Nedocromil sodium, asthma

Cromolyn sodium (Intal) and nedocromil sodium (Tilade) are chemically related drugs called chromones that are used for the prophylaxis of mild or moderate asthma. Both are administered by inhalation and have... 

Cromolyn sodium and nedocromil sodium are used almost exclusively for the prophylactic treatment of mild to moderate asthma and should not be used for the control of acute bronchospasm. These agents are effective in about 60 to 70% of children and adolescents with asthma. Unfortunately, there is no reliable means to predict which patients will respond. They are less effec-... 

Cromolyn sodium (disodium cromoglycate) and nedocromil sodium are stable but extremely insoluble salts (see structures below). When used as aerosols (by nebulizer or metered-dose inhaler), they effectively inhibit both antigen- and exercise-induced asthma, and chronic use (four times daily) slightly reduces the overall level of bronchial reactivity. However, these drugs have no effect on airway smooth muscle tone and are ineffective in reversing asthmatic bronchospasm they are only of value when taken prophylactically. 

Cromones such as cromolyn sodium (Intal, Nasal-crom) and nedocromil sodium (Tilade) can help prevent bronchospasm in people with asthma. These drugs are not bronchodilators and will not reverse bronchoconstriction during an asthmatic attack. Hence, these agents must be taken prior to the onset of bronchoconstriction, and they must typically be administered prophylactically to prevent asthma attacks that are initiated by specific, well-defined activities (e.g., exercise, exposure to a friend s pet, pollen).107 Likewise, the regular use of these drugs several times each day for several months may decrease airway hyperresponsiveness so that the incidence of asthmatic attacks decreases.102,113... 

There is some evidence that children under five years of age obtain benefit from use of nedocromil sodium or sodium cromoglicate. These agents are used only in prophylaxis cromoglicate is not a bronchodilator and cannot be used to treat acute episodes of asthma. Its action is not well understood but the prophylactic effect appears to be partly due to stabilization of mast cells, which reduces release of histamine and other mediators so that hyperactive bronchial muscle is less responsive to environmental triggers. 

Children may benefit from asthma prophylaxis using sodium cromoglicate or nedocromil sodium. 

Cromones. Cromolyn sodium was first available for use as a therapeutic agent in the United States in 1973. Administered as an aerosol, it is widely used for the prophylactic treatment of asthma, with the onset of activity manifesting after several weeks, and it causes few side effects. Nedocromil sodium possesses cromolyn-like activity [51] and is efficacious in the treatment of asthma when administered as an aerosol [52,53]. Despite a concerted research effort, the mechanism by which cromones exert their therapeutic activity remains enigmatic. Inhibition of mediator release from mast cells and a direct suppressive action on other inflammatory cells appear to be features of their clinical actions [54,55],... 

The importance of spacers and all techniques to improve delivery is relative. If the dose delivered the old way achieves maximum pharmacodynamic effect, improving delivery is moot [53]. This observation raises other questions about aerosol drug delivery, namely, the effective dose. It is likely that the dose overkill concept has been the reason for failure to show differences when some applications were compared. A new, refined device may not be more effective than an older one because the older one delivers such a large dose that, despite inefficiency, it is pharmacodynamically equivalent. At least one study shows no difference in protection from exercise-induced asthma by nedocromil sodium and by sodium cromoglycate via MDI, and use of a spacer did not change results [54]. 

In children with asthma the effect of prophylactic pharmaceutical treatment has been documented in several clinical trials [131]. Inhaled steroids are very efficacious in preventing exacerbations, reducing hospitalisations and even mortality. Sodium cromoglycate and nedocromil sodium have an effect in mild-to-moderate asthma, but are less efficacious than inhaled steroids [131]. None of these treatments are curative, and after cessation of prophylactic treatment symptoms usually reappear [132-135]. 

Nedocromil sodium - mast cell stabilizer asthma prophylaxis... 

Nedocromil sodium is a mast-cell stabilizer that inhibits release of mediators from inflammatory cell types associated with asthma, including histamine from mast cells and beta-glucuronidase from macrophages. It may also suppress local production of leukotrienes and prostaglandins and inhibit development of bronchoconstriction responses to inhaled antigen and other challenges such as cold air. It is... 

Steroidal and nonsteroidal anti-inflammatory drugs such as corticosteroids, sodium cromoglycate, and nedocromil sodium, respectively, are used to treat asthma and COPD. In the sections below, we present potential targets for these... 

Cromones are used to prevent asthma attacks. To be effective they have to betaken continuously. Their mechanism of action is poorly understood. Cromones (cromolyn sodium, nedocromil) act as mast cell-stabilizing agents,... 

The majority of the marketed products are used for asthma and COPD. Typical agents that are used for these indications are fl2-agonists such as salbutamol (albuterol), Terbutalin or formoterol, corticosteroids such as budesonide, FUxotide or beclomethasone and mast-cell stabilizers such as sodium cromoglycate or nedocromil. 

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