
Device
pMDI:
Portability,Treatment time, Drug
preparation, Reproducibility,
Coordination, Actuation, Drug
availability, Holding chamber,
Propellant
DPI:
Breath-actuation, Coordination,
Portability,Treatment time, Dose
counters, Flow requirement, Drug
availability, Resistance, Costs.
Aerosol
1. Particle size,Velocity, Physico-
chemical characteristics
Age
co-operation
compliance
airway anatomy
breathing patterns
Disease
20. Inhaled treatment for asthma
Preventers- inhalers
coloured in various shades
of brown, orange or
purple depending on their
strength) Should be used
twice each day to prevent
inflammation and long
term lung damage.
Most Preventers are taken
morning and evening .
21. Reliever inhalers-(normal dose, 2
puffs of blue)
To be given as and when necessary to relieve
cough, wheeze, breathlessness and chest
tightness.
Take 5-10 mins work by relaxing the tightness if
the muscles causing constriction in the
bronchioles.
Can be used before exercise .
You should expect 2 puffs of blue reliever inhaler,
when taken properly, to last for 4 hours.
For the duration of a cold an asthmatic child is
advised to take up to 2 puffs of their blue inhaler
every 4 hours
22. Medications
Rescuers
Relax tightened muscles
Short-Acting
Nebulizer or Puffer
Treat acute episodes and
symptoms
Reduce inflammation in
airways
Long-Acting
Take on a regular basis
Controllers:
23. Metered dose inhalers
Metered dose inhalers.These inhalers consist
of a pressurized canister containing
medication that fits into a boot-shaped
plastic mouthpiece.With most metered dose
inhalers, medication is released by pushing
the canister into the boot. One type of
metered dose inhaler releases medication
automatically when you inhale. Some
metered dose inhalers have counters so that
you know how many doses remain.
24. Metered Dose Inhalers (pMDI
Canister
Propellent gas (liquid
under pressure)
Drug
Dissolved or solid
microparticules into
the gas
Surfactant
Physical stabilisation
Prevent clustering
25. Propellant
Chloro fluoro carbon (CFC
Hydro fluoro alcan (HFA)
CFC (freon gas)
CFC not flammable
Not include chloride
Not disturbe Ozone layer
26. Freon (CFC)
Oropharyngeal irritation, cough and
bronchospasm
Harmfull for ozone layer
Cardiac arrhytmia
Less effective in cold climate
27. MDI
advantages Disadvantages
Rapid application
Handling
Multidose
Hand-breathe
coordinations
İneffective use in poor
ventilated patients
Oropharyngeal deposition
and local side effects
Not include dosimeter
31. Bronchodilator drugs
open up the airways in the lung within minutes of inhalation of the drug, by
relaxing the smooth muscle that surrounds the airways. Stimulate adenyl
cyclase and increasing cAMP
Short-acting bronchodilators: The effect of the usual type of bronchodilator
lasts for 3-4 hours and these short-acting drugs (e.g. albuterol, metaproterenol,
terbutaline) are used as needed or before exercise to prevent wheezing. The
short-acting drugs provide rapid relief during a mild or moderately severe
asthma attack, but they do nothing for the cause of the attack -
inflammation. These "rapidrelievers" or "rescue inhalers" may be needed
repeatedly until the attack subsides spontaneously or is controlled by an anti-
inflammatory drug.
Long -acting bronchodilators: Although bronchodilators do not prevent asthma
attacks, certain long-acting bronchodilators (e.g. Serevent and Foradil) can
improve lung function over 10-12 hour periods. This drug must NEVER be used
for the emergency rescue from an acute attack of asthma. Salmeterol and
formoterol
32. Albuterol(generic)
Generic: Albuterol
Type: MDI; fast/short
acting beta-2 agonist
Class: rescue/reliever
Functions:
bronchodilator, works in
5-15 minutes via inhaler
or nebulizer, effects last
4-5 hrs
Side
Effects/Suggestions:
shakiness of hands or
legs, fast heart beat,
anxiety, upset stomach,
headache , metallic taste
(rinse mouth)
Similar to:Ventolin,
Proventil
33. Ventolin®
Generic: /salbutamol
Type: MDI; fast/long
acting beta-2 agonist
Class: rescue/reliever
Functions: bronchodilator,
works in 5-15 minutes via
inhaler or nebulizer, effects
last 4-5 hrs
Side Effects/Suggestions:
shakiness of hands or legs,
fast heart beat, anxiety,
upset stomach, headache,
metallic taste (rinse
mouth)
Also available in:Ventolin
rotahaler
Similar to: Proventil,
Alupent, Maxair, Brethaire,
Metaprel
35. Ventolinrotahaler®
Generic: /salbutamol (?)
Type: rotahaler; fast/long (?)
acting beta-2 agonist
Class: rescue/reliever
Functions: bronchodilator,
works in 5-15 minutes via
inhaler or nebulizer, effects
last 4-5 hrs
Side Effects/Suggestions:
shakiness of hands or legs,
fast heart beat, anxiety, upset
stomach, headache, metallic
taste (rinse mouth)
Also available in:Ventolin
inhaler
Similar to: Proventil,
Alupent, Maxair, Brethaire,
Metaprel
36. Alupent®
Generic: metaproterenol
sulfate
Type: MDI; fast/short
acting beta-2 agonist
Class: rescue/reliever
Functions: bronchodilator,
works in 5-15 minutes via
inhaler or nebulizer, effects
last 4-5 hrs
Side Effects/Suggestions:
shakiness of hands or legs,
fast heart beat, anxiety,
upset stomach, headache,
metallic taste (rinse
mouth)
Similar to: Metaprel,
Ventolin, Proventil, Maxair,
albuterol, Brethaire
37. Brethaire®
Generic: terbutaline
sulfate
Type: MDI, fast/short
acting beta2-agonist
Class: rescue/reliever
Functions: bronchodilator,
works in 5-15 minutes via
inhaler or nebulizer, effects
last 4-5 hrs
Side Effects/Suggestions:
shakiness of hands or legs,
fast heart beat, anxiety,
upset stomach, headache,
metallic taste (rinse
mouth)
Similar to:Ventolin,
Alupent, Maxair, Proventil,
Metaprel
38. Foradilaerolizer®
Generic: formoterol
fumarate
Type: formoterol aerolizer
Class: controller/preventer
Functions: long-acting
bronchodilator; acts w/in 3
mins, effective for at least
12 hrs.
Side Effects/Suggestions:
tremors, heart rate,
headache; if sensitive to
drug, may develop rash,
itchiness, &
bronchospasm; don’t use
for quick relief
Similar to: Oxeze (and
related to Serevent)
39. Maxair®inhaler
Generic: perbuterol
acetate
Type: MDI; fast/short
acting beta2-agonist
Class: rescue/reliever
Functions: bronchodilator,
works in 5-15 minutes via
inhaler or nebulizer, effects
last 4-5 hrs
Side Effects/Suggestions:
shakiness of hands or legs,
fast heart beat, anxiety,
upset stomach, headache,
metallic taste (rinse
mouth)
Also available in: Maxair
autohaler
Similar to:Ventolin,
Alupent, Brethaire,
Metaprel, Proventil
40. Proventil®
Generic: albuterol
Type: MDI; fast acting
beta-2 agonist
Class: rescue/reliever
Functions:
bronchodilator, works in
5-15 minutes via inhaler
or nebulizer, effects last
4-5 hrs
Side
Effects/Suggestions:
shakiness of hands or
legs, fast heart beat,
anxiety, upset stomach,
headache, metallic taste
(rinse mouth)
Similar to:Ventolin,
Alupent, Maxair,
Brethaire, Metaprel
41. Serevent®
Generic: salmeterol xinafoate
Type: MDI; long acting beta2-
agonist
Class: controller/preventer
Functions: prevents
tightening of muscles around
lung tubes; takes 10-20 mins
to work, effective for at least
12 hrs.
Side Effects/Suggestions:
tremors, heart rate,
headache; if sensitive to drug,
may develop rash, itchiness,
& bronchospasm; don’t use
for quick relief
Also available in: Serevent
discus
Similar to: related to Foradil
& Oxeze
42. DOSES
DRUG FORM DOSE
Salmeterol MDI 21ug/puff
DPI 50 ug/blister
1 to 2 puffs bd
1 blister bd
Formeterol DPI 12ug/single use
capsule
1 cap bd
Albuterol MDI 90 ug/puff 2 to 8 puffs every
20 minutes for 3
doses than every 1
to 4 hr as needed
43. Anti-inflammatory drugs
work to reduce the irritability of the lung airways
by controlling the activities of inflammatory cells
in the airway walls. They are used to reduce
asthma severity over a period of time, and must
be used on a regular basis, usually 2-3 times per
day. These drugs do not provide immediate
relief from an asthma attack because they do not
act as bronchodilators. However, it is often
advised to temporarily increase the dose of the
anti-inflammatory drug during an acute
attack. Two types of anti-inflammatory drugs
exist -mast cell stabilizers, and corticosteroids.
44. Inhaled corticosteroids
are the most effective means of
controlling asthma and are the
usual type of drug given in the
routine anti-inflammatory
management of moderate
asthma. Combined preparations
containing a corticosteroid and a
long acting bronchodilator
(Advair, Dulera and Symbicort) are
proving to be useful in limiting the
amount of corticosteroid needed
for control of asthma.
MOA
Reduces the synthesis
of arachidonic acid by
phospholipase A2
Inhibit the expression
of COX-2 (anti-
inflammatory action)
Postulated that: this
drugs increases the
responsiveness of beta
agonists in the airway
45. DRUGS USED IN ASTHMA
Arachidonic acid
Lipooxygenase Cyclooxygenase
Hydroxypeptidase Endoperoxidase
Leukotrienes Prostacycline
Thromboxane A2
Prostaglandin
Membrane
Lipid
Phospholipase
A2
46. Aerobid®
Generic: flunisolide
Type: corticosteroid
(Metered Dose Inhaler)
Class: controller/preventer
Functions: anti-
inflammatory; slow-acting;
reduce hypersensitivity in
airways; long-term control
medication
Side Effects/Suggestions:
hoarseness; thrush; rinse
mouth with water after use
Also available in: mint flavor
Similar to:Azmacort,
Beclovent, Flovent,
Pulmicort,Vanceril
48. Aerobidmintflavor®
Generic: flunisolide
Type: corticosteroid
(Metered Dose Inhaler)
Class: controller/preventer
Functions:anti-
inflammatory; slow-acting;
reduce hypersensitivity in
airways; long-term control
medication
Side Effects/Suggestions:
hoarseness; thrush; rinse
mouth with water after use
Also available in: regular
Similar to:Azmacort,
Beclovent, Flovent,
Pulmicort,Vanceril
49. Azmacort®
Generic: triamcinolone
acetonide
Type: corticosteroid (Metered Dose
Inhaler)
Class: controller/preventer
Functions: anti-
inflammatory; slow-acting;
reduce hypersensitivity in
airways; long-term control
medication
Side Effects/Suggestions:
hoarseness; thrush; rinse
mouth with water after use
Similar to: Aerobid,
Beclovent, Flovent,
Pulmicort,Vanceril
51. Beclovent®
Generic:beclomethasone
dipropionate
Type: corticosteroid (Metered
Dose Inhaler)
Class:
controller/preventer
Functions: anti-
inflammatory; slow-
acting; reduce
hypersensitivity in
airways; long-term
control medication
Side
Effects/Suggestions:
hoarseness; thrush; rinse
mouth with water after
use
Similar to: Aerobid,
Azmacort, Pulmicort,
Vanceril
52. Vanceril®
Generic:beclomethasone
dipropionate
Type: corticosteroid (Metered
Dose Inhaler)
Class: controller/preventer
Functions: anti-
inflammatory; slow-acting;
reduce hypersensitivity in
airways
Side Effects/Suggestions:
hoarseness; thrush; rinse
mouth with water after use
Also available in: double
strength
Similar to:Azmacort,
Beclovent, Aerobid,
Pulmicort
53. Vancerildoublestrength®
Generic:beclomethasone
dipropionate
Type: corticosteroid (Metered
Dose Inhaler)
Class: controller/preventer
Functions: anti-
inflammatory; slow-acting;
reduce hypersensitivity in
airways
Side Effects/Suggestions:
hoarseness;
Also available in: regular
strength
Similar to:Azmacort,
Beclovent, Aerobid,
Pulmicort
54. Beclomethasone
Strength Low Dose
Medium
Dose
High Dose
42, 84
μg/puff cfc
40,80
μg/puff
HFA-
propellant
84-336 μg
(2-8 puffs
of 42
μg/puff
or1-4 puffs
of 84
μg/puff)
336-672 μg
(8-16 puffs
of 42
μg/puff or
4-8 puffs of
84 μg/puff)
>672 μg (>
16 puffs of
42 μg/puff
or> 8 puffs
of 84
μg/puff)
55. Flovent®
Generic: fluticasone
propionate
Type: corticosteroid MDI
Class: controller/preventer
Functions: anti-
inflammatory; slow-acting;
reduce hypersensitivity in
airways; long-term control
medication
Side Effects/Suggestions:
hoarseness; thrush; rinse
mouth with water after use
Similar to: Aerobid,
Azmacort, Beclovent,
Pulmicort,Vanceril
56. Fluticasone
Strength Low Dose
Medium
Dose
High Dose
44, 110, 220
μg/puff (MDI)
88-176 μg (2-4
puffs of 44
μg/puff
176-440 μg (4-10
puffs of 44
μg/puff or2-4
puffs of 110
μg/puff or1-2
puffs of 220
μg/puff
440 μg (>4 puffs
of 110 μg/puff or
> 2 puffs of 220
μg/puff)
DPI
50,100,150ug./in
halation
100 to 200 ug 200 to 400 ug More than 400
ug
60. MUSCARINIC ANTAGONISTS
Useful in 1/3 to 2/3
of asthmatic patients
(especially children)
No effect on the
inflammatory aspects
of asthma
Useful in many COPD
patients
More effective
and less toxic
than β agonists
MUSCARINIC
ANTAGONISTS
Ipatropium
Quaternary
antimuscarinic drug
Delivered to the
airways by
pressurized aerosol
Have little systemic
action
Tiotropium
Newer longer-acting
analog
61. Atrovent®
Generic: ipratropium
bromide
Type: anti-cholinergic
MDI
Class: rescue/reliever
Functions:
bronchodilator (relaxes
smooth muscle bands
around bronchial tubes),
works in 5-15 minutes
Side
Effects/Suggestions:
dryness of mouth,
metallic taste, avoid
contact with eye
62. Mast cell stabilizers
• Inhaled medications that work to prevent bronchial
tube swelling as part of a regular maintenance plan
• Also taken before exercise
MOA
Decrease in the release of mediators (leukotrienes and
histamine) from mast cells
Prevents both early and late responses to challenge
Intal
cromolyn sodium
inhalation aerosol
Metered dose
800 mcg/inhalation
Metered dose
1.75 mg/actuation
Tilade
nedocromil
sodium
63. Intal®
Generic: Cromolyn sodium
Type: non-steroidal MDI
Class: controller/preventer
Functions: anti-
inflammatory, inhibits
immediate & non-
immediate
bronchoconstrictive
reactions to inhaled
antigens; long-term
control medication
Side Effects/Suggestions:
throat irritation, cough; use
before exercise or contact
with a known trigger
Also available in: nebulizer
form, Intal Forte
Similar to:Tilade
64. Tilade®
Generic: Nedocromil
sodium
Type: non-steroidal MDI
Class:
controller/preventer
Functions: anti-
inflammatory, inhibits
immediate & non-
immediate
bronchoconstrictive
reactions to inhaled
antigens; long-term
control medication
Side
Effects/Suggestions:
unpleasant taste, may
cause stomach upset
Similar to: Intal
65. IntalForte®
Intal Forte ®
Generic: Cromolyn sodium
Type: non-steroidal MDI
Class: controller/preventer
Functions: anti-
inflammatory, inhibits
immediate & non-
immediate
bronchoconstrictive
reactions to inhaled
antigens; long-term
control medication
Side Effects/Suggestions:
throat irritation, cough; use
before exercise or contact
with a known trigger
Also available in: nebulizer
form, regular strength Intal
Similar to:Tilade
®
68. Combivent®
Generic: ipratropium
bromide & albuterol
sulfate
Type: anticholinergic &
beta2-agonist MDI
Class: combination
Functions: bronchodilator,
works in 5-15 minutes via
inhaler or nebulizer, effects
last 4-5 hrs
Side Effects/Suggestions:
tremors, heart rate,
headache, dizziness,
nausea, cough, dry mouth
Similar to: (kind of similar
to Advair)
69. Symbicort
Generic: budesonide, a
steroidal anti-
inflammatory agent, and
formoterol, a
bronchodilator
Type: steroid & beta2-
agonist MDI
Class:
combination"controller
Functions: bronchodilator,
works in 5-15 minutes via
inhaler or nebulizer, effects
last 4-5 hrs
Side Effects/Suggestions:
tremors, heart rate,
headache, dizziness,
nausea, cough, dry mouth
71. Autohaler
This is a breath activated
device, and thus had the advantage
that breathing and pressing don’t
need to be co-ordinated.
Shake the device
Remove the cap
Prime the device – pull the red lever
up so that it clicks
Whilst sat upright, take a normal
breath out.
Inhale slowly and deeply – don’t be
put off by the click. Keep breathing
in to a full inspiration, and then hold
your breath for 10 seconds
Push the red lever back
down. Replace the cap
Remember the tell the patient they
wont feel the spraying sensation
at the back of the throat and that
this is normal. They may still be
able to taste the drug though.
72. Maxairautohaler®
Generic: pirbuterol acetate
Type: autohaler; fast/short
acting beta2-agonist
Class: rescue/reliever
Functions: bronchodilator,
works in 5-15 minutes via
inhaler or nebulizer, effects
last 4-5 hrs
Side Effects/Suggestions:
shakiness of hands or legs,
fast heart beat, anxiety,
upset stomach, headache,
metallic taste (rinse
mouth)
Also available in: Maxair
inhaler
Similar to:Ventolin,
Alupent, Brethaire,
Metaprel, Proventil
74. MDI Spacer
A spacer not only allows for better co-
ordination of breathing and dispensing the
drug, but it also has a molecular effect. Larger
molecules of drug are the ones that normally
deposit themselves on the mucosa, and thus
these are the ones that can lead to candida,
hoarseness of the voice or systemic effects if
swallowed. But in a space, the larger
molecules remain in the spacer, and only the
smaller drug molecules are actually inhaled
75. How Should a Child Use an Inhaler –
with a Spacer?
• Ask child to breathe out
• Have child place spacer in
mouth
• Press down on inhaler
• Ask child to take a slow deep
breath
• Encourage child to hold breath
for five (5) seconds
• Remove spacer for exhalation
• Wait one minute before
repeating the process if there
is a second puff ordered
77. With a spacer
Need to be replaced every couple of months
Need to be washed every day in soapy warm
water, and only let them dry by
evaporation (drip drying) – do not wipe it
dry! –this causes build up of static electricity
They reduce the velocity of the drug particles,
and thus reduce the number of particles
being deposited on the mouth and pharynx
78. Washing the mouth
If you rinse out your mouth with water after
using the inhaler this reduces the risk of
thrush and irritation to the mucosa of the
mouth and pharynx.
80. Dry-powder inhaler – Breath-
activated inhalers
This kind of inhaler uses just dry-powder and no
propulsion system at all. All you have to do is
take a deep, fast breath which will make you
inhale a single dose. they usually rely on a
manual mechanism to insert one dose of dry-
powder drug into the mouthpiece.
The most common systems are the turbohaler
and the diskhaler. In both systems, you have to
turn or twist the body until a “click” sound
signals that a dose has been inserted and is
ready to be inhaled
81. DRY POWDERED INHALERS (DPIs
With DPIs the patient's breath (rather than
hand action) actuates delivery of the
medication.You cannot see the spray because
the only way to get the medication is to inhale
it from the mouthpiece. Within the DPI
category, there are two broad types:DPIType
1): the medication is contained within the
inhaler device at all times, until inhaled, or
DPIType 2): the medication comes in a
separate capsule that must be placed into the
inhaler device at the time of use.
82. Type 1 medication is contained within
the inhaler device ..eg pulimcort
DPIType 2. Medication is separate from the inhaler,
in a capsule eg he widely used drug Spiriva
(tiotropium bromide)
•Turbuhaler
83. Classification of Dry Powder Inhalers,
Based on Design and Function
Single-Dose Devices
Aerolizer formoterol capsule
single
HandiHaler tiotropium capsule
single
86. Sereventdiscus®
Generic: salmeterol
xinafoate
Type: dry powder discus;
long acting beta2-agonist
Class: controller/preventer
Functions: prevents
tightening of muscles
around lung tubes; takes
10-20 mins to work,
effective for at least 12 hrs.
Side Effects/Suggestions:
tremors, heart rate,
headache; if sensitive to
drug, may develop rash,
itchiness, &
bronchospasm; don’t use
for quick relief
Also available in: Serevent
inhaler
Similar to: related to
Foradil & Oxeze
88. Advair®
Generic: fluticasone &
salmeterol
Type:combination, powder
discus
Class: controller/rescue
Functions: anti-
inflammatory; open
airways for at least 12
hours
Side Effects/Suggestions:
hoarseness; rinse mouth
with water after use; never
increase the puffs unless
directed
Also available in: purple,
blue; 100, 250, 500 mcg
Similar to: Combivent
(ipratropium bromide &
albuterol sulfate)
91. PROPELLANT-FREE "SOFT MIST"
INHALERS
This is the latest type of
inhaler for asthma and
COPD. At this writing
there is only one soft mist
inhaler marketed in the
United State
COMBIVENT budesonide
+ formoterol
RESPIMAT does not
contain any of these
harmful propellants and
uses a spring mechanism
to release the medication
92. Nebulizer
Compressor nebulizer is the most
commonly used and this consists of
an air compressor that is connected
to a cup provided for medication.
This cup is attached to a
mouthpiece or face mask.The
compressor produces compressed
air that is passed through the cup
with liquid medicine.As the air
comes in contact with the liquid
medicine, an aerosol mist is formed
and this mist is inhaled by the
patient through the mouthpiece or
face mask. In case of nebulizer
treatments for infants, usually a face
mask is used and not the
mouthpiece.
in short, nebulizer
converts liquid
medicine to aerosol
mist that can go deep
into the airways and
alleviate inflammation.
93. VENTOLIN®
Respirator Solution VENTOLIN NEBULES
Respirator Solution/
5 mg salbutamol
base/ml
The average dose for a single
treatment is 0.25 to 0.5 mL of
VENTOLIN®
Respirator Solution (1.25 to 2.5 mg of
salbutamol) diluted in 2 to 5 mL or
more of sterile normal saline. For
more refractory cases, the single dose
ofVENTOLIN®
Respirator Solution may be increased
to 1 mL (5 mg of salbutamol).
Treatment may be
repeated four times a day if necessary.
Nebules/unit dose/
2.5 or 5.0 mg
salbutamol base/ 2.5 mL
Children requiring a single dose of 2.5
mg may be administered
the contents of a singleVENTOLIN®
Respirator Solution unit dose
(VENTOLIN
NEBULES®
P.F. 2.5 mg of salbutamol). For more
refractory cases children may use a
5 mg unit dose (see dosage above).
Treatment may be repeated 4 times a
day if necessary
94. Dose (mg) of
Salbutamol
(per treatment)
Volume (mL) of
Ventolin respirator
Solution
(per treatment)
Volume* (mL) of Sterile
Normal Saline to be
added as diluen
1.25 0.25 2-5 mL or mor
2.5 0.50 2-5 mL or mor
5 1.00 2-5 mL or mor