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Clinical Drug Therapy Chapter 44 – Drugs for Asthma and Other Bronchoconstrictive Disorders Copyright © <year> Wolters Kluwer Health | Lippincott Williams & Wilkins Bronchoconstrictive Disorder Characteristics • Bronchoconstriction • Inflammation, mucosal edema • Excessive mucus production – Asthma – Bronchitis – Emphysema Copyright © <year> Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement True or False? Asthma occurs only in children. Copyright © <year> Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Asthma may occur at any age but is especially common in children. Children who are exposed to allergens and airway irritants (tobacco smoke, etc) during infancy are at high risk for developing asthma. Copyright © <year> Wolters Kluwer Health | Lippincott Williams & Wilkins Asthma • Characteristics – Bronchoconstriction, inflammation – Hyperactivity to stimuli • Symptoms – Dyspnea, wheezing, chest tightness – Cough, sputum production • GERD association Copyright © <year> Wolters Kluwer Health | Lippincott Williams & Wilkins Asthma Pathophysiology • Bronchoconstriction narrows airways – Sphincter action can completely occlude airway – Aggravated by inflammation, mucosal edema, excessive mucus • Mast cells release substances in response to causative stimuli bronchoconstriction and inflammation Copyright © <year> Wolters Kluwer Health | Lippincott Williams & Wilkins Chronic Obstructive Pulmonary Disease • AKA, COPD • Chronic bronchitis, emphysema – Usually develops with long-standing exposure to airway irritants •Eg, cigarette smoke – Symptoms are •More constant, less reversible Copyright © <year> Wolters Kluwer Health | Lippincott Williams & Wilkins Bronchoconstriction Drug Therapy • Drug classifications – Long-term control (prophylactic) •Achieve and maintain control of persistent asthma – Quick relief (rescue) •Used during periods of acute symptoms and exacerbations Copyright © <year> Wolters Kluwer Health | Lippincott Williams & Wilkins Bronchoconstriction Drug Therapy (cont.) • Bronchodilators – Prevent, treat bronchoconstriction • Anti-inflammatory medications – Prevent, treat airway inflammation – Reduce bronchoconstriction Copyright © <year> Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement True or False? Two major groups of drugs used to treat asthma and COPD are bronchodilators and anti-inflammatory medications. Copyright © <year> Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True. Two major groups of drugs used to treat asthma, acute and chronic bronchitis, and emphysema are bronchodilators and antiinflammatory medications. Bronchodilators prevent/treat bronchoconstriction; antiinflammatories prevent/treat airway inflammation. Copyright © <year> Wolters Kluwer Health | Lippincott Williams & Wilkins Bronchodilators • Adrenergics – Stimulate receptors in bronchi and bronchioles •Producing bronchodilation – Adverse effects •Cardiac stimulation Copyright © <year> Wolters Kluwer Health | Lippincott Williams & Wilkins Bronchodilators (cont.) • Anticholinergics – Block the action of acetylcholine in bronchial smooth muscle •Reduces bronchoconstrictive substance release • Adverse effects – Cough, nervousness, nausea, GI upset, headache, dizziness – Vary depending on medication used Copyright © <year> Wolters Kluwer Health | Lippincott Williams & Wilkins Anti-inflammatory Agents • Corticosteroids – Treat acute and chronic asthma, other bronchoconstrictive disorders – Resulting in • Mucus secretion • Airway mucosa edema •Repaired epithelium damage •Reduced airway reactivity Copyright © <year> Wolters Kluwer Health | Lippincott Williams & Wilkins Anti-inflammatory Agents (cont.) • Leukotriene modifier drugs – Long-term treatment of asthma – Prevent acute asthma attacks induced by •Allergens, exercise, cold air, hyperventilation, irritants, NSAIDs – Not effective in relieving acute attacks Copyright © <year> Wolters Kluwer Health | Lippincott Williams & Wilkins Anti-inflammatory Agents (cont.) • Mast cell stabilizers – Prevent release of bronchoconstrictive and inflammatory substances •In response to allergens, other stimuli – Used in prophylaxis of acute asthma in mild, persistent asthma – Not effective in acute bronchospasm or status asthmaticus Copyright © <year> Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement True or False? In acute, severe asthma, a topical corticosteroid (in relatively high doses) is indicated for a patient whose respiratory distress is not relieved by an inhaled beta2 agonist. Copyright © <year> Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. In acute, severe asthma, a systemic corticosteroid (in relatively high doses) is indicated for a patient whose respiratory distress is not relieved by an inhaled beta2 agonist. A topical corticosteroid will not be effective against airway inflammation. Copyright © <year> Wolters Kluwer Health | Lippincott Williams & Wilkins Drug Selection, Administration Guidelines • Selective, short-acting adrenergic agonist is initial drug of choice for acute bronchospasm • Direct action of inhaled medications on airways can be given in smaller doses with fewer adverse effects than oral or parenteral medications • Inhaled corticosteroids are used early in disease process when inflammation is established as major asthmatic component Copyright © <year> Wolters Kluwer Health | Lippincott Williams & Wilkins Drug Selection, Administration Guidelines (cont.) • In chronic disorders, inhaled corticosteroids should be taken on regular schedule using lowest dose required to control symptoms • Multidrug regimens offer advantage of smaller doses of each medication, which can decrease adverse effects, allow dosage increase as needed in exacerbations • Drug dosing must be individualized to attain most therapeutic effects with fewest adverse effects Copyright © <year> Wolters Kluwer Health | Lippincott Williams & Wilkins Recognition of Management of Toxicity • Most likely to occur because of overuse of bronchodilators in efforts to relieve dyspnea • Bronchodilator overdose adverse effects – Excessive cardiac stimulation •Angina, tachycardia, palpitations, serious dysrhythmias, cardiac arrest – Excessive CNS stimulation •Agitation, anxiety, insomnia, seizures, tremors Copyright © <year> Wolters Kluwer Health | Lippincott Williams & Wilkins Use in Special Populations • Children • Older adults • Renal impairment • Hepatic impairment • Critical illness • Home care Copyright © <year> Wolters Kluwer Health | Lippincott Williams & Wilkins