jiří slíva m.d. absolute number of patients suffering from ab in czech. rep. period number of...

Jiří Slíva M.D.

Absolute number of patients suffering from AB in Czech. Rep.

Period

Number of patients

THE MOST IMPORTANTALERGENES

JANUARY

FEBRUARY

MARCH

APRIL

MAY

1. DEC. 2. DEC. 3. DEC. Pollen situation of„Alnusglutinosa“ in the Europe

DIAGNOSIS

1. ANAMNESIS

3. LABORATORYTESTS

2. CLINICALFEATURES

4. ALLERGOLOGICAL TESTS

own pharmacoterapylife style

specific imunotherapy

symptomaticantiinflammatoric

preventive

• sympatomimetics

• anticholinergics

• corticosteroides

• methylxantines

• antileucotriens

• antihistamines

Groups of drugs:

β-mimetics

- nonselective - adrenaline, isoproterenol, orciprenaline, ephedrine

- selective - metaproterenol, albuterol, salbutamol, terbutalin, fenoterol => more effective via inhalation then per os administration => increase of cAMP

Parasympatolytics

ipratropium

Antiasthmatics with rapid effect:

theophylline - myotropic influence via inhibition of phosphodiesterase and via influence on the adenosine receptors A2

=> bronchodilatation

=> prevention from bronchoconstriction caused by histamine, cholinergic agonists (metacholine) or exertion.

Aminophylline = theophylline + ethylendiamine

Methylxantines:

inhibition of degranulation of mastocytes after exposition to specific agents full effect after 4-6 weeks

Drugs used for prevention and maintained treatment:

cromoglycate sodium

nedocromil• similar to cromoglycate in mechanism of action

β2-mimetics with long-term effect:

• via inhalation salmeterol and formoterol • via per os ( tabl, sirup) klenbuterol, prokaterol, salbutamol

Teophylline with prolonged releasing

zafirlukast zileuton montelukast

Antileucotriens =

Leucotriene Receptor Antagonists (LTRAs):

beklometasone budesonide flunisolide fluticasone triamcinolone

potent antiinflammatory effect

decrease of number of inflammatory potent

cells

inhibition of bronchoconstrictory mechanisms

direct relaxation of smooth muscle cells

Corticosteroids:

astemizole (Hismanal) clemastineterphenadineketotifen (Zaditen)

reversible competitive antagonists of H-receptors

Antihistamines:

verapamile (Isoptin) nifedipine others

inhibition of calcium influx => inhibition of contraction of smooth muscle cells

induction of bronchodilatation

used experimentaly

Inhibitors of calcium channels:

Comparison of numbers of drugs used in therapy of bronchial asthma