Chapter 20 Drugs Used in the Treatment of Asthma, Chronic Obstructive Pulmonary Disease and Allergies
2. Both nonimmunogenic (Box 20-1) and immunogenic factors (Fig. 20-1) play a role in the pathogenesis of asthma.
3. Drug therapy, which includes anti-inflammatory agents and bronchodilators, affects these factors.
1. This progressive obstructive airway disorder, which usually results from smoking, is marked by airway reactivity.
a. Chronic bronchitis and bronchiectasis are associated with chronic cough with increased sputum production and dyspnea.
TABLE 20-1 Asthma Pharmacotherapy
| Drug Type | Example | USE |
|---|---|---|
| Daily Medications for Long-Term Control | ||
| Inhaled corticosteroids | Beclomethasone | First-line treatment |
| Systemic corticosteroids | Triamcinolone | Used to gain prompt control when initiating long-term inhaled corticosteroids |
| Mast cell stabilizers | Cromolyn | |
| Long-acting β2-receptor agonist | Salmeterol | |
| Methylxanthines | Theophylline | Adjunct to inhaled corticosteroids |
| Leukotriene inhibitors | Zafirlukast | Prophylaxis and long-term management (alone or in combination) |
| “Rescue” Medications Useful in Acute Episode | ||
| Short-acting β2-receptor agonists | ||
| Anticholinergic | Ipratropium | |
a. Corticosteroids generally inhibit the inflammatory response, thereby preventing bronchoconstriction and producing smooth muscle relaxation.
b. Inhibition of the release of arachidonic acid by increasing the synthesis of lipocortin, which inhibits phospholipase A2 activity
d. Inhibition of the production of cytokines involved in the inflammatory cascade (interferon-γ, interleukin 1, interleukin 2)
(b) Tight binding to serum proteins limits its access to glucocorticoid receptors in skin, eye, and bone.
• Often treated with a combination of inhaled steroids with selective β2-adrenergic receptor agonists such as salmeterol
(1) Oral (prednisone) or parenteral steroids (methylprednisolone) are used for severe asthma or COPD if bronchodilators do not resolve the airway obstruction.
(1) Iatrogenic Cushing’s syndrome, diabetes mellitus, hypertension, peptic ulcer disease, hypomania, psychosis, adrenal insufficiency on abrupt cessation of therapy (see Chapter 22)
(2) To prevent adrenal insufficiency, patients who have been receiving oral corticosteroid treatment for longer than 1 week should be given diminishing doses.
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