Pharmacological agents to treat asthma Flashcards
(11 cards)
Importance
It is useful to teach patients the concept of the ‘preventer’ and the ‘reliever’ for their asthma treatment.
‘Preventer’ drugs or anti-inflammatory agents
These medications are directed toward the underlying abnormalities bronchial hyper-reactivity and associated airway inflammation.
They are underused in practice.
Treatment with a preventer medication is recommended if;
- asthma episodes >3/wk or
- those who use SABA >3 times/wk.
Corticosteroids
Inhaled: Types—
- beclomethasone
- budesonide
- ciclesonide
- fluticasone (long acting).
- Dose range: 400–1600 mcg (adults)
aim to keep below 400 mcg (children), 1000 mcg (adults)
Note: Rinse mouth out with water and spit out after using inhaled steroids.
Oral:
Prednisolone is used mainly for exacerbations, given with the usual inhaled corticosteroids and bronchodilators.
- Dose: up to 1 mg/kg/d for 1–2 wks
Sodium cromoglycate (SCG)
This mast cell stabiliser, available as;
- dry capsules for inhalation
- metered dose aerosols
- nebuliser solution
The availability of the metered aerosol and spacer has helped the use of SCG in the management of asthma in children.
Nedocromil sodium
A newer non-steroid cromolyn metered aerosol.
The initial dose is 2 inhalations qid.
Leukotriene antagonists
These new agents, which include;
- montelukast
- zafirlukast
are very useful for seasonal asthma and aspirin-sensitive asthma
and may reduce the need for inhaled steroids.
‘Reliever’ drugs or bronchodilators
The three groups of bronchodilators are:
- β2-adrenoceptor agonists (β2-agonists)
- Methylxanthines—theophylline derivatives
- Anticholinergics
All pts should be prescribed a reliever.
B2-agonists
Oral administration of B2-agonists is rarely required.*
The inhaled drugs produce measurable bronchodilatation in 1–2 mins and peak effects by 10–20 mins.
The traditional agents such as salbutamol and terbutaline are short-acting preparations (SABA).
The new longer acting agents (LABA) include;
- salmeterol
- vilanterol
- eformoterol.
LABA should only be used in combination, not as monotherapy.
Combination therapy
Inhaled corticosteroids (ICS) + LABA
Rules: use for moderate–severe asthma
The different types should be used in different ways.
When stabilised, drop LABA component and return to ICS.
Fixed dose combination medication:
fluticasone + salmeterol = Seretide
MDI: 50/25; 125/25; 250/25 mg
Dose: adults: 2 inhalations bd; children 4–12: 2 inhal 50/25 bd
Accuhaler: 100/50; 250/50; 500/50
Dose: adults: 1 inhal bd; children 4–12: 1 inhal 100/50 bd
budesonide + eformoterol = Symbicort
Turbuhaler: 100/6; 200/6; 400/12
Dose: 1–2 inhal bd, according to age and need children >12: 100/60 or 200/6
fluticasone + eformoteral = Flutiform (MDI)
fluticasone + vilanterol = Breo ellipta (dry powder for inhalation)
