Bronchial Asthma (M.Ahmad Mansoor).pdf

ASTHMA  Group “D” M. Ahmad Mansoor Abu-Baker M. Ahmad M. Ahmad Jameel Arkam Ali Rehan Hussain Abdullah Hammad Junaid Akram Nouman Ali M. Abdullah M. Shoaib...

ASTHMA  Group “D” M. Ahmad Mansoor Abu-Baker M. Ahmad M. Ahmad Jameel Arkam Ali Rehan Hussain Abdullah Hammad Junaid Akram Nouman Ali M. Abdullah M. Shoaib Prepared By: M. Ahmad Mansoor Presented By : Abu-Baker  01 Asthma 02 Bronchial Asthma Contents Drugs of Bronchial Table of 03 Asthma MECHANISM OF 04 BRONCHODILATION  ASTHMA “Asthma is a chronic reactive airway disorder causing episodic airway obstruction that results from bronchospasms” Although asthma strikes at any age, about 50% of patients are younger than age 10; twice as many boys as girls are Affected in this age group. One-third of patients develops asthma between ages 10 and 30 Causes of Asthma 1. Genetic predisposition 2. Allergens (e.g., pollen, dust mites, pet dander, mold) 3. Respiratory infections 4. Air pollution 5. Occupational exposure to irritants 6. Obesity 7. Diet 8. Exercise 9. Cold air  Symptoms of Asthma 1. Shortness of breath 2. Chest tightness or pain 3. Wheezing (a whistling sound when exhaling) 4. Coughing 5. Trouble sleeping due to breathing problems Treatment of Asthma 1. Quick-relief (Rescue) Medications: Short-acting beta-agonists (SABAs): e.g., albuterol Anticholinergics: e.g., ipratropium 2. Long-term Control Medications: Inhaled corticosteroids: e.g., fluticasone, budesonide Long-acting beta-agonists (LABAs): e.g., salmeterol (often combined with inhaled corticosteroids) Leukotriene modifiers: e.g., montelukast Combination inhalers: Contain both inhaled corticosteroids and LABAs Theophylline: Less commonly used but can help control asthma  Bronchial Asthma “Bronchial Asthma is defined as a Chronic inflammatory disorder of the airways which manifests itself as recurrent episodes of wheezing, breathlessness, chest tightness and cough.” It is characterized by Bronchial hyper-responsiveness and variable airflow obstruction.  CLASSIFICATION 1). Atopic/extrinsic/allergic (70%): Most common type Environmental agent: dust, pollen, food, animal dander Family history - present Serum IgE levels: Increased Skin test with offending agent-wheal flare 2).Non-atopic/ intrinsic/non-allergic(30%) Triggered by respiratory tract infection Viruses - most common cause Family history uncommon IgE level normal No associated allergy Skin tests NEGATIVE Cause- hyperirritability of bronchial tree  CLASSIFICATION 3). Drug induced asthma Several pharmacologic agents Aspirin sensitive asthma Increased bronchoconstrictor, leukotrienes. Sensitive to small doses of aspirin. Inhibits COX pathway, without affecting LPO pathway.  APPROACHES TO TREATMENT 1. Prevention of AG:AB reaction: Avoidance of antigen, hypo sensitization-possible in extrinsic asthma and if antigen can be identified. 2. Neutralization of IgE (reaginic antibody): Omalizumab 3. Suppression of inflammation and bronchial hyperreactivity: Corticosteroids. 4. Prevention of release of mediators: Mast cell stabilizers. 5. Antagonism of released mediators: Leukotriene antagonists, Antihistamines, PAF antagonists. 6. Blockade of constrictor neurotransmitter: Anticholinergics. 7. Mimicking dilator neurotransmitter: Sympathomimetics. 8. Directly acting bronchodilators: Methylxanthines.  Drugs I. BRONCHODILATORS A. β2 Sympathomimetics Salbutamol (Albuterol): Used for quick relief in asthma. Side effects: tachycardia, tremor, headache. Terbutaline: Used for asthma and bronchospasm. Side effects: nervousness, dizziness, headache. Bambuterol: Used for long-term asthma treatment. Side effects: tremor, headache, palpitations. Salmeterol: Long-acting bronchodilator for asthma and COPD. Side effects: headache, throat irritation, muscle pain. Formoterol: Long-acting for asthma and COPD. Side effects: tremor, nervousness, palpitations.  Drugs I. BRONCHODILATORS B. Methylxanthines Theophylline (anhydrous): Used for asthma and COPD. Side effects: nausea, vomiting, insomnia, seizures. Aminophylline: Used for asthma and COPD. Side effects: similar to theophylline. Choline theophyllillate: Used for asthma. Side effects: gastrointestinal disturbances, CNS stimulation. Hydroxyethyl theophylline: Used for asthma. Side effects: similar to theophylline. Theophylline ethanolate of piperazine: Used for asthma. Side effects: similar to theophylline. Doxophylline: Used for asthma and COPD. Side effects: less than other methylxanthines.  Drugs I. BRONCHODILATORS C. Anticholinergics Ipratropium bromide: Used for COPD. Side effects: dry mouth, cough, headache. Tiotropium bromide: Used for COPD. Side effects: dry mouth, constipation, urinary retention.  Drugs II. LEUKOTRIENE ANTAGONISTS Montelukast: Used for asthma and allergies. Side effects: headache, dizziness, abdominal pain. Zafirlukast: Used for asthma. Side effects: headache, nausea, liver dysfunction. III. MAST CELL STABILIZERS Sodium cromoglycate: Used for asthma and allergies. Side effects: throat irritation, cough, skin rash. Ketotifen: Used for asthma and allergies. Side effects: drowsiness, weight gain, dry mouth.  Drugs IV. CORTICOSTEROIDS A. Systemic Hydrocortisone: Used for severe asthma, allergies. Side effects: weight gain, osteoporosis, hyperglycemia. Prednisolone: Used for severe asthma, inflammation. Side effects: similar to hydrocortisone, mood changes, hypertension. B. Inhalational Beclomethasone dipropionate: Used for asthma. Side effects: oral thrush, hoarseness. Budesonide: Used for asthma and COPD. Side effects: oral thrush, throat irritation. Fluticasone propionate: Used for asthma and COPD. Side effects: similar to budesonide. Flunisolide: Used for asthma. Side effects: nasal congestion, oral thrush. Ciclesonide: Used for asthma. Side effects: headache, nasopharyngitis.  Drugs V. ANTI-IgE ANTIBODY Omalizumab: Used for severe asthma. Side effects: injection site reactions, viral infections, headache THANKS