MW L3 Asthma treatment 2 Flashcards
Classes of anti-inflammatory drugs used in asthma (4)
Glucocorticoids
PDE inhibitors
Mediator antagonists
Cytokine antagonists
2 e.g. of glucocorticoids
prednisolone
budesonide
Why used glucocorticoids early
Inflammation is believed to drive tissue remodelling
How do glucocorticoids work?
- regulating gene transcription (inhibit cytokine transcription and leukocyte migration)
- promote eosinophil apoptosis
- indirectly inhibit PLA2
How do PDE inhibitors cause anti-inflammatory effects?
Inhibit PDE which usually breaks down cAMP.
Leads to increased cAMP
cAMP inhibits chemotaxis, granule release, respiratory burst
Why are mediator antagonists rarely used?
Not proven to be better than glucocorticoids
but people seem to feel better
e.g. of both types of mediator antagonists
Leukotriene receptor antagonists (montelukast)
Leukotriene synthesis inhibitors (zileuton)
How are mediator antagonists administered?
Orally
What is effective in the late phase of asthma attack?
And in the early state
Beudesonide (glucocorticoid) - late
Montelukast - eary
Give both to protect throughout
Cytokine inhibitors are rarely used becuase
expensive
Example of cytokine inhibitor used in therapy
IL5 antibodies
resulting in less eosinophils BUT no effect on late stage response
Role of IL5 in allergy
there is more of it and it primes and makes eosinophils grow
Are cytokine inhibitors still being pursued?
No - no longer considered a good therapeutic target as there was no response BUT it is likely the benefit would come later and be in tissue remodelling anyway
Future cytokine inhibitor strategies?
anti-IL4
anti-IL13
anti-TNF
