INTRODUCTION

Asthma is a chronic (long term) lung disease that inflames and narrows the airways. Asthma
causes recurring periods of wheezing (a whistling sound when you breathe), chest tightness,
shortness of breathe, and coughing. The coughing often occurs at night or easily in the morning.

Asthma affects people of all ages, but it most starts during childhood. In the United states,
more than 25 million people are known to have asthma. About 7 million of these people are
children.

To understand asthma, it helps to know how the airways work. The airways are tubes that carry
air into and out of your lungs. People who have asthma have inflamed have inflamed airways.
The inflammation makes the airways swollen and very sensitive. The airways tend to react
strongly to certain inhaled substances.

When the airways react, the muscle around them tighten. The narrows the airways the airways
the airways causing less air to flow into the lungs. The swelling also can worsen making the
airways even narrower. Cells in the airways might more mucus than usual. Mucus is a stickly,
thick liquid that can further narrow the airways.
TYPES OF ASTHMA

Exercise-Induced Asthma: Exercise can trigger bronchoconstriction both in people with or

without asthma. It occur in most people with asthma and up to 20% of people without asthma
Exercise –Induced bronchoconstriction is common in professional athlelets .The highest rates
are among cyclists (up to 45%) swimmer and cross country skiers.While it may occur with any
weather conditions it more common when it is dry and cold.Inhaled beta2-agonist do not
improve athletic performance among those without asthma however oral doses may improve
endurance and strength.

Specific symptoms : Chest tightness , and cough.

 Nocturnal Asthma- Worsening of asthma at night at night is very common and treatment of
underlying causes can help greatly. As with exercise , when is a problem at night , it usually
means that the inflammation in the airways is worse .
 Occupational Asthma- Workplace exposure to certain chemicals or dusts can induce
asthma. These exposure to certain or dusts can induce asthma. These exposures can cause
an allergic of reaction or to be an irritant to the airways. Quick recognition and control of
workplace exposure is important.
 Steroid-Resistant asthma(Severe Asthma)- While the majority of patients respond to regular
inhaled glucocortoid (steroid) therapy,some people are steroid resistant.These people do
not respond to steroids at normal doses.Spesk with your healthcare provider about an
action plan for working with this type of asthma.
 Allergic Asthma-it is triggered when you inhale one of the following allergens:
a) Tobacco smoke.
b) Animal dander
c) Cockroaches
d) Dust mites
e) Molds
f) Pollen

Specific symptoms: Running nose ,watery eyes, wheezing, swollen nasal passages,
excess mucus.

CAUSES:

 Sulfites and preservative added to some types of foods and beverage, including shrimp
,dried fruit, processed , beer and wine.
 Gastroesophageal reflux disese (GERD), a condition in which stomach acids backs up into
your throat.
 Stess and emotion.
 Asthma triggers: Exposure to irritants and substances that trigger allergies (allergens) can
trigger signs and symptoms of asthma. Asthma triggers are different from person to person
and can include.
 Respiratory infections , such as the common salt.
 Physical activity
 Cold air
 Air pollutants and irritants such as smoke
 Certain medication including beta blocker, aspirin,ibuprofen and naproxen.
TRAMISSION

 Asthma affects the respiratory system of one individual and it cannot be passed from one
person to another.
 Asthma may affect the transmission of other disease or illness due to chronic coughing
caused by thick mucus.

PATHOPHSIOLOGY
Asthma is the result of chronic inflammation of the conducting zone of the airways
(most especially the bronchi and bronchilles) which subsequently results in increased
contractability of the surrounding smooth muscles. This among other factors leads to
bouts narrowing of the airways and the classic symptoms of wheezing . The narrowing
typically reversible with or without treatment .Occasionally the airways themselves
change . change in the airways include an increase in eosinopils and thickening of the
lamina reticularis. Chronically the airways smooth muscle may increase in size along
with an increase in the numbers of mucous glands. Other cell tupes involved included. T
lymphocytes, macrophages and reutrophils. There may also be involvement of other
compents of the immune system including cytokinesis , chemokines, histamine and
leukotrienes among others.
DIAGNOSE:

There are some key asthma tests your doctor will use in diagnosing asthma. Some asthma tests
such as lung (or pulmonary) function tests, measure lung function. Other asthma tests can help
determine if you are allergic to specific foods , pollen , or other asthma tests can help
determine overall health specific tests also measure levels of immunoglobulin E (IgE) a key
antibody that’s relesed during an allergic reaction . While everyone makes IgE ,people who have
allergies make larger quantities of the protective protein.

LUNG FUNCTION TEST:

 Lung test are asthma that asses lung function. The most common lung function tests used
to diagnose asthma are spirometry and methacholine challenge tests . Spirometry is a
simple breathing test that measures how much and how fast you can blow air out of your
lungs.IT is often used to determine the amount of airways obstruction you lungs .It is often
to determin the amount of airways obstruction you have .

CHEST X-RAY

 While a chest x-ray is not an asthma test, it may be used to make sure nothing else is
causing your asthma symptoms .An x-ray is an image of the body that is created by using
low doses of radiation to see internally .X-RAY can be used to dignosed a wide range of
conditions from bronchitis to a broken bone.

EXHALED NITRATE OXIDES

You breathe into a tube connected to a machine that measures the amount of nitric
oxide gas in your breathe .Nitric oxide gas is produced by the body normally but high
levels in your breath can your can mean your airways are inflamed a sign of asthma.

ALLERGY TESTS:
Allergy testing may be recommended to identify any allergies that asthma symptoms .

EXALUATION OF THE SINUSES

The presence of nasal polyps or sinusitis may make asthma harder to treat and control
.Sinusitis also called called sinus infection is an inflammation or swelling of the sinuses
due to infection .
APPROACHES TO TREATMENT

 Prevention of AG:AB reaction avoidance of antigen ,hypersensitization possible in extensic

can be identified.
 Neutralization of IgE (reagenic antibody ) omalizumb.Supression of inflammation and
brochial hyperactivity –Corticosteroid.
 Prevation of realse of medication mast cell stabilizer.
 Antagonism of realse of mediators-leukotriene antagonists antihistamine ,PAF Antagonists.
 Blockade of constrictor neurotransmitter –Anticholinergics.
 Directly acting bronchodilators –Methylazxanthines.

MANAGEMENT

 The most effective treatment for asthma is identifying triggers such as cigarette smoke pets
or aspirin and eliminating exposure to them .If trigger avoidance is insufficient the use of
medication is recommended .Pharmaceuticl drugs are selected based on among other
things the severity of illness and the frequence of symptoms .Specific medications for
asthma are broadly classified into fast acting and long catergories.
 Bronchidilators are recommended for short term relief of symptoms .In those with
occasional attack no other medication is needed.If mild persistent disease is present (more
than two attack a week ) low dose inhaled corticosteroids or alternatively an oral
leukotriene antagonist or mast cell stabilizer is recommended.For those who have daily
attacks a higher dose of inhaled corticosteroid is used. In a moderate or severe
exacerbation oral corticosteroids are added to these treatments.

MEDICATION

 Medication used to treat asthma are divided into two general classes quick relief
medication used to treat acute symptoms and ling term control medications used to
prevevt further exacerbation.

FAST ACTING

 Fast acting beta adrenoceptor agonist (SABA) Such as salbutamol are line the first line
treatment for asthma symptoms .They are recommended before exercise in those with
exercise induced symptoms
 Anticholinergic medication such as ipratropium bromide ,provide additional benefit when
used in combination with SABA in those with miderate or sever symptoms
 Older less selective adrenergic agonists such as inhaled epinephrine have similar efficacy to
SABAs . They are however not recommended to concern regarding excessive cardiac
stimulation
 SALBUTAMOL meterd dose inhaler commonly used to treat asthma

LONG TERM CONTROL

 Corticosteroids are generally considered the most effective treatment available for long
term control
 Fluticasone propionate metered dose inhaler commonly used for long control
AGE GROUP PREFERRED DEVICE ALTERNATIVE DEVICE

Younger than 4 years Pressurized metered dose Nebulizer with face mask
inhaler plus dedicated space
with face mask

4-5 years Pressurized metered dose Nebulizer with mouthpiece

inhaler plus dedicated spacer
with mouthpiece

Older than 6 years
Dry powder inhaler or beath Nebulizer with mouthpiece
actulated pressurized meter
dose inhaler or pressurized
metered dose inhaler with
spacer with mouthpiece

BRONCHODILATERS:

 Long acting beta adrenoceptor agonists (LABA) such as salmeterol and formoterol can
improve asthma control at least in adults when given in combination with inhaled
corticosteroid.
 Methylxanthines: Theophylline, aminophylline, hydroxyyethyl theophylline, doxaphylline.
 Leukotriene receptor antagonist (such as montelukast and zafirlukast) may be used in
addition to inhaled corticosteroid.
 Mast cell stabilizer (such as cromolyn sodium) are another non preferred alternative to
corticosteroids.
 Carticosteroid;-Systemic : 1)Hydrocartisone, prednisolone
2) Inhalation: Beclomethsone, Dipropioate, Budesonide,
Fluticasone propionate
 Anti –ige antibody- Omalizumab

MECHANISM OF ACTION;

(a) BRONCHIDILATOR (salbutamol)- salbutamol stimulates beta 2 receptors which are

predominant receptors in bronchial smooth muscle of the lung. Stimulation of beta 2
receptor leads to the activation of enzyme adenyl cyclase that form cyclic AMP
(adenosine mono phosphate ) from ATP (Adenosine tri phosphate) This high level of
cyclic AMP relaxes bronchial smooth muscle and decreases airways resistance by
lowering intracellular ionic calcium concentration .Salbutamol relaxes the smooth
muscles of airways from trachea to terminal bronchioles.

Prepration;-Salbutamol is available as tablet ,syrup ,inhaler, nebulizer solution and

intramuscular or intravenous injectable form

 Tablet fom- Each tablet contains 2 or 4mg salbutamol or 8mg extended release salbutamol
 Syrup form-Each 5ml syrup (one teaspoon) contains 3mg salbutamol
 Inhaler prepration –Two types of inhaler present one is salbutamol metered dose inhaler
(MDI) and another is salbutamol dry powder inhaler (DPI)

Dosages:
 Oral form –The usual dose of oral salbutamol is 2 to 4 mg three times a day in adult in adult
and 1 to 2 mg three times a day in children
 Inhaler formulation –One to two puffs (100 to 200) microgram of salbutamol metered dose
inhaler is inhaled as need basis
 Nebulizer solution – 1 to 2 ml of salbutamol nebulizer solution should be diluted with
normal saline to final volume of 2-4 ml is inhaled from a nebulizer until aerosol generation
ceases.IT may be required repeated in acute attack
 Injection form -5 to 10 ml (each ml contain 50 microgram) of salbutamol injection is used
intramuscularly or iv severe acute attack
Side effects:

 Palpation
 Tachycardia
 Chest discomfort
 Muscle cramps
 Hypokalemia

(B) ANTICHOLINERGICS;
Anticholinergics drugs competively inhibit binding of the neurotramsmitter,
acetylcholine.They tarhet either muscuranic acetylcholine receptors or less commonly
nicotinic acetylcholine receptors
 Muscuranic receptor are found on nerve ending to smooth muscles cells, secreatory glands
and the eye .The are also found in the nervous system
 Nicotinic acetylcholine receptors are located at the endings of neuromuscular junction and
are the target of muscle relaxing drugs
 REFERENCE:
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asthma decling? Systemic review of epidemiological studies ‘’ . Allergy 65 (2) : 152-67.
Doi:10.11 11/j. 1398.2008.0224x. PWID 19912154.
2. Manniche L (1999). Scared luxuries : fragrance , aromatherapy, and cosmetics in ancient
Egypt Cornell university press. Ppra.
3. Murray john F (2010) ‘’CH 38 Asthma ‘’ In Robert J Murray john F broaddus v Courtney ,
Nadel, Jay A . Martin Thumas R King jr Tlmadge E Schraunagel , Dean E Murray and Nadel
textbook of respiratory medicine (5th ed) Elsevier, ISBN 1-4160-4710-7
4. delhi Jaypee brother medical publisher .p. 242 ISBN 978-93-5025-073-0
5. Chen CM Tischer C; Schnappinger , M Heinrich J (January 2010)’’ the role of cats and dogs in
asthma and allergy and allergy – a systematic review’’ International journal of hygiene and
environment health 213 (1)
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‘’ THE Cochrane database of systemic reviews
7. Strategic advisory group of exprerts on immunization – report of the extraordinary meeting
on the influenza A (H1N1) 2009 pandemic 7 july 2009’’ Wkly epidemiol rec 84 (30) -4 jul 24,
2009.
8. Jindal ,Ronald B (2005) Chest medicine essential of pulmonary and critical care medicine
.New Delhi jaypee brother medical publisher p .242 ISBN 978-93-5025-073-0
9. Boult LP (April 2009) ‘’ Influrnza of comorbid condition on asthma ‘’ European respiratory
journal 33(4) 897-906
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smoke free legislation on perinatal and child health a systemic review and meta analysis ‘’
Lancer 383
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ratom CRC press .p.100 ISBN
12. WWW.medicinenet.com/asthma
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 ACKNOWLEDGEMENT

We have taken efforts in this project .However it would have not been
possible without the kind support and help of many individuals and
organization . We would like to external our sincere thanks to all of them.

We would like to express my gratitude towards my parents for their kind

co-operation and encouragement which helped me in We thanks my God
and parents for providing me with everything required in completing the
project.

Sincere thanks to Dr. RAN SINGH & Dr. MEERA SINGH for providing us
infrastructure library and internet facility for completion of work.

We are indepted to Dr. M.S. ASHAWAT for his unseen support , blessing,
boundless energy and enthusiasm that always compelled me to do work
hard, harder and hardest.

We are thankful to my guide MISS. DIMPLE RANA, Assistant professor of

Pharmacy practice for his guidance and constant supervisions as well as for
providing necessary information regarding the project and also for his
support in completing the project.
 CERTIFICATE BY GUIDE

It is to certify that the project entitled “RECENT ADVANCES IN THE TREATMENT AND
MANAGEMENT OF ASTHMA” submitted by Mr. Ashish prashar. Roll No. BP 4010654 of VIII
semester , Laureate Institute of Pharmacy Kathog, under my supervision and guidance.

Date:

Place: Signature of the guide

Miss. Dimple Rana

Assistant Professor of Pharmacy Practice

Laureate Institute of Pharmacy

Kathog, Tehsil-Dehra
 CERTIFICATE BY HEAD INSTITUTION

It is to certify that the project entitled “RECENT ADVANCES IN THE TREATMENT AND
MANAGEMENT OF ASTHMA ” is a bonafide and genuine work carried out by Mr. Ashish
prashar, Roll No.BP4010654 under the guidance of Miss. Dimple Rana.

Date:

Place:

Signature of principal
Dr.M.S.Ashawat
Principal
Laureate Institute of Pharmacy
Kathog,Tehsil-Dehra
Distt-Kangra,(H.P)
RECENT ADVANCE IN THE TREATMENT AND MANAGEMENT OF ASTHMA
A Project Submitted to

Himachal Pradesh Technical University , Hamirpur

In the partial fulfillment of the requirement for the degree of

BACHELOR OF PHARMACY

By

Ashish Prashar

Roll.No. BP 4010654

8TH Semester

Under the guidance of

Miss. Dimple Rana

Asst. Professor of Pharmacy Practise

Laureate Institute of Pharmacy

Kathog, Tehsil- Dehra

Distt – Kangra , (H.P) Pin code -177101

 CERTIFICATE OF CANDIDATE

We hereby declare that work describe in this project entitled ‘’RECENT ADVANCES IN THE
TEATMENT AND MANAGEMENT OF ASTHMA’’ which is being submitted by me in partal
fulfillment for the award of bachelor in pharmacy to Himachal Pradesh Technical University ,
Hamirpur is the result of reviews carried out by use under the guidance of , Miss. Dimple Rana,
Assistant Professor of pharmacy practice. The work is original and has not been submitted for
any degree/diploma of this or any university.

Date:

Place: Signature of candidate

Mr. Ashish Prashar

Roll No. BP4010654

RECENT ADVANCES IN THE TREATMENT AND MANAGEMENT OF
ASTHMA