Krómóglýköt Krómóglýköt ((Chomoglycates)Chomoglycates)

Sigurður RagnarssonSigurður Ragnarsson

stud. med.stud. med.

Langtíma meðferð við Langtíma meðferð við astmaastma

• BarksterarBarksterar– budesonidebudesonide– fluticasonefluticasone

• Leukotrien blokkarLeukotrien blokkar– safirlukastsafirlukast– montelukastmontelukast

• ββ22-agonistar-agonistar– langvirkirlangvirkir

• formoterolformoterol• salmeterolsalmeterol

– stuttvirkir (per necesitas)stuttvirkir (per necesitas)• MethylxanthinesMethylxanthines

– theophyllinetheophylline– aminophyllineaminophylline

• KrómóglykatKrómóglykat

KrómóglýkötKrómóglýköt

• Fyfirbyggjandi meðferðFyfirbyggjandi meðferð• Minnka immediate og late-phase astma Minnka immediate og late-phase astma

svörun og minnkar hyperreactivity. svörun og minnkar hyperreactivity.

VerkunarmátiVerkunarmáti

• Ekki vitað nákvæmlega hvernig Ekki vitað nákvæmlega hvernig virkar. virkar.

• Eru ekki bronchodilators, hafa ekki Eru ekki bronchodilators, hafa ekki áhrif á slétta vöðva né hindra áhrif á slétta vöðva né hindra sléttvöðva-stimulants.sléttvöðva-stimulants.

• ““Mast cell stabilizer”Mast cell stabilizer”• Minnkar neuronal reflexaMinnkar neuronal reflexa

ÁbendingarÁbendingar

• Áhrifarík meðferð í:Áhrifarík meðferð í:– antigentengdum (atópískum) astmaantigentengdum (atópískum) astma– irritanttengdum astmairritanttengdum astma– áreynslutengdum astmaáreynslutengdum astma

• Meiri áhrif í börnumMeiri áhrif í börnum en fullorðnum. en fullorðnum.

LyfjafræðiLyfjafræði

• Lélegt frásog um meltingarvegLélegt frásog um meltingarveg• Gefið sem innúði. Gefið sem innúði. • T ½ 90 mín.T ½ 90 mín.

• Rapport um urticariu og anaphylaxaRapport um urticariu og anaphylaxa

KrómóglykötKrómóglyköt

Cromylin sodiumCromylin sodium NedochromilNedochromilfullorðnirfullorðnirbörn og fullorðnirbörn og fullorðnir

ICS versus SCGICS versus SCGinhaled corticosteroids vs. sodium cromoglycateinhaled corticosteroids vs. sodium cromoglycate

• ICS: færri tilvik af ICS: færri tilvik af astmaversnunumastmaversnunum

• betri lungnafunctionbetri lungnafunction• færri astmaeinkennifærri astmaeinkenni• minni notkun PN minni notkun PN

berkjuvíkkandi lyfjaberkjuvíkkandi lyfja• lítill munur á lítill munur á

alvarleika alvarleika aukaverkunaaukaverkuna

Cochrane og Cochrane og krómóglýkötkrómóglýköt

• Publication biasPublication bias• Sami fjöldi einkennalausra dagaSami fjöldi einkennalausra daga• ““no or only minimal benefit for DSCG no or only minimal benefit for DSCG

compared to placebo as maintanance compared to placebo as maintanance therapy for childhood asthma”therapy for childhood asthma”

• ““day cough, day wheezing, use of rescue day cough, day wheezing, use of rescue oral steroids, and hospital admission, oral steroids, and hospital admission, failed to reveal any significant group failed to reveal any significant group differences between DSCG and placebo”differences between DSCG and placebo”

HeimildirHeimildir

• Guevara JP. Ducharme FM. Keren R. Nihtianova S. Zorc J. Guevara JP. Ducharme FM. Keren R. Nihtianova S. Zorc J. Inhaled corticosteroids Inhaled corticosteroids versus sodium cromoglycate in children and adults with asthma.versus sodium cromoglycate in children and adults with asthma. [Review] [121 [Review] [121 refs] [Journal Article. Meta-Analysis. Review] Cochrane Database of Systematic Reviews. refs] [Journal Article. Meta-Analysis. Review] Cochrane Database of Systematic Reviews. (2):CD003558, 2006. (2):CD003558, 2006.

• Spooner CH. Spooner GR. Rowe BH. Spooner CH. Spooner GR. Rowe BH. Mast-cell stabilising agents to prevent Mast-cell stabilising agents to prevent exercise-induced bronchoconstriction.exercise-induced bronchoconstriction. [Review] [79 refs] [Journal Article. Meta- [Review] [79 refs] [Journal Article. Meta-Analysis. Review] Cochrane Database of Systematic Reviews. (4):CD002307, 2003. Analysis. Review] Cochrane Database of Systematic Reviews. (4):CD002307, 2003.

• van der Wouden JC. Tasche MJ. Bernsen RM. Uijen JH. de Jongste JC. Ducharme FM. van der Wouden JC. Tasche MJ. Bernsen RM. Uijen JH. de Jongste JC. Ducharme FM. Inhaled sodium cromoglycate for asthma in children.Inhaled sodium cromoglycate for asthma in children. [Review] [180 refs] [Journal [Review] [180 refs] [Journal Article. Review] Cochrane Database of Systematic Reviews. (3):CD002173, 2003. Article. Review] Cochrane Database of Systematic Reviews. (3):CD002173, 2003.

• Kelly K. Spooner CH. Rowe BH. Kelly K. Spooner CH. Rowe BH. Nedocromil sodium vs. sodium cromoglycate for Nedocromil sodium vs. sodium cromoglycate for preventing exercise-induced bronchoconstriction in asthmatics.preventing exercise-induced bronchoconstriction in asthmatics. [Review] [28 [Review] [28 refs] [Journal Article. Review] Cochrane Database of Systematic Reviews. (4):CD002731, refs] [Journal Article. Review] Cochrane Database of Systematic Reviews. (4):CD002731, 2000. 2000.

• Tasche MJ. Uijen JH. Bernsen RM. de Jongste JC. van der Wouden JC. Tasche MJ. Uijen JH. Bernsen RM. de Jongste JC. van der Wouden JC. Inhaled disodium Inhaled disodium cromoglycate (DSCG) as maintenance therapy in children with asthma: a cromoglycate (DSCG) as maintenance therapy in children with asthma: a systematic review.systematic review. [see comment]. [Review] [58 refs] [Journal Article. Review] Thorax. [see comment]. [Review] [58 refs] [Journal Article. Review] Thorax. 55(11):913-20, 2000 Nov. 55(11):913-20, 2000 Nov. UI: 11050259 UI: 11050259

• Chipps BE. Chipps DR. Chipps BE. Chipps DR. Approach to the difficult pediatric asthmatic.Approach to the difficult pediatric asthmatic. [Review] [32 [Review] [32 refs] [Journal Article. Review] Current Opinion in Pulmonary Medicine. 5(1):52-7, 1999 refs] [Journal Article. Review] Current Opinion in Pulmonary Medicine. 5(1):52-7, 1999 Jan. Jan.

• Godfrey S. Konig P. Godfrey S. Konig P. Inhibition of exercise-induced asthma by different Inhibition of exercise-induced asthma by different pharmacological pathways.pharmacological pathways. [Review] [23 refs] [Clinical Trial. Journal Article. Review] [Review] [23 refs] [Clinical Trial. Journal Article. Review] Thorax. 31(2):137-43, 1976 Apr. Thorax. 31(2):137-43, 1976 Apr.