Pharmacological agents in bronchial asthma and copdDr. Marya Ahsan
This document provides an overview of pharmacological agents used to treat bronchial asthma and chronic obstructive pulmonary disease (COPD). It discusses the classification, mechanisms of action, and side effects of various drugs including bronchodilators, corticosteroids, leukotriene modifiers, mast cell stabilizers, methylxanthines, monoclonal antibodies, and other agents. Treatment guidelines are also presented, outlining a stepwise approach for asthma management and algorithms for acute asthma exacerbations.
This document discusses drugs used to treat respiratory diseases like asthma. It begins by describing the clinical features and pathophysiology of asthma, which involves chronic airway inflammation and bronchospasm due to mediators released from mast cells. The main classes of drugs used to treat asthma are then summarized: bronchodilators like beta-2 agonists relieve bronchospasm, while anti-inflammatories like corticosteroids control the underlying inflammation. The mechanisms and uses of representative bronchodilators like epinephrine and beta-2 agonists are then outlined, along with their adverse effects and how tolerance can develop.
This document discusses drugs used to treat respiratory diseases like asthma. It begins by describing the clinical features and pathophysiology of asthma, which involves chronic airway inflammation and bronchospasm due to release of mediators from mast cells. Drugs used to treat asthma are classified as bronchodilators or anti-inflammatories. Bronchodilators work by relaxing airway smooth muscle through stimulation of beta-2 receptors or inhibition of muscarinic receptors. Corticosteroids are the most important anti-inflammatory drugs for long-term asthma control by suppressing the inflammatory process in the airways. The document then focuses on specific bronchodilator drugs like epinephrine, isoproterenol, and beta
This document provides information on the pharmacotherapy of bronchial asthma. It begins by defining asthma as a condition characterized by airway hyperresponsiveness and inflammation. It then discusses the symptoms, risk factors, and pathophysiology involving inflammatory cells and mediators.
The document outlines the various approaches to treating asthma, including preventing antigen reactions, suppressing inflammation, and antagonizing released mediators. It classifies medications and discusses bronchodilators, corticosteroids, leukotriene antagonists, mast cell stabilizers, and anti-IgE antibodies in detail.
Finally, it provides guidance on choosing treatment based on asthma severity, and protocols for managing status asthmaticus, including glucocortico
Asthma is a chronic inflammatory disease of the airways characterized by recurrent episodes of wheezing, breathlessness, chest tightness, and coughing. It is caused by constriction and inflammation of the bronchial airways. The document discusses various drugs used to treat asthma, categorized as bronchodilators and anti-inflammatory drugs. Bronchodilators such as beta-2 agonists, methylxanthines, and muscarinic antagonists work to relax smooth muscle in the airways. Anti-inflammatory drugs such as corticosteroids, leukotriene receptor antagonists, and 5-lipoxygenase inhibitors work to reduce inflammation in the airways. The long-term goals of treatment
This document discusses the pharmacotherapy of bronchial asthma. It begins with an overview of asthma, including its etiology, pathogenesis and clinical features. It then covers the various drug classes used to treat asthma, including beta-2 agonists, corticosteroids, leukotriene modifiers, mast cell stabilizers, monoclonal antibodies and methylxanthines. It also discusses the GINA guidelines for stepwise treatment of asthma based on disease severity and control. The document provides details on dosing and administration of the various asthma medications.
ASTHMA etiology, risk factors, pathophysiology and it's managementPoovarasanA5
Asthma is a common disease which we come across all over the world, certain factors helps to avoid and try to improve livelihood by changing life style modifications
Pharmacological agents in bronchial asthma and copdDr. Marya Ahsan
This document provides an overview of pharmacological agents used to treat bronchial asthma and chronic obstructive pulmonary disease (COPD). It discusses the classification, mechanisms of action, and side effects of various drugs including bronchodilators, corticosteroids, leukotriene modifiers, mast cell stabilizers, methylxanthines, monoclonal antibodies, and other agents. Treatment guidelines are also presented, outlining a stepwise approach for asthma management and algorithms for acute asthma exacerbations.
This document discusses drugs used to treat respiratory diseases like asthma. It begins by describing the clinical features and pathophysiology of asthma, which involves chronic airway inflammation and bronchospasm due to mediators released from mast cells. The main classes of drugs used to treat asthma are then summarized: bronchodilators like beta-2 agonists relieve bronchospasm, while anti-inflammatories like corticosteroids control the underlying inflammation. The mechanisms and uses of representative bronchodilators like epinephrine and beta-2 agonists are then outlined, along with their adverse effects and how tolerance can develop.
This document discusses drugs used to treat respiratory diseases like asthma. It begins by describing the clinical features and pathophysiology of asthma, which involves chronic airway inflammation and bronchospasm due to release of mediators from mast cells. Drugs used to treat asthma are classified as bronchodilators or anti-inflammatories. Bronchodilators work by relaxing airway smooth muscle through stimulation of beta-2 receptors or inhibition of muscarinic receptors. Corticosteroids are the most important anti-inflammatory drugs for long-term asthma control by suppressing the inflammatory process in the airways. The document then focuses on specific bronchodilator drugs like epinephrine, isoproterenol, and beta
This document provides information on the pharmacotherapy of bronchial asthma. It begins by defining asthma as a condition characterized by airway hyperresponsiveness and inflammation. It then discusses the symptoms, risk factors, and pathophysiology involving inflammatory cells and mediators.
The document outlines the various approaches to treating asthma, including preventing antigen reactions, suppressing inflammation, and antagonizing released mediators. It classifies medications and discusses bronchodilators, corticosteroids, leukotriene antagonists, mast cell stabilizers, and anti-IgE antibodies in detail.
Finally, it provides guidance on choosing treatment based on asthma severity, and protocols for managing status asthmaticus, including glucocortico
Asthma is a chronic inflammatory disease of the airways characterized by recurrent episodes of wheezing, breathlessness, chest tightness, and coughing. It is caused by constriction and inflammation of the bronchial airways. The document discusses various drugs used to treat asthma, categorized as bronchodilators and anti-inflammatory drugs. Bronchodilators such as beta-2 agonists, methylxanthines, and muscarinic antagonists work to relax smooth muscle in the airways. Anti-inflammatory drugs such as corticosteroids, leukotriene receptor antagonists, and 5-lipoxygenase inhibitors work to reduce inflammation in the airways. The long-term goals of treatment
This document discusses the pharmacotherapy of bronchial asthma. It begins with an overview of asthma, including its etiology, pathogenesis and clinical features. It then covers the various drug classes used to treat asthma, including beta-2 agonists, corticosteroids, leukotriene modifiers, mast cell stabilizers, monoclonal antibodies and methylxanthines. It also discusses the GINA guidelines for stepwise treatment of asthma based on disease severity and control. The document provides details on dosing and administration of the various asthma medications.
ASTHMA etiology, risk factors, pathophysiology and it's managementPoovarasanA5
Asthma is a common disease which we come across all over the world, certain factors helps to avoid and try to improve livelihood by changing life style modifications
This document provides an overview of asthma management. It defines asthma as a disease characterized by episodic airway obstruction, airway hyperresponsiveness, and usually eosinophilic airway inflammation. Common manifestations include shortness of breath, wheezing, cough, chest tightness and mucus production in relation to triggers. The diagnosis is based on patient history, physical exam, pulmonary function tests showing reversibility and airway responsiveness testing. Treatment involves reducing triggers, medications to provide rapid relief of symptoms like SABAs, and controllers to reduce inflammation like ICSs alone or in combination with LABAs. The goals of treatment are to control symptoms and exacerbations.
This document discusses the pharmacotherapy of bronchial asthma. It begins by classifying asthma and outlining its pathophysiology. It then describes various routes of drug administration, focusing on inhaled delivery methods like metered dose inhalers and nebulizers. The document details the management of asthma through both non-pharmacological and pharmacological approaches. It provides an overview of the main drug classes used to treat asthma, including beta-2 agonists, anticholinergics, methylxanthines, corticosteroids, and others. For each class, it outlines examples of drugs, their mechanisms of action, uses, dosages, and side effects.
This document discusses the pharmacotherapy of bronchial asthma. It begins by defining asthma as a chronic inflammatory airway disorder characterized by variable airflow obstruction and airway hyperresponsiveness. It then discusses the risk factors, pathophysiology, clinical presentation, diagnosis, and therapeutic objectives of asthma. The mainstay of treatment involves reliever medications like short-acting beta-agonists for acute symptoms and controller medications like inhaled corticosteroids to control inflammation and reduce exacerbations. The document outlines the specific drug classes used for treatment, including beta-agonists, anticholinergics, corticosteroids, leukotriene modifiers, mast cell stabilizers, anti-IgE, and anti-IL5 monoclonal antibodies
Asthma is a chronic inflammatory disease of the airways that causes periodic obstruction of airflow. The document outlines the pharmacological basis for treating asthma, including the pathophysiology and various drug classes used. The main drug classes used are bronchodilators like beta-2 agonists, corticosteroids, leukotriene modifiers, and monoclonal antibodies. Treatment is aimed at preventing symptoms, exacerbations, and maintaining normal lung function and activity levels.
Pharmacotherapy of Chronic Obstructive Pulmonary Disease (COPD)Arvind Kumar
This document provides an overview of pharmacotherapy for chronic obstructive pulmonary disease (COPD). It discusses non-pharmacologic approaches like pulmonary rehabilitation and smoking cessation. Standard maintenance therapies include long-acting bronchodilators like tiotropium. Newer bronchodilators in development include once-daily long-acting beta-2 agonists. Anti-inflammatory treatments target mediators like leukotrienes, cytokines, proteases, and phosphodiesterase-4 inhibitors. Vaccines against influenza and pneumococcus are recommended to prevent exacerbations. Antibiotics are used to treat mild, moderate, and severe exacerbations based on risk factors.
This document provides information on bronchial asthma including its definition, classification, pathophysiology, and treatment approaches. It discusses the different types of asthma such as atopic, non-atopic, and drug-induced asthma. It describes the cells and mediators involved in asthma inflammation. It covers the mechanisms and classes of drugs used to treat asthma, including bronchodilators, leukotriene antagonists, mast cell stabilizers, corticosteroids, and anti-IgE antibody. It provides details on the mechanisms of action and side effects of various bronchodilators and corticosteroids. It also discusses inhalational drug delivery systems and the treatment of acute asthma attacks.
This document provides an overview of pharmacology related to the respiratory system. It begins by outlining the contents to be covered, including drugs for asthma, COPD, expectorants, nasal decongestants, and respiratory stimulants. The document then delves into detailed descriptions of asthma pathogenesis and treatment, characteristics of COPD, and principles and specific treatments for COPD management, with a focus on the roles and mechanisms of bronchodilators, corticosteroids, methylxanthines, leukotriene antagonists, and other emerging targeted therapies.
This document provides information about drugs used to treat respiratory conditions like asthma and COPD. It begins by outlining the contents to be covered, which include anti-asthmatic drugs, drugs for COPD, expectorants, nasal decongestants, and respiratory stimulants. The document then discusses the pathogenesis and treatment of asthma in detail. It describes the classes of drugs used for asthma including bronchodilators, corticosteroids, leukotriene antagonists, and monoclonal antibody treatment. The principles and specific drugs for managing COPD are also outlined.
Asthma medications aim to reduce airway inflammation, prevent bronchoconstriction, and minimize symptoms. Common classes include bronchodilators like albuterol, anti-inflammatory corticosteroids, and leukotriene inhibitors like montelukast. Severe asthma may be treated with biologics targeting immunoglobulin E, interleukin-5, or the interleukin-4 receptor. Proper inhaler technique allows targeted delivery of medications to the airways.
drugs used in bronchial asthma & COPD.pptDrxKhan16
This document discusses the pharmacology of drugs used to treat bronchial asthma and chronic obstructive pulmonary disease (COPD). It describes the pathophysiology and symptoms of these conditions. The main classes of drugs discussed are bronchodilators and anti-inflammatory agents. Bronchodilators like short-acting beta-2 agonists are used to relieve acute asthma attacks, while long-acting beta-2 agonists and antimuscarinics are used for COPD. Anti-inflammatory drugs like inhaled corticosteroids are used to prevent asthma attacks.
This document provides information on bronchial asthma including its pathophysiology, classification, approaches to treatment, and classifications of treatment agents. Bronchial asthma is a chronic inflammatory airway condition characterized by hyperresponsiveness and narrowing of the airways. It can be episodic or chronic. Common symptoms include dyspnea, wheezing, and cough. Treatment approaches include prevention of allergic reactions, suppression of inflammation, antagonism of mediators, and direct bronchodilation. Classes of treatment agents discussed include bronchodilators, corticosteroids, leukotriene modulators, mast cell stabilizers, and anti-IgE monoclonal antibodies. Specific agents within each class are also described.
Asthma is a major public health problem affecting over 150 million people worldwide. It is caused by bronchial hyperreactivity and airway inflammation in response to various stimuli in genetically susceptible individuals. Common triggers include allergens, exercise, viral infections, and air pollution. Treatment aims to provide symptomatic relief through bronchodilation and modify the underlying disease process using anti-inflammatory drugs such as inhaled corticosteroids. Acute exacerbations can be life-threatening and require prompt treatment with bronchodilators, systemic corticosteroids, and oxygen supplementation.
Asthma and copd e000 1233730950067181-1guest62e4da
Asthma is a major public health problem affecting over 150 million people worldwide. It is caused by bronchial hyperreactivity and airway inflammation in response to various stimuli in genetically susceptible individuals. Current drug treatment aims to provide symptomatic relief through bronchodilation and modify the disease through reducing inflammation. Common classes of drugs used include beta-2 agonists, anticholinergics, theophylline, glucocorticoids, and leukotriene receptor antagonists. Management of acute severe asthma involves oxygen supplementation, nebulized bronchodilators, systemic corticosteroids, and hospital admission if inadequate response.
This document summarizes information about asthma, including its pathophysiology, triggers, diagnosis, and treatment approaches. It describes asthma as an inflammatory airway condition caused by various stimuli in genetically susceptible individuals. Key features include mucosal edema, mucus secretion, epithelial damage, and bronchoconstriction. Treatment aims to provide symptomatic relief and modify the disease through reducing inflammation and lung damage. A variety of drug classes are discussed for treating asthma, including beta-agonists, anticholinergics, corticosteroids, leukotriene receptor antagonists, and theophylline. Guidelines for managing acute exacerbations are also presented.
Respiratory Disorders Physiology Presentation by group 1 .pptxRimshaWaqar3
This document provides an overview of drugs used to treat various respiratory disorders. It focuses on preferred and alternative drugs for treating asthma. The preferred drugs discussed are inhaled beta-2 agonists like albuterol for quick relief of symptoms and long-acting beta-2 agonists like salmeterol as long-term controllers. Inhaled corticosteroids are identified as the long-term controllers of choice. Alternative drugs mentioned include leukotriene modifiers, cromolyn, anticholinergics, theophylline, and monoclonal antibodies. The document reviews the mechanisms of action, indications, and side effects of these drug classes.
Hakeem khan presented on asthma. Key points include:
1. Asthma is a chronic inflammatory disorder of the airways characterized by wheezing, coughing, and shortness of breath.
2. It is caused by factors like allergies, environment, emotions, and drugs.
3. Clinical features include coughing, wheezing, tightness in the chest, and labored breathing.
4. Treatment involves short-acting bronchodilators for relief of symptoms and long-acting controllers like inhaled corticosteroids to reduce inflammation.
This document discusses bronchial asthma, including its definition, clinical features, pathological findings, precipitating factors, goals of treatment, and various treatment options. Bronchial asthma is an inflammatory disorder characterized by bronchoconstriction and wheezing. The underlying cause is inflammation of the airways. Symptoms are triggered by factors like allergens, infections, and irritants. Treatment focuses on bronchodilation to relieve symptoms and suppressing inflammation. Common medications include bronchodilators, corticosteroids, leukotriene antagonists, and mast cell stabilizers.
1) Asthma is a chronic inflammatory airway disease characterized by recurrent episodes of breathlessness, wheezing, coughing and chest tightness. 2) Pharmacotherapy includes relievers like beta-2 agonists for acute symptoms and controllers like inhaled corticosteroids to control underlying inflammation. 3) Other controller options include leukotriene modifiers, theophylline, mast cell stabilizers and monoclonal antibody omalizumab for severe asthma.
This document provides an overview of asthma management. It defines asthma as a disease characterized by episodic airway obstruction, airway hyperresponsiveness, and usually eosinophilic airway inflammation. Common manifestations include shortness of breath, wheezing, cough, chest tightness and mucus production in relation to triggers. The diagnosis is based on patient history, physical exam, pulmonary function tests showing reversibility and airway responsiveness testing. Treatment involves reducing triggers, medications to provide rapid relief of symptoms like SABAs, and controllers to reduce inflammation like ICSs alone or in combination with LABAs. The goals of treatment are to control symptoms and exacerbations.
This document discusses the pharmacotherapy of bronchial asthma. It begins by classifying asthma and outlining its pathophysiology. It then describes various routes of drug administration, focusing on inhaled delivery methods like metered dose inhalers and nebulizers. The document details the management of asthma through both non-pharmacological and pharmacological approaches. It provides an overview of the main drug classes used to treat asthma, including beta-2 agonists, anticholinergics, methylxanthines, corticosteroids, and others. For each class, it outlines examples of drugs, their mechanisms of action, uses, dosages, and side effects.
This document discusses the pharmacotherapy of bronchial asthma. It begins by defining asthma as a chronic inflammatory airway disorder characterized by variable airflow obstruction and airway hyperresponsiveness. It then discusses the risk factors, pathophysiology, clinical presentation, diagnosis, and therapeutic objectives of asthma. The mainstay of treatment involves reliever medications like short-acting beta-agonists for acute symptoms and controller medications like inhaled corticosteroids to control inflammation and reduce exacerbations. The document outlines the specific drug classes used for treatment, including beta-agonists, anticholinergics, corticosteroids, leukotriene modifiers, mast cell stabilizers, anti-IgE, and anti-IL5 monoclonal antibodies
Asthma is a chronic inflammatory disease of the airways that causes periodic obstruction of airflow. The document outlines the pharmacological basis for treating asthma, including the pathophysiology and various drug classes used. The main drug classes used are bronchodilators like beta-2 agonists, corticosteroids, leukotriene modifiers, and monoclonal antibodies. Treatment is aimed at preventing symptoms, exacerbations, and maintaining normal lung function and activity levels.
Pharmacotherapy of Chronic Obstructive Pulmonary Disease (COPD)Arvind Kumar
This document provides an overview of pharmacotherapy for chronic obstructive pulmonary disease (COPD). It discusses non-pharmacologic approaches like pulmonary rehabilitation and smoking cessation. Standard maintenance therapies include long-acting bronchodilators like tiotropium. Newer bronchodilators in development include once-daily long-acting beta-2 agonists. Anti-inflammatory treatments target mediators like leukotrienes, cytokines, proteases, and phosphodiesterase-4 inhibitors. Vaccines against influenza and pneumococcus are recommended to prevent exacerbations. Antibiotics are used to treat mild, moderate, and severe exacerbations based on risk factors.
This document provides information on bronchial asthma including its definition, classification, pathophysiology, and treatment approaches. It discusses the different types of asthma such as atopic, non-atopic, and drug-induced asthma. It describes the cells and mediators involved in asthma inflammation. It covers the mechanisms and classes of drugs used to treat asthma, including bronchodilators, leukotriene antagonists, mast cell stabilizers, corticosteroids, and anti-IgE antibody. It provides details on the mechanisms of action and side effects of various bronchodilators and corticosteroids. It also discusses inhalational drug delivery systems and the treatment of acute asthma attacks.
This document provides an overview of pharmacology related to the respiratory system. It begins by outlining the contents to be covered, including drugs for asthma, COPD, expectorants, nasal decongestants, and respiratory stimulants. The document then delves into detailed descriptions of asthma pathogenesis and treatment, characteristics of COPD, and principles and specific treatments for COPD management, with a focus on the roles and mechanisms of bronchodilators, corticosteroids, methylxanthines, leukotriene antagonists, and other emerging targeted therapies.
This document provides information about drugs used to treat respiratory conditions like asthma and COPD. It begins by outlining the contents to be covered, which include anti-asthmatic drugs, drugs for COPD, expectorants, nasal decongestants, and respiratory stimulants. The document then discusses the pathogenesis and treatment of asthma in detail. It describes the classes of drugs used for asthma including bronchodilators, corticosteroids, leukotriene antagonists, and monoclonal antibody treatment. The principles and specific drugs for managing COPD are also outlined.
Asthma medications aim to reduce airway inflammation, prevent bronchoconstriction, and minimize symptoms. Common classes include bronchodilators like albuterol, anti-inflammatory corticosteroids, and leukotriene inhibitors like montelukast. Severe asthma may be treated with biologics targeting immunoglobulin E, interleukin-5, or the interleukin-4 receptor. Proper inhaler technique allows targeted delivery of medications to the airways.
drugs used in bronchial asthma & COPD.pptDrxKhan16
This document discusses the pharmacology of drugs used to treat bronchial asthma and chronic obstructive pulmonary disease (COPD). It describes the pathophysiology and symptoms of these conditions. The main classes of drugs discussed are bronchodilators and anti-inflammatory agents. Bronchodilators like short-acting beta-2 agonists are used to relieve acute asthma attacks, while long-acting beta-2 agonists and antimuscarinics are used for COPD. Anti-inflammatory drugs like inhaled corticosteroids are used to prevent asthma attacks.
This document provides information on bronchial asthma including its pathophysiology, classification, approaches to treatment, and classifications of treatment agents. Bronchial asthma is a chronic inflammatory airway condition characterized by hyperresponsiveness and narrowing of the airways. It can be episodic or chronic. Common symptoms include dyspnea, wheezing, and cough. Treatment approaches include prevention of allergic reactions, suppression of inflammation, antagonism of mediators, and direct bronchodilation. Classes of treatment agents discussed include bronchodilators, corticosteroids, leukotriene modulators, mast cell stabilizers, and anti-IgE monoclonal antibodies. Specific agents within each class are also described.
Asthma is a major public health problem affecting over 150 million people worldwide. It is caused by bronchial hyperreactivity and airway inflammation in response to various stimuli in genetically susceptible individuals. Common triggers include allergens, exercise, viral infections, and air pollution. Treatment aims to provide symptomatic relief through bronchodilation and modify the underlying disease process using anti-inflammatory drugs such as inhaled corticosteroids. Acute exacerbations can be life-threatening and require prompt treatment with bronchodilators, systemic corticosteroids, and oxygen supplementation.
Asthma and copd e000 1233730950067181-1guest62e4da
Asthma is a major public health problem affecting over 150 million people worldwide. It is caused by bronchial hyperreactivity and airway inflammation in response to various stimuli in genetically susceptible individuals. Current drug treatment aims to provide symptomatic relief through bronchodilation and modify the disease through reducing inflammation. Common classes of drugs used include beta-2 agonists, anticholinergics, theophylline, glucocorticoids, and leukotriene receptor antagonists. Management of acute severe asthma involves oxygen supplementation, nebulized bronchodilators, systemic corticosteroids, and hospital admission if inadequate response.
This document summarizes information about asthma, including its pathophysiology, triggers, diagnosis, and treatment approaches. It describes asthma as an inflammatory airway condition caused by various stimuli in genetically susceptible individuals. Key features include mucosal edema, mucus secretion, epithelial damage, and bronchoconstriction. Treatment aims to provide symptomatic relief and modify the disease through reducing inflammation and lung damage. A variety of drug classes are discussed for treating asthma, including beta-agonists, anticholinergics, corticosteroids, leukotriene receptor antagonists, and theophylline. Guidelines for managing acute exacerbations are also presented.
Respiratory Disorders Physiology Presentation by group 1 .pptxRimshaWaqar3
This document provides an overview of drugs used to treat various respiratory disorders. It focuses on preferred and alternative drugs for treating asthma. The preferred drugs discussed are inhaled beta-2 agonists like albuterol for quick relief of symptoms and long-acting beta-2 agonists like salmeterol as long-term controllers. Inhaled corticosteroids are identified as the long-term controllers of choice. Alternative drugs mentioned include leukotriene modifiers, cromolyn, anticholinergics, theophylline, and monoclonal antibodies. The document reviews the mechanisms of action, indications, and side effects of these drug classes.
Hakeem khan presented on asthma. Key points include:
1. Asthma is a chronic inflammatory disorder of the airways characterized by wheezing, coughing, and shortness of breath.
2. It is caused by factors like allergies, environment, emotions, and drugs.
3. Clinical features include coughing, wheezing, tightness in the chest, and labored breathing.
4. Treatment involves short-acting bronchodilators for relief of symptoms and long-acting controllers like inhaled corticosteroids to reduce inflammation.
This document discusses bronchial asthma, including its definition, clinical features, pathological findings, precipitating factors, goals of treatment, and various treatment options. Bronchial asthma is an inflammatory disorder characterized by bronchoconstriction and wheezing. The underlying cause is inflammation of the airways. Symptoms are triggered by factors like allergens, infections, and irritants. Treatment focuses on bronchodilation to relieve symptoms and suppressing inflammation. Common medications include bronchodilators, corticosteroids, leukotriene antagonists, and mast cell stabilizers.
1) Asthma is a chronic inflammatory airway disease characterized by recurrent episodes of breathlessness, wheezing, coughing and chest tightness. 2) Pharmacotherapy includes relievers like beta-2 agonists for acute symptoms and controllers like inhaled corticosteroids to control underlying inflammation. 3) Other controller options include leukotriene modifiers, theophylline, mast cell stabilizers and monoclonal antibody omalizumab for severe asthma.
Similar to recentadvancesinthemanagementofbronchialasthma-161027153903.pdf (20)
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1. Recent Advances in the
Pharmacotherapy of Bronchial Asthma
Dr Pritam Biswas
2. As we go along
• Introduction
• Pathophysiology
• Current Management Guidelines.
• Recent Advances
Pharmacotherapy
Monoclonals & Anti cytokines
Immunotherapy
Non Pharmacological
3. Introduction
• Asthma represents a global public health issue due to high
prevalence rates in the general population( 1% to 18% of
the population in different Countries),
• Affects approximately 300 million people worldwide
• Rising prevalence in developing countries which is
associated with increased urbanization.
4. Asthma is defined as a chronic inflammatory disease
Airway hyper responsiveness
Recurrent symptoms such as wheezing, dyspnea
(shortness of breath), chest tightness and coughing.
Episodes are associated with widespread ,variable,
airflow obstruction within the lungs that is reversible
spontaneously or with appropriate asthma treatment
13. Current Management of Asthma .
Short acting beta 2 agonist for symptom relief
Step
1
Mild
intermittent
asthma
Mild
Persistent
asthma
Moderate
Persistent
asthma
Severe
asthma
ICS+ Leukotriene modifier add on
Step
2
Step
3 Low dose ICS +LABA
High dose ICS+ LABA
Leukotriene modifier
Step
4
Severe
Persistent
asthma
Step
5
Oral steroid+ high
dose ICS+ LABA
14. Inhalational corticosteroids &
Advances in Steroid resistance
Beta 2 agonists
Phosphodiesterase Inhibitors
Methyl xanthines
Anticholinergics
Anti IgE
Anti cytokines
Novel class of
bronchodilators
Immunomodulatory therapies
Newer anti-inflammatory
therapies
Miscellaneous approaches
CTRH
Toll like receptors
Marcolides
Endothelin antagonists
15. Inhalational corticosteroids
ICS Pharmacokinetics Safety
Triamcinolone Greater systemic side
effects
Beclomethasone
Fluticasone High first Pass
Metabolism (liver )
Fewer systemic side
effects
Safe at higher doses
Budesonide
Momethasone
Ciclesonide Prodrug
High First Pass
metabolism
High plasma protein
binding
Minimal systemic side
effects
16. Ciclesonide
Prodrug, converted to active ingredient
des-ciclesonide by lung esterases
Oral Bioavailability <1 %
Highly Plasma protein bound 99%
Half-life: 0.71 hr (ciclesonide); 6-7 hr
(des-ciclesonide)
Clearance: 152 ML/hr high
Lipid Binding to fatty acids in lung
Decreased
systemic toxicity
Increased Local
action
17.
18. Soft steroids
They have improved local, topical selectivity and have
much less steroid effect outside target area.
Lactone GCS conjugate
Glucocorticoid with a lactone ring
Stable in the lung , not metabolized by lung esterases
Metabolized quickly by plasma paraoxonase
Soft steroids
Loteprednol
Approved for ophthalmic use
Phase 2 development in Germany
Lactone GCS
Butixocort/ Tipredane Lack clinical efficacy
Rofleponide Preclinical phase
19. SEGRA- Selective Glucocorticoid
receptor agonist
Desirable anti-inflammatory and immuno suppressive properties of classical
glucocorticoids drugs but with fewer side effects .
Transactivation
annexin
A1, angiotensin-
converting
enzyme, neutral
endopeptidase
Transrepression
COX,NO
synthase, TNF, TG
F BETA, ICAM-1
20. Mapracorat ( SEGRA )
• Topical treatment of atopic dermatitis and
inflammation following cataract surgery.
• New frontier for asthma research .
21. Advances in Steroid resistance
About 5-10% of asthmatics are resistant to steroids
Definition
Failure to improve baseline FEV1by more than 15% after treatment with
prednisolone (30– 40 mg daily) for 2 weeks
Type I Steroid Resistant Asthma
Reduction in glucocorticoid receptor‐binding affinity
High concentrations of IL‐2 and IL‐4 or by IL‐13 alone
Type II Steroid Resistant Asthma
Due to low numbers of glucocorticoid receptors
22.
23.
24. IV immunoglobulins:
Steroid-sparing effect appears to be present but is not used, as it is
prohibitively expensive.
IL-2 & IL-4 levels can be lowered by IV immunoglobulins: 2-3 mg / kg /
wk / 4wks
Methotrexate:
Methotrexate causes inhibition of T cell proliferation through inhibition
of enzyme Amidophosphoribosyltransferase.
Concomitant weekly methotrexate therapy causes clinically
significant reduction in oral prednisolone doses 15mg/day to
5mg/day.
Methotrexate therapy also increases peripheral blood T cell sensitivity
to prednisolone inhibition.
25. Cyclosporine:
selectively inhibits T lymphocyte proliferation, IL-2 and other cytokine
production and response of inducer T cells to IL-1.
It is used as a second line immunomodulator drug in steroid resistant
asthma.
Gold:
Has been used in Japan, and isolated studies in
Europe and America have shown decreased use of steroids,
improved symptoms but no change in FEV 1
Leflunomide:
A disease modifying agent for rheumatic diseases, it also causes selective
suppression of Th cytokine expression. They have a steroid sparing effect.
27. SIT - Single Inhaler therapy
• LABA monotherapy has been associated with an
increased risk of asthma-related morbidity and mortality,
• Should only be used along with an ICS
Combination therapy
Inhalational corticosteroid +LABA
Maintenance
28. Rational of ICS + LABA
Common combinations
Beclomethasone+ salmeterol
Fluticasone + salmeterol
ICS
1. Prevents down regulation of Beta receptors
2. Prevents desensitization
LABA
Helps In enhancing the binding of Glucocorticoids to GCR
Maintenance Levosalbutamol
29. SMART – Single Inhaler Maintenance
and reliever therapy
Formoterol has a fast onset of action <1min compared to
other LABA like salmeterol with a onset of 30min
Therefore ICS+ LABA Combinations that contain
formoterol
Budesonide + formoterol
Fluticasone + formoterol
Maintenance and
reliever
30. Advances in Beta 2 agonists
Ultra LABA’s
Ultralong acting LABA . Duration > 24 hrs.
Indacaterol
Bambuterol
carmoterol,
vilanterol
olodaterol,
Indacaterol
Initial trials
Safe
Improvements in FEV1 at 4 weeks ,
Long term studies – Not established the effect
on asthma disease control
Asthma exacerbations
32. CysLT 2 Receptor antagonists
• Studies have revealed that Cyst LT2 mRNA is
abundantly expressed on activated eosinophils.
• Raised the possibility that Cyst LT2 antagonists
would be more effective in ameliorating the LT’s
response explaining the relative failure of the
existing Cyst LT1 antagonists.
33. Methyl xanthines
Low dose Sustained release theophylline
Plasma values 5 to 10 mg/l – Anti-inflammatory / Less side effects .
Mechanisms :
Histone deacetylase activation- Steroid resistant asthma
Effects on apoptosis
Interleukin-10
Inhibition of NF-KB
Indications
Low dose sustained release theophyline as a add on to ICS in severe asthma
34. Doxofylline
• Novel xanthine bronchodilator
Mechanism of action
• Inhibition of phosphodiesterase 4,
• Decreased affinities towards adenosine A1 and A2
receptors,
Comparative Safety Profile
No CNS stimulation
No cardiac arrhythmias
35. Phosphodiesterase Inhibitors
PDE4 inhibition is thought to lead to elevated levels of
intracellular cAMP,
• suppression inflammatory cell function
• inhibition of mucin production epithelial cells
• alterations in airway smooth muscle tone
Selective PDE inhibitors
Roflumilast , Cilomilast, Rolipram, Ibudilast,
Piclamilast, Luteolin
38. Results
Long acting Muscarinic Agonists ( Tiotropium )
1. In moderate to severe asthma , as a add on when no response to
ICS+ LABA
2. In mild persistent asthma as a add on to ICS .
Important outcomes that are not evaluated in all studies published until
now are the reduction of exacerbations and the anti-inflammatory
effects of tiotropium
Currently available data on the efficacy of tiotropium in asthmatic patients are
not sufficient to recommend the use of this drug
39. Novel classes of bronchodilators
Magnesium sulfate
MOA
• Reduces cytosolic calcium in airway smooth
musclebronchodilatation
USES :
Useful as an additional drug to SABA in A/c severe asthma
can be given by IV/nebulisation
Side effects
Include flushing and nausea
Not suitable to be employed alone as clinical benefit is small
40. Potassium channel openers
Potassium channel openers that open calcium activated
large conductance K+ channels in smooth muscle
Calcium channel blockers Nifedipine, verapamil
-Prevent calcium entry into smooth muscle
-Inhibit stimuli induced bronchoconstriction
41. VIP analogs
- VIP binds to VPAC1(smooth muscles of blood vessels) &
VPAC2(airway smooth muscle)couple to Gs
adenylyl cyclase stimulated-smooth muscle
relaxation
- VIP potent bronchodilator in vitro studies but in patients
it is rapidly metabolized and also has vasodilator Side
effects
Stable analog of VIP (RO 25-1533) selectively stimulate
VPAC2-produces rapid bronchodilatation but effect is
not prolonged .
42. ANP & related peptide Urodilatin
- Activates membrane guanylyl cyclase cGMP
bronchodilatation
- Bronchodilator effects comparable to SABA.
- Useful for additional bronchodilatation in Acute severe
asthma
44. Route : S/c or IV every 2- 4 weeks
Use :
severe persistent extrinsic asthma who are resistant to
other forms of treatment.
Reduces exacerbations and requirement of oral and
inhaled steroids in them
Drawback : high cost
S/E : local reaction at inj. Site
urticarial, rash, flushing
rarely anaphylactic reaction
46. Anti IL-5
IL-5
Anti IL-5 Antibodies
Mepholizumab
Humanized Monoconal antibody
Phase 3 trials
Reduced Eosinophil entry in the airways
Decrease asthma exacerbation
Reslizumab
Phase 2
Pronounced in a subgroup
of patients with highest blood &sputum
eosinophils,
IL5 Receptor antibodies
Benralizumab
Pre-clincial stage
Decrease of circulating eosinophills
47. Anti IL-4
IL-4
Th2 differentiation
Switching of B cells to IgE synthesis
Eosinophil recruitment
Development of mast cells
Anti IL4
Pitrakinra ( s.c / inhaled )
Pascolizumab
Dupilumab decrease in asthma exacerbation rate during
withdrawal of inhaled therapy with
corticosteroids and long-acting 𝛽2-
adrenergic agonists,
marked improvement of respiratory function
TH2
48. Anti IL-13
Lebrikizumab ( PHASE 3)
Improvement of lung function in patients
with moderate-to severe asthma
Improvement of FEV1 from baseline
Tralokinumab ( s.c) -- Phase 3
Decrease need for rescue medication
Anti IL-9
MEDI -528
Improved Asthma Symptom scores
In Trial for exercise induced asthma
TH2
49. Anti TNF alpha Th1 TNF alpha
Recruitment neutrophils and eosinophils via upregulation of
epithelial and endothelial adhesion molecule
Anti TNF alpha Evidence from phase 2
trials
Concern
infliximab circadian oscillations in
peak expiratory
flow
active tuberculosis,
pneumonia, sepsis, and
several different
malignancies
(breast cancer, B-cell
lymphoma, metastatic
melanoma, cervical
carcinoma, renal cell
carcinoma, basal cell
carcinoma,
and colon cancer)
golimumab Not conclusive
etanercept improve lung function,
airway hyper-
responsiveness, and
quality of life
50. Anti IL-17
TH1 IL-17
Neutrophilic inflammation, airway remodeling, Steroid resistant
Secukinumab Humanized anti IL17 antibody
Brodalumab Il-17 receptor antibody
On Going Phase 2 trials in severe asthma that is not adequately
controlled by ICS+LABA
IL-17 is also involved in immune protection against infectious and
carcinogenic agents
51. In vitro studies human anti-GM-CSF monoclonal
IgG1 antibody (MT203) has been developed,
capable of significantly decreasing survival and activation
of peripheral human eosinophils
Anti GM-CSF
GM-CSF is a growth factor over expressed in asthmatic
airways
54. CRTH2
CRTH2 (Chemo attractant Receptor-homologous
molecule expressed on Th2 cells)
G-protein coupled receptor expressed by Th2
lymphocytes, eosinophils, and basophils.
The receptor mediates the activation and chemotaxis of
these cell types in response to prostaglandin D2 (PGD2),
produced by mast cells.
Contributes to the so-called “Th2 polarization”
55. CRTH2 antagonists
Using indomethacin, a CRTH2 agonist, as a starting block
and have prepared novel CRTH2 DP2-selective
antagonists
An oral CRTH2 antagonist (OC0000459) showed a 7.4%
improvement in FEV1 at 28 days (p=0.037).
led to a reduction in total IgE concentration and a trend
toward decreasing sputum eosinophils
57. Statins are now under evaluation in asthma therapy by
AAAAI
It was observed that asthmatics with co-morbidities who
are on statins have 30% lower risk for ER visits &
hospitalizations due asthma than controls.
58. Miscellaneous approaches
Endothelin antagonists may improve structural changes in asthma.
However not tested.
Antioxidants more potent than Vit C&E, N-Acetyl cysteine in development
as oxidative stress important in asthma.
Bitter taste receptors agonists ---chloroquine,saccharine
60. Bronchial thermoplasty
Concept:
Passing RF pulses
through the airway
tissues generates heat
due to tissue resistance
debulking of ASM
Devices :
thermoplasty apparatus
and RF compatible FOB
61.
62. • In a double-blind, randomized, sham-controlled
clinical study of bronchial thermoplasty
• Improved Qol
• Reduction in asthma attacks
• Reduction in emergency room visits for
respiratory symptoms
• Reduction in days lost from work, school,
• Reduction in hospitalizations for respiratory
symptoms
FDA approved 2010
63. Immunotherapy
• Administration of increasing doses of allergen extracts to
induce persistent immune tolerance in patients with
allergen-induced symptoms
• Recently SubLingual immunotherapy (SLIT) is preferred
and claimed to be more effective in asthma
64. Benefits include: ↓ in symptom scores, ↓ in
medication usage and ↓ airway reactivity
Mechanism:
Increased regulatory T cell activity
Restoration of Th1- Th 2 balance
Switching of allergen-specific B
cells towards IgG4 production.
Usual course:
3-5 years on maintenance therapy.
65. Allergen peptides:
The active peptides of allergens are used → down
regulation of T cells without co-stimulatory signals
1. Short T cell epitope peptides: induce tolerance without
mediator release (no IgE binding)
2. B cell epitope derived peptides: stimulate B cells to
produce blocking IgG 1 without IgE binding
Recombinant allergens:
Reconstructed with reduced allergenic activity
66. CpG-DNA based immunotherapy:
• Giving cytosine guanine plasmid DNA with allergen
extract produce a strong Th-1 response with increase of
mucosal IF-ϒ and decrease IgE production
67.
68. Is the insertion of a functional gene in a target cell
to exert the gene function
Genes transferred to target cells by a viral vector
or a liposome (? nanocarrier)
Target cells in the lungs are respiratory epithelium
69. Cytokine encoding genes:
Genes encoding for IL-12, IF-ϒ, IL-18:
Cause marked reduction in eosinophilic inflammation, IgE
production and airway hyper responsiveness
Genes encoding for IL-10 and TGF-β:
Cause suppression of both Th-1&Th-2 response
β2 receptors encoding genes:
To over express β2 receptors and potentiate bronchodilation
Glucocorticoid R genes:
Over expression overcomes GCR resistance and decrease systemic
SEs
70. Cloned Th -1 cells are now under Phase 2 trials
Aim: correction of Th1-Th2 imbalance in
asthma with correction of cytokine profile:
↑↑ IL-12, IF-ϒ & ↓↓ IL-4, IL-5, IL-13
T cell Therapy