Drugs used in bronchial asthma

Bronchial asthma: It is a COPD charcterized by paroxysmal dyspnoea accompained by wheezing resulting from narrowing of bronchial airways by muscle spasm,muscular swelling or viscid secretion.These abnormalities are released by chemical inflammatory mediators that are released from mast cells.These are histamine,serotonin and arachidonic acid derivetives.

Types:There are various types of bronchial asthma:

[A]Asthma associated with specific allergic reaction:

Criteria:        

·         Very early onset.

·         Extrinic type.

[B]Asthma not associated with known allergy:

Criteria:           

·         Late onset.

·         Intricsic type.

[C]Excercise induced asthma:With a few min asthma develops.

[D]Asthma associated with:COPD.

Drugs that can be used for treatment of Br.asthma:

Acte asthma	Chronic asthma	Prophylaxis of asthma
1.Inj.Aminophyllin -By infusion(in normal saline or dextrose saline) -IV 2.Adrenalin(IM) 3.Isoprenaline(IM) 4.Salbutamol(Inhalation) 5.Steriod(inj)	1.Aminophylline (oral) 2.Theophylline(oral) 3.Salbutamol (oral/inhalation) 4.Ephidrin(oral)	1.Disodium chromoglycate (inhalation) 2.Nidocromil sodium(Inhalation) 3.Steroid-Prednisolon(oral) or Beclomethasone (Inhalation) 4.Anti-histaminic:Ketotifen

Classification of bronchodilators: 

      

[A]Bronchodilators:

(1)Adrenergic drugs:

a)      Selective  agonist:(Inj.or oral)

·         Salbutamole.

·         Terbutaline.

·         Femoterol.

·         Rimiterol.

·         Recproterol.

b)      Non-selectives:(in sever acute asthma only & given IV)

·         Adrenaline.

·         Isoprinaline.

·         Ephedrine.

(2) Xanthine derivatives:(IV)

a)      Aminophylline.

b)      Theophylline.   

c)       Caffine.So tea,coffea should be taken asthma pt.

(3)Antimuscurinic drug:(Nebulizer)

·         Ipratropium.

·         Oxytropium.

[B]Drugs that inhibit the release of bronchoconstrictor mediator: 

(1)Glucocorticoids:(IV):To face the stressful condition in sever acute attack of asthma.

·         Hydrocortisone(Inj)

·         Prednisolone(tablet)

·         Beclomethasone(Inhaler)

·         Betamethasone(Inhaler)

·         Triamcilone(Inhaler)

·          

(2)Mast cell stabilizer:

·         Disodium chromoglycate.

·         Nidocromil sodium.

(3)Antihistaminic drug:Ketotifen.

[C]Others:

a)      Leukotriens pathway inhibitor:Zilenton,Zaferlukast.

b)      Ca channel blocker:Nifedipine,Amlodipine,Verapamil.

Drugs used by inhalation route in the treatment of bronchial asthma:

[A]Antimuscurinic drugs:

·         Ipratropium.

·         Oxytropium.

[B]Glucocorticoids:

·         Beclomethasone.

·         Betamethasone.

·         Triamcilone.

·         Budesonide.

·         Flunisolide.

·         Fluticasone.

·         Mometasone.

Status asthmaticus: Acute sever asthma is an acute medical emergency characterized by sever wheeze,breathlessness to such extent that the pt can not speak,tachycardia,central cyanosis and sometimes pulsus paradoxus may develop.Pt must be hospitalized immediately.

Treatment:

[A]immediate treatment:

1)      Propped up position.

2)      Salbutamol by nabulizer.

3)      Prednisolone-IV.

4)      Ipratropium-by nebulizer.

5)      Inj.Aminophylline.

[B]Subsequent management:   

        

1)      40-60%  

2)      Prednisolone-orally (30-60mg/day)

3)      Salbutamole by nabulizer.