farmacologia clinica del asma
TRANSCRIPT
Maria Bea Merscher – Interna en Medicina Interna – Estudiante de Intercambio
GINA – Management and Treatment of Asthma
How does GINA define asthma?
“Asthma is a chronic inflammatory disorder of the airways in which many cells
and cellular elements play a role. The chronic inflammation is associated with
airway hyperresponsiveness that leads to recurrent episodes of wheezing,
breathlessness, chest tightness and coughing particularly at night or in the
early morning. These episodes are usually associated with widespread, but
variable airflow obstruction within the lung that is often reversible either
spontaneously or with treatment.”
What is the aim of GINA?
Impro
ve the
Impro
ve the
patient’s
patient’s
complia
nce!!
complia
nce!!
Don’t forg
et the
Don’t forg
et the
educatio
n of
educatio
n of
others!
others!
Levels of Control Characteristics Controlled (all of
the following) Partially controlled Not controlled
Daily symptoms No (≤ 2x per week) >2 per week
≥3 characteristics of partially controlled asthma in any week
Limitation of activities No Any
Nighttime symptoms / patient
is woken by symptoms
No Any
Use of short-acting β2-agonists for
symptom control
No (≤ 2x per week) >2 per week
Pulmonary function (FEV1 or peak flow)
>80% predicted/personal
best
<80% predicted/personal
best
Exacerbations No ≥1 1x per week
Imp
airm
ent
Ris
k
Severity
Severity Frequency of symptoms
Nighttime symptoms FEV1 Variety of
FEV1
Usage of short-acting β2-agonists
Intermittent ≤ 2x per week ≤ 2x per month ≥ 80% < 20% ≤ 2 days per
week
Mild persistent
> 2x per week but not daily
3-4 x per month ≥ 80% 20-30%
> 2 days per week but not
daily
Moderate persistent Daily
> 1x per week but not at nighttime
60-80% > 30% Daily
Severe persistent
Throughout the day
Frequent (~7x per week) < 60% > 30% Several times
a day
Theophylline• Xanthin derivative• Competitive nonselective phosphodiesterase inhibitor raises
intracellular cAMP activates PKA inhibits TNF-alpha and inhibits leukotriene synthesis reduces inflammation and innate immunity
• Nonselective adenosine receptor antagonist, antagonizing A1, A2, A3 receptors almost equally explains cardiac side effects
• Inhibits TGF (transforming growth factor)-beta-mediated conversion of pulmonary fibroblasts into myofibroblasts in COPD and asthma via cAMP-PKA pathway which codes for collagen
• Directly activates HDAC2 (histone deacetylase) repackaging of DNA promoter regions of inflammatory genes are unavailable for binding of transcription factors such as NF-kappa-B
• Smoking inhibits the HDAC2-activity theophylline should be considered in smoking asthmatics
Systemic glucocorticosteroids
Patients with long-term systemic glucocorticosteroids should receive osteoporosis-profilaxis!