Pharmacotherapy of

Bronchial Asthma
Dr.Yeshwanth Rao

Definition
It is a condition characterized by recurrent,
reversible obstruction of the airways in
response to
stimuli which may not be themselves
noxious and
which do not affect non asthmatic subjects
Symptoms - wheeze, shortness of breath
and often
nocturnal cough.

Classification of anti asthma drugs:

A Bronchodilators
i.Sympathomimetics : Short acting agents: - salbutamol,
terbutaline,
orciprenaline,
bambuterol
Long acting agents : salmetrol, formoterol
ii Anti cholinergics:ipratropium bromide, oxitropium, tiotropium

iii Methyl Xanthines: theophylline, etophylline, aminophylline

B.Anti - inflammatory agents
Corticosteroids
Systemic : hydrocortisone, prednisolone
Inhalational : beclomethasone,
budesonide
C.Mast cell stabilizers:
Sodium chromoglycate, Nedocromil
sodium
Ketotifen

D. Leukotriene antagonists:
Montelukast, zafirlukast,
pranlukast
E. 5-lipoxygenase inhibitors:
Ziluton
F.Anti histamines:
Ceterizine, loratidine, azelastine
G. Monoclonal antibodies
Omalizumab

 Corticosteroids
act by their broad antiinflammatory efficacy, mediated in
part by inhibition of production of
inflammatory cytokines
reduce bronchial reactivity and
reduce the frequency of asthma
exacerbations if taken regularly
inhibition of the infiltration of
asthmatic airways by lymphocytes,
eosinophils, and mast cells

 Clinical Use/status of Corticosteroids

oral and parenteral corticosteroids
are reserved for patients who
require urgent treatment
Regular or "controller" therapy is
maintained with aerosol
corticosteroids
(beclomethasone, budesonide,
ciclesonide, flunisolide, fluticasone,
mometasone, and triamcinolone)

 They are now routinely prescribed for

patients
who require more than occasional
inhalations of a agonist for relief of
symptoms.
Adverse effects of inhaled steroids
oropharyngeal candidiasis
(can be reduced by having patients
gargle
water and spit after each inhaled
treatment)
Hoarseness of voice

 Mast cell stabilizers

Cromolyn sodium (disodium
cromoglycate) and nedocromil
sodium
have no effect on airway smooth
muscle tone
Mechanism of Action
alteration in the function of delayed
chloride channels in the cell
membrane, inhibiting cell activation
(e.g mast cells)

Severe acute asthma (status

asthmaticus)
Severe acute asthma is a medical
emergency
requiring hospitalisation.
Treatment includes oxygen (in high
concentration,
usually 60%), inhalation of salbutamol
given by
nebuliser, and intravenous hydrocortisone
followed by a course of oral prednisolone