Asthma

Olena Pilipovich
What is Asthma?
Asthma is a chronic disease characterized by recurrent
attacks of breathlessness and wheezing, which vary in
severity and frequency from person to person
During an asthma attack, the lining of the bronchial
tubes swells, causing the airways to narrow and
reducing the flow of air into and out of the lungs
The causes of asthma are not completely understood.
However, risk factors for developing asthma include
inhaling asthma triggers, such as allergens, tobacco
smoke and chemical irritants. Asthma cannot be
cured, but appropriate management can control the
disorder and enable people to enjoy a good quality of
life
https://www.slideshare.net/AllergyChula/inhaled-corticosteroids-in-clinical-practice
 Controllers: Inhaled Corticosteroids
ICS are now first-line therapy for all patients with
persistent asthma
Budesonide and fluticasone propionate have a
greater first pass metabolism than
beclomethasone dipropionate (BDP) and are
therefore less likely to produce systemic effects
at high inhaled doses

Inhaled Corticosteroids, Peter J. Barnes, National Heart and Lung

Institute, Imperial College, London, UK
Inhaled Corticosteroids, Peter J. Barnes, National Heart and Lung
Institute, Imperial College, London, UK
 Controllers: Inhaled Corticosteroids
Side-effects:
Systemic effects of inhaled glucocorticosteroids
are not a problem in adults at doses of 400 mg
budesonide or equivalent daily
The systemic side-effects of long-term treatment
with high doses of inhaled glucocorticosteroids
include easy bruising, adrenal suppression and
decreased bone mineral density
Inhaled glucocorticosteroids have also been
associated with cataracts and glaucoma in
cross-sectional studies, but there is no evidence
of posterior-subcapsular cataracts in prospective
studies
 Controllers
Inhaled long-acting 2-agonists added to ICS further
improve asthma control and are commonly given as
combination inhalers, there are important molecular
interactions between these two classes of drug
(corticosteroids have anti-inflammatory effects but
also increase the numbers of 2-receptors, whereas
2-agonists, as well as inducing direct
bronchodilatation, act on glucocorticoid receptors to
increase the anti-inflammatory effects of
corticosteroids)

Inhaled Corticosteroids, Peter J. Barnes, National Heart and Lung

Institute, Imperial College, London, UK
Controllers: Long-acting inhaled b2-
agonists

Long-acting inhaled b2-agonists, including

formoterol and salmeterol, should never be
used as monotherapy for asthma as these
medications do not appear to influence the
airway inflammation in asthma
Other controllers
Leukotriene modifiers (cysteinylleukotriene 1
receptor antagonists (montelukast, pranlukast and
zafirlukast) and a 5-lipoxygenase inhibitor (zileuton))

Theophylline (bronchodilator and, when given in a

lower dose, has modest anti-inflammatory properties)

Anti-IgE (omalizumab) is a treatment option limited to

patients with elevated serum levels of IgE

Systemic glucocorticosteroids

Oral anti-allergic compounds

 Relievers
Bronchodilators do nothing to reduce the
inflammation in the airway. They provide
temporary relief of bronchospasm by relaxing
the muscles that have tightened around the
bronchiole tubes
Most bronchodilators open the airway and help
restore normal breathing within 10 to 15
minutes. The effect lasts for about 4 hours

Rapid-acting inhaled b2-agonists

Anticholinergics (Inhaled ipratropium bromide)
Short-acting oral b2-agonists
 Rapid-acting inhaled b2-
agonists
The medications of choice
Side-effects include dryness of the mouth and
a bitter taste, but there is no evidence of a
drying effect on airway mucus
Side-effects such as tremor and tachycardia
occur with higher doses