Antiasthmatics

25 slides

1. WELCOME

2. ANTIASTHMATICS Presented by P.Pavani 10T22SO112 Under The Guidence of Mr. J. Anoop

3. . . Definition: Asthma is a chronic inflammatory disorder of the airways that is characterized by increased responsiveness of the tracheobranchial tree to a variety of stimuli resulting in widespread spasmodic narrowing of the air passages which may be relieved spontaneously or therapy. Asthma literally meaning ‘Panting’

4. Characteristics of Asthma: Inflammation of airways Bronchial hyper-reactivity/hyper- responsivness Reversible airway obstruction

5. CLASSIFICATION OF ASTHMA: Based on the stimuli initiating bronchial asthma,broad etiologic types are described: Extrinsic(allergic, atopic) asthma Intrinsic( idiosyncratic,non -atopic) asthma Mixed type

6. PATHOPHYSIOLOGY:

7. MORPHOLOGICAL FEATURES : 1.The mucus plugs contain normal or degenerated respiratory epithelium forming twisted strips called “ Curschmann’s sprials ”. 2.The sputum usually contains numerous eosinophils and diamond-shaped crystals derived from eosinophils called “Charcot-Leyden crystals”. 3. Airway remodeling.

8. Symptoms: Early Warning Signs Breathing changes Sneezing Runny/stuffy nose Coughing Chin or throat itches Feeling tired Dark circles under eyes Trouble sleeping Asthma Episode Symptoms Wheezing Shortness of breath Tightness in the chest

9.   Severe Asthma Episode Symptoms personal Severe coughing, wheezing, Shortness of breath or tightness in the chest Difficulty talking or concentrating Walking causes shortness of breath Breathing may be shallow and fast or slower than usual Hunched shoulders (posturing) Nasal flaring Retractions Cyanosis .

10. Asthma Diagnosis: The diagnosis of asthma is based on: History Physical examination Supportive diagnostic tests: *Pulmonary funcion tests Spirometery Peak flow meter Methacholine challenge test *Allergic test *Chest x-ray *GERD assesment test

11. APPROACHES TO TREATMENT: 1.Prevention of AG:AB reactions 2.Neutralisation of IgE antibody eg : Omalizumab 3.Suppresssion of inflamation and bronchial hyperreactivity eg : cotricosteriods 4.Prevention of realease of mediators eg : mast cell stabilisers 5.Antagonism of realeased mediators eg : leukotriene antagonis ts 6.Blocked of constictor neurotransmitters eg:anticholinergics 7.Mimicking dilator neurotransmitter eg:sympathomimetics . 8.Directly acting bronchodilators eg:methylxanthines

12. CLASSIFICATION: Bronchodilators ß2 sympathomimetics : Salbutamol , Terbutaline,Salmetrol Methylxanthines : Theophylline , Aminophylline Anticholinergics : Ipratropium bromide Leukotriene antagonists : Montelukast , Zafirlukast Anti-inflammatory agents Mast cell stabilisers : sodium cromoglycate , Nedocromil Corticosteriods Inhalational : Beclomethasone , fluticasone Systemic : Hydrocortisone, Prednisolone Anti- IgE antibody : Omlizumab

13. STEPWISE MANAGEMENT OF ASTHMA: Mild intermittent asthma ↓ Regular preventer therapy ↓ Add -on therapy ↓ Persistent poor control ↓ Continuous or frequent use of oral steriod

14. SHORT -ACTING ß2 AGONISTS: Eg : Salbutamol , T erbutaline These are mainstay of asthma management M.O.A: ß2 Receptor stimulation →↑ ed cAMP in bronchial muscle cell → relaxation Route of administration: By inhalation of aerosol, powder. Salbutamol is given as intravenous infusion in status asthmaticus . Adverse reactions: Down regulation of bronchial ß2 receptors Tachycardia , palpitations

15. CORTICOSTEROIDS: Corticosteriods afford more complete and sustained symptomatic relief than bronchodialators and others M.O.A: Decrease formation of cytokines(Th2), that recruit and activate eosinophils and are responsible for promoting the production of IgE and expression of IgE receptors. INHALED CORTICOSTERIODS: Eg : Beclomethasone , fluticasone , ciclesonide 1 ST choice in patients with any degree of persistent asthma

16. ROUTE OF ADMINISTRATION: Inhalation by MDI SLOWLY and DEEPLY inhalation for solution type inhalers QUICKLY and DEEPLY inhalation for dry powdet inhalers ADVERSE REACTIONS: Hoarseness Oral or pharyngeal candidiasis Adrenal suppression ICS directly targets underlying airway inflammation

17. . SYSTEMIC STERIODS EG: Hydrocortisone, prednisolone These are oral steriods Used in status asthmaticus . ADVERSE REACTIONS: Adrenal suppression Cushing syndrome Growth suppression in children

18. ANTI- IgE ANTIBODY: Eg : Omalizumab M.O.A: This drug leads to ↓ ed binding of IgE to high affinity IgE receptors on surface of mast cells and basophils and limits realease of mediators of allergic response USES: ◦ In moderate to severe asthma patients who are poorly controlled with conventional therapy. ◦Reduces steriod requirements

19. Status Asthmaticus : In which the smooth muscles of the bronchi suddenly contract and narrow the airways. Status asthmaticus can vary from a mild form to a severe form with bronchospasm . Status asthmaticus is an acute episode of asthma that remains unresponsive to standard treatment with bronchodilators . symptoms: extreme difficulty with breathing, which causes restlessness coughing and wheezing are not common, because there is not enough airflow advanced symptoms include little or no breath sounds inability to speak

20. skin becomes bluish heavy sweating unconsciousness and even cardiopulmonary arrest, which can be fatal TREATMENT: Hospitalisation is necessary The initial treatment starts with supplemental oxygen to increase blood oxygen levels. Inhaled or intravenous bronchodilator to open the airways. large doses of corticosteroids drugs and bronchodilators to reduce inflammation .

21. Conclusion: Asthma is a curable disease, so it is needed to take proper medication and there is a need to follow the medication therapy systematically.