Asthma

Pharmacotherapy of Bronchial Asthma

Dr.Yeshwanth Rao

Definition • It is a condition characterized by recurrent, reversible obstruction of the airways in

response to stimuli which may not be themselves

noxious and which do not affect non – asthmatic subjects

• Symptoms - wheeze, shortness of breath and often

nocturnal cough.

Classification of anti – asthma drugs:A Bronchodilatorsi. Sympathomimetics : - Short acting agents: - salbutamol,

terbutaline, orciprenaline, bambuterol Long acting agents : salmetrol, formoterolii Anti – cholinergics:- ipratropium bromide, oxitropium, tiotropium

iii Methyl Xanthines: - theophylline, etophylline, aminophyllineB. Anti - inflammatory agents Corticosteroids Systemic : hydrocortisone, prednisolone Inhalational : beclomethasone,

budesonideC. Mast cell stabilizers: Sodium chromoglycate, Nedocromil

sodium Ketotifen

D. Leukotriene antagonists: Montelukast, zafirlukast,

pranlukastE. 5-lipoxygenase inhibitors: ZilutonF. Anti histamines: Ceterizine, loratidine, azelastine G. Monoclonal antibodies Omalizumab

• Corticosteroids• act by their broad anti-

inflammatory efficacy, mediated in part by inhibition of production of inflammatory cytokines

• reduce bronchial reactivity and reduce the frequency of asthma exacerbations if taken regularly

• inhibition of the infiltration of asthmatic airways by lymphocytes, eosinophils, and mast cells

• Clinical Use/status of Corticosteroids• oral and parenteral corticosteroids

are reserved for patients who require urgent treatment

• Regular or "controller" therapy is maintained with aerosol corticosteroids

• (beclomethasone, budesonide, ciclesonide, flunisolide, fluticasone, mometasone, and triamcinolone)

• They are now routinely prescribed for patients

who require more than occasional inhalations of a agonist for relief of symptoms.

• Adverse effects of inhaled steroids• oropharyngeal candidiasis• (can be reduced by having patients

gargle water and spit after each inhaled

treatment)• Hoarseness of voice

• Mast cell stabilizers• Cromolyn sodium (disodium

cromoglycate) and nedocromil sodium

• have no effect on airway smooth muscle tone

• Mechanism of Action• alteration in the function of delayed

chloride channels in the cell membrane, inhibiting cell activation (e.g mast cells)

Severe acute asthma (status asthmaticus)

• Severe acute asthma is a medical emergency

requiring hospitalisation. • Treatment includes oxygen (in high

concentration, usually ε 60%), inhalation of salbutamol

given by nebuliser, and intravenous hydrocortisone followed by a course of oral prednisolone