Asthma

Bronchial asthma is a spasmodic obstructive disease of the airways, and symptoms may vary from wheeziness to severe bronchoconstriction that can be fatal. Attacks may be precipitated by exposure to allergens, which may vary from house dust to pollen, fungal spores and animal hair. In some susceptible patients certain drugs, including aspirin, may initiate a severe asthmatic attack. Treatment is basically with drugs that have a relatively selective bronchodilatory action, and, in the case of those drugs given by aerosol inhalation, patients must be given careful instruction in the optimum response is to be obtained. Ephedrine and use of the inhaler device if the optisoprenaline have been used in asthma, but have been virtually replaced by salbutamol and other more selective P,-adrenoceptor stimulants. Adrenaline also has a powerful bronchodilator action, but it may cause cardiac arrhythmias, and it is now used mainly in acute anaphylaxis.
Salbutamol, now widely used, may be given orally by aerosol inhalation, or, in acute conditions, by injection. Ipratropium and oxitropium are anticholinergic agents with a relatively selective bronchodilator action, and are of value in patients who cannot tolerate sympathomimetic agents of the salbutamol type.
Some long-acting may limit their use. ome xanthine products have a sustained action associated with reduced side-effects, but such products are not necessarily bioequivalent, and a change from one product to another should not be made without good cause. Corticosteroids are also of value in both the prophylaxis and treatment of asthma, and those given by inhalation are beclomethasone, budesonide and fluticasone. The recently introduced salmeterol is a derivative of salbutamol intended for use together with inhaled corticosteroid therapy in the prophylactic treatment of asthma. It has a slow initial action, but twice daily treatment is claimed to give relief over 24 hrs. Other drugs for the prophylaxis of asthma are sodium cromoglycate and nedocromil, given by oral inhalation of a dry powder. Ketotifen is an antihistamine with some of the properties of sodium cromoglycate.

Approved names                    Brand names

bambuterol                            Bambec
eformoterol                           Foradil
fenoterol                                Berotec
reproterol                              Bronchodil
salbutamol                            Salbulin, Ventolin, Volmax
terbutaline                            Bricanyl, Monovent
tulobuterol                            Respacal other stimulat
orciprenaline                         Alupent
oxitropium                            Oxivent
xanthines
aminophylline                       Pecram, Phyllocontin Continua
theophylline                          Choledyl, Lasma, Nuelin,
beclomethasone                   Becotide, Becodisks, Becloforte
budesonide                          Pulmicort
fluticasone                           Flixotide
sodium                                Intel cromoglycate
ketoprofen                          Zaditen
nedocromil                        Tilade anticholinergic agents
pratroplum                         Atrovent
oxitropium                         Oxivent

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