PHL1: PHARMACOTHERAPY BRONCHIAL ASTHMA

BRONCHIAL ASTHMA
Define: Bronchial asthma is a
• Chronic inflammatory disease of the airways
• Associated with recurrent, reversible airway obstruction with
• intermittent episodes of wheezing and dyspnoea and,
• bronchial hypersensitivity caused by various stimuli, which stimulates the Vagus nerve
• leading to bronchial smooth muscle constriction, hypersecretion of mucus, and mucosal oedema.

Symptoms of Bronchial Asthma

Chest tightness may occur with or without the below symptoms
Shortness of breath
Wheezing whistling or hissing sound when breathing out
Coughing may be chronic, usually worse at night and early
morning may occur after exercise or when
exposed to cold, dry air
Shortness of breath especially with exertion or at night

*Settings symptoms occur and diagnostic testing very important in recognizing this disorder.
*Symptoms of asthma vary from person to person and in any individual from time to time.
Asthma Triggers
Mechanism:
• Tobacco smoke
1. Allergen such as sensitizers, viruses, air pollutants induce
inflammation • Infections (colds, flu, or pneumonia)
2. Causing chronic eosinophilic bronchitis lead to airway • Allergens (food, pollen, dust mites,
hyperresponsiveness triggered by allergen, exercise, cold and pet dander)
air • Exercise
3. Which exarcebate symptoms like cough, wheeze, chest, • Air pollution and toxins
dyspnea and tightness • Weather, especially extreme changes
in temperature
• Drugs (aspirin, NSAID, B-blockers)
• Food additives (MSG)
• Emotional stress and anxiety
• Singing, laughing, or crying
• Smoking, perfumes, sprays
• Acid reflux

Immunologic model of pathogenesis bronchial asthma

PHL1: PHARMACOTHERAPY BRONCHIAL ASTHMA

SHORT-ACTING BRONCHODILATORS
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LONG-ACTING BRONCHODILATORS

ANTI-INFLAMMATORY MEDICATIONS
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OTHER MEDICATIONS

POSSIBLE MECHANISM OF BRONCHODILATOR DRUGS

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SUMMARY TREATMENT STRATEGIES IN ASTHMA

What is a nebulizer? , A nebulizer changes liquid medicine into fine droplets (in aerosol or mist form) that are
inhaled through a mouthpiece or mask.
§ Nebulizers can be used to deliver bronchodilator (airway-opening) medicines such as salbutamol or
ipratropium bromide or both along with Oxygen
§ In acute exacerbation of asthma :When MDI may not be helpful a nebulizer may be used instead
§ It is powered by a compressed air machine and plugs into an electrical outlet.
§ Portable nebulizers, powered by an internal battery are available for individuals requiring treatments
away from home.

Commonly used
bronchodilators in acute
attack of asthma
MUST REMEMBER
§ Salbutamol is also known as reliever or rescue medication
- Short acting beta 2 agonists by inhalation through MDI to produce quick effects and
to reduce systemic side effects.
§ Long acting beta 2 agonists are used for prophylaxis but not for acute attack and are
administered in combination with inhaled corticosteroids

Acute exacerbation or in § The only Corticosteroids that can be administered by oral and parenteral routes
severe asthma § Systemic side effects are more with oral and parenteral corticosteroids.

Chronic asthma § Inhaled glucocorticosteroids are most important as

- controller medications
- anti- inflammatory drugs
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§ Add on drugs:
1. Theophylline,
2. leukotriene modifiers,
3. anticholinergic
§ Cromolyn used as prophylactic medications in early stage or exercise induced asthma
§ Inhaled route is preferred for beta2-agonists and steroids
- as it produces the same benefit with fewer side effects compared to oral route.
- In addition, inhaled medications exert their effects at lower doses and quickly.
§ The pressurised metered dose inhaler (MDI) is suitable for most patients as long as inhalation technique is correct.
§ For patients with poor coordination, alternative methods for drug inhalation are:
- use of spacer devices
- dry powder inhalers (DPI)
§ The nebulised route is preferred in the management of acute exacerbation.

§ Oral route: § Parenteral route:

1. Corticosteroids in severe asthma, 1. IV corticosteroids
2. Theophylline 2. Short acting beta 2 agonists
3. Leukotriene modifiers 3. Aminophylline (severe asthma)

ASTHMA DIAGNOSIS
§ Reversible and variable airflow limitation as measured by a peak expiratory flow (PEF) meter in following
way:
- PEF increases > 15%, 15-20minafter inhaling a short-acting beta2-agonist, or
- PEF varies > 20% from morning measurement upon arising to measurement 12 hours later in patients who
taking a bronchodilator ( >10% patients who are not taking a bronchodilator)
- PEF decreases > 15% after 6 minof running or exercise
- Spirometry (most reliable method)

PEF MEASUREMENT
1. During periods of “well-being”
§ This allows measurement of patient’s best PEF value which provides the target for doctor and patient to aim for.
Twice daily measurements (morning and evening) before any inhaled bronchodilator treatment will determine the
diurnal variability of airway calibre.
§ This is calculated as the range divided by the highest value and expressed as a percentage.
PEF (max) – PEF (min) x 100 = % PEF (max)
§ Good control of asthma means PEF variability is maintained at <10%.

2. During symptomatic episodes

§ During an attack of asthma PEF fairly accurately measures the degree of bronchospasm.
Condition PEF Value
normal or best suggests a very severe attack < 50%
suggests a life-threatening attack. < 30%
§ When the best PEF value is not known, a single reading of <200 L/min usually indicates a severe attack.
§ In addition to history and physical findings the PEF helps the doctor decides on the appropriate therapy.
As far as possible patients with moderate and severe persistent asthma should regularly measure their
PEF twice a day.
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QUESTIONS

§ Name 3 bronchodilator drugs .

§ What do you understand by reliever or rescue medication and
§ name the most common reliever drug used in bronchial asthma.
§ What do you understand by controller medication in bronchial asthma and name
three controller medications used in bronchial asthma. What is the most important
controller medication used in bronchial asthma?
§ Name anti-inflammatory drugs used in bronchial asthma and name the most
important anti-inflammatory drugs used in bronchial asthma.
§ What are the merits and demerits of MDI (Metered Dose Inhaler)?
§ Which drugs can be administered by MDI?
§ What are the advantages of using a spacer with MDI?
§ Name three corticosteroids used by inhalation route.
§ Explain why inhaled corticosteroids are preferred medications for the treatment of
chronic asthma
§ What are the most common adverse effects of inhaled corticosteroids?
§ What advice you will give to the patients to prevent these adverse effects?
§ Explain how aspirin can exacerbate an asthma attack and how leukotriene modifiers
can abort an asthma attack?