| example | mech | use | side effects | |||||
| anti-inflammatory drugs | glucocorticoids inhalors | 1-budesonide 2-beclomethasone | 1-stim syn of LP ! Phospholipase A2 2-stim syn of cytokines >IL3 w inhibit formation of mast cells | prevention of late phase Rx involve macrophages ,eisinophils ,PAF ** in acute asthma use oral prednisolone + inhalors | minimal as it has local effect oral candidiasis ,dysphonic (voice problem) ,, systemic toxicity :minimal and appear in children e long term therapy in high doses | |||
| chromolyn sod | inhalation in form of pw , aerosol ,nebulized soln | 1-mast cell stabilizer (less potent) 2-inhibit exaggerated neuronal reflexes responsible for neuronal hyperactivity | it inhibit immediate & late Rx *used in childhood asthma | due to pw form 1-cough 2-bronchospasm 3-nausea & hypersensitivity Rx | ||||
| Nedocromil sod | inhalation *it is structurally related to chromolyn sod but has all Rx as it *chromolyn & nedocromil >ionized form so can not be taken orally | it is sp for ttt of pulmonary inf | ||||||
| H1 blocker | ketotifen | used in ttt of mild childhood asthma | ||||||
| bronchodilators | B2 agonists | short duration (orally or parentrally) 1-salbutamol 2-terbutaline ,long acting (by inhalation) 1-salmeterol 2-formoterol | 1-they have direct action on B2 receptors of small muscle in air ways 2-inhibit mediator release | use >inhibition of immediate Rx | ||||
| xanthine | methylxanthine derivatives | theophylline (most used) ,theobromine ,caffeine ,propyl xanthine >enprophylline | 1-competitive antagonist of adenosine at adenosine receptors ,adenosine >responsible for bronchospasm ,, enprophylline >is strong bronchodilator & not antagonise adenosine 2-inhibit phosphodiesterase enz cAMP >> ADP + AMP ,theophylline inhibit phosphodiesterase ,, against this theory >conc of theophylline req to inhibit phosphodiesterase is above therapeutic range :action of theophylline is anti asthmatic (bronchodilator) as + cAMP (1-mu relaxant ,inhibit inf cells >so ! med release | use :ttt of noctural asthma (sustained release tablet it is also CNS stimulent >tremors >nervousness *on CVS :+ve chronotropic effect & intropic ,V.D of all bl vessels except cerebral vessels so used in ttt of headache *on kidney | Tremors ,nervousness ,GIT ,disturbance | |||
| anti muscarinic broncho dilator | Ipratropium Br | by inhalation | used in exercise induced asthma & iriitant induced asthma *+ parasym tone >so ttt by ipratropium to inhibit exaggerated parasym stim *used e other strong bronchodilators | |||||
| immunotherapy | skin test | intradermal for hyposensitisation | ||||||