Drugs for Bronchial Asthma
Introduction
to Bronchial Asthma
- Chronic inflammatory disease
of airways
- Symptoms: Wheezing,
breathlessness, chest tightness, coughing
- Goals of therapy:
Bronchodilation, reduce inflammation, prevent exacerbations
Classification
of Anti-Asthmatic Drugs
- Bronchodilators
- Beta-2 agonists:
Salbutamol, Terbutaline, Salmeterol, Formoterol
- Methylxanthines:
Theophylline, Aminophylline
- Anticholinergics:
Ipratropium bromide
- Leukotriene antagonists: Montelukast, Zafirlukast
- Mast cell stabilizers: Sodium cromoglycate,
Ketotifen
- Corticosteroids:
- Systemic: Hydrocortisone,
Prednisolone
- Inhaled: Budesonide,
Beclomethasone dipropionate, Fluticasone propionate
Beta-2
Agonists (Salbutamol, Terbutaline, Salmeterol, Formoterol)
- Mechanism: Stimulate beta-2 receptors
→ bronchodilation
- Indications: Acute asthma
(short-acting), maintenance (long-acting)
- Adverse Effects: Tremor, tachycardia,
hypokalemia
- Interactions: MAO inhibitors,
beta-blockers
Methylxanthines
(Theophylline, Aminophylline)
- Mechanism: Phosphodiesterase
inhibition → increased cAMP → bronchodilation
- Indications: Chronic asthma, COPD
- Adverse Effects: Nausea, seizures,
arrhythmias
- Interactions: Metabolized by CYP enzymes;
interacts with antibiotics, anti-epileptics
Anticholinergic
(Ipratropium Bromide)
- Mechanism: Blocks muscarinic receptors
→ reduces bronchoconstriction
- Indications: COPD, asthma (especially
with beta-agonists)
- Adverse Effects: Dry mouth, cough
- Interactions: Limited, additive with
other anticholinergics
Leukotriene
Antagonists (Montelukast, Zafirlukast)
- Mechanism: Block leukotriene receptors
→ reduce inflammation and bronchoconstriction
- Indications: Prophylaxis of asthma,
allergic rhinitis
- Adverse Effects: Headache, GI upset, rare
neuropsychiatric effects
- Interactions: Zafirlukast inhibits CYP2C9
(interacts with warfarin)
Mast Cell
Stabilizers (Sodium Cromoglycate, Ketotifen)
- Mechanism: Inhibit mast cell
degranulation → prevent histamine release
- Indications: Prophylaxis of asthma,
allergic conditions
- Adverse Effects: Throat irritation, cough
- Interactions: Minimal
Systemic
Corticosteroids (Hydrocortisone, Prednisolone)
- Mechanism: Anti-inflammatory, suppress
immune response
- Indications: Severe asthma, status
asthmaticus
- Adverse Effects: Weight gain, hyperglycemia,
osteoporosis
- Interactions: NSAIDs (↑ GI risk),
vaccines (↓ efficacy)
Inhaled
Corticosteroids (Budesonide, Beclomethasone, Fluticasone)
- Mechanism: Reduce airway inflammation,
decrease cytokine production
- Indications: Maintenance therapy in
asthma
- Adverse Effects: Oral thrush, dysphonia
- Interactions: Ritonavir and ketoconazole
(↑ steroid levels)
Visual
Aids
- Diagrams: Asthma
pathophysiology, drug action sites
- Tables: Onset and duration
of bronchodilators
- Flowchart: Stepwise asthma
management (GINA guidelines)
Presentation on Drugs for Bronchial Asthma
END OF THE CHAPTER
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