Anti-inflammatory drugs asthma

The desired outcome in the pharmacological treatment of asthma is to prevent or relieve the reversible airway obstruction and airway hyperresponsiveness caused by the inflammatory process. Therefore, categories of medications include bronchodilators and anti-inflammatory drugs. 

Voltarol is a proprietary preparation of diclofenac. Diclofenac, like all the nonsteroidal anti-inflammatory drugs, may lead to bronchoconstriction (particularly when used systemically) and therefore must be used with caution in asthma. 

Hypersensitivity to salicylates or nonsteroidal anti-inflammatory drugs (NSAIDs). Use extreme caution in patients with history of adverse reactions to salicylates. Cross-sensitivity may exist between aspirin and other NSAIDs that inhibit prostaglandin synthesis, and aspirin, and tartrazine. Aspirin cross-sensitivity does not appear to occur with sodium salicylate, salicylamide, or choline salicylate. Aspirin hypersensitivity is more prevalent in those with asthma, nasal polyposis, chronic urticaria. 

Special interest in the prostaglandins has focused on pain of inflammation and allergic responses. The medical significance is easy to see. Five million Americans have rheumatoid arthritis, an inflammatory disease. Bronchial asthma and other allergic diseases are equally important. Our most common medicine is aspirin, an anti-inflammatory drug. Both the inflammatory response and the immune response are normal parts of the defense mechanisms of the body, but both are potentially harmful, and it is their regulation that is probably faulty in rheumatoid arthritis and asthma. Overproduction of prostaglandins may be a cause of menstrual cramps.308... 

Corticosteroids—a group of anti-inflammatory drugs similar to the natural corticosteroid hormones produced by the cortex of the adrenal glands. The disorders that often improve upon corticosteroid treatment include asthma, allergic rhinitis, eczema, and rheumatoid arthritis. 

Non-steroidal anti-inflammatory drugs (NSAIDs) (e.g. aspirin), which can precipitate an attack in 5% of people with asthma. 

Corticosteroids are anti-inflammatory drugs and are available in a range of formulations. These drugs are used in the management of short- and long-term control of asthma. A wide range of formulations and types of corticosteroids varying in potency are available. 

Aspirin-induced asthma has an onset of 30 minutes to 3 hours after ingestion. Affected individuals are cross-sensitive to all non-steroidal anti-inflammatory drugs (NSAIDs). Paracetamol is seldom associated with cross-sensitivity in patients with aspirin-induced asthma. Aspirin-induced asthma is believed to involve inhibition of COX-1. Patients should be provided with information on which drugs these are. 

Nettis E, Di PR, Ferrannini A, Tursi A. Tolerability of rofecoxib in patients with cutaneous adverse reactions to nonsteroidal anti-inflammatory drugs. Ann AUergy Asthma Immunol 2002 88(3) 331. ... 

Quaratino D, Romano A, Di Fonso M, Papa G, Perrone MR, D Ambrosio FP, Venuti A. Tolerability of meloxicam in patients with histories of adverse reactions to nonsteroidal anti-inflammatory drugs. Ann Allergy Asthma Immunol 2000 84(6) 613-17. 

Chronic inflammation is associated with nonspecific BHR and induces asthma exacerbations. Exacerbations are characterized by symptoms or worsening of asthma over a period of days or even weeks. Although the inflammatory nature of chronic asthma is not completely nnderstood, corticosteroids remain the most potent anti-inflammatory drugs for use in the treatment of asthma. 

Aspirin and other nonsteroidal anti-inflammatory drugs can precipitate an attack in up to 20% of adults with asthma. The mechanism is related to cyclooxygenase inhibition, and 5-hpoxygenase inhibition can prevent the symptoms. The prevalence increases with age. The greatest frequency occurs in severe corticosteroid-dependent asthmatics in their fourth and fifth decades who also have perennial rhinitis and nasal polyposis (presence of several polyps). Other drugs that do not precipitate bronchospasm but which prevent its reversal are the 8-blocking agents. ... 

The medication cost increase over the past 10 years resulted from a doubling of prescribed medications, as well as a 169% increase in unit cost per medication, presumably owing to a shift to more expensive anti-inflammatory drugs consistent with the recommendations of the NAEPP guidelines. Asthma severity obviously has an impact on cost of care. Studies from health-maintenance organizations suggest that up to 45% of the cost of asthma is accrued by 10% of the patients, primarily as a result of emergency care. ... 

All aspirin-sensitive asthmatics do not fit the classic aspirin triad picture, and not all patients with asthma and nasal polyps develop sensitivity to aspirin. In most cases, aspirin-sensitive asthmatics are clinically indistinguishable from the general population of asthmatics except for their intolerance to aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). Aspirin-induced asthmatics are not at higher risk of having fatal asthma if aspirin and other NSAIDs are avoided. ... 

Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) can produce two general types of reactions, urticaria/angioedema and rhinosinusitis/asthma, in susceptible patients. Approximately 20% of asthmatics are sensitive to aspirin and other NSAIDs. 

Cyclic AMP (cAMP) is an important intracellular mediator regulating the activation of inflammatory cells. Particularly important with respect to asthma, cAMP also plays a role in regulating airway and vascular smooth muscle contractibility, inflammatory cell proliferation, and pulmonary neuronal responsiveness. Cyclic phosphodiesterases (PDEs) comprise a protein superfamily, whose function is to inactivate cyclic AMP and cyclic GMP. The fact that certain PDE inhibitors suppress immune cell functions in vitro and pulmonary inflammation in vivo may represent an opportunity for the development of novel anti-inflammatory drugs. 

Corticosteroids are anti-inflammatory drugs that can be used in asthma to reduce airway hyper-responsiveness and to decrease bronchial oedema and mucus secretion. They are effective in the late phase reaction and reduce the intensity of allergic reactions. They are used in emergency treatment of severe acute attacks, for the treatment of mild to moderate attacks and prophylactically to prevent attacks. Corticosteroids can be useful in reducing acute exacerbations of chronic bronchitis. 

Subgroups of Antiasthmatic Drugs Drugs useful in asthma include bronchodilators (smooth muscle relaxants) and anti-inflammatory drugs (Figure 20-2). Leukotriene antagonists may have both bronchodilator and anti-inflammatory properties. 

The most important anti-inflammatory drugs in the treatment of asthma are the corticosteroids and dmgs such as cromolyn and nedocromil that inhibit release of mediators from mast cells and other inflammatory cells. The lipoxygenase inhibitor zileuton probably also exerts an anti-inflammatory effect in asthma. 

---