Presented by : Abdulhadi Burzangi . Pharm.d

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I. Background of Asthma.II. Clinical presentation.III. Drug used in asthma.IV. Stepwise approach for managing asthma. V. Steps for using inhaler.VI. Case.

Key Point..

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I- BackgroundI- Background

•Definition :

- Asthma is a chronic inflammatory disease

of airway associated with inflammation,

obstruction and increase airway hyper-

responsiveness.4

• Types of asthma :

Intermittent Persistent Mild Moderate Severe

symptoms< 2 days/week < 2 days/week

but not daily

Daily Through out the day

Night time awakening

< 2 days/month3-4 days/month >1 day/weekOften 7 days/w

SABA use for symptoms

control> 2 days/week >2 days/weekDaily Several time

per day

Interference with normal

activityNone Minor limitation Some limitation Extremely

limited

• Asthma triggers : 1- Allergens.

2- Occupational exposure. 3- Disease. 4- Environmental changes. 5- Emotions. 6- Exercise. 7- Drugs and preservatives.

11- Clinical presentation

- In case of chronic ambulatory asthma : 1- Episode of dyspnea.

2- Chest tightness. 3- Coughing ( particularly at night ). 4- Wheezing or a whistling sound when breathing.

- In case of severe acute asthma : 1- Severe dyspnea.

2- Chest tightness. 3- S.O.B 4- The patient is able only to say a few words with

each breath.

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111111 - -Drugs used in asthmaDrugs used in asthma

A. Beta 2 agonist.

1- Short acting beta agonist (SABA).

2- Long acting beta agonist (LABA).

B. Corticosteroids (CS).

1- Inhaled.

2- Oral.

C. Leukotrine receptor antagonist.D. Mast cell stabilizer.E. Phosphodiestrease inhibitor.F. Anti IgE.G. Anticholinergic.

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A. Beta 2 agonistA. Beta 2 agonist

• SABA : - e.g : Albuterol .

- Uses

• LABA : - e.g : 1-Salmetrol 2-Formetrol .

- Uses

- Side effect of both : 1- Tachycardia. 2- Palpitation. 3- Tremor. 4- Hypokalemia. 7

B. CorticosteroidB. Corticosteroid

• Inhaled CS :

- e.g : 1- Beclomethasone. 2- Budesonide. 3- Flunisolide. 4- Fluticasone. 5- Trimcinolone.

- Uses

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• Oral CS :

-e.g : 1-predinsone , 2-predinsolone

3-methylpredinsolone

-Uses

• Short term and long term side Short term and long term side effect :effect :

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Short term S.E Long term S.E

-Facial flushing.-Appetite stimulant. -GIT irritation.-Mood change.-Acne.-Weight gain.-Hyperglycemia.-Leukocytosis.-Hypocalsemia.

-HPA axis suppression.-Growth retardation.-HTN.-Osteoporosis.-Hirsutism. -Myopathy.

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C. Leukotriene receptor antagonist - e.g : ( Montelukast, Zafirlukast and

Zileuton ).

- Uses D. Mast cell stabilizer

- e.g : ( Cromolyn Na+ and Nedocromil ).

- Uses

E. Phosphodiestrase inhibitors E. Phosphodiestrase inhibitors

- e.g : ( Theophylline ).

- use - Factors affecting serum theophylline concentration :

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Decrease Theophylline conc.Increase Theophylline conc.

-High protein diet. -Smoking.-Rifampin.-Phenytoin.-Phenobarbital.-Carbamazepine.

-High carbohydrate diet.-Systemic viral infection.-Cimetidine.-Erythromycin.-Ciprofloxacin.-Ticlopidine.

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Other Drugs

F. Anti IgE (Omalizumab).

G. Anticholinergic (Ipratropium).

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IV. Stepwise approach for managing asthma.

V. Steps for using inhaler.

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1 .Remove the cap and hold inhaler upright.

2 .Shake the inhaler.

3 .Tilt your head back slightly and breathe out slowly.

4 .Position the inhaler in one of the following ways

5 .Press down on the inhaler to release medication as

you start to breathe in slowly.

6 .Breathe in slowly (3 to 5 seconds).

7 .Hold your breath for 10 seconds to allow the medicine to reach deeply into your lungs.

8 .Repeat puff as directed. Waiting 1 minute between

puffs may permit second puff to penetrate your

lungs better.

VI. CaseVI. Case

K.M is 33years old female , she came to ambulatory care department at last Saturday . She had been bronchial asthma X 13 years . She was complaining of cough, wheezing , chest tightness and drowsiness. The patient said ( sometimes my family want to take me to ED when i had asthmatic attack but i didn’t want to visit ED). She on seretid (Flutacasone/Salmetrol) for her asthma.

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Subjective :

• Chief complaint: - wheezing.

- cough. - chest tightness. - drowsiness.

• Problem list : - bronchial asthma X 13 years.

- iron deficiency anemia.

• Social history : - single.

• Allergy : - Food > banana … shrimp.

- Drugs > no known drug allergy.

- Others > dust and costs.

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ObjectiveObjective : :

• Vital sings : R.R : 20 rate/min Temp. : 36.8 ْc

B.P : 130/61 Pulse : 81 beat/min

• Weight : 68.6 kg Height : 150cm.

• Past medication : - Inhaled beclomethasone 100 mcg puff bid.

- Ventolin (Albuterol).

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Current medication: - Seretid ( Fluctasone 250mcg + Salmetrol

50mcg )BID. - Ferrose (100 mg iron as iron III hydroxide polymaltose

complex).

Assessment : -The patient diagnosed with mild persistent

asthma. - She doesn’t response to her medication.

Plan : -Ventolin solution + Ventolin neublizer.

- Ferrose.

RecommendationRecommendation

-Check the patient compliance…..-Stop gradually…..-General measure for treating asthma.

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