Drug therapy : Asthma

  • Drug therapy
    • Three types of anti-inflammatory drugs
      • Corticosteroids (e.g., beclomethasone, budesonide)
        • Suppress inflammatory response
        • Reduce bronchial hyper-responsiveness
        • Decrease mucous production
        • Inhaled form is used in long-term control
        • Systemic form to control exacerbations and manage persistent asthma
        • Oropharyngeal candidiasis, hoarseness, and a dry cough are local side effects of inhaled drug
        • Can be reduced using a spacer or by gargling after each use
      • Leukotriene modifiers or inhibitors (e.g., zafirlukast, montelukast, zileuton)
        • Block action of leukotrienes—potent bronchoconstrictors
        • Have both bronchodilator and antiinflammatory effects
        • Not indicated for acute attacks
        • Used for prophylactic and maintenance therapy
      • Monoclonal antibody to IgE
        • Anti-IgE (e.g., Xolair)
          • Decrease in circulating IgE levels
          • Prevents IgE from attaching to mast cells, preventing release of chemical mediators
          • Subcutaneous administration every 2 to 4 weeks
        • β-Adrenergic agonists (SABAs)
          • Examples: albuterol, pirbuterol
          • Effective for relieving acute bronchospasm
          • Onset of action in minutes and duration of 4 to 8 hours
          • Prevent release of inflammatory mediators from mast cells
          • Not for long-term use
        • Methylxanthines (e.g., theophylline)
          • Less effective long-term bronchodilator
          • Alleviates early phase of attacks but has little effect on bronchial hyper-responsiveness
          • Narrow margin of safety
        • Anticholinergic drugs
          • Block action of acetylcholine
          • Promote bronchodilation
          • Short-acting drugs used for severe acute asthma exacerbation
    • Patient teaching related to drug therapy
      • Correct administration of drugs is a major factor in success
        • Inhalation of drugs is preferable to avoid systemic side effects
        • MDIs, DPIs, and nebulizers are devices used to inhale medications
        • Using an MDI with a spacer is easier and improves inhalation of the drug
        • DPI (dry powder inhaler) requires less manual dexterity and coordination
          • DPIs are simpler to use than MDIs.
          • The DPI contains dry, powdered medication and is breath-activated. No propellant is used.
          • Instead an aerosol is created when the patient inhales through a reservoir containing a dose of powder.


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