Pharmacological Management of Asthma

Question 1

Describe the Management of Acute Asthma

Answer 1

Mild- Inhlaed Beta-2 receptor agonist
Severe attacks
Oxygen or nebulised salbutamol
Prednisone (Oral) or Hydrocortisone/methylprednisone

Question 2

Describe Asthma management therapy in Acute Exacerbations

Answer 2

1. Ipratropium Bromide
   - 2nd line bronchodilator
   - combination with Beta2-agonist
2. MgSO4(IV)
   -Severe or life-threatening- no response to 2nd line(which is Ipratropium bromide)

Question 3

Describe the Agents, Pharmacokinetics, MOA and Side Effects of Asthma Attack relievers(Beta 2-selective) and Short-acting muscarinic antagonists(SAMA))

Answer 3

Beta 2-selective drugs
1. Pharmacokinetics- Inhaled,oral,IV. Short-acting. Used as required(acute attack)
2. Agent(s)- Salbutamol
3. Side Effects
Skeletal muscle tremor
Tachycardia and palpitations
Increase in peripheral vasodilation
Hypokalaemia
Restlessness
Hyperglycaemia
Increased bllod free fatty acid concentrations

Short-Acting Muscarinic Antagonists(SAMA)
1. Pharmacokinetics-Inhaled or nebulised, and is Short acting-Ipratropium bromide
2. Adverse effects- Dry mouth

Question 4

Controllers

Corticosteroids are used in controlling Asthma Attacks. Describe its MOA and it is administered in severe asthma exacerbations.

Answer 4

Mech. Of Action
-Anti-inflammatory
-Inhibit inflammatory cytokines
-Induce apoptosis of Eosinophils
-Inhibt multiple inflammatory genes
-Prevent and reverse muscous glycoprotein secretion

FIRST LINE

Severe asthma exacerbations
-High oral dose of Prednisone daily
- Or IV dose of Methylprednisolone every 6-12 hours
- Taper oral therapy slowly to avoid precipitation of adrenal insufficiency

Question 5

Controllers

Inhalad corticosteroids(ICS) are used in controlling Asthma Attacks.

Describe the Agents(2), Indication and Side effects of Inhlaled Corticosteroids.

Answer 5

Agents Include
1. Beclomethasone
2. Budesonide
Indication-Persistent Asthma

*Side Effects
Oropharyngeal candiadiasis(treat with nystatin drops)
Dysphonia(hourseness)

Question 6

Controllers

Describe the agents(2), and pharmacokinetics of Long-Acting Beta-2 Agonists(LABAs)

Answer 6

LABA Agents
1. Salmeterol and
2. Formoterol
Don’t use as Monotherapy

Use with ICS to improve Asthma Control
NB, Salmeterol has delayed onset of action- not useful in acute exacerbation

Question 7

Controllers

Leukotriene Receptor Antagonists (LTRA)

Answer 7

Montelukast approve for children>12 months

Question 8

Controllers

Describe the Agent(s), MOA and Indications of Longer- Acting Antimuscarinic Agents (LAMAs)

Answer 8

Agents
1. Tiotropium Bromide

MOA- Bind M1, M2 and M3 receptors

Used when not adequately controlled with maximal ICS/LABA therapy.

Question 9

Describe the Indications Agent(s), MOA, Pharmacokinetics, Side effects of Methylxanthines

Answer 9

Indications- Bronchodilation, but limited use in Asthma Treatment
Agent(s)- Theophylline
Pharmacokinetics
Dosage in individualised and Therapeutic Drug Monitoring is required.
Adverse Effects
-Common side effects: Headache, Nausea, Vomitting, Abdominal Discomfort, Restlessness
-Increased gastric acid secretion
In high concentrations- cardiac arrythmias and seizures.

Question 10

Name the drugs to avoid in Asthma

Answer 10

1. All Beta blockers
2. NSAIDs(COX-1 inhibitors)
   3.

Question 11

Describe Asthma pharmacotherapy in children aged 5-16

Answer 11

1. Offer SAMA
2. Offer ICS in paeds, but low doses
3. Consider adding LTRA
4. Consider changing ICS and LABA to MART regimen
5. Refer to Paediatric Pulmonologist

Question 12

Describe ther pragmatic thresholds to define uncontrolled asthma

Answer 12

1. 3 or more days a week with symptoms
2. 3 or more days a week with required use of a SABA for symptomatic relief
3. 1 or more nights with awakening due to asthma.