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Pharmacotherapy of
Bronchial Asthma
Dr.Vinay Bajaj
JR1
Dept of Pharmacology
Pharmacotherapy of bronchial
asthma
Overview
Introduction
Etiopathogenesis
Pharmacotherapy
Phenotypes of Asthma
Recent guidelines for treatment
Various ...
• Chronic inflammatory airway disease associated with
increased airway responsiveness and reversible airway
obstruction.
•...
 Asthma is one of the most common disease
encountered in clinical practice
 300 million people suffer from asthma worldw...
Recurrent episodes characterized by:
• Breathlessness
• Wheezing
• Coughing- especially at night or early morning
• Tightn...
Pharmacotherapy of
bronchial asthma
Endogenous
• Atopy
• Genetic
predisposition
• Obesity
• Early infections
Environmental...
Etiopathogenesis
Pharmacotherapy of bronchial
asthma
Pharmacotherapy of bronchial
asthma
Etiopathogenesis
Pharmacotherapy of bronchial
asthma
Pharmacotherapy of bronchial
asthma
Pharmacotherapy
Pharmacotherapy of bronchial
asthma
Relievers
• Beta 2 agonists
• Anticholinergics
• Methylxanthines
Controller
• Corticos...
Classified as:
 SABAs(short acting)- Salbutamol, Terbutaline,
Levalbuterol, Fenoterol, Pirbuterol, Metaproterenol
 LABAs...
 Mechanism:cause bronchial smooth muscle
relaxation by decreasing calcium, opening potassium
channels, inhibiting myosin ...
 Ultra long acting drugs : duration of action is
24 hrs & hence used at OD doses for
prophylaxis of asthma
Side effects ...
Pharmacotherapy of bronchial
asthma
Name Oral Parentral Inhaled
Salbutamol
(albuterol)
2- 4 mg 0.25-
0.5mg,IM/SC
100-200g...
Pharmacotherapy of bronchial
asthma
Doses
Name Oral Inhalation
Salmeterol - 50-100 g.
Formoterol - 12-24g.
Bambuterol 10...
• Trials comparing salmeterol with placebo found increased
mortality and exacerbations in salmeterol group
• Discontiuatio...
• These drugs mainly cause dilation of large airways
• Less effective than beta-2 agonists as they inhibit
only the cholin...
Pharmacotherapy of bronchial
asthma
Anticholinergics
M3 > M1
 Ipratropium
 Tiotropium
 Oxitropium
• Ipratropium : short acting (6 hrs) & hence can
be used for an acute attack of bronchial
asthma
• Oxitropium: Intermediat...
 Drugs include :
 Theophylline, Aminophylline, Theobromine
 Mechanism :
 Act by inhibiting Phosphodiesterase which is ...
 Theophylline can be used by oral route at a dose of 8
mg/kg BD for persistent asthma along with inhalational
corticoster...
 These are potent anti-inflammatory drugs & also
decrease bronchial hyperactivity & mucosal edema.
 Mechanism: Arachidon...
• Steroids are used if patient has to use SABA more
than 2 times a week for symptomatic relief
• Systemic steroids have a ...
• Inhalational corticosteroids are drug of choice for
persistent asthma
Pharmacotherapy of
bronchial asthma
Corticosteroid...
Synergism between steroids and β2 agonists
• They interact with each other to potentiate their
actions
• Steroids:
a) Incr...
• Lipooxygenase inhibitors:
Zileuton inhibits synthesis of LTB4 (chemotactic) ,
LTC4 and LTD4 (bronchoconstrictor).
Limiti...
• Sodium cromoglycate and nedocromil prevent the
degranulation of mast cells by trigger
stimuli indicated only for prophyl...
Omalizumab is a monoclonal antibody against
IgE and is indicated to prevent the attack of
bronchial asthma in patients not...
 Allergic asthma :
 Most easily recognized asthma phenotype
 Often commences in childhood
 Associated with a past and/...
 Non-allergic asthma :
 The sputum of these patients may be neutrophilic,
eosinophilic or contain only a few inflammator...
Late-onset asthma :
Women, present with asthma for the first time in
adult life, non-allergic and often require higher do...
 Acute severe asthma :
Uncontrolled asthma progress to an acute state in
which inflammation, airway edema, mucus
accumula...
ASTHMA MANAGEMENT
-GINA GUIDELINES
Pharmacotherapy of bronchial
asthma
 The long-term goals of asthma management are:
• To achieve good control of symptoms and maintain
normal activity levels
...
Identify and reduce exposure to risk factors
• Clinician should evaluate potential role of allergens,
particularly indoor ...
Pharmacotherapy of bronchial
asthma
 Pharmacological and non-pharmacological treatment
is adjusted in a continuous cycle ...
Pharmacotherapy of bronchial
asthma
Medication is adjusted up or down in a Stepwise
approach to achieve good symptom contr...
Pharmacotherapy of bronchial
asthma
Pharmacotherapy of bronchial
asthma
 For Step 4 treatment, add-on tiotropium is now
extended to patients aged ≥12 years with a history of
exacerbations
 For...
Pharmacotherapy of bronchial
asthma
If a patient has persisting symptoms and/or
exacerbations despite 2–3 months of contro...
Pharmacotherapy of bronchial
asthma
o For adults and adolescents, the preferred step-up
treatment is combination ICS/long-...
Status Asthmaticus
• Acute asthmatic attack not responding to
routine treatment & β2 agonist, life
threatening condition
•...
Status Asthmaticus (Cont’d
• Hydrocortisone Hemisuccinate 100mg iv stat 4-8
hourly infusion (take 6 hours to act)
• Nebuli...
SPECIAL CONSIDERATIONS
Pharmacotherapy of bronchial
asthma
Exercise-induced bronchospasm
• Pretreatment before exercise-
Inhaled beta2-agonists- prevent EIB in more than
80 percent
...
Surgery and Asthma
• Attempts made to improve lung function
preoperatively
• Short course of oral systemic corticosteroids...
Pregnancy and Asthma
• Asthma increases risk of preterm birth, IUGR and
perinatal mortality.
• NEVER WITHHOLD TREATMENT
• ...
DEVICES
Pharmacotherapy of bronchial
asthma
Inhalational delivery systems
Dry Powder Inhalers
Metered Dose Inhaler Spacer
Nebuliser
METERED DOSE INHALER
1. Take off the
cap. Shake the
inhaler well.
2. Breathe out
though your
mouth.
3. Place the inhaler
b...
The Spacer is a holding chamber which can be
attached to the Metered Dose Inhaler.
1. Assemble the
Spacer by
pushing the
n...
Dry Powder Inhalers
1. Insert the
transparent end of
the Rotacap into
the raised square
hole of the
rotahaler.
2. Hold the...
Attach the hose and mouthpiece to the
medicine cup
Place the mouthpiece in your mouth.
Breathe through your mouth until al...
RECENT ADVANCES
Pharmacotherapy of bronchial
asthma
INDICATEROL:
 Inhaled once-daily β2 agonist
 Onset of action faster than salmeterol
 Duration of action ~ 24 hrs
 Has ...
Pharmacotherapy of bronchial
asthma
Pharmacotherapy of bronchial
asthma
Pharmacotherapy of bronchial
asthma
 Mapracorat: Selective glucocorticoid receptor
agonist that targets receptors for inflammation only
& is devoid of system...
Pharmacotherapy of bronchial
asthma
Allergen-specific immunotherapy may be an option if allergy
plays a prominent role, e....
Bronchial Thermoplasty
• Catheter introduced through a
bronchoscope
• It delivers thermal energy to the
airway wall to red...
 Influenza causes significant morbidity and mortality
in the general population, and the risk can be reduced
by annual va...
 Asthma is a serious global health problem affecting
all age groups
 Despite of better understanding of
 Pathophysiolog...
 Global Initiative for Asthma. Global Strategy for Asthma
Management and
Prevention, 2016. Available from: www.ginasthma....
 Principles of pharmacology-HL Sharma & kk sharma
 Harrison’s principles of internal medicine:19th edition
 Tiotropium ...
Pharmacotherapy of bronchial
asthma
Next topic- Pharmacotherapy of Epilepsy
Date: 14/09/16
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Pharmacotherapy of bronchial asthma

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Pharmacotherapy of bronchial asthma

  1. 1. Pharmacotherapy of Bronchial Asthma Dr.Vinay Bajaj JR1 Dept of Pharmacology Pharmacotherapy of bronchial asthma
  2. 2. Overview Introduction Etiopathogenesis Pharmacotherapy Phenotypes of Asthma Recent guidelines for treatment Various devices used now-a-days Recent advances Summary Pharmacotherapy of bronchial asthma
  3. 3. • 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?
  4. 4.  Asthma is one of the most common disease encountered in clinical practice  300 million people suffer from asthma worldwide out of which 30 million asthmatics are in India  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
  5. 5. 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
  6. 6. Pharmacotherapy of bronchial asthma Endogenous • Atopy • Genetic predisposition • Obesity • Early infections Environmental • Indoor allergens • Outdoor allergens • Passive smoking Risk Factors
  7. 7. Etiopathogenesis Pharmacotherapy of bronchial asthma
  8. 8. Pharmacotherapy of bronchial asthma Etiopathogenesis
  9. 9. Pharmacotherapy of bronchial asthma
  10. 10. Pharmacotherapy of bronchial asthma Pharmacotherapy
  11. 11. Pharmacotherapy of bronchial asthma Relievers • Beta 2 agonists • Anticholinergics • Methylxanthines Controller • Corticosteroids • Mast cell stabilizers • Anti Leukotriens • Biological Agents
  12. 12. Classified as:  SABAs(short acting)- Salbutamol, Terbutaline, Levalbuterol, Fenoterol, Pirbuterol, Metaproterenol  LABAs(Long acting) - Salmeterol, Formoterol  Ultra LABA: Indicaterol ( yet not approved for asthma) Pharmacotherapy of bronchial asthma Beta-2 Agonists
  13. 13.  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)  Short acting drugs :Onset of action is 5 minutes,duration of action (4-6 hrs) & hence are drug of choice for acute attack  Long acting drugs:Duration of action (12 hrs)& hence at BD doses used for prophylaxis Pharmacotherapy of bronchial asthma Beta-2 Agonists
  14. 14.  Ultra long acting drugs : duration of action is 24 hrs & hence used at OD doses for prophylaxis of asthma 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…
  15. 15. Pharmacotherapy of bronchial asthma Name Oral Parentral Inhaled Salbutamol (albuterol) 2- 4 mg 0.25- 0.5mg,IM/SC 100-200g Levalbuterol - - 0.63-1.25 mg Terbutaline 5mg 0.25mg,SC 250 g Metaproteronol - - 650 g Pirbuterol - - 200 g Doses
  16. 16. Pharmacotherapy of bronchial asthma Doses Name Oral Inhalation Salmeterol - 50-100 g. Formoterol - 12-24g. Bambuterol 10-20mg. -
  17. 17. • 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:  A direct deleterious effect on bronchial smooth muscle  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
  18. 18. • 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
  19. 19. Pharmacotherapy of bronchial asthma Anticholinergics M3 > M1  Ipratropium  Tiotropium  Oxitropium
  20. 20. • 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…
  21. 21.  Drugs include :  Theophylline, Aminophylline, Theobromine  Mechanism :  Act by inhibiting Phosphodiesterase which is involved in breakdown of cAMP & by blockade of adenosine receptors  Inhibition of phosphodiesterase in lymphocytes gives additional anti-inflammatory effect Pharmacotherapy of bronchial asthma Methylxanthines
  22. 22.  Theophylline can be used by oral route at a dose of 8 mg/kg BD for persistent asthma along with inhalational corticosteroids  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
  23. 23.  These are potent anti-inflammatory drugs & also decrease bronchial hyperactivity & mucosal edema.  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
  24. 24. • 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
  25. 25. • Inhalational corticosteroids are drug of choice for persistent asthma Pharmacotherapy of bronchial asthma Corticosteroids Contd..  Beclomethasone dipropionate 200-400 g BD  Flunisolide 25 g BD  Budesonide 200-400 g BD  Fluticasone propionate 100-250 g BD  Ciclosenide 40 – 160 g OD
  26. 26. 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
  27. 27. • 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
  28. 28. • 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
  29. 29. 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
  30. 30.  Allergic asthma :  Most easily recognized asthma phenotype  Often commences in childhood  Associated with a past and/or family history of allergic disease such as eczema, allergic rhinitis, or food or drug allergy.  Examination of sputum reveals eosinophilic airway inflammation  Respond well to inhaled corticosteroid (ICS) treatment. Pharmacotherapy of bronchial asthma Phenotypes
  31. 31.  Non-allergic asthma :  The sputum of these patients may be neutrophilic, eosinophilic or contain only a few inflammatory cells (paucigranulocytic).  Patients with non-allergic asthma often respond less well to Inhaled corticosteroids Pharmacotherapy of bronchial asthma
  32. 32. 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 Asthma with obesity : Some obese patients with asthma have prominent respiratory symptoms and little eosinophilic airway inflammation Pharmacotherapy of bronchial asthma
  33. 33.  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.  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
  34. 34. ASTHMA MANAGEMENT -GINA GUIDELINES Pharmacotherapy of bronchial asthma
  35. 35.  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.  It is also important to elicit the patient’s own goals regarding their asthma, as these may differ from conventional medical goals. Pharmacotherapy of bronchial asthma Goals of manangement
  36. 36. 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
  37. 37. Pharmacotherapy of bronchial asthma  Pharmacological and non-pharmacological treatment is adjusted in a continuous cycle that involves assessment, treatment and review  Asthma outcomes have been shown to improve after the introduction of control-based guidelines CONTROL-BASED ASTHMA MANAGEMENT
  38. 38. 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 2–3 months, treatment may be stepped down in order to find the patient’s minimum effective treatment . STEPWISE approach for asthma Rx
  39. 39. Pharmacotherapy of bronchial asthma
  40. 40. Pharmacotherapy of bronchial asthma
  41. 41.  For Step 4 treatment, add-on tiotropium is now extended to patients aged ≥12 years with a history of exacerbations  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 ≥12 years with severe eosinophilic asthma Pharmacotherapy of bronchial asthma What’s new in GINA 2016 guidelines
  42. 42. Pharmacotherapy of bronchial asthma If a patient has persisting symptoms and/or exacerbations despite 2–3 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
  43. 43. 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 6–11 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 patient’s lowest treatment that controls both symptoms and exacerbations
  44. 44. 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
  45. 45. Status Asthmaticus (Cont’d • 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
  46. 46. SPECIAL CONSIDERATIONS Pharmacotherapy of bronchial asthma
  47. 47. Exercise-induced bronchospasm • Pretreatment before exercise- Inhaled beta2-agonists- prevent EIB in more than 80 percent  SABA use may be helpful for 2–3 hours  LABAs can be protective up to 12 hours  Leukotrine receptor antagonist can attenuate EIB in up to 50 percent of patients  Cromolyn or nedocromil taken shortly before exercise is an alternative
  48. 48. 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
  49. 49. 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
  50. 50. DEVICES Pharmacotherapy of bronchial asthma
  51. 51. Inhalational delivery systems Dry Powder Inhalers Metered Dose Inhaler Spacer Nebuliser
  52. 52. 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.
  53. 53. 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
  54. 54. 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.
  55. 55. 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
  56. 56. RECENT ADVANCES Pharmacotherapy of bronchial asthma
  57. 57. INDICATEROL:  Inhaled once-daily β2 agonist  Onset of action faster than salmeterol  Duration of action ~ 24 hrs  Has been approved only for COPD  Clinical trials in asthma underway to test safety and efficacy of once-daily combination of indacaterol with mometasone Pharmacotherapy of bronchial asthma
  58. 58. Pharmacotherapy of bronchial asthma
  59. 59. Pharmacotherapy of bronchial asthma
  60. 60. Pharmacotherapy of bronchial asthma
  61. 61.  Mapracorat: Selective glucocorticoid receptor agonist that targets receptors for inflammation only & is devoid of systemic side effects  Abediterol: Ultra LABA under trial for bronchial asthma prophylaxis  Recently MgSo4 by I.V. and inhalational route has been tried for acute severe asthma. Recent advances Contd…
  62. 62. 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
  63. 63. 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
  64. 64.  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
  65. 65.  Asthma is a serious global health problem affecting all age groups  Despite of better understanding of  Pathophysiology  Presence of reliable diagnostic tools,availability of a wide range of effective & affordable drugs  Simplified national and international asthma management guidelines Asthma remains poorly managed across the globe Pharmacotherapy of bronchial asthma SUMMARY
  66. 66.  Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2016. Available from: www.ginasthma.org  Asthma insights & management in India; JAPI (SEP. 2015 vol.63)  Medicine Update 2016:volume 2 (Gurpreet S Wander,kk Pareek)  Crofton & dougla’s respiratory diseases:5th edition  Goodman and Gilman's -12th The Pharmacological basis of therapeutics Pharmacotherapy of bronchial asthma REFERENCES
  67. 67.  Principles of pharmacology-HL Sharma & kk sharma  Harrison’s principles of internal medicine:19th edition  Tiotropium respimat:a review of its use in asthma poorly controlled with ICS & LABA { DRUGS vol.75} Pharmacotherapy of bronchial asthma
  68. 68. Pharmacotherapy of bronchial asthma Next topic- Pharmacotherapy of Epilepsy Date: 14/09/16

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