Current Drugs for Asthma
Short-acting ß2-andrenoceptor agonists (SABA)
Inhaled corticosteroids (ICS)
Long-acting ß2-andrenoceptor agonists (LABA)
Leukotriene receptor antagonists (LTRA)
Anti-IgE monoclonal antibodies
Oral corticosteroids (try to avoid)
Activates ß2-andrenoceptors on airway's smooth muscle to quickly relieve symptoms in 1-2 minutes, but are short acting (2-6 hours).
Examples are SABAs such as Salbutamol (Ventolin®).
These are not for regular prophylactic use.
Work by relaxing bronchial smooth muscle irrespective of the spasmogen.
These act as "functional antagonists" regardless of what caused the provocation, and these are very effective.
Side Effects of ß-Agonists
SABAs are well-tolerated, but some minor side effects include tremors, tachycardia, and tachyphylaxis.
LABAs are the same as above.
Used regularly for phophylaxis.
Include inhaled corticosteroids (ICS), ICS/LABA combinations, and leukotriene receptor antagonists (LTRA).
The anti-inflammatory effect has a slow onset of 1-3 hours, but has a long duration of action of 12-24 hours.
* Controllers are indicated if there is any sign of poor control. *
When Controllers are Indicated
If there is any signs of poor control.
Controlled Asthma Criteria
Daytime symptoms of <4 days a week
Nighttime symptoms <1 night a week
Physical activity is normal
Excaberations are mild and infrequent
Absence from work or school - none
Need for SABA <4 doses a week
FEV1 is >90% of personal best
PEF diurnal variation is <10-15%
Side Effects of Inhaled Corticosteroids (ICS)
Because of the oropharyngeal deposition, the patient may experience hoarseness, sore throat, or thrush.
Systemic effects for inhaled corticosteroids are not nearly as strong as with systemic corticosteroids, but high-doses of ICS in children may lower growth velocity and have a final height that is ~1cm shorter.
Leukotriene Receptor Antagonists
Leukotrienes are potent bronchoconstrictors.
Leukotrienes cause inflammation and mucous secretions, therefore by adding antagonists this can help in patients with asthma.
These are typically used as an add-on therapy.
Indications for use in patients who have moderate to severe asthma despite guideline care.
Have serum IgE between 30 and 700.