WELCOME

ANTIASTHMATICS

Presented byP.Pavani10T22SO112

Under The Guidence

of Mr. J. Anoop

..Definition: Asthma is a chronic inflammatory disorder of the airways that is characterized by increased responsiveness of the tracheobranchial tree to a variety of stimuli resulting in widespread spasmodic narrowing of the air passages which may be relieved spontaneously or therapy.

• Asthma literally meaning ‘Panting’

Characteristics of Asthma:

Inflammation of airways

Bronchial hyper-reactivity/hyper-responsivness Reversible airway obstruction

CLASSIFICATION OF ASTHMA:

Based on the stimuli initiating bronchial asthma,broad etiologic types are described:

Extrinsic(allergic, atopic) asthma

Intrinsic(idiosyncratic,non-atopic) asthma

Mixed type

PATHOPHYSIOLOGY:

MORPHOLOGICAL FEATURES:

1.The mucus plugs contain normal or degenerated respiratory epithelium forming twisted strips called “Curschmann’s sprials”.

2.The sputum usually contains numerous eosinophils and diamond-shaped crystals derived from eosinophils called “Charcot-Leyden crystals”.

3. Airway remodeling.

Symptoms:

Early Warning SignsBreathing changesSneezingRunny/stuffy noseCoughingChin or throat itchesFeeling tiredDark circles under eyesTrouble sleeping

Asthma Episode SymptomsWheezingShortness of breathTightness in the chest

 

Severe Asthma Episode Symptomspersonal Severe coughing, wheezing, Shortness of breath or tightness in the chestDifficulty talking or concentratingWalking causes shortness of breathBreathing may be shallow and fast or slower

than usualHunched shoulders (posturing)Nasal flaring

RetractionsCyanosis

.

Asthma Diagnosis:

The diagnosis of asthma is based on:History

Physical examination

Supportive diagnostic tests:

*Pulmonary funcion testsSpirometeryPeak flow meterMethacholine challenge test

*Allergic test*Chest x-ray *GERD assesment test

APPROACHES TO TREATMENT:

1.Prevention of AG:AB reactions2.Neutralisation of IgE antibody

eg: Omalizumab3.Suppresssion of inflamation and bronchial hyperreactivity

eg: cotricosteriods4.Prevention of realease of mediators

eg: mast cell stabilisers5.Antagonism of realeased mediators

eg: leukotriene antagonis ts6.Blocked of constictor neurotransmitters

eg:anticholinergics7.Mimicking dilator neurotransmitter

eg:sympathomimetics.8.Directly acting bronchodilators

eg:methylxanthines

CLASSIFICATION:

Bronchodilatorsß2 sympathomimetics : Salbutamol,

Terbutaline,SalmetrolMethylxanthines : Theophylline,

AminophyllineAnticholinergics : Ipratropium bromideLeukotriene antagonists : Montelukast,

Zafirlukast

Anti-inflammatory agentsMast cell stabilisers : sodium cromoglycate,

NedocromilCorticosteriods

Inhalational : Beclomethasone, fluticasone

Systemic : Hydrocortisone, Prednisolone

Anti-IgE antibody : Omlizumab

STEPWISE MANAGEMENT OF ASTHMA:

Mild intermittent asthma ↓

Regular preventer therapy ↓

Add -on therapy↓

Persistent poor control ↓

Continuous or frequent use of oral steriod

SHORT -ACTING ß2 AGONISTS:

Eg: Salbutamol, T erbutaline

These are mainstay of asthma management

M.O.A:ß2 Receptor stimulation →↑ed cAMP in

bronchial muscle cell → relaxation

Route of administration:By inhalation of aerosol, powder.Salbutamol is given as intravenous infusion in

status asthmaticus.

Adverse reactions:Down regulation of bronchial ß2 receptorsTachycardia , palpitations

CORTICOSTEROIDS:

Corticosteriods afford more complete and sustained symptomatic relief than bronchodialators and others

M.O.A:

Decrease formation of cytokines(Th2), that recruit and activate eosinophils and are responsible for promoting the production of IgE and expression of IgE receptors.

INHALED CORTICOSTERIODS:

Eg: Beclomethasone, fluticasone, ciclesonide

1ST choice in patients with any degree of persistent asthma

ROUTE OF ADMINISTRATION:

Inhalation by MDISLOWLY and DEEPLY inhalation for solution

type inhalersQUICKLY and DEEPLY inhalation for dry

powdet inhalers

ADVERSE REACTIONS:

Hoarseness Oral or pharyngeal candidiasisAdrenal suppression

ICS directly targets underlying airway inflammation

.

SYSTEMIC STERIODS

EG: Hydrocortisone, prednisolone These are oral steriods

Used in status asthmaticus.

ADVERSE REACTIONS:

Adrenal suppression

Cushing syndrome

Growth suppression in children

ANTI-IgE ANTIBODY:

Eg: Omalizumab

M.O.A:This drug leads to ↓ed binding of IgE

to high affinity IgE receptors on surface of mast cells and basophils and limits realease of mediators of allergic response

USES:◦In moderate to severe asthma

patients who are poorly controlled with conventional therapy.

◦Reduces steriod requirements

Status Asthmaticus:

In which the smooth muscles of the bronchi suddenly contract and narrow the airways.Status asthmaticus can vary from a mild form to a severe form with bronchospasm.Status asthmaticus is an acute episode of asthma that remains unresponsive to standard treatment with bronchodilators.

symptoms: extreme difficulty with breathing, which causes

restlessness coughing and wheezing are not common,

because there is not enough airflow advanced symptoms include little or no breath

sounds inability to speak

skin becomes bluish heavy sweating unconsciousness and even cardiopulmonary

arrest, which can be fatal

TREATMENT:

•Hospitalisation is necessary•The initial treatment starts with supplemental oxygen to increase blood oxygen levels.• Inhaled or intravenous bronchodilator to open the airways. •large doses of corticosteroids drugs and bronchodilators to reduce inflammation.

Conclusion:

Asthma is a curable disease, so it is needed to take proper medication and there is a need to follow the medication therapy systematically.