Please enable JavaScript.
Coggle requires JavaScript to display documents.
ASTHMA TREATMENT (LEUKOTRIENE RECEPTOR ANTAGONISTS (Effective (Exercise…
ASTHMA TREATMENT
LEUKOTRIENE RECEPTOR ANTAGONISTS
EXAMPLE: Montelukast
EXAMPLE: Zafirlukast
Counsel parents on recognising symptoms of hepatic disorder
Nausea & vomiting
Malaise
Pharmacology / Mechanism of action
CysLT1 antagonists
Effective
Exercise-induced asthma
Used alone
With inhaled corticosteroid
Asthma with concomitant rhinitis
Not effective
Severe asthma
Also taking high doses of other drugs
Side effects
Churg-Strauss syndrome
Rarely
Causes inflammation of blood vessels
CROMOGLICATE & CHROMONES
EXAMPLE: Sodium Cromoglicate
EXAMPLE: Nedocromil
Prophylaxis less effective than
with inhaled corticosteroids
Effective in children
Aged
5 - 12 years
Especially exercise-induced asthma
May reflect poor asthma control
Pharmacology / Mechanism of action
Mast cell stabilisation
Inhibition of sensory nerves
Blocks Cl- channel
Not effective
Acute asthma attacks
Side effects
Paradoxical bronchospasm
Constriction of bronchioles AFTER using asthma therapy
OMALIZUMAB
Pharmacology / Mechanism of action
Monoclonal antibody
Binds to IgE
Only in patients
Proven IgE-mediated sensitivity to inhaled allergens
High dose corticosteroid + LABA doesn't work
Persistent allergic asthma
Initiated by physicians in specialist centres
Additional Step 4 therapy
Subcutaneous injection
Every 2 to 4 weeks
Dose based on
Body weight
Baseline IgE
Side effects
Churg-Strauss syndrome
Rarely
Causes inflammation of blood vessels
Hypersensitivity reactions
STEPWISE TREATMENT
STEP 1
Mild intermittent asthma
Short-acting beta-2 agonist
STEP 2
Regular preventer therapy
Short-acting beta-2 agonist
AND Inhaled corticosteroid
STEP 3
Initial add-on therapy
Short-acting beta-2 agonist
AND Inhaled corticosteroid
AND Long-acting beta-2 agonist
GOOD Response
Continue LABA
Response but INADEQUATE
Increase steroid dose to 800 mcg/day
NO Response
Stop LABA
Increase steroid dose to 800 mcg/day
STEP 4
Persistent poor control
Short-acting beta-2 agonist
AND Inhaled corticosteroid
ADD
SR Theophylline
OR beta-2 agonist tablet
Leukotriene receptor antagonist
Increase steroid dose to 2000 mcg/day
STEP 5
Continuous or frequent use of oral steroids
Short-acting beta-2 agonist
AND Inhaled corticosteroid
AND
Leukotriene receptor antagonist
SR Theophylline
OR Beta-2 agonist tablet
Maintain steroid dose at 2000 mcg/day
AND Daily corticosteroid tablet (lowest dose)
Refer to specialist care
INHALED CORTICOSTEROIDS
Side effects
LONG-term
HIGH Dose
Bone mineral density reduction
Adrenal suppression
Children
Coma
Adrenal crisis
Growth failure
Monitor growth anunually
LRTI
Glaucoma
Cataracts
Hoarseness
Candidiasis of mouth or throat
Fewer systemic effects than oral
Pharmacology / Mechanism of action
REDUCE inflammatory cell activation
DECREASE IgE synthesis
Up-regulate beta-2 receptor expression
Steroid card if on HIGH dose
Written advice to consider steroid replacement
during stress
BRONCHODILATORS
BETA-2 AGONIST
Short acting
Short-term relief
Mild and intermittent asthma
EXAMPLE: Salbutamol
STEP 1
As required
EXAMPLE: Tertubatline
Long acting
Must be used in combination therapy
STEP 3
Pharmacology / Mechanism of action
G-Protein Coupled Receptor
CAMP Phosphorylates PKA
Relaxation of bronchial
smooth muscle
COMBINATION THERAPY
LABA + Inhaled corticosteroid
EXAMPLE: Symbicort
Formoterol fumarate + Budesonide
TURBOHALER
EXAMPLE:Seretide
Salmeterol + Fluticasone propionate
EVOHALER or ACCUHALER
EXAMPLE: Fostair
CFC-free
Formoterol fumarate + Beclometasone dipropionate
pMDI
EXAMPLE: Flutiform
Formoterol fumarate +
Fluticasone propionate
EXAMPLE: Relvar Ellipta
Vilanterol +
Fluticasone furoate
