Professional Documents
Culture Documents
Mast cell
IL-4
IL-13
Th2-cell
Antigen-presenting
cell
IL-5
Eosinophil
Histamine
Leukotrienes
Prostaglandins
Cytokines
Atopic
disease
IgE-dependent release
of inflammatory mediators
Allergens
IgE
FcRI
Immediate release
Granule contents:
Histamine, TNF-,
Proteases, Heparin
Sneezing
Nasal congestion
Itchy, runny nose
Watery eyes
Over minutes
Lipid mediators:
Prostaglandins
Leukotrienes
Wheezing
Bronchoconstriction
Over hours
Cytokine production:
Specifically IL-4, IL-13
Mucus production
Eosinophil
recruitment
Numerous allergens
Controlled (All
Partly Controlled
of the
followings)
(Any measure
present in any week)
Day time
symptoms
None (twice
or less/week)
More than
twice/week
Limitations of
activities
None
Any
Nocturnal
symptoms/awak
ening
None
Any
Need for
reliever/rescue
treatment
None (twice
or less/week)
More than
twice/week
Lung Function
(PEFR or FEV1)
Normal
<80% predicted or
personal best.( if
known)
Uncontrolled
Three or more
features of partly
controlled asthma
present
Symptom controllers
They are
1) Long acting 2 agonistSalmeterol
2) Long acting Theophylline/ Aminophylline,
3) Sustained release Salbutamol
.
Glucocorticoid
May not inhibit the release of mediators from
the mast cells
Steroid has no direct bronchodilator effect
Can't prevent remodeling of airways directly
Huge side effects on prolonged systemic
uses
Inhalation form also may have few systemic
effects
Antileukotriene drugs
Blocks both the early and late phases
of bronchial Asthma
Can inhibit the release of Th2
cytokines(IL-3,IL-4,GM-CSF)
Size of these effects is similar to that
seen in patients treated with 400-500g
of inhaled beclomethasone daily
NEWER DRUGS
Omalizumab
Recombinant humanized monoclonal anti IgE
Ab
It inhibits binding of IgE to mast cell thus
prevents mast cell degranulation.
It is used in the treatment of asthma and in
GINA guideline it is used as add on therapy.
MgSO4
Relaxation of bronchial smooth muscle
Modulation of calcium ion movement both within the cell and
through transmembrane calcium channels
Frusimide:
Frusemide acts as bronchodilator by inhibition of K channel in
bronchial smooth muscle.
May be of help as
bronchodilator in asthma patient with arrhyth
Others:
Troliendomycine (TAO) It is reduces the
theophylline clearance, histamine
sensitivity and increases effectiveness of
steroid.
Roflumilast It is the selective
phosphodiasterase 4 inhibitor.
Immunointerventions
Immunotherapy -Subcutaneous
Sublingual
--
ICU management
of Asthma
Refractory asthma
A patient getting step IV or V or VI treatment
with at least one of the following criteria
may be categorized as suffering from
refractory asthma.
Asthma symptoms requiring short acting B2
agonist use on a daily or near daily basis.
Persistent airway obstruction (FEV1 <80%
of predicted value; diurnal PEF- variability >
20%; morning PEF is < 80% of personal
best result).
One or more urgent care visits for asthma
per year.
Refractory asthma
Three or more course of oral rescue steroid
per year
Prompt deterioration with <25% reduction in
oral or inhaled corticosteroid dose.
Near fatal asthma event in the past.
Management: While continuing step IV or V or
VI treatment the following points should be
considered in managing refractory asthma:
Pitfalls in management
Intensive patient education- environmental
control, drug adherence, self management
plan.
Home nebulization- continuous nebulization
or as per need
Refractory asthma
Vaccination- influenza, measles and
pneumococcal vaccine.
Disease modifying agents may be helpful in
some patients.
Omalizumab and sublingual
immunotherapy.
Bronchial Thermoplasty
The tip of the catheter is inflated until it touches the
sides of the airway wall.
Radio frequency energy is then sent through the
catheter, heating the smooth muscle walls of the airway
to approximately 149 F
This temperature is sufficient to thin the smooth airway
wall muscles without scarring or damaging them.
Thus causes bronchodilatation
Bronchial thermoplasty
Human Airway
Lobectomy Study
Untrea
ted
Treated
Cytokine Inhibitors
Newer drugs for asthma
Drug
Action
Outcomes
Mepolizumab anti-IL5
Pitrakinra
antiIL4/IL13
AMG317
antiIL4/IL13
Cytokine Inhibitors
Newer drugs for asthma
Drug
Action
Outcomes
Etanercept
anti-TNF
alpha
Infliximab
anti TNF
alpha
Golimumab
anti TNF
alpha
Conclusion
Treatment of bronchial Asthma has
undergone revolutionary changes in the last
decade with the invent of drugs notably
inhaled steroids,antileukatrienes & 2agonist,Xanthine derivatives and
Omazulomab . Inspite of that worldwide
prevalence of Asthma, as well as its
morbidity and mortality is still rising. As yet
there is no cure for Asthma.Therapy only
ameliorates the symptoms. So we need more
and more new therapeutics options.