16. Treatment of asthma, definition, and treatment of severe asthma

Question 1

The 2 main types of treatment offered to asthmatic patients

Answer 1

• Short term relievers [bronchodilators]
• Long term controllers [anti-inflammatory agents]

Question 2

Examples of Short term relievers

Answer 2

• Beta 2 agonists
• Xanthines
• Muscarinic Antagonists
• Smooth muscle spasmolytics

Question 3

Examples of long term controllers

Answer 3

• Inhaled corticosteroids
• Leukotrienes pathway modifiers
• Cromons
• H1 receptor antagonists
• Immunomodulation/Immunosuppressive drugs

Question 4

Long term treatment options for Chronic Asthma

Answer 4

• Inhaled Beta 2 agonists [Albuterol - short acting, acute attacks; Salmeterol - long acting, nightime before sleep]
• Inhaled corticosteroids [for moderate to severe asthma with exacerbations more than 2 times a week]
• Antimuscarinic agents [Tiotopium - long acting; Ipratropium - short acting, severe life threatening attacks]
• Leukotriene pathway modifiers [less efficacious than ICS, in mild exercise induced asthma, alternative to ICS]
• Cromolyn sodium/Nedocromil sodium [only used for prophylaxis]

Question 5

Treatment for acute, severe exacerbations

Answer 5

• Inhaled Beta 2 agonists [nebulizers]
• Corticosteroids [usually IV initially. Initiate ICS when clinical symptoms improve to taper out IV corticosteroids]
• Third line agent like IV magnesium [not as effective as beta agonists, helps with bronchospasms]
• Supplemental O2
• Antibiotics for suspecion of infection
• Intubation when respiratory failure is imminent or occuring