Bronchodilator therapy inhalant

If asthmatic symptoms occur frequently or if significant airflow obstruction persists despite bronchodilator therapy, inhaled corticosteroids should be started. For patients with severe symptoms or severe airflow obstruction (eg, FEVi < 50% predicted), initial treatment with a combination of inhaled and oral corticosteroid (eg, 30 mg/d of prednisone for 3 weeks) treatment is appropriate. Once clinical improvement is noted, usually after 7-10 days, the oral dose should be discontinued or reduced to the minimum necessary to control symptoms. 

The optimal treatment of acute severe asthma depends on the severity of the exacerbation (Figs. 11-2 and 11-3). The patient s condition usually deteriorates over several hours, days, or weeks however, rapid deterioration can occur in some patients.3 Gradual deterioration may indicate failure of long-term controller therapy. Patients with rapid deterioration usually respond well to bronchodilator therapy.40 Severity at the time of the evaluation can be estimated by signs and symptoms, but patient response 30 minutes after inhalation of a bronchodilator is the best predictor of outcome.12... 

Theophylline is not recommended for treatment of acute asthma.2 It provides no additional benefit when optimal inhaled bronchodilators are used and increases the risk of adverse events. Similarly, although magnesium has bron-chodilator activity, it offers no significant benefits when optimal bronchodilator therapy is used.12,40... 

Leukotriene modifiers (e.g., zafirlukast and montelukast) have not been adequately evaluated in COPD patients and are not recommended for routine use. Small, short-term studies showed improvement in pulmonary function, dyspnea, and quality of life when leukotriene modifiers were added on to inhaled bronchodilator therapy.27,28 Additional long-term studies are needed to clarify their role. 

Methylxanthines are no longer considered first-line therapy for COPD. Inhaled bronchodilator therapy is preferred over theophylline for COPD because of theophylline s risk for drug interactions and the interpatient variability in dosage requirements. Theophylline may be considered in patients who are intolerant or unable to use an inhaled bronchodilator. A methylxanthine may also be added to the regimen of patients who have not achieved an optimal clinical response to an inhaled anticholinergic and [i2-agonist. 

Consensus guidelines indicate that inhaled corticosteroid therapy should be considered for symptomatic patients with stage III or IV disease (FEVj less than 50%) who experience repeated exacerbations despite bronchodilator therapy. 

Inhalant bronchodilator therapy 313 Anti-inflammatory therapy 318 Antimicrobial therapy 322 References 324... 

In those receiving bronchodilators by inhalation concomitantly with inhalation of steroid therapy, advise the patient to use bronchodilator several minutes before corticosteroid aerosol (enhances penetration of the steroid into bronchial tree). 

Combination bronchodilator therapy - This topic has been recently reviewed In chronic asthma, the combination of IB and fenoterol was more effective administered by a metered dose inhaler than salbutamol. Aerosol IB when administered concurrently with Inhaled fenoterol and oral oxtriphylline increased bronchodllation with no detectable additional side effects. Inhalation of IB followed by metaproterenol resulted in additive bronchodllation that was greater and longer lasting than IB alone, metaproterenol alone or metaproterenol followed by IB. ° Neither Inhaled terbutallne nor DSCG were very effective in cold air-induced bronchoconstriction whereas both drugs in combination were much more effective. The interaction of methylxanthlnes and B-agonists continues to be a subject of interest. An Increased Incidence of... 

Rutten-van Molken M, Vandoorslaer EKA, Jansen MCC, Vanessenzandvliet EE, Rutten FFH (1993) Cost-effectiveness of inhaled corticosteroid plus bronchodilator therapy versus bronchodilator monotherapy in children with asthma. Pharmacoeconomics 4 257-270. 

Individuals with hyperreactive airways will benefit from bronchodilator therapy and possibly from steroids after exposure to a toxic inhalant. This statement, however, does not constitute an endorsement for routine steroid use in all toxic inhalational injuries. 

Both corticosteroids and bronchodilator therapy should routinely be delivered by a pressurised metered dose inhaler (pMDI) and spacer system, with a facemask where necessary in infants, toddlers and children under 5 years of age. 

Dhand R, Tobin MJ. Inhaled bronchodilator therapy in mechanically ventilated patients. Am J Respir Crit Care Med 1997 156 3-10. 

Cromolyn sodium is administered by inhalation. Its mode of action involves the inhibition of the release of histamine and other inflammatory mediators from several cell types. Its main use is for the prophylactic treatment of bronchial asthma. Inhalation of a selective [beta-2]-adrenergic agonist such as albuterol is the preferred form of bronchodilator therapy for asthma. 

Add standing treatment with one or more long-acting bronchodilators (i.e., tiotropium, salmeterol, and formoterol) ° Add inhaled corticosteroid therapy if repeat exacerbations... 

Several studies have shown an additive effect with the combination of inhaled corticosteroids and long-acting bronchodilators. Combination therapy with salmeterol plus fluticasone or formoterol plus budesonide is associated with greater improvements in FEVj, health status, and exacerbation frequency than either agent alone. The availability of combination inhalers makes administration of both drugs convenient and decreases the total number of inhalations needed daily. 

Asthma is managed by the use of an inhaled bronchodilator prescribed on an as-required (p.r.n.) basis to relieve acute attacks and administration of an inhaled corticosteroid as maintenance therapy. Budesonide is available as inhaled corticosteroid. Amoxicillin or another antibacterial agent may be required for short-term periods. Codeine, being an antitussive, should be used with caution in asthmatics and certainly not routinely. 

---