 Asthma is a condition in which your airways

narrow and swell and produce extra mucus.

This can make breathing difficult and trigger
coughing, wheezing and shortness of breath
• Shortness of breath
• Chest tightness or pain
• Trouble sleeping caused by shortness of
breath, coughing or wheezing
• A whistling or wheezing sound when exhaling
(wheezing is a common sign of asthma in
children)
• Coughing or wheezing attacks that are
worsened by a respiratory virus, such as a
cold or the flu
 Exercise-induced asthma, which may be
worse when the air is cold and dry

 Occupational asthma, triggered by workplace

irritants such as chemical fumes, gases or
dust

 Allergy-induced asthma, triggered by

particular allergens, such as pet dander,
cockroaches or pollen
 Exposure to various substances that trigger
allergies (allergens) and irritants can trigger
signs and symptoms of asthma:

 Airborne allergens, such as pollen, animal

dander, mold, cockroaches and dust mites

 Respiratory infections, such as the common

cold

 Physical activity (exercise-induced asthma)

 Cold air

 Air pollutants and irritants, such as smoke

 Certain medications, including beta blockers,

aspirin, ibuprofen (Advil, Motrin IB, others) and
naproxen (Aleve)

 Strong emotions and stress

 Sulfites and preservatives added to some types of

foods
 Chronic obstructive pulmonary disease
(COPD) refers to a group of lung diseases that
block airflow and make breathing difficult.

 Emphysema and chronic bronchitis are the

two most common conditions that make up
COPD.
• Chronic bronchitis is an inflammation of the
lining of your bronchial tubes, which carry air
to and from your lungs.

• Emphysema occurs when the air sacs (alveoli)

at the end of the smallest air passages
(bronchioles) in the lungs are gradually
destroyed

• Damage to your lungs from COPD can't be

reversed, but treatment can help control
symptoms and minimize further damage
• Shortness of breath, especially during
physical activities

• Wheezing, Chest tightness

• Having to clear your throat first thing in the

morning, due to excess mucus in your lungs

• A chronic cough that produces sputum that

may be clear, white, yellow or greenish
 Blueness of the lips or fingernail beds
(cyanosis)

 Frequent respiratory infections

 Lack of energy

 Unintended weight loss (in later stages)

 Symptoms of COPD often don't appear until
significant lung damage has occurred, and
they usually worsen over time.

 For chronic bronchitis, the main symptom is a

cough that persists at least three months a
year for two consecutive years
 Short acting – Salbutamol [Ventolin®]
 Long acting – Formeterol

Indications: Treatment or prevention of

bronchospasm in patients with reversible
obstructive airway disease; prevention of
exercise-induced bronchospasm
 Stimulates β2 receptors which are
predominant receptors in bronchial smooth
muscle of the lung

 This leads to the formation of cyclic AMP

 High level of cyclic AMP relaxes bronchial

smooth muscle and decreases airway
resistance by lowering intracellular ionic
calcium concentrations.
 Salbutamol relaxes the smooth muscles of
airways, from trachea to terminal bronchioles

 High level of cyclic AMP are also inhibits the

release of bronchoconstrictor mediators such
as histamine, leukotreine from the mast cells
in the airway
 Beta-Blockers (Beta1 Selective): May diminish
the bronchodilatory effect of Beta2-Agonists

 Beta-Blockers (Nonselective): May diminish

the bronchodilatory effect of Beta2-Agonists.
Risk X: Avoid combination

 Avoid or limit caffeine (may cause CNS

stimulation).
 Central nervous system stimulation

 Dizziness, irritability, migraine, nervousness

 Hyperglycemia, hypokalemia

 Xerostomia
 Administration – from group project
 Ipratropium [Atrovent®]
 Tiotropium [Spiriva®]

 Indications - Anticholinergic bronchodilator

used in bronchospasm associated with COPD,
bronchitis, and emphysema
 Blocks the action of acetylcholine at
parasympathetic sites in bronchial smooth
muscle causing bronchodilation;

 Local application to nasal mucosa inhibits

serous and seromucous gland secretions
 Headache

 Dizziness

 Xerostomia

 Taste perversion

 Back pain
 Half-life elimination: 5-6 days

 Time to peak, plasma: 5 minutes

 Administration – Group project

 Beclomethasone [Becotide®]

 Indication: Maintenance treatment of asthma

as prophylactic therapy;
 Also for patients requiring oral corticosteroid

therapy for asthma to assist in total

discontinuation or reduction of total oral
dose
 Airway inflammation is known to be an important
component in the pathogenesis of asthma

 Inflammation occurs in both large and small airways.

 Corticosteroids have multiple anti-inflammatory

effects, inhibiting both inflammatory cells and
release of inflammatory mediators

 These anti-inflammatory actions of corticosteroids

contribute to their efficacy in asthma
 Oral candidiasis (≤31%)

 Nausea/vomiting (1% to 9%)

 Headache (2% to 14%)

 Oral corticosteroid

 MoA: Decreases inflammation by suppression

of migration of leukocytes and reversal of
increased capillary permeability;

 Also suppresses the immune system by

reducing activity and volume of the lymphatic
system
 Anti-inflammatory dose: Oral:
 Children:
 0.1-2 mg/kg/day in divided doses 1-4
times/day
 Adults: Usual range: 5-60 mg/day

 Should be taken after meals or with food or

milk to decrease GI effects;
 Increase dietary intake of pyridoxine, vitamin C,
vitamin D, folate, calcium, and phosphorus.
 Symbicort Turbuhaler is inhaled into the
lungs for the treatment of asthma or Chronic
Obstructive Pulmonary Disease (COPD).

 Contains two active ingredients in one

inhaler:
 budesonide and formoterol
 Budesonide belongs to a group of medicines
called corticosteroids.
 Budesonide acts directly on your airways to

reduce inflammation.

 Formoterol belongs to a group of medicines

called beta-2-agonists.
 Formoterol opens up the airways to help you

breathe more easily.

 Administration – group project
 Indications: Treatment of symptoms and
reversible airway obstruction due to chronic
asthma, or other chronic lung diseases
 Causes bronchodilatation by blocking
phosphodiesterase which increases tissue
concentrations of cyclic adenine
monophosphate (cAMP) which in turn
promotes induces release of epinephrine
from adrenal medulla cells
 Flutter, tachycardia
 Headache, hyperactivity (children), insomnia
 Nausea, vomiting

 Plasma glucose, uric acid, free fatty acids,

total cholesterol, HDL, HDL/LDL ratio, and
urinary free cortisol excretion may be
increased by theophylline.
 Montelukas [Singulair®]

 Indications: Prophylaxis and chronic

treatment of asthma; prevention of exercise-
induced bronchoconstriction
 Montelukast blocks the action of leukotriene
on the cysteinyl leukotriene receptor CysLT1
in the lungs and bronchial tubes by binding
to it.

 This reduces the bronchoconstriction

otherwise caused by the leukotriene and
results in less inflammation.
 Headache

 Dizziness, fatigue

 Increased serum AST, increased serum ALT

 Abnormal dreams, aggressive behavior