Inhaled drugs asthma

Educate patients on the use of inhaled drug delivery devices, peak flow monitors, and asthma education plans. 

Many corticosteroids are used as inhalation drugs for bronchial asthma. 

Like pirbuterol, procaterol exhibits similar broncholytic properties as albuteral, but it has somewhat of a more prolonged action. It is recommended for use as an inhaled drug for treating bronchial asthma. Synonyms of this drug are onsukil, masacin, procadil, meptin, and others. 

Several inhaled drugs are used for the relief and management of asthma. The drug, formulated into a solution which can be reduced to fine particles, is inhaled from an inhaler device and most patients over the age of about 6 years can be trained to use the device so as to get an effective dose into the bronchial tree. How far does the drug go Studies have shown... 

Other factors that determine the absorbed fraction of inhaled glucocorticoids include the age of the child, as lung deposition of inhaled drugs increases with age (80). Therefore, the minimum effective dose may fall as the child becomes older. Moreover, it is reasonable to hypothesize that systemic absorption will increase once asthma control is established (81). Furthermore, patient adherence and inhaler technique are two factors that can have a large influence on the amount of glucocorticoid inhaled and absorbed. 

Cromolyn or nedocromil may be considered as an alternative to inhaled corticosteroids in patients with symptoms occurring more than twice a week or who are wakened from sleep by asthma. They may also be useful in patients whose symptoms occur seasonally or after clear-cut inciting stimuli such as exercise or exposure to animal danders or irritants. In patients whose symptoms are continuous or occur without an obvious inciting stimulus, the value of these drugs can only be established with a therapeutic trial of inhaled drug four times a day for 4 weeks. If the patient responds to this therapy, the dose can be reduced. Maintenance therapy with cromolyn appears to be as effective as maintenance therapy with theophylline and, because of concerns over the possible long-term toxicity of systemic absorption of inhaled corticosteroids, has become widely used for treating children in the USA. 

In certain therapeutic situations, rapid presystemic elimination may be desirable. An important example is the use of glucocorticoids in the treatment of asthma. Because a significant portion of inhaled drug is swallowed, glucocorticoids with complete presystemic elimination entail only a minimal systemic load for the organism (p.340). The use of acetylsalicylic acid for inhibition of thrombocyte aggregation (see p.155) provides an example of a desirable presystemic conversion. 

The first MDI products were developed by Riker Laboratories and marketed in 1956, using a newly patented design of metering valve. In most countries the MDI is now established as the principal dosage form of inhalation drug therapy for bronchial asthma and chronic obstructive pulmonary disease (COPD). Since its introduction, MDI technology has evolved steadily. However, with the phase-out in the commercial use of chlorofluorocarbon (CFC) propellants, which have been the mainstay of pharmaceutical MDIs, the pace of MDI technology development has accelerated with the transition to hydrofluorocarbon (HFC) propellants. ... 

Pulmonary delivery of drugs is the administration route of choice in respiratory diseases such as chronic obstructive pulmonary disease and asthma. Different devices are available, including metered-dose inhalers, dry powder inhalers, and nebulizers, and nearly 80% of asthmatic patients worldwide use metered dose inhalers (1). Chlorofluorocarbons have been used as an aerosol propellant in metered-dose inhalers however, they deplete the ozone layer and are being replaced by more environment-friendly propellants, even though the contribution of aerosols of this type to the total global burden of chlorofluorocarbons is less than 0.5%. The first chloro-fluorocarbon-free metered-dose inhaler for asthma treatment was approved by the FDA in 1996 (2) and the European Union has set 2005 as a target date for the withdrawal of all chlorofluorocarbon-based inhalers (1). In the USA, prescriptions for chlorofluorocarbon-free medications rose from 16.4 million in 1996 to 33.8 million in 2000 (2). Most of the chlorofluorocarbon-free medications were steroids for nasal use (27.2 million). However, chlorofluorocarbon-containing medications stiU represented two-thirds of all prescriptions and increased from 63.0 to 67.6 million dispensed (2). 

There was also an arm treated with inhaled fluticasone alone. Outcome variables were peak flow and asthma symptoms. Both combination and concurrent therapy with fluticasone plus salmeterol resulted in significantly better symptom control and higher peak flows than fluticasone alone. There were no significant differences in the effects of fluticasone plus salmeterol delivered in a combination inhaler versus separate inhalers. Drug-related adverse effects were similar in all three treatment groups most were asthma-related, but hoarseness, dysphonia, and throat irritation were the commonest adverse effects attributed to therapy (1-4%). 

Monitoring consists of quantitating the use of inhaled shortacting /S2-agonists, days of limited activity, and number of symptoms (especially nocturnal). The NAEPP recommends yearly spirometric studies. In moderate to severe persistent asthma, once-daily (on awakening) peak-flow monitoring is recommended. Patients also should be asked about exercise tolerance. All patients on inhaled drugs should have their inhalation delivery technique evaluated periodically— monthly initially and then every 3 to 6 months. 

Information for Patients The action of albuterol tablets may last up to 8 hours or longer. Albuterol tablets should not be taken more frequently than recommended. Do not increase the dose or frequency of albuterol tablets without consulting your physician. If you find that treatment with albuterol tablets becomes less effective for symptomatic relief, your symptoms get worse, and/or you need to take the product more frequently than usual, you should seek medical attention immediately. While you are taking albuterol tablets, other asthma medications and inhaled drugs should be taken only as directed by your physician. Common adverse effects include palpitations, chest pain, rapid heart rate, and tremor or nervousness. If you are pregnant or nursing, contact your physician about use of albuterol tablets. Effective and safe use of albuterol tablets includes an understanding of the way that it should be administered. 

Although the effects of isoproterenol are stated not to be potentiated by tricyclic antidepressants (38 ) a death was reported (39 ) in a 30-year-old woman using an isoproterenol inhalant for asthma who took amitriptyline without the knowledge of her physician. However, the patient was also taking other drugs including a combination product containing theophylline and ephedrine. 

In the USA, LTRAs have largely replaced theophylline as the incremental drug for the treatment of moderate and severe asthma, where LABA plus ICS alone do not provide adequate control. For patients with mild persistent asthma, LTRAs have been designated as a suitable substitute for low dose ICS by the National Asthma Education Panel Program (NAEPP) of the National Heart and Lung Institute (National Institutes of Health). However, inhaled ICS are more efficacious. 

---