1. Moses Busi
8th Sem

2. *
*Treatment of infection
*Avoidance of allergens and
other precipitating factors
*Drugs
*hyposensitization

3. *
•Bronchodilators
•Β2 agonists
•Anti-cholinergics
•Theophyllines
•Controllers
•ICS
•Systemic corticosteroids
•Antileukotrienes
•Cromones
•Anti-Ig-E
•immunotherapy

4. *
*Salbutamol
*Terbutaline
*Route: inhalation- to reduce side-effects
*Rapid onset of relief so used in
symptomatic relief
*Prevents EIA if taken prior to exercise
*SE: Muscle tremors, palpitations

5. Short acting : epinephrine
isoetharine
Intermediate: terbutaline
metaproterenol
Long acting: salmeterol
formeterol

6. *
*Ipratropium bromide
*Tiotropium bromide
*Less effective than B2 agonists-as
they inhibit only cholinergic reflex
component
*High doses through nebulizer- to treat
acute severe asthma
*SE: dry mouth, urinary retention,
glaucoma

7. *
Not used now-a days because of side effects
*MOA- cyclic amp by inhibiting
phopsphodiesterase in smooth muscle cells
*At low doses anti-inflammatory effect
*Used as additional bronchodilator in pt. of severe
asthma
*s/e nausea, vomiting, palpitations, diuresis,
seizures, death

8. *Inhaled corticosteriods
*Systemic corticosteriods
*Antileukotrienes
*Cromones
*ANTI-IgE
*Immunotherapies

9. *Most effective
*Reduces eosinophils in airways and sputum and number
of activated T lymphocytes & surface mast cells
*M/O: switch of transcription of multiple activated
genes that encode inflammatory proteins such as
chemokines, cytokines, adhesion molecules &
inflammatory enzymes
*Effective in preventing EIA and nocturnal exacerbations
*First line therapy for patients with persistent asthma

10. *But if asthma not controlled at low doses ,it is usual to
add LABA as next step
*S/E:
* Local side effects: Hoarseness (dysphonia)&oral
candidiasis which can be reduced by a large volume spacer
device
*Systemic side effects: due to absorption from lungs
*At highest recommended doses there is suppression of
plasma and urinary cortisol concentrations
*No convincing evidence of osteoporosis and growth
retardation in children

11. *Treating acute severe asthma
*A course of 30-45mg O.D. for 5 to 10 days
*Side effects – trunkal obesity, bruising, osteoporosis,
diabetes, hypertension, gastric ulcers, cataract.
*If patients require maintenance treatment, it is
important to monitor bone density. So that treatment
with bisphosphonates or oestrogen may be initiated.

12. *
*Montelukast and Zafirlukast block cys-LT1
receptors and prevent bronchoconstriction.
*These are less effective than ICS. And less effect
on airway inflammation.
*Useful as an add-on therapy in some patients not
controlled with low doses of ICS.
*Given orally once or twice daily.

13. *
*Cromolyn sodium and nedocromyl sodium
inhibit mast cell and sensory nerve activation,
so effective in blocking trigger induced asthma
such as E.I.A and allergen and sulphur dioxide-
induced symptoms.
*Little effect in long term control of asthma due
to short duration of action.

14. *
*Methotrexate, cyclosporine, azathioprine,
gold and i.v gammaglobulin.
*These are associated with relatively high
risk of side effects, so not used on a routine
basis.

15. *
*Omalizumab- blocking antibody that neutralises
circulating IgE without binding to cell bound IgE.
*Expensive treatment and only suitable for highly
selected patients who are not controlled on
maximal dose of inhaler therapy.
*Omalizumab given as s.c. injection every 2-4
weeks.

16. Stage of
severity
Symptoms Night time
Symptoms
PEF
Step 1
Intermittent
<1 time a week
Asymptomatic
& normal
between
attacks
<2 times a
month
>80%
Predicted
variability <20%
Step 2
Mild Persistent
>1 time a week
But <1 time a
day
>2 times a
month
>80%
Predicted
variability 20-
30%
Step 3
Moderate
Persistent
Daily
Use B2 agonist
daily
Attacks affect
severity
>1 time a week <80%
Predicted
variability >30%
Step 4
Severe
Persistent
Continuous
Limited
physical
activity
Frequent <60%
Predicted
variability>30%