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1ASTHMA & COPD

ASTHMAExacerbating factors

B-blockers Can cause bronchospasm Especially non-cardioselective e.g

propranolol, timolol Give prostaglandin analogue instead

e.g. bimatoprost, travoprost NSAIDS

Can cause bronchospasm in thosesensitive

Aspirin sensitivity affects 5-20% ofasthma patients

Use clopidogrel instead

Acute Severe Asthma PEF 33-50% of best Cant complete sentences in one breath Resp rate >= 25/min Pulse >= 110/min

Life-threatening features PEF

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LRA/X thi

2ASTHMA & COPD

COPDFigure 1 MANAGEMENT OF INFECTIVE EXACERBATIONS OF

COPD

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3ASTHMA & COPD

Targeting immedicate phase bronchospasmBronchodilators

B2 agonists Muscarinic antagonists Xanthines

Targeting late phase inflammationAnti-inflammatory

Glucocorticoids Leukotriene antagonists 5-Lipoxygenase Inhibitor Mast cell stabilisers

ASTHMA MODE OF ACTION INDICATIONS ADVERSE EFFECTS

S A B 2

a g o n

i s t

SALBUTAMOL

Act on beta2 adrenergic receptor Cause smooth muscle relaxation

occasional for symptom relief If more than once daily or at night? go to

step 2

Tremor, anxiety, headache, muscle cramps,dry mouth, and palpitation. allergic reactionsof paradoxical bronchospasm, urticaria,angioedema, hypotension, and collapse

L A B 2

a g o n

i s t

Salmeterol

Maintenance and prevention of asthmamaintenance of (COPD) symptoms.

Some benefit but not enough? Increasesteroid dose.

No benefit? stop.

dizziness, sinus infection, and migraineheadaches

A n

t i -

M u s c a r

i n i c

IPRATROPIUMTiotropium

Cholinergic antagonists. Block the vagallymediated contraction of airway smoothmuscle and mucus secretion. Not wellabsorbed

Not as effective unless with presence of COPDPt that unable to tolerate adrenergic agonists.

Blurred vision Dry mouth Urinary retention Glaucoma

X a n

t h i n e

Theophylline

Inhibits phosphodiesterase to raiseintracellular cAMP.

Reduces inflammation and innateimmunity

Reverse steroid insensitivity

Narrow therapeutic window, high side effectprofile.

GI: Nausea, Diarrhoea Tachycardia Cardiac Arrhythmiaso/dose may cause seizure or fatal

arrhythmias

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4ASTHMA & COPD

C o r t

i c o s t e r o

i d

Beclometasone(Inhaled)

Budesonide -COPD

FluticasoneHydrocortisone

(IV)

ICS do not directly affect the airway smoothmuscle. Instead, ICS therapy directly targetsunderlying airway inflammation by decreasingthe inflammatory cascade, reversing mucosaloedema, decreasing the permeability ofcapillaries, and inhibiting the release ofleukotrines

Reduce inflammation and mucusproduction

Second step asthma (beclomethasone)Budesonide (Severe COPD)

Oral candida, Hoarseness Bruising Increased appetite/Weight gain Osteoporosis Cataracts Mood changes, Difficulty sleeping Glucose intolerance Cushings syndrome Increased incidence of LRTIs in elderlyPrednisolone

(Oral)

Irreversibly binds with glucocorticoidreceptors. Inhibition of gene transcriptionfor COX2, cytokines, cell adhesionmolecules, and inducible NO synthase

Blockage of Vit D3-mediated induction ofosteocalcin gene in osteoblast

Modification of collegenase genetranscription

Severe exacerbation of asthma.

L e u

k o t r i e

n e

R A g

Montelukast Block the effect of cysteinyl leukotrines.

Asthma in children 6 months of age. Prophylaxis of asthma. Prevention of exercise-induced

bronchospasm

Gi disturbances. Elevations in serum hepaticenzymes. Churg-Strauss syndrome. Headachedyspepsia.

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5ASTHMA & COPD