Asthma, treatment

Improvements in asthma treatment include the development of more effective, safer formulations of known dmgs. The aerosol adrninistration of P2-agonists or corticosteroids results in a decrease in side effects. Also, the use of reUable sustained release formulations has revolutionized the use of oral xanthines which have a very narrow therapeutic index (see Controlled release technology). For many individuals, asthma symptoms tend to worsen at night and the inhaled bronchodilatots do not usually last through an entire night s sleep (26,27). 

Two newer potent selective H -antagonists, terfenadine (23) (132) and astemizole (24) (133), have been developed which have neither the sedative nor the anticholinergic Habilities of the earlier agents. Both of these compounds have proven efficacious in the treatment of hay fever and produce very few side effects, prompting a re-evaluation of the role of antihistamines in asthma treatment. 

Given the routine use of mast cell stabilizers in the clinic, for example in the setting of asthma treatment, these preclinical results may stimulate clinical evaluation in humans. 

Glucocorticoids are widely used to treat a variety of inflammatory and immune diseases. With the recognition that airway inflammation is present even in patients with mild asthma, treatment with glucocorticoids is now the mainstay of asthma therapy. Consequently, by far the most common use of glucocorticoids today is in the treatment of asthma and inhaled glucocorticoids have now become established as first-line treatment in adults and children with persistent asthma, the commonest chronic airway inflammatory disease. 

Because of the varying presentation of asthma, treatment guidelines for asthma therapy should serve as a guide for therapy with the therapeutic plan individualized for each patient to achieve these goals. 

Patients should play an active role in their therapy. The development of a health care provider-patient partnership is vital to the success of any treatment plan. Goals for asthma treatment should be shared with the patient and family, and the patient and health care provider should jointly agree on the patient s personal treatment goals. 

Patients must understand the role of long-term control and quick relief medications in their asthma treatment plan. The importance of understanding asthma as a chronic disease and the need for daily treatment with long-term control medications should be stressed. Additionally, the importance of proper use of medication delivery devices should be continually reinforced. Basic education should be provided over several visits with the health care provider. 

Taburet, A. M., Schmit, B., Pharmacokinetic optimisation of asthma treatment, Clin. Pharmacokinet. 1994, 26, 396-418. 

Drazen JM, Yandava CN, Dube L, SzCZERBACK N, HlPPENSTEEL R, PlLLARI et al. Pharmacogenomic association between ALOX5 promoter genotype and the response to anti-asthma treatment. Nature Genet 1999 22 168-170. 

Tab. 10.1 Pharmacogenetic mechanisms with implications for asthma treatment...

Drazen, J., et al., "Pharmacogenetic Association Between ALOX5 Promoter Genotype and the Response to Anti-Asthma Treatment," Nat. Genet., 22, 168-170 (1999). 

D. In all asthma treatment regimens, inhaled 2-adrenoceptor agonists are used as bronchodilators as needed to relieve acute symptoms. As asthma is an inflammatory disease of the airway, inhaled corticosteroids are also used as standard therapy to control symptoms in all but the mildest cases. The potential for dangerous side effects and drug... 

Figure 8.52 Prostanoid antagonists developed for asthma treatment.

Observation of the use of leaves from Datura stramonium for asthma treatment in India led to the discovery of atropine, a potent competitive inhibitor of acetylcholine at postganglionic muscarinic receptors, as a bronchodilator. Interest in the potential value of antimuscarinic agents increased with demonstration of the importance of the vagus nerves in bronchospastic responses of laboratory animals and by the development of a potent atropine analog that is poorly absorbed after aerosol administration and that is therefore relatively free of systemic atropine-like effects. 

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