Corticosteroids agonists

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). 

Corticosteroids Glucocorticoid agonists Steroids Asthma controllers... 

Johnson M (2004) Interactions between corticosteroids and beta2-agonists in asthma and chronic obstructive pulmonary disease. Proc Am Thorac Soc 1 200-6... 

Along with the bronchodilators, several types of dragp are effective in Hie treatment of asthma. These include corticosteroids, leukotriene formation inhibitors, leukotriene receptor agonists, and mast cell stabilizers. 

Corticosteroids, such as beclomethasone (Beclovent), flu-nisolide (AeroBid), and triamcinolone (Azmacort), are given by inhalation and act to decrease the inflammatory process in the airways of the patient with asthma, hi addition, the corticosteroids increase the sensitivity of the p2-receptors. With increased sensitivity of the ( -receptors, the p2-receptor agonist drugs are more effective... 

Opioids, benzodiazepines, barbiturates, corticosteroids, dopamine agonists (e.g., amantadine, bromocriptine, levodopa, pergolide, pramipexole, ropinirole), H2-receptor antagonists, anticholinergics (e.g., diphenhydramine, trihexylphenidyl), P-adrenergic blockers, clonidine, methyldopa, carbamazepine, phenytoin, baclofen, cyclobenzaprine, lithium, antidepressants (e.g., tricyclic antidepressants, selective serotonin reuptake inhibitors), and interleukin-2... 

Systemic corticosteroids if no immediate response or incomplete response to aggressive inhaled P2-adrenergic agonist therapy, if patient recently received an oral corticosteroid, or if the episode is considered severe... 

Treatment of severe acute asthma includes the use of oxygen for the rapid reversal of hypoxemia, a short-acting P2-agonist to reverse airway constriction, and a systemic corticosteroid to attenuate the inflammatory response.1 Close monitoring of objective measures such as FEVi or PEF is important to quantify the response to therapy. Because recovery from exacerbations is often gradual, intensified therapy should be continued for several days. 

Daily use of inhaled short-acting corticosteroids and long-acting inhaled acting inhaled p2-agonists... 

Corticosteroids are the most potent anti-inflammatory agents available for the treatment of asthma. The efficacy of corticosteroids is due to their ability to affect multiple inflammatory pathways, resulting in the suppression of inflammatory cell activation and function, prevention of microvascular leakage, decreased mucus production, and upregulation of P2-adrenergic receptors.10,18 Clinically, corticosteroids decrease airway inflammation, decrease AHR, decrease mucus production and secretion, and improve the response to P2-agonists.18 Corticosteroids for the treatment of asthma are available in inhaled, oral, and injectable dosage forms. 

Assess the patient s adherence to long-term control therapy. If the patient is non-adherent, stress the importance of adherence to this therapy. Evaluate the complexity of the patient s treatment plan and simplify it as much as possible. Determine whether the patient would benefit from an inhaled corticosteroid/inhaled long-acting p2-agonist combination product. 

Reassess pulmonary function every 20 to 30 minutes. If there was not an immediate response to the inhaled short acting p2-agonist, initiate systemic corticosteroid therapy. If the patient is not improving, add ipratropium to the patient s therapy and continue with a high-dose inhaled short-acting P2-agonist. 

If the patient is discharged home, ensure that the patient has a short-acting P2-agonist, review the appropriate technique for inhaler use with the patient, and ensure that the patient has a prescription for 3 to 10 days of oral corticosteroids. 

For moderate persistent asthma, either a combination of low-dose inhaled corticosteroids with a long-acting / -agonist or an increase in the dose of inhaled corticosteroids is recommended. 

Systemic corticosteroids (Table 80-4) are indicated in all patients with acute severe asthma not responding completely to initial inhaled /J2-agonist administration (every 20 minutes for three to four doses). Prednisone, 1 to 2 mg/kg/day (up to 40 to 60 mg/day), is administered orally in two divided doses for 3 to 10 days. Because short-term (1 to 2 weeks), high-dose systemic steroids do not produce serious toxicities, the ideal method is to use a short burst and then maintain the patient on appropriate long-term control therapy with inhaled corticosteroids. 

Sustained-release theophylline is less effective than inhaled corticosteroids and no more effective than oral sustained-release /J2-agonists, cromolyn, or leukotriene antagonists. 

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