BRONCHIAL ASTHMA

 DEFINITION
 SYMPTOMS
 PREDISPOSING FACTORS
 TYPES
 MECHANISM
 APPROACHES TO TREATMENT
 CLASSIFICATION OF DRUGS
 DRUGS
 CHOICE OF TREATMENT
 INTRODUCTION

 HYPERESPONSIVENESS OF TRACHEO BRONCHIAL

SMOOTH MUSCLE TO A VARIETY OF STIMULI,
RESULTING IN NARROWING OF AIRTUBES.
ACCOMPANIED BY ↑ SECRETION, MUCOSAL EDEMA &
MUCOSAL PLUGGING


A PRIMARY INFLAMMATORY CONDITION –

INFLAMMATION UNDERLYING HYPERACTIVITY


 VARIETY OF TRIGGER FACTORS MAY BE INVOLVED

 SYMPTOMS

 DYSNEA
 WHEEZING
 COUGH
 LIMITATION OF ACTIVITY
 PREDISPOSING FACTORS

 ALLERGY
 INFECTION
 POLLUTANTS
 EXERCISE
 EXPOSUE TO COLD AIR
 PSYCHOGENIC PROBLEMS
TYPES OF STHMA

EXTRINSIC INTRINSIC
ASTHMA ASTHMA
• STARTS AT EARLY AGE • STARTS IN THE MIDDLE AGE
• MOSTLY EPISODIC • ASSUMES CHRONIC FORM –
• LESS PRONE TO STATUS STATUS ASTHMATICUS
ASTHMATICUS • NO FAMILY HISTORY OF
ALLERGIES
 MECHANISM OF ASTHMA

INITIAL REACTION
↓
ACTIVATION OF MAST CELLS & INFLAMMATORY CELLS
↓
RELEASE OF MEDIATORS – HISTAMINE, PROTEASE
ENZYMES, TNF∝


RELEASE OF PHOSPHOLIPIDS FROM CELL MEMBRANE

FOLLOWED BY MEDIATOR SYNTHESIS – PG’S, LT’S, PAF


ACTIVATION OF GENES FOLLOWED BY PROTEIN

SYNTHESIS- INTERLEUKINS, TNF ∝

APPROACHES TO TREATMENT

 PREVENTION OF AG: AB REACTION – AVOIDANCE OF ANTIGEN; HYPOSENSITIZATION

 NEUTRALIZATION OF IgE - OMALIZUMAB
 SUPPRESSION OF INFLAMMATION AND BRONCHIAL HYPERACTIVITY - CORTICOSTEROIDS
 PREVENTION OF RELEASE OF MEDIATORS – MAST CELLS STABILIZERS
 ANTAGONISM OF RELEASED MEDIATORS – LT ANTAGONISTS, ANTI HISTAMINES, PAF
ANTAGONISTS
 BLOCKADE OF CONSTRICTOR NEUROTRANSMITTER - ANTICHOLINERGICS
 MIMICKING DILATOR NEUROTRANSMITTER - SYMPATHOMIMETICS
 DIRECTLY ACTING BRONCHODILATORS - METHYLXANTHINES
CLASSIFICATION OF DRUGS

BRONCHODILATO
RS
ANTI
PDE4 INFLAMMATORY
INHIBITOR AGENTS

ANTI IgE
MAST CELL
ANTIBOD
STABILIZERS
Y
LT RECEPTOR
ANTAGONISTS
 1.BRONCHO DILATORS

SYMPATHOMIME METHYL ANTI

TICS XANTHINES CHOLINERGICS
• SELECTIVE 𝛃2
AGONIST
• THEOPHYLLINE • IPRATROPIUM
• AMINOPHYLLINE BROMIDE,
• NON SELECTIVE • TIOTROPIUM
AGENTS • ATROPINE
 1.A) SYMPATHOMIMETICS
 POTENT BRONCHO DILATOR TO RELIEVE SPASM
 CAUTIOUSLY USED IN HYPERTENSIVES, ISCHAEMIC HEART DISEASE, & IN
THOSE RECEIVING DIGITALIS
 FASTER ACTING WHEN INHALED
SELECTIVE 𝛃2 AGONIST
 SHORT ACTING – SALBUTAMOL, TERBUTALINE
 LONGER ACTING – SALMETEROL, FENOTEROL, FORMOTEROL, PIRBUTEROL,
INDACATEROL

SHORTER ACTING

• FASTEST ACTING WITH PEAK EFFECT IN 10 MINS,

ACTION LASTS FOR 3- 4 HRS
• CONVENIENT & RELATIVELY SAFE
• AVAILABLE AS METER DOSE INHALERS, NEBULIZER
SOLUTIONS, INJECTIONS & ALSO TABLETS
SALBUTAMOL
 ORAL BIOAVAILABILITY –
i. SALBUTAMOL 50%
ACTION 4-6 HRS
HIGHLY SELECTIVE 𝛃2 AGONIST

LONGER ACTING
SAFER THAN
 CARDIAC SIDE EFFECTS ARE LESS PROMINENT ISOPRENALINE
 SELECTIVITY IS INCREASED BY INHALING THE
DRUG DOSAGE :
 INHALED SALBUTAMOL  BRONCHODILATATION
2-4 mg ORAL,
WITHIN 5 MINS, THE ACTION LASTS FOR 2-4 0.25- 0.5 mg IM/SC
HRS 100 – 200 MICROGRAM

BY INHALATION
USED TO ABORT & TERMINATE EFFECTS OF
ASTHMA
 NOT SUITABLE FOR ROUND THE CLOCK
PROPHYLAXIS
 SIDE EFFECTS – MUSCLE TREMOR,
PALPITATIONS, RESTLESSNESS, NERVOUSNESS,
THROAT IRRITATION, ANKLE EDEMA

ORAL 𝛃2 AGONIST THERAPYIS RESERVED FOR

 BECAUSE OF MOST FREQUENT SIDE EFFECTS,

PATIENTS WHO CANNOT CORRECTLY USE

INHALERS
 ii)TERBUTALINE
 SIMILAR TO SALBUTAMOL IN PROPERTIES & USE
 DOSAGE – 5 mg ORAL, 0.25 mg S.C, 250 𝛍g BY INHALATION

• INHALED SALBUTAMOL & TERBUTALINE – POPULAR FOR QUICK

REVERSAL OF BRONCHOSPASM
• REGULAR USE DOES NOT REDUCE HYPERACTIVITY; WORSEN IT
• MAY BE RESPONSIBLE FOR DIMINISHED RESPONSIVENESS AFTER
LONG TERM USE
• REGULAR USE – DOWN REGULATES BRONCHIAL 𝛃2 RECEPTORS
• ADVICED THAT PATIENTS REQUIRING REGULAR MEDICATION SHOULD
BE TREATED WITH INHALED STEROIDS, & USE OF 𝛃AGONISTS
 LONGER ACTING –
 i)SALMETEROL
FIRST LONG ACTING SELECTIVE β2 ANTAGONIST WITH SLOW ONSET OF ACTION
 INHALATION ON A TWICE DAILY SCHEDULE FOR MAINTENANCE THERAPY &
NOCTURNAL ASTHMA (NOT FOR ACTUAL SYMPTOMS)
 MORE SELECTIVE THAN SALBUTAMOL & MORE LIPOPHILIC
 REGULAR USE WORSENS IT
 HOWEVER CLINICAL STUDIES SHOWS IMPROVEMENT IN ASTHMA SYMPTOMS & LUNG
FUNCTION
 CONCURRENT USE OF INHALED SALMETROL + GLUCOCORTICOID
 PRODUCES EFFECTS EQUIVALENT TO DOUBLE DOSE OF CORTICOID ALONE

SALMETER, SEROBID 25 MICROG PER METERED DOSE INHALER– 2 PUFFS

BD. SEVERE CASES 4 PUFFS BD
SEROBID ROTACAPS 50 MICRO GRAM 1-2CAPSBD BY INHALATION
 3.FORMOTEROL
• LONG ACTING SELECTIVE β2
2. BAMBUTEROL

ANTAGONIST
• BISCARBAMATE ESTER PRODRUG • ACT FOR 12 HRS WHEN INHALED
OF TERBUTALINE IS SLOWLY • USED ON REGULAR MORNING
HYDROLYSED IN PLASMA & EVENING SCHEDULE FOR ROUND THR
LUNGS BY CLOCK BRONCHODILATATIOND
• DOSAGE
PSEUDOCHOLINESTERASE TO
• 12- 14 MICRO GRAM BY INHALATION
RELEASE ACTIVE DRUG OVER 24
TWICE DAILY
HRS.
• INDICATED IN CHRONIC B.A IN A
SINGLE EVENING DOSE OF 10- 20
Foratec – 12 micro
mg
BAMBUDIL 10 mg, 20 mg tabs, gram rotacaps
5mg/5 ml oral solution, BETADAY
10, 20 mg tab
 1. B)METHYL XANTHINES

 CAFFEINE, THEOPHYLLINE, THEOBROMINE

 HAVE QUALITATIVELY SIMILAR ACTIONS, BUT THERE ARE MARKED
QUANTITATIVE & PHARMACOKINETIC DIFFERENCES

↓
A)RELEASE OF Ca2+ FROM SARCOPLASMIC RETICULUM

B) INHIBITION OF PHOSPHODIESTERASE WHICH DEGRADES CYCLIC

NUCLEOTIDES INTRACELLULARLY
↓
↑ CYCLIC NUCLEOTIDES
↓
BRONCHODILATATION, CARDIAC STIMULATION, VASODILATATION
 ACTION CAFF THE
O
CNS STIMULATION +++ ++
HEART STIMULATION ++ +++
BLOOD VESSEL RELAXATION + ++
BRONCHI DILATATION + +++
KIDNEY DIURESIS + ++
SK. MUSCLE INCREASED CONTRACTILITY +++ ++
GASTRIC IRRITATION + ++
MUCOSA
PHOSPHODIES INHIBITION ++ +++
TERASE
ADENOSINE ++ +++
ANTAGONISM
 THEOPHYLLINE

 WELL ABSORBED ORALLY;

 DISTRIBUTED IN ALL TISSUES, CROSSES PLACENTA, SECRETED IN MILK
 50 % PLASMA BOUND; METABOLIZED IN LIVER
 10% ELIMINATED UNCHANGED IN URINE
 CHILDREN ELIMINATE MUCH FASTER; ELDERLY ELIMINATE SLOWLY
 ADVERSE EFFECTS :
 NARROW MARGIN OF SAFETY
 DOSE DEPENDENT TOXICITY
 CHILDREN ARE MORE LIABLE TO DEVELOP CNS TOXICITY
Status in bronchial asthma
CONDITION TREATMENT

CHRONIC ASTHMA MILD TO MODERATE B.A – ORAL THEOPHYLLINE

ACUTE ATTACKS – ETOPHYLLINE + 80% THEOPHYLLINE
INJECTIONS IM

ACUTE BRONCHOSPASM DERIPHYLLINE IM INJECTION

DOESN’T RESPOND TO β2 AGONISTS; 250 mg OVER 15 – 20

ACUTE SEVERE ASTHMA AMINOPHYLLINE- GIVEN IV SLOWLY, IF ACUTE ATTACKS

MINS
INHALED DRUG MAY FAIL TO REACHDURING ATTACK
APNEA IN PREMATURE THEOPHYLLINE/ CAFFEINE MAY BE USED
INFANTS
DRUG INTERACTIONS
AGENTS WHICH INDUCE THEOPHYLLINE METABOLISM ↓ITS PLASMA
LEVEL – SMOKING(1.6), PHENYTOIN (1.5), RIFAMPICIN(1.5),


PHENOBARBITONE(1.2), CHARCOAL BROILED MEAT MEAL (1.3)

DRUGS WHICH INHIBIT THEOPHYLLINEMETABOLISM & ↑ ITS PLASMA
LEVEL – ERYTHROMYCIN, CIPROFLOXACIN, ORAL CONTRACEPTIVES,


ALLOPURINOL; DOSE SHOULD BE REDUCED BY 2/3

THEOPHYLLINE ENHANCES THE EFFECT OF – FUROSEMIDE,
SYMPATHOMIMETICS, DIGITALIS, ORAL ANTI COAGULANTS,


HYPOGLYCAEMICS
 THEOPHYLLINE DECREASES THE EFFECT OF – PHENYTOIN, LITHIUM
AMINOPHYLLINE INJECTION SHOULD NOT BE MIXED IN THE SAME
INFUSION BOTTLE/ SYRINGE WITH – ASCORBIC ACID,


CHLORPROMAZINE, PROMETHAZINE, MORPHINE, PETHIDINE,

PHENYTOIN, PHENOBARBITONE, INSULIN, PENICILLIN G,
ERYTHROMYCIN, TETRACYCLIN
 USES
1. BRONCHIAL ASTHMA & COPD
• CAUSE BRONCHODILATATION BY DECREASING RELEASE OF
INFLAMMATORY MEDIATORS, IMPROVED MUCOCILIARY
CLEARANCE,STIMULATION OF RESPIRATORY DRIVE & BY
AUGMENTING DIAPHRAGMATIC CONTRACTILITY
• ITS USE HAS DECLINED DUE TO NARROWED SIDE EFFECTS
• ORAL THEOPHYLLINE – MILD TO MODERATE SEVERE ASTHMA
• 3RD LINE DRUG FOR PT WITH NOCTURNAL ASTHMA
• MORE USEFUL IN COPD

2. APNEA IN PREMATURE INFANT

• REDUCES THE FREQUENCY & DURATION OF EPISODES OF
APNEA THAT OCCUR IN PRETERM INFANTS IN THE FIRST WEEK
OF LIFE
• CLOSELY MONITORED ORAL / IV TREATMENT IS EMPLOYED FOR
1-3 WEEKS
1.C)ANTICHOLINERGICS
 CAUSE BRONCHODILATATION BY BLOCKING CHOLINERGIC CONSTRICTOR
TONE, ACT PRIMARILY IN THE LARGE AIRWAYS
 PATIENTS OF ASTHMATIC BRONCHITIS, COPD, PSYCHOGENIC ASTHMA
RESPOND BETTER
 SLOW RESPONSE THAN SYMPATHOMIMETICS
 SUITABLE FOR REGULAR PROPHYLAXIS
INHALED IPRATROPIUM BROMIDE + 𝛃2 AGONIST  PRODUCES MARKED &
LONGLASTING BRONCHO DILATATION


DUOLIN INHALER – 100 𝛍g + 20 𝛍g per metered dose

DUOLIN ROTACAP: 200𝛍g + 40𝛍g per rotacap
DUOLIN RESPULES : 2.5 mg + 500 𝛍g in 2.5 ml solution
 2.1)CORTICOSTEROIDS

 NOT A BRONCHODILATOR
 REDUCES BRONCHIAL HYPERACTIVITY, MUCOSAL EDEMA & BY
SUPPRESSING INFLAMMATORY RESPONSE TO AG: AB REACTION OR OTHER
TRIGGER STIMULI
 AFFORD MORE COMPLETE & SUSTAINED SYMPTOMATIC RELIEF THAN
BRONCHODILATOR
 IMPROVE AIRFLOW, REDUCE ASTHMA EXACERBATION& MAY INFLUENCE
AIRWAY MODELING, RETARDING DISEASE PROGRESSION
 LONG TERM SYSTEMIC STEROID THERAPY HAS ITS OWN ADVERSE EFFECTS
WHICH MAY BE WORSE THAN ASTHMA
 SYSTEMIC STEROID THERAPY

SEVERE CHRONIC ASTHMA STATUS ASTHMATICUS

 NOT CONTROLLED BY BRONCHODILATORS • START WITH HIGH DOSE OF
& INHALED STEROIDS/ FREQUENT RAPIDLY ACTING IV.
RECURRENCE OF INCREASING SEVERITY GLUCOCORTICOSTEROID
WHICH GENERALLY ACT IN 6-
 START WITH PREDNISOLONE 20-60 mg 24 HRS
 ATTEMPT DOSE DEDUCTION AFTER 1-2 • SHIFT TO ORAL THERAPY
WEEKS OF GOOD CONTROL FOR 5-7 DAYS
• DISCONTINUE ABRUPTLY/
 FINALLY TRY SHIFTING PATIENT ON TO TAPER RAPIDLY
INHALED STEROID
 FEW PATIENTS REQUIRE LONG TERM ORAL COPD
STEROIDS; IN THEM DOSE SHOULD BE KEPT • SHORT COURSE OF ORAL
MINIMUM GLUCOCORTICOID MAY
 ALTERNATIVE RX WITH BENEFIT DURING AN
IMMUNOSUPPRESANTS LIKE EXACERBATION
METHOTREXATE(LOW DOSE) OR
 INHALED STEROIDS

 GLUCOCORTICOIDS WITH HIGH TOPICAL & LOW SYSTEMIC ACTIVITY

 BECLOMETHAZONE DIPROPIONATE, BUDESONIDE, FLUTICASONE , CICLESONIDE
 AIRWAY INFLAMMATION & BRONCHIAL REMODELLING PRESENT IN MILD STATE AS WELL, IT
HAS BEEN SUGGESTED THAT INHALED STEROIDS SHOULD BE THE STEP ONE RX FOR ALL
PATIENTS
 CURRENTLY NOT CONSIDERED
INDICATED WHEN INHALED 𝛃2 AGONISTS ARE REQUIRED ALMOST DAILY / THE DISEASE IS
NOT EPISODIC


 START WITH 100-200 𝛍g BD, TITRATE DOSE UPWARD EVERY 3-5 DAYS MAXIMUM; 400𝛍g QID,
 NO ROLE DURING AN ATTACK/ STATUS ASTHMATICUS
 PEAK EFFECT AFTER 5-7 DAYS OF USE; PERSISTS AFTER 4-7 DAYS OF DISCONTINUATION
DRUG ACTION DOSAGE

BECLOMETHAS • AS METERED DOSE INHALER & 100-400 mcg 2-4 PUFFS A

ONE ROTACAPS DAY
DIPROPIONATE • AVAILABLE IN COMBINATION WITH
SALBUTAMOL
100-400 μg 2-4 TIMES A
DAY
BUDENOSIDE • HIGH TOPICAL ACTIVITY & ABSORBED

BUDATE F RESP 100 μg

PORTION IS RAPIDLY METABOLIZED
CAP
• USED IN PROPHYLAXIS OF BRON.
ASTHMA & NASAL THERAPY IN
ALLERGIC RHINITIS
25-100 μg TWICE DAILY
FLOHALE 25, 50, 125 μg/
FLUTICASONE • POORLY ABSORBED IN GUT; UNLIKE

METERED DOSE – 2-3

SYSTEMIC ADVERSE EFFECTS
PUFFS TWICE DAILY
• NOT RECOMMENDED FOR CHILDREN
BELOW 4 YRS
80-160 μg OD INHALATION
CALCICLEZ OSMODE 160
CICLESONIDE • PRODRUG ; GETS CONVERTED IN

μg/MDI
BRON. EPITHELIAL CELLS
• UNABLE TO BIND GLUCOCORTICOID
RECEPTORS IN SEVERAL TISSUES,
STATUS OF GLUCOCORTICOIDS IN
ASTHMA

mg/ DAY FOR 7 DAYS IS GIVEN IN ADDITION TO β2 AGONISTS

 ACUTE EXACERBATION – SHORT COURSE (5-7 DAYS) OF ORAL PREDNISOLONE 30 – 60

CHRONIC ASTHMA – STEROID INHALATION (2-4 TIMES A DAY) FOR ALONG

PERIOD OF PROPHYLAXIS


STATUS ASTHMATICUS – IV HYDROCORTISONE HEMISUCCINATE 100- 200 mg

FOLLOWED BY ANOTHER DOSE EVERY 8 HR; MAY BE SWITCHED OVER TO


ORAL PREDNISOLONE ASAP

 • NOT ABSORBED ORALLY

2.B) MAST CELL STABILIZERS • ADMINISTERED AS AEROSAL

INHALER
• SMALL FRACTION OF
 INHALED DRUG IS ABSORBED
INHIBITS DEGRANULATION OF MAST
SYSTEMATICALLY
CELLS BY TRIGGER STIMULI
• RAPIDLY EXCRETED
 RESTRICT RELEASE OF LTs, PAF, UNCHANGED IN URINE & BILE
INTERLEUKINS
 INHIBITS CHEMOTAXIS OF USES
INFLAMMATORY CELLS • BRONCHIAL ASTHMA
 PREVENT BRONCHOSPASM INDUCED BY • ALLERGIC RHINITIS
ALLERGENS • ALLERGIC
CONJUCTIVITIS
 DOESN’T INTERFERE AG:AB REACTION
 NOT A BRONCHODILATOR; DOES ADVERSE
NOT EFFECTS
• SYSTEMIC TOXICITY
ANTAGONIZE CONSTRICTOR IS MINIMAL
ACTION OF
• ltS
HISTAMINE, Ach, BRONCHOSPASM,
etc., THROAT IRRITATION &
COUGH OCCUR IN SOME PATIENTS
• RARELY NASAL CONGESTION, HEADACHE,
DIZZINESS, ARTHRALGIA
 DOSE – 1-2 PUFFS, 3-4 TIMES A DAY;
USES OF MAST CELL STABILIZERS FINTAL INHALER 1 mg
1. BRONCHIAL ASTHMA
• CROMOLYN SODIUM USED FOR
LONG PERIOD – 2 PUFFS. 3-4
TIMES DAILY REDUCES
EPISODES OF ACUTE ASTHMA
• USED FOR PROPHYLAXIS
• USE HAS DECLINED NOW
2. ALLERGIC RHINITIS
3. ALLERGIC CONJUCTIVITIS
EYE DROPS – 1-2 DROPS, 3-4
TIMES A DAY

NEDOCROMIL
SIMILAR TO CROMOLYN
SODIUM IN ACTION & USE
GIVE TWICE DAILY
KETOTIFEN

 AN ANTIHISTAMINIC WITH ACTIONS LIKE CROMOLYN

SODIUM
 INHIBITS AIRWAY INFLAMMATION
 BENEFICIAL EFFECTS ARE SEEN AFTER 6- 12 WEEKS
OF USE
 USED FOR PROPHYLAXIS FOR B.A
 ORALLY EFFECTIVE; 50 % BIOAVAILABILITY
 DROWSINESS & DRY MOUTH ARE COMMON SIDE
EFFECTS
 DOSE 1-2 mg BD, KETAZMA, KETOVENT 1 mg Tab
 2.C) LEUKOTRIENE RECEPTOR
ANTAGONIST
 MONTELUKAST & ZAFIRLUKAST
 HAVE EFFECTS IN ASPIRIN INDUCED ASTHMA
 HAVE SIMILAR ACTIONS & UTILITY
 ANTAGONIZE cysLT1 receptor mediated bronchoconstriction, increased vascular permeability &
recruitment of eosinophils
 Some responds, some don’t
 INDICATED FOR MILD TO MODEARATE ASTHMA AS ALTERNATIVES TO INHALED
GLUCOCORTICOIDS
 OVERALL EFFICACY IS LOWER THAN INHALED STEROIDS, MAY BE ACCEPTABLE IN CHILDREN
 VERY SAFE & PRODUCE SIDE EFFECTS LIKE HEADACHE, RASHES; EOSINOPHILIA & NEUROPATHY
ARE INFREQUENT; CHURG STRAUSS SYNDROME MAY BE REPORTED
 WELL ABSORBED ORALLY
2.D) PDE4 INHIBITORS

ROFLUMILAST –
 LONG ACTING
 EFFECTIVE ORALLY
 HAS ANTI INFLAMMATORY
PROPERTIES
 3. ANTI IgE ANTIBODY
OMALIZUMAB

 HUMANAL MONOCLONAL ANTIBODY AGAINST IgE

 ADMINISTERED IV/SC ,
 GIVEN SC ONCE IN 2-4 WEEKS, HAS A LONG ELIMINATION t1/2 OF 26 DAYS
 WELL TOLERATED, OCCASIONALLY CAUSE PAIN AT SITE OF INJECTION &
ALLERGIC REACTIONS
 SMALL % DEVELOP CANCERS, BUT THE CORRELATION BETWEEN
OMALIZUMAB & CANCER IS YET TO BE STUDIED
 CAN BE GIVEN IN ASTHMATICUS(ABOVE 12 YEARS OF AGE) WITH MODERATE
TO SEVERE ASTHMAFOR PROPHYLAXIS, AS IT REDUCES THE FREQUENCY &
SEVERITY OF EXACERBATIONS
DURING ACUTE ATTACK
GINA (GLOBAL INITIATIVE FOR BRONCHIAL ASTHMA) GUIDELINES
UPDATED IN 2019 HAVE REVISED THE RX STRATEGY FOR ASTHMA TO
INCLUDE AN INHALATIONAL STEROID IN ALL ASTHMA PATIENTS
MILD ASTHMA
ACUTE EPISODES

INHALED 𝛃2 STIMULANTS LIKR SALBUTAMOL

 OCCASIONAL ACUTE EPISODES OF BRONCHOSPASM NEED RAPIDLY ACTING,

 PREFERABLY TAKEN AT THE ONSET OF BRONCHOSPASM

 REGULAR PROPHYLAXIS IS NOT REQUIRED
MILD CHRONIC ASTHMA IS CHA. BY EPISODES OF MILD BRONCHOSPASM ONCE A
DAY.


 REQUIRES LONGTERM CROMOGLYCATE/ STEROIDS

 ACUTE BRONCHOSPASM – MANAGED WITH 𝛃2 AGONIST INHALATION
 MODERATE ASTHMA
 REGULAR PROPHYLAXIS WITH CROMOGLYCATE
 IF SYMPTOMS PERSIST, INHALED STEROIDS ARE GIVEN FOR PROPHYLAXIS
 ACUTE EPISODES – INHALED LONG ACTING 𝛃2 AGONIST
IF INHALED STEROIDS ARE CONTRAINDICATED, LEUKOTRIENE ANTAGONISTS
MAY BE TRIED


SEVERE ASTHMA/ CHRONIC PERSISTENT

ASTHMA
 HOSPITALIZATION
 REGULAR INHALED STEROIDS
 INHALED 𝛃2 AGONISTS 3-4 TIMES A DAY-- 𝛃2 AGONIST MAY BE USED
 ORAL STEROIDS MAY BE CONSIDERED
 ADDITIONAL INHALED IPRATROPIUM BROMIDE / ORAL THEOPHYLLINE MAY BE GIVHOSEN
TREATMENT OF STATUS ASTHMATICUS
(REFRACTORY ASTHMA)
[ANY PATIENT OF THE ASTHMA HAS THE POTENTIAL TO DEVELOP ACUTE
SEVERE ASTHMA WHICH MAY BE LIFE THREATENING]

 HYDROCORTISONE HEMISUCCINATE 100 mg (EQUIVALENT DOSE OF ANOTHER GLUCOCORTICOID)

IV,=. STAT, FOLLOWED BY 100- 200 mg 4-8 HOURLY INFUSION; MAY TAKE UPTO 6 HOURS TO ACT.
 NEBULIZED SALBUTAMOL (2.5 – 5 mg) + IPRATROPIUM BROMIDE (0.5 mg) intermittent
inhalations driven by o2 EVERY 30 MINS
 HIGH FLOW HUMIDIFIED OXYGEN INHALATION
 SALBUTAMOL/ TERBUTALINE 0.4 mg IM/ SC, MAY BE ADDED, SINCE INHALED DRUG MAY NOT
REACH SMALLER BRONCHI DUE TO SEVERAL NARROWING/ PLUGGING
 INTUBATION & MECHANICAL VENTILATION, IF NEEDED
 TREAT CHEST INFECTION WITH INTENSIVE ANTIBIOTIC THERAPY
 CORRECT DEHYDRATION & ACIDOSIS WITH SALINE + SODIUM BICARBONATE/ LACTATE INFUSION
 AMINOPHYLLINE 250 mg SLOW IV OVER 15 – 20 MINS MAY BE GIVEN CAREFULLY- NOT
PREFERRED NOW