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OSMANIA UNIVERSITY
HYDERABAD,TELANGANA
RECENT ADVANCEMENT IN PHARMACOTHERAPY OF ASTHMA
SUBMITTED BY SHAYESTA NISHATH
REG
...
170721882029
Ph
...
MARYAM
ASSISTANT PROFESSOR
DECCAN SCHOOL OF PHARMACY
DARUSSALAM,AGHAPURA,HYDERABAD
DECCAN SCHOOL OF PHARMACY Dar-us-salam, Aghapura,Hyderabad500001
DECLARATION BY THE CANDIDATE
I, SHAYESTA NISHATH hereby declare that the Practice School entitled “RECENT
ADVANCEMENT IN PHARMACOTHERAPY OF ASTHMA” was carried out in the Dept
...
Maryam
...
Place: Hyderabad
Date: 10th April, 2023
SHAYESTA NISHATH
Registration no: 170721882029
ASTHMA
Asthma is a long-term condition affecting children and adults
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This causes asthma symptoms such as cough, wheeze, shortness of
breath and chest tightness
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Other common triggers can make asthma symptoms worse
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Causes
Many factors have been linked to an increased risk of developing asthma, although it is
often difficult to find a single, direct cause
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● Asthma is more likely in people who have other allergic conditions, such as
eczema and rhinitis (hay fever)
...
● Events in early life affect the developing lungs and can increase the risk of
asthma
...
● Exposure to a range of environmental allergens and irritants are also thought to
increase the risk of asthma, including indoor and outdoor air pollution, house dust
mites, moulds, and occupational exposure to chemicals, fumes or dust
...
diagnose asthma
Your healthcare provider will review your medical history, including information about your
parents and siblings
...
Your provider will
need to know any history of allergies, eczema (a bumpy rash caused by allergies) and other
lung diseases
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This test measures airflow through your lungs and is
used to diagnose and monitor your progress with treatment
...
Long-term control medications
In most cases, these medications need to be taken every day
...
These decrease your body's sensitivity to a particular allergen or prevent your immune
system from reacting to allergens
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β2-Adrenergic
receptor stimulation activates adenyl cyclase, which produces an increase in intracellular cyclic
adenosine monophosphate
...
Aerosol administration enhances broncho selectivity and provides a more rapid
response and greater protection against provocations that induce bronchospasm (e
...
,
exercise, allergen challenges) than does systemic administration
...
Regular treatment (four times daily) does not
improve symptom control over as-needed use
...
Short-acting β2 –agonists should be continued for acute
exacerbations
...
In acute severe asthma, continuous nebulization of short-acting β2 agonists (e
...
,
albuterol) is recommended for patients having an unsatisfactory response after three
doses (every 20 minutes) of aerosolized β2-agonists and potentially for patients
presenting initially with PEF or FEV1 values <30% of predicted normal
...
Short-acting agents
provide complete protection for at least 2 hours after inhalation; long-acting agents
provide significant protection for 8 to 12 hours initially, but the duration decreases
with chronic regular use
...
However, nocturnal asthma may be an
indicator of inadequate anti-inflammatory treatment
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Inhaled
corticosteroids are the preferred long-term control therapy for persistent asthma in
all patients because of their potency and consistent effectiveness; they are also the
only therapy shown to reduce the risk of death from asthma
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Patients with more severe disease require multiple daily
dosing
...
The response to inhaled corticosteroids
is delayed; symptoms improve in most patients within the first 1 to 2 weeks and reach
maximum improvement in 4 to 8 weeks
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Systemic toxicity of inhaled corticosteroids is minimal with low to moderate inhaled
doses, but the risk of systemic effects increases with high doses
...
The ability of spacer devices to enhance lung
delivery is inconsistent and should not be relied on
...
Prednisone, 1 to 2 mg/kg/day (up to 40 to 60 mg/day), is administered orally in
two divided doses for 3 to 10 days
...
In patients who require chronic systemic corticosteroids for asthma control, the
lowest possible dose should be used
...
Methylxanthines
Theophylline appears to produce bronchodilation by inhibiting
phosphodiesterases, which may also result in antiinflammatory and other non
bronchodilator activity through decreased mast cell mediator release,
decreased eosinophil basic protein release, decreased T-lymphocyte
proliferation, decreased T-cell cytokine release, and decreased plasma
exudation
...
Sustained-release theophylline is the preferred oral preparation,
whereas its complex with ethylenediamine (aminophylline) is the preferred
parenteral product due to increased solubility
...
Theophylline is eliminated primarily by metabolism via hepatic cytochrome
P450 mixed-function oxidase microsomal enzymes (primarily CYP1A2 and
CYP3A4) with 10% or less excreted unchanged in the kidney
...
Clinically significant reductions in
clearance can result from cotherapy with cimetidine, erythromycin,
clarithromycin, allopurinol, propranolol, ciprofloxacin, interferon, ticlopidine,
zileuton, and other drugs
...
Because of large interpatient variability in theophylline clearance, routine
monitoring of serum theophylline concentrations is essential for safe and
effective use
...
Sustained-release oral preparations are favored for outpatient therapy, but
each product has different release characteristics and some products are
susceptible to altered absorption from food or gastric pH changes
...
Adverse effects include nausea, vomiting, tachycardia, jitteriness, and difficulty
sleeping; more severe toxicities include cardiac tachyarrhythmias and seizures
...
Anticholinergics
Ø Ipratropium bromide and tiotropium bromide are competitive inhibitors of
muscarinic receptors; they produce bronchodilation only in cholinergic mediated
bronchoconstriction
...
They attenuate, but do not block, allergen- or exercise-induced
asthma in a dose-dependent fashion
...
5 to 10
minutes)
...
Ipratropium
bromide has a duration of action of 4 to 8 hours; tiotropium bromide has a duration of
24 hours
...
Tiotropium bromide has not been studied in asthma
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They inhibit the
response to allergen challenge as well as EIB but do not cause bronchodilation
...
Ø
Both drugs are remarkably nontoxic
...
Ø Cromolyn and nedocromil are indicated for the prophylaxis of mild persistent
asthma in children and adults regardless of etiology
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Neither agent is as
effective as inhaled corticosteroids for controlling persistent asthma
...
Ø
Most patients experience improvement in 1 to 2 weeks, but it may take
longer to achieve maximum benefit
...
Leukotriene Modifiers
Ø Zafirlukast and montelukast are oral leukotriene receptor antagonists that
reduce the proinflammatory (increased microvascular permeability and airway edema)
and bronchoconstriction effects of leukotriene D4
...
However, they are less effective in asthma
than low-dose inhaled corticosteroids
...
The adult dose
of zafirlukast is 20 mg twice daily, taken at least 1 hour before or 2 hours after meals;
the dose for children aged 5 through 11 years is 10 mg twice daily
...
Ø
Zafirlukast and montelukast are generally well tolerated
...
An idiosyncratic syndrome similar to the Churg-Strauss syndrome,
with marked circulating eosinophilia, heart failure, and associated eosinophilic
vasculitis, has been reported in a small number of patients; a direct causal
association has not been established
...
The dose of zileuton
tablets is 600 mg four times daily with meals and at bedtime
...
Ø
Use of zileuton is limited due to the potential for elevated hepatic enzymes
(especially in the first 3 months of therapy), and inhibition of the metabolism of
some drugs metabolized by CYP3A4 (e
...
, theophylline, warfarin)
...
Combination Controller Therapy
Ø
The addition of a second long-term control medication to inhaled
corticosteroid therapy is one recommended treatment option in moderate to
severe persistent asthma
...
The inhalers
contain varied doses of the inhaled corticosteroid with a fixed dose of the long-acting
β2-agonist
...
Combination therapy is
more effective than higher-dose inhaled corticosteroids alone in reducing asthma
exacerbations in patients with persistent asthma
...
However, the magnitude of these benefits is less than that reported with the
addition of long-acting β2-agonists
...
Ø The dosage is determined by the patient’s baseline total serum IgE (international
units/mL) and body weight (kg)
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Because of its high cost, it is only indicated as step 5 or 6
care for patients who have allergies and severe persistent asthma that is inadequately
controlled with the combination of high-dose inhaled corticosteroids and long-acting
β2-agonists
...
1% incidence of anaphylaxis, patients should remain in
the physician’s office for a reasonable period after the injection because 70% of
reactions occur within 2 hours
...