Asthma Intervention Drugs - Short acting β agonist,Inhaled anticholinergic agents

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ASTHMA IN CHILDREN

Dr C.T.Deshmukh
Professor of Pediatrics, K.E.M Hospital

Intervention Drugs

Short acting β agonist

B-agonist bronchodilators vary in their degree of selectivity from non-selective(e.g., isoproterenol) to relatively β -selective agonists ( β 2 -agonists) (e-g., Salbutamol or albuterol, terbutaline). It is preferable to use a selective β -agonist because they have a longer duration of action and are less likely to produce cardiovascular side effects.

Inhaled β 2-agonists are preferable to oral drugs the treatment of chronic asthma because rapid onset of action, are generally more effective than other routes of administration, and infrequently produce adverse reactions. Inhaledβ 2 -agonists are generally the safest and most effective treatment for acute asthma. In general, oral β2-agonists should not be administered for the treatment of acute severe asthma. They are available in inhaler, nebulized solution and oral forms.

Inhaled β 2-agonists may be more effective when administered on an as needed basis rather than on a regular basis in the treatment of chronic asthma. If greater than eight inhalations per day (or approximately one canister per month) are needed, the addition of cromolyn, nedocromil, or inhaled corticosteroids should be considered.

The administration of β 2-agonists in the treatment of acute or chronic asthma is not a substitute for the early use of anti-inflammatory drugs.

Spacers attached to inhaled β 2-agonists improve drug delivery in patients who do not correctly use inhalers. Patients must be carefully instructed, often more than once, in the use of inhaled β2-agonists because a large percentage of patients fail to use inhaler devices correctly.

Inhaled β 2-agonists are generally considered the agent of choice for prevention of exercise induced asthma. It should be taken 15 to 30 minutes before exercise.

Tolerance to β 2-agonists may develop after continued use of these drugs and can be associated with an unrecognized decrease in efficacy and delay in seeking medical attention. This may be reversible after the administration of corticosteroids,

Tremor and central nervous system effects are minimized by inhalation of β 2-agonists, although hypokalemia and significant cardiovascular effects can occur when these drugs are administered by this route. Serious adverse effects from the administration of β2-agonists, when administered in recommended doses, are uncommon when given orally and extremely uncommon when administered by inhalation.

β2-agonists when administered by inhalation, can produce a sudden paradoxical increase in bronchospasm, which may be life-threatening in some asthmatic patients.

Inhaled anticholinergic agents

Drugs such as ipratropium, appear to be more effective when used to treat patients with chronic mild to moderate asthma.

Ipratropium, may be indicated in whom alternative agents have not been sufficiently effective, are inappropriate because of other medical conditions, or have produced unacceptable side effects.

Inhaled anticholinergic medication is not sufficiently effective to be used as a single agent in the treatment of acute severe asthma but may benefit when combined with a B-agonist or other primary therapeutic agent

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