The document discusses the pharmacotherapy of bronchial asthma over 67 paragraphs. It outlines the various classes of drugs used to treat asthma, including inhaled corticosteroids, long-acting beta2-agonists, leukotriene modifiers, theophylline, and monoclonal antibodies. It also discusses combination therapy with different drug classes and the importance of patient education and adherence to treatment plans for effective asthma management.
DISEASES OF THE UPPER RESPIRATORY TRACT (nose.pptxssuseref3feb
The document summarizes diseases of the upper respiratory tract including the nose, nasopharynx, and larynx. It describes common inflammatory conditions like rhinitis and sinusitis caused by viruses and bacteria. It also mentions nasal polyps, nasopharyngeal carcinoma which is associated with Epstein-Barr virus, and laryngeal conditions such as vocal cord nodules, papillomas, and squamous cell carcinoma which occurs most often in smokers.
1) Tuberculosis is a major cause of death worldwide caused by the bacterium Mycobacterium tuberculosis. It usually affects the lungs but can affect other organs in up to one-third of cases.
2) If properly treated with drugs, tuberculosis is curable in virtually all cases, but if untreated it can be fatal within 5 years in 50-65% of cases. It is transmitted through the airborne spread of droplet nuclei produced by infectious patients.
3) Mycobacterium tuberculosis is an acid-fast, rod-shaped bacterium that is difficult to treat due to its waxy cell wall containing mycolic acids and other lipids.
The document discusses various types of upper respiratory tract infections including the common cold, pharyngitis, tonsillitis, croup, epiglottitis, diphtheria, otitis media, sinusitis, and lower respiratory tract infections including pneumonia. It provides details on the causative agents, epidemiology, pathogenesis, clinical features, diagnosis, treatment and prevention of these conditions. The upper respiratory tract is defined as above the vocal cords while the lower respiratory tract is below.
The document discusses several infectious diseases of the respiratory system. It begins by describing the anatomy of the respiratory system and classifying it into the upper and lower respiratory tract. It then discusses several bacterial and viral infections that can affect the upper respiratory tract, such as streptococcal pharyngitis, diphtheria, and the common cold. Next, it covers lower respiratory tract infections like pneumonia, whooping cough, and tuberculosis. It concludes by briefly mentioning influenza and some systemic fungal infections like histoplasmosis.
COPD is a progressive lung disease characterized by airflow limitation and lung damage. The two main conditions that make up COPD are chronic bronchitis and emphysema. It is usually caused by smoking and affects over 30 million Americans. Symptoms include cough, sputum production, and shortness of breath. Diagnosis involves assessing symptoms, risk factors like smoking history, and pulmonary function tests.
This document provides an overview of autacoids and the arachidonic acid cascade that produces inflammatory mediators. It defines autacoids as locally-acting substances produced by cells that have biological activity. The main classes of autacoids - amine, lipid, peptide and others - are described. The document then focuses on the arachidonic acid cascade, outlining the enzyme pathways, key players like prostaglandins and leukotrienes, and how NSAIDs inhibit parts of this cascade. The roles of these inflammatory mediators in various body systems and processes like inflammation are summarized.
This document discusses histamine and histamine antagonists (antihistamines). It begins by outlining the objectives which are to describe the histamine receptor subtypes, distinguish between first and second generation antihistamines, and discuss the actions and side effects of histamine and antihistamines. It then provides details on the distribution, synthesis, and physiological and pathophysiological actions of histamine. The mechanisms of action, indications, and side effect profiles of first and second generation antihistamines are compared. In summary, the document is a review of histamine pharmacology and the clinical applications of antihistamines.
nose, paranasal sinus and pharynx dev't.pptxssuseref3feb
1) The structures of the face, nose, and pharynx develop from the pharyngeal arches, pouches, grooves, and membranes in early embryonic development.
2) The nose develops from the frontonasal prominence and lateral nasal processes. The nasal cavities form from invaginations between the medial and lateral nasal folds.
3) The palate develops from the intermaxillary segment and palatine shelves fusing together. The primary palate develops from the intermaxillary segment, while the secondary palate develops from the palatine shelves and nasal septum.
DISEASES OF THE UPPER RESPIRATORY TRACT (nose.pptxssuseref3feb
The document summarizes diseases of the upper respiratory tract including the nose, nasopharynx, and larynx. It describes common inflammatory conditions like rhinitis and sinusitis caused by viruses and bacteria. It also mentions nasal polyps, nasopharyngeal carcinoma which is associated with Epstein-Barr virus, and laryngeal conditions such as vocal cord nodules, papillomas, and squamous cell carcinoma which occurs most often in smokers.
1) Tuberculosis is a major cause of death worldwide caused by the bacterium Mycobacterium tuberculosis. It usually affects the lungs but can affect other organs in up to one-third of cases.
2) If properly treated with drugs, tuberculosis is curable in virtually all cases, but if untreated it can be fatal within 5 years in 50-65% of cases. It is transmitted through the airborne spread of droplet nuclei produced by infectious patients.
3) Mycobacterium tuberculosis is an acid-fast, rod-shaped bacterium that is difficult to treat due to its waxy cell wall containing mycolic acids and other lipids.
The document discusses various types of upper respiratory tract infections including the common cold, pharyngitis, tonsillitis, croup, epiglottitis, diphtheria, otitis media, sinusitis, and lower respiratory tract infections including pneumonia. It provides details on the causative agents, epidemiology, pathogenesis, clinical features, diagnosis, treatment and prevention of these conditions. The upper respiratory tract is defined as above the vocal cords while the lower respiratory tract is below.
The document discusses several infectious diseases of the respiratory system. It begins by describing the anatomy of the respiratory system and classifying it into the upper and lower respiratory tract. It then discusses several bacterial and viral infections that can affect the upper respiratory tract, such as streptococcal pharyngitis, diphtheria, and the common cold. Next, it covers lower respiratory tract infections like pneumonia, whooping cough, and tuberculosis. It concludes by briefly mentioning influenza and some systemic fungal infections like histoplasmosis.
COPD is a progressive lung disease characterized by airflow limitation and lung damage. The two main conditions that make up COPD are chronic bronchitis and emphysema. It is usually caused by smoking and affects over 30 million Americans. Symptoms include cough, sputum production, and shortness of breath. Diagnosis involves assessing symptoms, risk factors like smoking history, and pulmonary function tests.
This document provides an overview of autacoids and the arachidonic acid cascade that produces inflammatory mediators. It defines autacoids as locally-acting substances produced by cells that have biological activity. The main classes of autacoids - amine, lipid, peptide and others - are described. The document then focuses on the arachidonic acid cascade, outlining the enzyme pathways, key players like prostaglandins and leukotrienes, and how NSAIDs inhibit parts of this cascade. The roles of these inflammatory mediators in various body systems and processes like inflammation are summarized.
This document discusses histamine and histamine antagonists (antihistamines). It begins by outlining the objectives which are to describe the histamine receptor subtypes, distinguish between first and second generation antihistamines, and discuss the actions and side effects of histamine and antihistamines. It then provides details on the distribution, synthesis, and physiological and pathophysiological actions of histamine. The mechanisms of action, indications, and side effect profiles of first and second generation antihistamines are compared. In summary, the document is a review of histamine pharmacology and the clinical applications of antihistamines.
nose, paranasal sinus and pharynx dev't.pptxssuseref3feb
1) The structures of the face, nose, and pharynx develop from the pharyngeal arches, pouches, grooves, and membranes in early embryonic development.
2) The nose develops from the frontonasal prominence and lateral nasal processes. The nasal cavities form from invaginations between the medial and lateral nasal folds.
3) The palate develops from the intermaxillary segment and palatine shelves fusing together. The primary palate develops from the intermaxillary segment, while the secondary palate develops from the palatine shelves and nasal septum.
The development of the respiratory system begins in the 4th week of gestation with the formation of the laryngotracheal groove. This groove evaginates to form the laryngotracheal diverticulum which separates the foregut into the esophagus and laryngotracheal tube. The laryngotracheal tube gives rise to the larynx, trachea, bronchi and lungs. Lung development occurs through four stages - pseudoglandular, canalicular, saccular and alveolar. Maturation continues after birth as alveoli multiply leading to fully developed gas exchange ability in adults.
This document discusses epidemiological concepts of disease causation. It describes the epidemiological triangle model which shows the interaction between the host, agent, and environment in disease occurrence. It also discusses other models like the web of causation and wheel of causation which are used to better understand diseases with multiple interacting factors. The concepts of necessary and sufficient causes are explained. Finally, it discusses how the time, place and person framework can help understand disease occurrence and identify cases.
This document discusses epidemiologic surveillance. It begins by defining epidemiologic surveillance as the systematic collection, analysis, interpretation and dissemination of health-related data on an ongoing basis. Surveillance provides information that can be used to investigate, prevent and control disease. There are different types of surveillance including passive, active, and sentinel surveillance. The main purpose of surveillance is early detection of outbreaks, providing baseline data for planning health programs, and defining the magnitude and distribution of diseases.
Socialization is a lifelong process through which individuals develop their human potential and personality through social experience. It involves learning social and cultural norms. Personality and sense of self emerge through socialization as individuals interact with others and internalize their perspectives. Various theorists have proposed stages of socialization and personality development across the lifespan from childhood to old age. Socialization also occurs through specific social institutions and roles that individuals learn at different life stages.
Increases in sociocultural complexity, energy usage, and population size over the past 10,000 years have significantly impacted human health and disease. As populations became more sedentary with the rise of agriculture around 10,000 years ago, infectious diseases spread more easily in crowded settlements and epidemics became more severe. Industrialization in cities further exacerbated health problems due to poor sanitation and nutrition. While infectious diseases were historically the leading cause of death, many societies have undergone an epidemiological transition so that non-communicable diseases are now more prevalent as living standards improve.
SOSA Chapter 5and 6 Kinship, marriage and family.pptxssuseref3feb
This document discusses kinship, marriage, family, and social processes. It defines kinship as social relationships through blood, marriage, or other ties. Kinship is created through consanguinity (blood), affinity (marriage), or fictitious kinship (non-blood/marriage relationships). Marriage is defined as a union between a man and woman that establishes rights and status of children. Family is a social group united by marriage, ancestry, or adoption responsible for child rearing. Social processes are repetitive patterns of interaction at micro and macro levels, including competition, conflict, cooperation, accommodation, and assimilation over scarce resources.
Introduction to Medical Anthropology and Sociology (0).pptssuseref3feb
Medical sociology and anthropology are concerned with the social and cultural factors that influence health, illness, and medical systems. Medical sociology examines medicine as a social institution and applied enterprise, and how social factors relate to illness and medical treatment. Medical anthropology takes a cross-cultural perspective to study traditional and modern medical systems, and how biological and socio-cultural characteristics of groups influence health and disease. Both fields look at how social groups experience illness and how societies define, treat, and support responses to disease.
This document discusses the doctor-patient relationship and communication. It covers:
1) The core of medicine is the doctor-patient relationship, with patients expecting both a good relationship and cure. The relationship itself can be part of the therapeutic process.
2) Patients want to trust their doctor's competence, navigate the healthcare system effectively, be treated with dignity and respect, understand how illness/treatment affects their lives, discuss impacts on family/finances, and learn self-care.
3) Effective communication is unique due to the immediate trust and vulnerability patients have with doctors during examinations. Respect, empathy, objectivity, and understanding patient autonomy and values are important.
Psychological and behavioral interventions are important for treating behavioral disorders and promoting healthy behaviors. Psychologists develop models of behavior change to encourage self-protective actions and reduce health risks. Stress management techniques taught by psychologists include managing bodily reactions, exercise, meditation, modifying ineffective behaviors, seeking social support, and developing a hardy personality. Addictive behaviors are explained by various theories including moral, biomedical, and social learning models.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
The development of the respiratory system begins in the 4th week of gestation with the formation of the laryngotracheal groove. This groove evaginates to form the laryngotracheal diverticulum which separates the foregut into the esophagus and laryngotracheal tube. The laryngotracheal tube gives rise to the larynx, trachea, bronchi and lungs. Lung development occurs through four stages - pseudoglandular, canalicular, saccular and alveolar. Maturation continues after birth as alveoli multiply leading to fully developed gas exchange ability in adults.
This document discusses epidemiological concepts of disease causation. It describes the epidemiological triangle model which shows the interaction between the host, agent, and environment in disease occurrence. It also discusses other models like the web of causation and wheel of causation which are used to better understand diseases with multiple interacting factors. The concepts of necessary and sufficient causes are explained. Finally, it discusses how the time, place and person framework can help understand disease occurrence and identify cases.
This document discusses epidemiologic surveillance. It begins by defining epidemiologic surveillance as the systematic collection, analysis, interpretation and dissemination of health-related data on an ongoing basis. Surveillance provides information that can be used to investigate, prevent and control disease. There are different types of surveillance including passive, active, and sentinel surveillance. The main purpose of surveillance is early detection of outbreaks, providing baseline data for planning health programs, and defining the magnitude and distribution of diseases.
Socialization is a lifelong process through which individuals develop their human potential and personality through social experience. It involves learning social and cultural norms. Personality and sense of self emerge through socialization as individuals interact with others and internalize their perspectives. Various theorists have proposed stages of socialization and personality development across the lifespan from childhood to old age. Socialization also occurs through specific social institutions and roles that individuals learn at different life stages.
Increases in sociocultural complexity, energy usage, and population size over the past 10,000 years have significantly impacted human health and disease. As populations became more sedentary with the rise of agriculture around 10,000 years ago, infectious diseases spread more easily in crowded settlements and epidemics became more severe. Industrialization in cities further exacerbated health problems due to poor sanitation and nutrition. While infectious diseases were historically the leading cause of death, many societies have undergone an epidemiological transition so that non-communicable diseases are now more prevalent as living standards improve.
SOSA Chapter 5and 6 Kinship, marriage and family.pptxssuseref3feb
This document discusses kinship, marriage, family, and social processes. It defines kinship as social relationships through blood, marriage, or other ties. Kinship is created through consanguinity (blood), affinity (marriage), or fictitious kinship (non-blood/marriage relationships). Marriage is defined as a union between a man and woman that establishes rights and status of children. Family is a social group united by marriage, ancestry, or adoption responsible for child rearing. Social processes are repetitive patterns of interaction at micro and macro levels, including competition, conflict, cooperation, accommodation, and assimilation over scarce resources.
Introduction to Medical Anthropology and Sociology (0).pptssuseref3feb
Medical sociology and anthropology are concerned with the social and cultural factors that influence health, illness, and medical systems. Medical sociology examines medicine as a social institution and applied enterprise, and how social factors relate to illness and medical treatment. Medical anthropology takes a cross-cultural perspective to study traditional and modern medical systems, and how biological and socio-cultural characteristics of groups influence health and disease. Both fields look at how social groups experience illness and how societies define, treat, and support responses to disease.
This document discusses the doctor-patient relationship and communication. It covers:
1) The core of medicine is the doctor-patient relationship, with patients expecting both a good relationship and cure. The relationship itself can be part of the therapeutic process.
2) Patients want to trust their doctor's competence, navigate the healthcare system effectively, be treated with dignity and respect, understand how illness/treatment affects their lives, discuss impacts on family/finances, and learn self-care.
3) Effective communication is unique due to the immediate trust and vulnerability patients have with doctors during examinations. Respect, empathy, objectivity, and understanding patient autonomy and values are important.
Psychological and behavioral interventions are important for treating behavioral disorders and promoting healthy behaviors. Psychologists develop models of behavior change to encourage self-protective actions and reduce health risks. Stress management techniques taught by psychologists include managing bodily reactions, exercise, meditation, modifying ineffective behaviors, seeking social support, and developing a hardy personality. Addictive behaviors are explained by various theories including moral, biomedical, and social learning models.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Overview
ïIntroduction
ïEtiopathogenesis
ïPharmacotherapy
ïPhenotypes of Asthma
ïRecent guidelines for treatment
ïVarious devices used now-a-days
ïRecent advances
ïSummary
Pharmacotherapy of
bronchial asthma
- 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.
Pharmacotherapy of
bronchial asthma
What is bronchial asthma?
ï± Asthma is one of the most common disease
encountered in clinical practice
ï± 300 million people suffer from asthma worldwide
out of which 30 million asthmatics are in India
ï± According to WHO, India has the largest number of
asthma deaths in the world, contributing to 22.3% of
all global asthma deaths
Pharmacotherapy of
bronchial asthma
Burden of disease
Recurrent episodes characterized by:
- Breathlessness
- Wheezing
- Coughing- especially at night or early morning
- Tightness in the chest
- Hyperinflation
- Increased mucus production
Pharmacotherapy of
bronchial asthma
Clinical features
ï± Mechanism:cause bronchial smooth muscle
relaxation by decreasing calcium, opening potassium
channels, inhibiting myosin light chain kinase (MLCK)
and stimulating myosin light chain
phosphorylase(MLCP)
ï¼ Short acting drugs :Onset of action is 5
minutes,duration of action (4-6 hrs) & hence are drug
of choice for acute attack
ï¼ Long acting drugs:Duration of action (12 hrs)&
hence at BD doses used for prophylaxis
Pharmacotherapy of
bronchial asthma
Beta-2 Agonists
ï¼ Ultra long acting drugs : duration of action is
24 hrs & hence used at OD doses for
prophylaxis of asthma
ï¶Side effects :Tremors are most common due
to β2 receptor stimulation in skeletal muscles
Other-palpitations, QT prolongation
Pharmacotherapy of
bronchial asthma
Beta-2 Agonists Contd
Pharmacotherapy of bronchial
asthma
Doses
Name Oral Inhalation
Salmeterol - 50-100 ïg.
Formoterol - 12-24ïg.
Bambuterol 10-20mg. -
- Trials comparing salmeterol with placebo found increased
mortality and exacerbations in salmeterol group
- Discontiuation of ICS after LABA results in increased markers
of inflammation
- Black box warning issued by FDA on all LABA
- Postulated mechanisms are:
ï A direct deleterious effect on bronchial smooth muscle
ï Maintenance of lung function despite worsening inflammation; so
that patients tend to delay seeking treatment for an
exacerbation
Pharmacotherapy of
bronchial asthma
Safety issues of LABA
- These drugs mainly cause dilation of large airways
- Less effective than beta-2 agonists as they inhibit
only the cholinergic reflex component of
bronchoconstriction
- These drugs are not approved by FDA but used off
label in patients not responding to or intolerant to β2
agonists
- Combined with β2-agonists in treating acute severe
asthma
Pharmacotherapy of
bronchial asthma
Anticholinergics
- Ipratropium : short acting (6 hrs) & hence can
be used for an acute attack of bronchial
asthma
- Oxitropium: Intermediate acting & can be
used in nocturnal asthma
- Tiotropium : longest acting(24 hrs) & used in
long term prophylaxis in combination with
corticosteroids
Pharmacotherapy of
bronchial asthma
Anticholinergics Contd
ï¶ Drugs include :
ï Theophylline, Aminophylline, Theobromine
ï¶ Mechanism :
ï Act by inhibiting Phosphodiesterase which is involved
in breakdown of cAMP & by blockade of adenosine
receptors
ï Inhibition of phosphodiesterase in lymphocytes gives
additional anti-inflammatory effect
Pharmacotherapy of
bronchial asthma
Methylxanthines
ï± Theophylline can be used by oral route at a dose of 8
mg/kg BD for persistent asthma along with inhalational
corticosteroids
ï± Aminophylline can be used by I.V route with a loading
dose of 6mg/kg followed by 0.5 mg/kg/hr for
treatment of Acute attack of asthma
Pharmacotherapy of
bronchial asthma
Methylxanthines Contd
Theophylline has a low therapeutic index and hence
therapeutic monitoring is done to maintain plasma
concentration within range i.e 5-15 mg/L
ï These are potent anti-inflammatory drugs & also
decrease bronchial hyperactivity & mucosal edema.
ï Mechanism: Arachidonic acid (AA) is released
from the membrane phospholipids with the help of
enzyme phospholipase A2 that is
inhibited by corticosteroids. AA is converted to PG
and TX by cyclooxygenase and to LT
with the help of enzyme 5-lipooxygenase (5 LOX).
Thus, these mediators are not generated
when corticosteroid therapy is initiated
Pharmacotherapy of
bronchial asthma
Corticosteroids
- Steroids are used if patient has to use SABA more
than 2 times a week for symptomatic relief
- Systemic steroids have a lot of adverse effects,
therefore are reserved for resistant severe chronic
asthma and in status asthmaticus
- Hydrocortisone( 100 mg bolus) is I.V. Steroid of
choice as it is fastest acting systemic steroid
- Oral prednisolone can be used for persistent asthma
Pharmacotherapy of
bronchial asthma
Corticosteroids
- Inhalational corticosteroids are drug of choice for
persistent asthma
Pharmacotherapy of
bronchial asthma
Corticosteroids Contd..
ï¯ Beclomethasone dipropionate 200-400 ïg BD
ï¯ Flunisolide 25 ïg BD
ï¯ Budesonide 200-400 ïg BD
ï¯ Fluticasone propionate 100-250 ïg BD
ï¯ Ciclosenide 40 160 ïg OD
Synergism between steroids and β2 agonists
- They interact with each other to potentiate their
actions
- Steroids:
a) Increase transcription of β2 receptor gene in airway
mucosa
b) Prevent downregulation of β2 receptors
- β2 agonists:
a) Enhance binding of Glucocorticoid Receptors to
DNA
b) Increase in translocation of Glucorticoid Receptors
to the nucleus
- Lipooxygenase inhibitors:
Zileuton inhibits synthesis of LTB4 (chemotactic) ,
LTC4 and LTD4 (bronchoconstrictor).
Limitions- short duration of action and hepatotoxicity.
- Leukotrine receptor antagonists:
Montelukast and zafirlukast inhibit the
bronchoconstrictor action of Leukotrines
Prophylactic agents for bronchial asthma, few cases of
Churg Strauss syndrome (vasculitis with eosinophilia)
have been associated with their use.
Pharmacotherapy of
bronchial asthma
- Sodium cromoglycate and nedocromil prevent the
degranulation of mast cells by trigger
stimuli indicated only for prophylaxis of bronchial
asthma given by inhalational route.
- Ketotifen has antihistaminic action apart from mast
cell stabilizing property and is specially indicated for
patients with multiple disorders (atopic dermatitis,
perennial rhinitis, conjunctivitis etc.).
Pharmacotherapy of
bronchial asthma
Mast cell stabilizers
Omalizumab is a monoclonal antibody against
IgE and is indicated to prevent the attack of
bronchial asthma in patients not responding to
combination of long acting β2 agonist and a
high dose of inhalational steroid. It is
administered by Subcutaneous route
Pharmacotherapy of
bronchial asthma
Drug inhibiting IgE Action
ï¶ Allergic asthma :
ï Most easily recognized asthma phenotype
ï Often commences in childhood
ï Associated with a past and/or family history of
allergic disease such as eczema, allergic rhinitis, or
food or drug allergy.
ï Examination of sputum reveals eosinophilic airway
inflammation
ï Respond well to inhaled corticosteroid (ICS)
treatment.
Pharmacotherapy of
bronchial asthma
Phenotypes
ï¶ Non-allergic asthma :
ï The sputum of these patients may be neutrophilic,
eosinophilic or contain only a few inflammatory cells
(paucigranulocytic).
ï Patients with non-allergic asthma often respond less
well to Inhaled corticosteroids
Pharmacotherapy of
bronchial asthma
ï¶Late-onset asthma :
Women, present with asthma for the first time in
adult life, non-allergic and often require higher doses
of ICS or are relatively refractory to corticosteroid
ï¶Asthma with obesity :
Some obese patients with asthma have prominent
respiratory symptoms and little eosinophilic airway
inflammation
Pharmacotherapy of
bronchial asthma
ï¶ Acute severe asthma :
Uncontrolled asthma progress to an acute state in
which inflammation, airway edema, mucus
accumulation and severe bronchospasm - profound
airway narrowing, poorly responsive to bronchodilator
therapy.
ï¶ Chronic Asthma :
Asthma can vary from chronic daily symptoms to only
intermittent symptoms.
Intervals between symptoms may be days, weeks,
months or years.
Pharmacotherapy of
bronchial asthma
ASTHMA MANAGEMENT
-GINA GUIDELINES
Pharmacotherapy of bronchial
asthma
ï± The long-term goals of asthma management are:
- To achieve good control of symptoms and maintain
normal activity levels
- To minimize future risk of exacerbations, fixed
airflow limitation and side-effects.
ï± It is also important to elicit the patients own goals
regarding their asthma, as these may differ from
conventional medical goals.
Pharmacotherapy of
bronchial asthma
Goals of manangement
Identify and reduce exposure to risk factors
- Clinician should evaluate potential role of allergens,
particularly indoor inhalant allergens
- Reduce, if possible, exposure to allergens to which
the patient is sensitized
- Avoid exposure to environmental tobacco smoke and
other respiratory irritants
- Avoid exertion outdoors when levels of air pollution
are high
Pharmacotherapy of bronchial
asthma
ï± Pharmacological and non-pharmacological treatment
is adjusted in a continuous cycle that involves
assessment, treatment and review
ï± Asthma outcomes have been shown to improve after
the introduction of control-based guidelines
CONTROL-BASED ASTHMA MANAGEMENT
Pharmacotherapy of bronchial
asthma
Medication is adjusted up or down in a Stepwise
approach to achieve good symptom control and minimize
future risk of exacerbations, fixed airflow limitation
and medication side-effects. Once good asthma control
has been maintained for 23 months, treatment may be
stepped down in order to find the patients minimum
effective treatment
.
STEPWISE approach for asthma Rx
Pharmacotherapy of bronchial
asthma
Pharmacotherapy of bronchial
asthma
ï¼ For Step 4 treatment, add-on tiotropium is now
extended to patients aged â¥12 years with a history of
exacerbations
ï¼ For Step 5 treatment, add-on treatment options for
patients with severe asthma uncontrolled on Step 4
which includes mepolizumab (anti-IL5) for patients
aged â¥12 years with severe eosinophilic asthma
Pharmacotherapy of
bronchial asthma
Whats new in GINA 2016 guidelines
Pharmacotherapy of bronchial
asthma
If a patient has persisting symptoms and/or
exacerbations despite 23 months of controller
treatment, assess and correct the following common
problems before considering any step up in
treatment:
- Incorrect inhaler technique
- Poor adherence
- Persistent exposure to agents such as allergens,
tobacco smoke, indoor or outdoor air pollution, or to
medications such as beta-blockers or NSAIDs
- Comorbidities that may contribute to respiratory
symptoms and poor quality of life
- Incorrect diagnosis
Pharmacotherapy of bronchial
asthma
o For adults and adolescents, the preferred step-up
treatment is combination ICS/long-acting beta2-agonist
(LABA).
o For children 611 years, increasing the ICS dose is
preferred over combination ICS/LABA.
- Consider step down once good asthma control has
been achieved and maintained for about 3 months, to
find the patients lowest treatment that controls both
symptoms and exacerbations
Status Asthmaticus
- Acute asthmatic attack not responding to
routine treatment & β2 agonist, life
threatening condition
- Precipitated by:
Acute respiratory infection
Abrupt cessation of steroid therapy
Pharmacological stimuli/allergens
Acute emotional stress
Status Asthmaticus (Contd
- Hydrocortisone Hemisuccinate 100mg iv stat 4-8
hourly infusion (take 6 hours to act)
- Nebulized salbutamol (2.5-5mg) + Ipratropium
Bromide (0.5mg)
- High flow humidified O2
- Salbutamol/Terbutaline 0.4mg S.C/I.M
- Intubation and mechanical ventilation
- Antibiotics
- Saline + Sod. Bicarbonate
SPECIAL CONSIDERATIONS
Pharmacotherapy of bronchial
asthma
Exercise-induced bronchospasm
- Pretreatment before exercise-
Inhaled beta2-agonists- prevent EIB in more than
80 percent
ï SABA use may be helpful for 23 hours
ï LABAs can be protective up to 12 hours
ï± Leukotrine receptor antagonist can attenuate EIB in
up to 50 percent of patients
ï± Cromolyn or nedocromil taken shortly before
exercise is an alternative
Surgery and Asthma
- Attempts made to improve lung function
preoperatively
- Short course of oral systemic corticosteroids may
be required
- For patients who have received oral systemic
corticosteroids during the past 6 months and for pts
on a long-term high dose of ICS
- 100 mg hydrocortisone every 8 hours i.v during the
surgical period & reduce dose rapidly within 24 hours
after surgery
Pregnancy and Asthma
- Asthma increases risk of preterm birth, IUGR and
perinatal mortality.
- NEVER WITHHOLD TREATMENT
- Monitoring of asthma status during prenatal visits
- Albuterol is the preferred SABA because it has an
excellent safety profile
- ICS are the preferred treatment for long-term
control medication
- Budesonide is the preferred ICS because more data
are available
METERED DOSE INHALER
1. Take off the
cap. Shake the
inhaler well.
2. Breathe out
though your
mouth.
3. Place the inhaler
between your lips. As
you start to breathe
in, press the top end
of the inhaler and
keep breathing in
steadily and deeply.
4. Remove the inhaler
from your mouth. Hold
your breath for 10
seconds or as long as
you find comfortable.
Breathe out.
The Spacer is a holding chamber which can be
attached to the Metered Dose Inhaler.
1. Assemble the
Spacer by
pushing the
notch of one half
into the slot of
the other half.
2. After shaking
the inhaler well,
fit it into the
Spacer.
3. Breathe out
through your
mouth. Then close
your lips around
the Spacer.
4. Press the top
end of the
inhaler. Then,
breathe in
deeply though
your mouth.
SPACER
Dry Powder Inhalers
1. Insert the
transparent end of
the Rotacap into
the raised square
hole of the
rotahaler.
2. Hold the top of
the Rotahaler firmly
with one hand.
Rotate the base until
the capsule breaks.
3. Breathe out
through your mouth.
Then, placing the
Rotahaler between
your lips (as shown),
breathe in though
your mouth as deeply
as possible.
4. Remove the Rotahaler
from your from your
mouth. Hold your
breathe for 10 seconds
or as long as you find
comfortable. Breathe
out.
Attach the hose and mouthpiece to the
medicine cup
Place the mouthpiece in your mouth.
Breathe through your mouth until all the
medicine is used, about 10-15 minutes.
Wash the medicine cup and mouthpiece
with water, and air-dry until your next
treatment
NEBULISERS
2 types: Jet nebulisers
Ultrasonic nebulisers
RECENT ADVANCES
Pharmacotherapy of bronchial
asthma
INDICATEROL:
ï Inhaled once-daily β2 agonist
ï Onset of action faster than salmeterol
ï Duration of action ~ 24 hrs
ï Has been approved only for COPD
ï Clinical trials in asthma underway to test safety and
efficacy of once-daily combination of indacaterol
with mometasone
Pharmacotherapy of
bronchial asthma
Pharmacotherapy of bronchial
asthma
Pharmacotherapy of bronchial
asthma
Pharmacotherapy of bronchial
asthma
ï Mapracorat: Selective glucocorticoid receptor
agonist that targets receptors for inflammation only
& is devoid of systemic side effects
ï Abediterol: Ultra LABA under trial for bronchial
asthma prophylaxis
ï Recently MgSo4 by I.V. and inhalational route has
been tried for acute severe asthma.
Recent advances Contd
Pharmacotherapy of bronchial
asthma
Allergen-specific immunotherapy may be an option if allergy
plays a prominent role, e.g. asthma with allergic
rhinoconjunctivitis.
There are currently two approaches:
Subcutaneous immunotherapy (SCIT) and
Sublingual immunotherapy (SLIT).
Allergen Immunotherapy
Bronchial Thermoplasty
- Catheter introduced through a
bronchoscope
- It delivers thermal energy to the
airway wall to reduce excess
smooth muscle
- Increases symptom-free days,
improves PEFR and reduces the
use of reliever medicines.
- FDA approval obtained in 2010
for treatment of severe asthma.
Cho JY. Recent Advances in Mechanisms and Treatments of Airway Remodeling in Asthma: A Message from
the Bench Side to the Clinic. Korean J Intern Med 2011; 26:367-383
ï¶ Influenza causes significant morbidity and mortality
in the general population, and the risk can be reduced
by annual vaccination. Influenza contributes to some
acute asthma exacerbations, and patients with
moderate-severe asthma are advised to receive an
influenza vaccination every year
Pharmacotherapy of
bronchial asthma
Vaccination
ï± Asthma is a serious global health problem affecting
all age groups
ï± Despite of better understanding of
ï¼ Pathophysiology
ï¼ Presence of reliable diagnostic tools,availability of a
wide range of effective & affordable drugs
ï¼ Simplified national and international asthma
management guidelines
Asthma remains poorly managed across the globe
Pharmacotherapy of
bronchial asthma
SUMMARY
ï¶ Global Initiative for Asthma. Global Strategy for Asthma
Management and
Prevention, 2016. Available from: www.ginasthma.org
ï¶ Asthma insights & management in India; JAPI
(SEP. 2015 vol.63)
ï¶ Medicine Update 2016:volume 2 (Gurpreet
S Wander,kk Pareek)
ï¶ Crofton & douglas respiratory diseases:5th edition
ï¶ Goodman and Gilman's -12th The Pharmacological basis of
therapeutics
Pharmacotherapy of
bronchial asthma
REFERENCES
ï¶ Principles of pharmacology-HL Sharma & kk sharma
ï¶ Harrisons principles of internal medicine:19th edition
ï¶ Tiotropium respimat:a review of its use in asthma poorly
controlled with ICS & LABA { DRUGS vol.75}
Pharmacotherapy of
bronchial asthma