asthma anti-inflammatory drugs, Glucocorticoids

Question 1

What are the effects of Glucocorticoids?

Answer 1

Prevent progression of chronic asthma

They improve lung function

Question 2

By what actions do Glucocorticoids give these therapeutic effects?

Answer 2

-Immunosuppressive
-Anti-inflammatory
-Reduce IL-3 synthesis
(IL-3 regulates mast cell production)
- Reduce cytokine production
(cytokines i.e.IL-5 activate eosinophils)

-Decrease microvascular permeabilty

• Relax bronchial muscle by
  
  • Increase β2-adrenoceptor levels
  • Increase G protein-expression

Question 3

What is the clinical use of inhaled glucocorticoids?

Answer 3

• First line for all patients with persistent symptoms

- Most effective preventer for adults and older children

Question 4

Give 3 examples of inhaled glucocorticoids

Answer 4

• Beclometasone Dipropionate (BDP)
• Budesonide
• Fluticasone

Question 5

Which inhaled glucocorticoid has the least systemic effects?

Answer 5

Fluticasone

Question 6

Which inhaled glucocorticoid is the most potent?

Answer 6

Fluticasone

Question 7

What are the local side effects of inhaled glucocorticoids (i.e affdect respiratory systyem)?

Answer 7

• Dysphonia (hoarseness)
• Oropharyngeal candidiasis (seen more commonly in elderly patients)
• Cough and throat irritation

Question 8

How can the local side effects of inhaled glucocorticoids be supressed?

Answer 8

All can be reduced by use of ‘spacing’ devices

Question 9

What are the systemic side effects of inhaled glucocorticoids?

Answer 9

• “Cushings syndrome” like symptoms (due to high levels of cortisol in body)

Question 10

Why are “Cushings syndrome” like symptoms less likely with fluticasone

Answer 10

as it is poorly absorbed into GI tract and undergoes presystemic metabolism

Question 11

Give an example of two oral Systemic glucocorticoids

Answer 11

• Prednisolone

- Prednisone

Question 12

Which oral Systemic glucocorticoid is preferred for treatment?

Answer 12

• Prednisolone preferred as prednisone has to be converted in liver to active prednisolone
• except in pregnant patients where prednisone is not converted in foetal liver.

Question 13

In what situation are oral Systemic glucocorticoids used?

Answer 13

Used if clinical situation deteriorates rapidly

Question 14

Give an example of a intravenous Systemic glucocorticoids

Answer 14

Hydrocortisone

Question 15

In what situation Hydrocortisone used?

Answer 15

• Used in acute / severe asthma

- Used if lung function is less than 30% predicted following other treatments