Makindo Medical Notes"One small step for man, one large step for Makindo" |
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Related Subjects: Asthma |Acute Severe Asthma |Exacerbation of COPD |Pulmonary Embolism |Cardiogenic Pulmonary Oedema |Pneumothorax |Tension Pneumothorax |Respiratory (Chest) infections Pneumonia |Fat embolism |Hyperventilation Syndrome |ARDS |Respiratory Failure |Diabetic Ketoacidosis
Drug Class | Drug Name | Indication | Comments |
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Short-Acting Beta-2 Agonists (SABA) | Salbutamol (Ventolin)
Terbutaline (Bricanyl) |
Relief of acute asthma symptoms (rescue inhalers) | First-line treatment for quick relief of bronchoconstriction. Often used as needed. |
Long-Acting Beta-2 Agonists (LABA) | Formoterol (Oxis, Foradil)
Salmeterol (Serevent) |
Maintenance treatment in combination with inhaled corticosteroids (ICS) | Not used as monotherapy; must be combined with ICS to reduce the risk of severe asthma attacks. |
Inhaled Corticosteroids (ICS) | Beclometasone (Qvar)
Budesonide (Pulmicort) Fluticasone (Flixotide) |
Maintenance treatment for controlling chronic asthma symptoms | Mainstay of long-term asthma control. Reduces inflammation in the airways. |
Combination Inhalers (ICS + LABA) | Fluticasone/Salmeterol (Seretide)
Budesonide/Formoterol (Symbicort), Beclometasone/Formoterol (Fostair) |
Maintenance treatment for asthma when single-drug therapy is insufficient | Convenient for patients requiring both ICS and LABA, ensuring compliance. |
Leukotriene Receptor Antagonists (LTRA) | Montelukast (Singulair)
Zafirlukast (Accolate) |
Add-on therapy for asthma, particularly in allergic asthma or exercise-induced symptoms | Oral medications that help reduce inflammation and bronchoconstriction. |
Short-Acting Muscarinic Antagonists (SAMA) | Ipratropium Bromide (Atrovent) | Relief of bronchoconstriction, often used in combination with SABA | Primarily used in acute exacerbations, often in a nebulizer form. |
Long-Acting Muscarinic Antagonists (LAMA) | Tiotropium (Spiriva)
Aclidinium (Eklira Genuair) |
Maintenance therapy for severe asthma, particularly in patients with overlapping COPD | Used as an add-on therapy in patients with difficult-to-control asthma. |
Theophyllines | Theophylline (Uniphyllin)
Aminophylline |
Maintenance treatment for asthma, particularly for nocturnal symptoms | Oral or IV medications with bronchodilator effects; requires regular monitoring due to narrow therapeutic index. |
Biologic Therapies | Omalizumab (Xolair)
Mepolizumab (Nucala) Benralizumab (Fasenra) |
Severe eosinophilic asthma or allergic asthma not controlled with standard therapy | Monoclonal antibodies targeting specific pathways in asthma; administered via injection. |
Oral Corticosteroids | Prednisolone
Dexamethasone |
Acute exacerbations or severe asthma uncontrolled by other treatments | Used short-term due to significant side effects; long-term use is reserved for severe cases. |
Step | Description | Details of management |
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Step 1 | Mild intermittent Asthma | Short acting beta agonist as required such as a Salbutamol [Albuterol] inhaler. Teach inhaler technique. |
Step 2 | Regular preventer medication | Add Inhaled corticosteroid 200-800 mcg/day - start at 400 mcg/day e.g. Beclomethasone, Budesonide, Fluticasone. Advise to rinse mouth after to avoid oral candidal infection or hoarseness. |
Step 3 | Add on therapy | Long acting beta₂-agonist (LABA) e.g. Salmeterol and/or increase inhaled steroid to 800 mcg/day if still not controlled. No response to LABA then stop it, continue steroid and consider SR Theophylline or Leukotriene receptor antagonist (Montelukast, Zafirlukast). |
Step 4 | Persistent poor control | Increase inhaled steroid dose to 2000 mcg/day - Add Leukotriene receptor antagonist/ Oral beta₂ agonist tablet/SR Theophylline |
Step 5 | Continuous or frequent oral steroid usage | Increase inhaled steroid dose to 2000 mcg/day to minimise oral steroids. Consider other treatments - refer to a specialist. Methotrexate has been used in severe Asthma. Patient involvement and education is fundamental at all stages. |