A Power Point Presentation on Bronchial Asthma

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1. Lower Respiratory T ract Disorder - Bronchial Asthma Dr. SHAIK KAREEMULLA Pharm.D, Ph.D Dept. of Pharmacy P ractice M. M. College of Pharmacy (MMDU)

2. CONTENTS INTRODUCTION EPIDEMIOLOGY ETIOLOGY & RISK FACTORS SIGNS & SYMPTOMS PATHOPHYSIOLOGY DIAGNOSIS TREATMENT COMPLICATIONS

3. Anatomy of Respiratory System

4. Introduction: The National Asthma Education & Prevention Program (NAEPP) define asthma as: It is a chronic illness of the lungs & respiratory system. It is an inflammatory disorder of airways in which many cells & cellular elements undergo inflammation. It is characterized by recurrent episodes of B reathlessness, Coughing, C hest tightness and Wheezing . These episodes usually associated with airflow obstruction which is often reversible either spontaneously or with treatment (Bronchodilators).

5. Narrowing of Bronchial Lumen

6. E pidemiology: Bronchial asthma is common and prevalent worldwide . In United States about 4 % of population suffering from asthma has been reported every year. It occurs at all age group people , but 50 % of asthma cases develop after the age of 10 years . In adults , both males & females are affected equally but in children , occurrence rate of boys & girls is 2 : 1 ratio.

7. Etiology and Risk factors: Asthma Triggers include Irritants in the air : Smoke, chemical fumes, strong odours . Indoor allergens : Pet dander and   dust mites. Outdoor allergens : Pollen from grass, trees and weeds. Weather conditions : C old air & extremely windy weather. Upper respiratory infection: C old, flu, sinusitis, Pharyngitis. Certain drugs: Aspirin, Beta blockers, Ibuprofen, Naproxen. Other causes include: Genetic Predisposition (Parent, Brother or Sister diagnosed as Asthma previously ).

8. Signs & Symptoms: Cough : It is chronic that occur during exercise and is nocturnal in nature with the presence of phlegm (sputum). Respiratory : Difficulty breathing, Breathing through the mouth , Tachypnea, Dyspnea, Wheezing and Frequent respiratory infections. Also common : Anxiety , Early awakening, Throat irritation, Chest tightness & Tachycardia.

9. Pathophysiology: Major characteristics of asthma occur due to Bronchospasm, Hypersecretion & Airway Inflammation . It is associated with the activation of immunoglobulin E ( IgE ) antibodies. Mast cells and macrophages are activated. Asthma patients have high viscosity expectorated mucus .

10. Diagnosis: Clinical manifestations, history, physical examination & laboratory tests. Radiographic examination. Pulmonary function tests; it helps to evaluate the severity of lung diseases. After the inhalation of β2 agonist drugs , If FEV1 / FVC is less than 80%, Spirometry test confirms presence of obstruction .

11. Treatment:

12. 1 ) SALBUTAMOL : It is a potent bronchodilator drug that acts directly on beta 2 receptors of bronchial smooth muscles . Salbutamol has less cardiac stimulant effect and so can be used safely in patients suffering from cardiac diseases . It has long duration of action due to resistance developed by inactivating COMT enzyme (Catechol–O–Methyl-Transferase). It is administered by oral, parenteral and inhalation routes. DOSE: 2 to 4 mg by oral route. 0.6 mg every 4 hours by S.C . or I.M. Injection 100 micro grams by inhalation.

13. 2 ) ADRENALINE : It is a potent drug having a significant role in relieving acute asthma attack and pulmonary congestion. Adrenaline acts by stimulating beta receptors of bronchial smooth muscles. Side effects include ventricular tachycardia and ventricular fibrillation . Adrenaline should not be given to patients suffering from cardiac asthma , hypertension and hyperthyroidism . Dose: 0.2 to 0.5ml of 1 in 1000 solution by S.C. injection .

14. 3 ) THEOPHYLLINE : It is a weak bronchodilator and acts synergistically with beta adrenergic agonist drugs there by producing a direct relaxant effect of bronchial smooth muscles. Usual route is oral or slow I.V. injection given at a dose of 250 to 500 mg . It is effective when adrenaline fails to relieve acute attack or if the patient is resistant to adrenaline . Repeated use of theophylline in children may produce disturbance in learning and sleep .

15. 4 ) EPHEDRINE : It is a sympathomimetic drug which acts on both alpha and beta adrenergic receptors . It is a week bronchodilator . It causes insomnia. This can be prevented by combining Ephedrine with Phenobarbitone. 5) KETOTIFEN: It acts by inhibiting airway inflammation that is induced by Platelet Activating Factor (PAF). It has antihistaminic effect . Side effects include Drowsiness and Dry mouth. Dose : 1 to 2 mg BD.

16. 6 ) DISODIUM CHROMOGLYCATE: It is a synthetic compound which acts by inhibiting the phosphodiesterase enzyme thereby preventing mast cell degranulation. It also prevents the release of spasmogenic substances like histamine and serotonin, But it does not have antihistaminic effects. It is poorly absorbed on oral administration and do not produce any adverse effect except local irritation. Dose : 20 mg given by inhalation 3 to 4 times daily by means of ' spinhaler '.

17. Complications: Poorly-controlled asthma can have a negative effect on quality of life. Complications include Pneumothorax, Pneumopericardium, Pneumonia, Pulmonary interstitial emphysema, Cardiac arrhythmias, Myocardial infarction, Electrolyte imbalances, Lactic acidosis, Hyperglycemia.