Presented By UTTAM BORAHB.PHARM 6th SEMESTER

(UNDER THE GUIDENCE OF MR BISWAJIT DASH)

TREATMENT OF ASTHMA

Asthma (AZ-ma) is a chronic (long-term) lung disease that inflames and narrows the airways.

According to WHO Asthma is a disease characterized by recurrent attacks of breathlessness(shortness of breath) and wheezing (breathe with a whistling or rattling sound in the chest, as a result of obstruction in the air passages.), which vary in severity and frequency from person to person.

DEFINATION OF ASTHMA

Between 10 and 15 cores people around the globe roughly the equivalent of the population of the Russian Federation suffer from asthma

India has an estimated 1.5-2.0 cores asthma patients.

In India, rough estimates indicate a prevalence of between 10% and 15% in 5-11 year old children.

CURRENT STATUS OF ASTHMA AS PER WHO

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 and naproxen Strong emotions and stress Gastroesophageal reflux disease (GERD), a condition in which stomach

acids back up into your throat

ETIOLOGY OF ASTHMA

Extrinsic Asthma -Allergy induced-Mostly episodic, Less prone to status asthmaticus

Intrinsic Asthma -Less prone to status asthmaticus -Triggered by RTI

Note- Status asthmaticus is a severe condition in which asthma attacks follow one another without pause.

TYPES OF ASTHMA

Cause mucosal edema

Inflammation of the pulmonary airways

Mediators constrict bronchial smooth muscle

Release of Mediators like histamine, leukotriene PGs etc.

Exposure to allergens ,infection, exercise or mental stress

CLINICAL CHANGES DURING ASTHMA

CLINICAL CHANGES DURING ASTHMA

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

SIGN & SYMPTOMS

BRONCHODILATORS LEUKOTRIENE ANTAGONIST MAST CELL STABILIZERS CORTICOSTERIODS Anti-IgE antibody Antibiotics(If any infection) Antiallergic Drug

DRUGS USED IN TREATMENT OF ASTHMA

Cause β2 receptor stimulation thereby relaxation of bronchial smooth muscle

Used in the form of tablet or as Inhaler

β2 sympathomimetics – Salbutamol, Salmeterol, Formoterol, Terbutaline

Inhaled salbutamol and terbutaline are most popular drug for quick relive.

BRONCHODILATORS(Β2 SYMPATHOMIMETICS)

Acted by inhibiting the enzyme phosphodiesterase So cAMP level rises resulting Bronchodilation Slow and sustained dose related bronchodilation It makes easier to get mucus out of the lungs. Dose depended toxicity including GIT pain & CNS toxicity Not the 1st Line Drugs in the treatment of Asthma Examples are Theophylline, Aminophylline etc.

BRONCHODILATORS(METHYLXANTHINES)

Acted by blocking cholinergic constrictor tone in larger airway

Produce slower action than β2 sympathomimetics

Psychogenic asthma respond better to these drugs

Given prophylactically to prevent asthma attack

Examples are Tiotropium Bromide, Ipratrpium etc.

BRONCHODILATORS(ANTICHOLINERGIC)

They completely antagonise cysLT1 receptor mediated bronchoconstriction

More acceptable in children

Very safe drug , produce side effects like headache & rashes

Drugs are Montelukast and Zafirlukast

LEUKOTRIENE ANTAGONIST

They cause degranulation of mast cell & Inflammatory cell by trigger stimuli

Release of mediators of asthma is restricted

Long term prophylactic in mild to moderate asthma

Drugs are Sodium Cromoglycate & Ketotifen

MAST CELL STABILIZERS

Choice of drugs for any type of asthma

They reduce bronchia hypersensitivity, mucosal edema

Supress the inflammatory response to AG:AB reactions

Given by using Inhalers or oral route

Drugs are Beclomethasone, Fluticasone, Budesonide, prednisolone, Hydrocortisone etc.

CORTICOSTERIODS

ANTI-IGE ANTIBODY

Given by i.v or s.c

It is humanised antibody against IgE

Neutralised free IgE in circulation

Name of the antibody is Omalizumab

It is very expensive drug (₹40,000/150mg)

Given when asthma associated with RTI

Most common in status asthmaticus

Antibiotics used are- Penicillins, Macrolides, Cephalosporins etc.

ANTIBIOTICS(IF ANY INFECTION)

Competitively antagonise action of histamine at H1 receptor

They cause Broncho dilation

Generally given along with leukotriene antagonist

Drugs are L-Cetrizine, Desloratadine, Fexofenadine etc

ANTIALLERGIC DRUG

COMBINED DRUG THERAPYType of Asthma Choice of drug Alternative

Mild episodic asthma β2 sympathomimetics (Inhalaer)

No alternatives

Seasonal asthma Low dose steroids (200-400µg/day)+ β2 sympathomimetics

Mild chronic asthma Low dose steroids + β2 sympathomimetics Cromoglycate

Moderate asthma Increased dose steroids + β2 agonist Leukotriene antagonist

Severe asthma Steroids, β2 agonist, Leukotriene antagonist Theophyline, ipratropium

Status Asthmaticus β2 agonist , hydrocortisone

A chest x ray  Broncho provocation  Lung Function Test Medical and Family Histories Physical Evaluation of patient  Allergy testing to find out which allergens affect you, if any

DIAGNOSIS OF ASTHMA

borahuttam

THANKS

Uttam Borah 9435369255borauttam uttamkborah