Bronchial Asthma
Bronchial Asthma
Bronchial Asthma
BRONCHIAL ASTHMA
3.Mucus plugs
1.Bronchodilators
Sympathomimetics - β2 agonists
Anticholinergics -Ipratropium,
- Tiotropium
methylxanthines - Theophylline, Aminophylline
2.Anti-inflammatory agents
1. Corticosteroids
2. Mast Cell Stabilizers
3. Leukotriene Modulators
4. Monoclonal Anti-lgE Antibody - Omalizumab
Drugs used in Bronchial Asthma
Bronchodilators
1. Selective β2- Agonists 2. Non-selective
Short acting Sympathomimetics
Salbutamol Adrenaline
Terbutaline Ephedrine,
Remiterol Isoprenaline.
Fenoterol
Long-acting
Salmeterol,
Formoterol,
Bambuterol.
1. β2-Selective adrenoceptor agonist
most widely used drugs .
1. Short acting:- Salbutamol,Terbutaline
used only for acute attack
1. Long acting:- Salmeterol, Formeterol
used for only prophlaxis
β2 receptor agonist-mechanism of
action
Stimulation of Intracellular
β2-receptors cAMP
Bronchial smooth
muscle relaxation
Selective β2 receptor agonists
1. Route of administration:
Usually delivered via a metered dose inhaler with
immediate effect
i.v used for acute attack.
S.C. (terbutaline)
Nebulization
Selective β2 receptor agonists
2. Adverse effect:
Cardiac arrhythmias (at high dose has β1
effects)
Tolerance to β agonist action.
Adrenaline/epinephrine:
Adrenaline/epinephrine
Agonist of α and β receptor
Adverse effect of cardiovascular system likeTachycardia,
Hypertension, Worsening of angina and even arrhythmias.
less used
S.C. injection( 0.5 ml of 1:1000 adrenaline)
Muscarinic antagonist - ipratropium
Quaternary derivative of atropine
Act by competitive blocking of muscarinic receptors
(M3 subtype) in brochioles
Also decrease mucus gland secretion
Reverses acute bronchospasm and vagally mediated
bronchospasm
Ineffective in allergen or exercise induced asthma
Ipratropium bromide - use
Dose
MDI – 18mcg/puff; 2-4 puffs every 6 hour
Mechanism:
1. Depress the inflammatory response in bronchial mucosa
thus diminish bronchial hyperresponsiveness.
3. Immunosuppressive effect.
Glucocorticoids -Route of administration
1.Inhalational
Metered dose inhaler: (deeply & slowly inhale)
Budesonide 200 to 400 µg BD or QID
Beclomethasone 50µg or 100µg per meter dose
2.Systemic
Intravenous used for: severe asthma, status
asthmaticus (hydrocortisone 100 mg 8th hourly)
oral- prednisolone ( 10mg BD)
Inhlational steroids – side effects
Local
Cough
Dysphonia
Oralcanidiasis
Minimised by using inhalation chamber and mouth
washing
SYSTEMIC
May occur with high dose therapy
Adrenal suppresssion, osteoporosis etc.
Mast cell stabilizers
Drugs
Sodium Cromoglycate, Nedocromil, Ketotifen
USE
Long term control medications that prevent
asthma symptoms
Improve air way function in mild persistent asthma
May help to reduce the dose of steroids
Leukotriene modifiers
Drugs :
5-Lipoxygenase inhibitor: Zileuton
Mechanism :
Block leukotriene production
Block lipo-oxygenase enzyme
Use :
Alternatives to low dose steroids in mild persistent
asthma
Leukotriene modifiers
Drugs
LT-receptor Antagonists: Zafirlukast, Montelukast.
Mechanism
Block receptors LT1 receptors and block the effects of
LTC4, LTD4, and LTE4.
Use
Alternatives to low dose steroids in mild
common precipitant.
Status asthmaticus
Acute severe exacerbation of asthma
charactarized by
Severe limitation of airflow
Increased work of breathing
severe narrowing/plugging.
bicarbonate/lactate infusion.
Aerosol Delivery of Drugs
Increased bioavailability.
Liquid aerosols
Metered dose inhaler (MDI)
Nebulizer
Powdered drugs
Dry powder inhaler (DPI), Spinhaler, Rotahaler
PMDI SPACER
Rotacap
NEBULIZER DPI(Dry powder inhaler)
Drugs to be avoided in patient with
bronchial asthma
1. NSAIDS like aspirin, ibuprofen,diclofenac
etc.(paracetamol can be used)
3. Cholinergic agents.
Conclusion
Asthma is treated with two types of
medicines:
Long term control - to reduce airway
inflammation and prevent asthma
symptoms.
Quick-relief medicines relieve asthma
symptoms that may flare up.
Initial treatment will depend on severity of the
disease.