Asthma Flashcards
Long-acting β2-agonist
Salmeterol
Formoterol
Short-acting β2-agonist
Salbutamol
Terbutaline
Methylxanthines
Theophylline
Leukotriene Receptor Antagonists
Montelukast
Zafirlukast
Inhaled Corticosteroids
Beclomethasone
Budesonide
Fluticasone
Adverse Effects of β2-agonists
Tremor
Tachycardia
Arrhythmias
Palpitations
Spacer Devices
Improve inhaler technique
Reduce drug deposition in oropharynx
Lower risk of oral candidiasis
Side Effects of Theophylline
Nervousness
Arrhythmias
Seizures
Low therapeutic index
Uses of Short-acting β2-agonists
Mild to moderate asthma
Acute asthma attacks
Long-acting β2-agonist
Salmeterol
Formoterol
Indications: Long-term control of asthma and COPD
Duration: 12-24 hours
Short-acting β2-agonist
Salbutamol
Terbutaline
Indications: Quick relief of asthma symptoms
Duration: 4-6 hours
Methylxanthines
Theophylline
Mechanism: Phosphodiesterase inhibition
Indications: Asthma and COPD, adjunct therapy
Side effects: Nausea, arrhythmias, seizures
Leukotriene Receptor Antagonists
Montelukast
Zafirlukast
Mechanism: Blockade of leukotriene receptors
Indications: Asthma management, allergic rhinitis
Inhaled Corticosteroids
Beclomethasone
Budesonide
Fluticasone
Indications: Long-term asthma control
Side effects: Oral candidiasis, dysphonia
Adverse Effects of β2-agonists
Tremor
Tachycardia
Hypokalemia
Palpitations
Spacer Devices
Purpose: Enhance drug delivery to the lungs
Benefits: Reduces oropharyngeal deposition, improves inhalation technique
Decreases risk of oral candidiasis
Side Effects of Theophylline
Common: Nausea, vomiting
Serious: Arrhythmias, seizures
Monitoring: Requires serum level monitoring due to narrow therapeutic index
Uses of Short-acting β2-agonists
Indications: Mild to moderate asthma, exercise-induced bronchospasm
Recommended: Use before exercise
Long-acting β2-agonists and Asthma
Not for monotherapy
Must be combined with inhaled corticosteroids
Muscarinic Antagonists (Anticholinergics)
Ipratropium
Tiotropium
Indications: COPD, adjunct therapy in asthma
Mechanism: Block muscarinic receptors to reduce bronchoconstriction
Side effects: Dry mouth, urinary retention
Systemic Corticosteroids
Prednisone
Methylprednisolone
Indications: Acute asthma exacerbations, severe COPD
Side effects: Hyperglycemia, osteoporosis, weight gain, mood changes
Cromones
Cromolyn sodium
Nedocromil
Mechanism: Inhibit mast cell degranulation
Indications: Asthma prevention, allergic conjunctivitis
Rarely used today
Omalizumab
Mechanism: Anti-IgE monoclonal antibody
Indications: Moderate to severe allergic asthma not controlled by inhaled corticosteroids
Side effects: Risk of anaphylaxis
Theophylline Toxicity Symptoms
Vomiting
Seizures
Arrhythmias
Tachycardia
Hypotension
Side Effects of Inhaled Corticosteroids
Oral candidiasis
Dysphonia
Long-term: Potential adrenal suppression
Combination Therapy in Asthma
Inhaled corticosteroids + Long-acting β2-agonists
Example: Fluticasone + Salmeterol
Indications: Moderate to severe asthma
Stepwise Management of Asthma
Step 1: SABA (Short-acting β2-agonist) as needed
Step 2: Low-dose ICS (Inhaled corticosteroids)
Step 3: ICS + LABA (Long-acting β2-agonist)
Step 4: Medium/High-dose ICS + LABA
Mechanism of Action of Leukotriene Antagonists
Inhibit leukotrienes that cause bronchoconstriction, edema, and inflammation
Prevent airway narrowing
Nebulizer vs Inhaler
Nebulizer: Delivers medication in mist form over several minutes
Inhaler: Delivers short bursts of medication, faster and more portable
ICS Dose Adjustment
Adjust based on asthma control
Step-up if symptoms persist
Step-down if stable for 3 months
Asthma Reliever vs Controller Medications
Reliever: Short-acting β2-agonists for immediate symptom relief
Controller: ICS, LABA, and leukotriene antagonists for long-term management
Oral Corticosteroid Use in Asthma
Short-term for severe exacerbations
Must taper to avoid adrenal insufficiency
Mast Cell Stabilizers
Cromolyn sodium
Prevents asthma by inhibiting mast cell degranulation
Rarely used due to limited effectiveness
Biologic Therapies in Asthma
Omalizumab: Anti-IgE
Mepolizumab: Anti-IL-5
Benralizumab: Anti-IL-5 receptor
Indications: Severe asthma with specific phenotypes
Example: These biologic therapies target specific pathways in asthma management.
Short-acting β2-agonists (SABA)
Albuterol
Levalbuterol
Indications: Acute asthma relief
Mechanism: Stimulate β2 receptors to relax bronchial smooth muscle
Side effects: Tremor, tachycardia
Example: SABA are commonly used for quick relief of asthma symptoms.
Magnesium Sulfate in Asthma
Use: Severe asthma exacerbations unresponsive to standard therapy
Mechanism: Smooth muscle relaxation, bronchodilation
Administered IV in emergency settings
Example: Magnesium sulfate is a key intervention in severe asthma attacks.
Step-Down Therapy in Asthma
Consider step-down when asthma is controlled for at least 3 months
Gradually reduce ICS dose while monitoring symptoms
Goal: Maintain control with the lowest effective dose
Example: Step-down therapy helps prevent overmedication in controlled asthma.
Indications for Oral Corticosteroids in Asthma
Severe asthma exacerbations
Poor response to inhaled medications
Maintenance in severe chronic asthma (rare)
Example: Oral corticosteroids are reserved for severe asthma cases.
Bronchial Thermoplasty
Non-pharmacological treatment for severe asthma
Uses radiofrequency energy to reduce smooth muscle in the airways
Helps reduce frequency of asthma attacks
Example: Bronchial thermoplasty is a novel approach for severe asthma management.
Common Triggers for Asthma Exacerbations
Allergens: Dust mites, pet dander, pollen
Irritants: Smoke, pollution, cold air
Respiratory infections
Exercise
Example: Identifying triggers is crucial in managing asthma exacerbations.
Mepolizumab
Anti-IL-5 monoclonal antibody
Indications: Severe eosinophilic asthma
Reduces exacerbations in patients with high eosinophil counts
Example: Mepolizumab targets eosinophil-related inflammation in asthma.
Inhaler Technique
Shake well before use
Exhale fully before inhaling the medication
Hold breath for 10 seconds after inhalation
Use a spacer to improve medication delivery if needed
Example: Proper inhaler technique ensures optimal drug delivery.
Spacers for Inhalers
Improve medication delivery to lungs
Reduce risk of oral side effects from inhaled corticosteroids
Especially useful in children and the elderly
Example: Spacers help enhance the effectiveness of inhaled medications.
ICS and Bone Health
Long-term use of inhaled corticosteroids can lead to decreased bone density
Monitor bone health in patients on chronic high-dose ICS therapy
Consider calcium and vitamin D supplementation
Example: ICS use requires monitoring for potential bone health effects.
Exercise-induced Bronchospasm
Symptoms: Shortness of breath, wheezing, coughing during/after exercise
Management: Pre-treatment with SABA or leukotriene antagonist
Example: Exercise-induced bronchospasm can be managed with appropriate pre-treatment.
SMART Therapy in Asthma
Single Maintenance and Reliever Therapy (SMART)
Combination of ICS and formoterol (LABA) used for both maintenance and relief
Reduces need for SABA in patients
Example: SMART therapy simplifies asthma management with a single inhaler.
