ASPEK FARMAKOLOGI ASMA BRONKIALE - Drug Addicts · ASPEK FARMAKOLOGI ASMA BRONKIALE dr H M Bakhriansyah, M.Kes., M.Med.Ed Bagian Farmakologi FK UNLAM. Integrated med Integrated med

ASPEK FARMAKOLOGI

ASMA BRONKIALE

dr H M Bakhriansyah, M.Kes., M.Med.Ed

Bagian Farmakologi

FK UNLAM

Integrated m ed Integrated m ed Integrated m ed Integrated m ed –––– RespiratoryRespiratoryRespiratoryRespiratory

The goals for successful

management of asthma

� Achieve and maintain control of symptoms.

� Prevent asthma exacerbations.

� Maintain pulmonary function as close to normal levels as possible.


� Maintain normal activity levels, including exercise.

� Avoid adverse effects from asthma medications.

� Prevent the development of irreversible airflow limitation.

� Prevent asthma mortality.

US National Heart, Lung, and Blood Institute publication "Global Strategy for Asthma Management and Prevention" (2002)



Medications for asthma

� Quick relief (reliever medications) � to relieve acute asthma exacerbations and to prevent EIA symptoms. � short-acting β-agonists (albuterol, levalbuterol) � anticholinergics (used for severe exacerbations),

� and systemic corticosteroids, which speed recovery from acute exacerbations (prednisone).

� Long-term control medications � inhaled corticosteroids (fluticasone, beclometasone, triamcinolone, budesonide) � cromolyn sodium,

� nedocromil, � long-acting β-agonists (salmeterol, formoterol)

� Methylxanthines (aminophyline), and � leukotriene antagonists (montelukast, zaferlukast).



Nocturnal asthma

� A long acting inhaled or oral beta 2 agonist, or

� A leukotriene modifier, or

� Inhaled corticosteroid, or

� A once-daily sustained release theophylline, or

� Changing the timing of oral corticosteroids to the mid afternoon

RECENT DEVELOPMENT IN ASTHMA MANAGEMENTS


Chronic Asthma

� Allergen avoidance� Lack of evidence based data

� Woodcock et al (2003), no associated with beneficial effect on peak expiratory flow

� Some benefits have been observed with more complex, intrusive, and expensive modalities combining avoidance of aeroallergens with other measures such as behavioural adaptation and environmental intervention.


� Dietary manipulation

� Vitamin C, vitamin E, Mg and fish oil are not associated with clinically significant beneficial effects

in clinical trials but epidemiological datum

� If people who are particularly susceptible to the

beneficial effects of antioxidants or lipids can be identified, dietary supplementation may have a future

role in specifically targeted patients.


� Buteyko technique� No improvements in lung

function, but symptoms and drug relievers when the Buteyko technique was incorporated into the routine care of asthmatic patients

� Asthma action plans� No apparent benefit of

doubling dose of inhaled CS in two trials, unless in real life setting


� Pharmacological management

� Combined lower dose of

inhaled corticosteroids and

long acting β2 agonist

inhalers (salmeterol and

formoterol)

� Improving patients’

adherence to the drugs

� Leading to reduction of

exacerbation

� Reducing adverse events

of CS


� Leucotriene receptor antagonists � No differences between montelucast and salmeterol given

along with CS in terms of exacerbation rates

� Similar improvement in quality of life

� Anti IgE� Omalizumab significantly improves the number of incidents

related to deterioration, exacerbation rates, ventilatoryfunctions, and symptoms scores (Ayres et al, 2004).

� Improving quality of life and exacerbation rates for patients with asthma and allergic rhinitis (Vignola et al, 2004).


� Anti IL5 and IL12

� Significantly lower eosinophil counts in sputum and peripheral blood (Leckie et al, 2000).

� Consistently dissociation between eosinophilcounts and the effect on airway

hyperresponsiveness (Bryan et al, 2000)


Acute asthma

� Magnesium

�Widely variation in result

�2 gr Mg IV has a greater FEV1 (Silverman et al, 2002)

�Large prospective trials are needed


� Leucotriene receptor antagonists

�Montelukast 7 or 14 mg give a more rapid recovery on FEV1 than placebo

�Needs less β2 agonist

�Fewer treatment failure

�Zafirlukast reduces the risk of relapse

References:

• Morris, M.J. 2006. Asthma. Downloaded at emedicine.com September 2008

• Currie, GP, et al. 2005. Recent developments in asthma managements.

BMJ. 330. 585-589


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ASPEK FARMAKOLOGI ASMA BRONKIALE - Drug Addicts · ASPEK FARMAKOLOGI ASMA BRONKIALE dr H M Bakhriansyah, M.Kes., M.Med.Ed Bagian Farmakologi FK UNLAM. Integrated med Integrated med