Asthma Common Drugs - Maintenance Drugs,Corticosteroids

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ASTHMA IN CHILDREN

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

Common drugs used in asthma

Maintenance drugs:

Corticosteroids

Recognition of importance of inflammation in the pathogenesis has led to early use of inhaled steroids and is considered the first line of therapy by most in persistent asthma.

Steroids exert multiple effects on the pathogenesis of inflammation which includes interference with arachidonic acid metabolism, synthesis of leukotrienes and prostaglandins, prevention of activation of inflammatory cells and increased responsiveness of b receptors.

Systemic corticosteroids should be considered in the management of acute asthma when the patient does not respond readily to bronchodilators.

Early use of corticosteroids shortens the course of asthma, prevents relapses, and reduces the need for hospitalization. The early use of corticosteroids is of particular importance in patients who have a history consistent with fatality-prone asthma.

Intravenous corticosteroids may be lifesaving in the treatment of severe intractable asthma.

After episodes of severe intractable asthma, complete restoration of pulmonary function may require weeks of treatment. Therefore after such events, corticosteroids should be continued at least until symptoms are controlled and pulmonary function is restored.

Inhaled steroids are the primary drugs of choice for persistent asthma. Currently available inhaled preparations include Beclamethasone diproprionate, Budesonide, Fluticasone, flunisolide and triamcinolone.

Benefits of inhaled steroids are seen after 2 - 4 weeks of therapy. Aim is to get a daily dose that controls asthma and then step down to minimum dose, which can maintain that control.

Moderate to severe asthmatic require high doses inhaled steroids along with inhaled long acting bronchodilators or theophylline.

Because of the potential for significant side effects from the prolonged use of systemic corticosteroids (and possibly high-dose inhaled corticosteroids), the need for oral corticosteroids should be monitored by pulmonary function tests, and inadequate control with maximal use of other treatment approaches should be a prerequisite for the long-term administration of systemic corticosteroids.

Adverse effects on linear growth from inhaled steroids are dose dependent. There is no evidence growth retardation occurs with the dose of inhaled steroids being less than 400 m g / day.

Use of spacers can reduce the dose and side effects and should be used in any patient taking moderate to high doses of steroids.

For interventional therapy predinisolone or such equivalent can be given in the dose between 1 - 2 mg/kg per day in 2 - 3 divided doses. Dosage should be continued until the patient is free from symptoms and signs of asthma. The average duration of therapy is 7 days. Dosage should be discontinued without tapering. Oral corticosteroids are as effective as parenteral unless they are not retained.

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