Stepwise Approach for Managing Asthma Symptomsday Sympt night PEF or FEV1 PEF variability Step1 Mild Intermittent 2 daysweek 2 nightmonth ID: 804268
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Slide1
Slide2Inhalers
DR. SAQIB RASHEED
Slide3Slide4Stepwise Approach for Managing Asthma
Symptoms/day
______________Sympt./nightPEF or FEV1_____________PEF variabilityStep1
Mild
Intermittent
≤2 days/week
_____________
≤2 night/month
≥ 80%
______
<20%
Step2
Mild Persistent
>2/week but < 1 time day
________________
> 2 night/month
≥80%
______
20
– 30%
Step3
Moderate Persistent
Daily
____________
> I night/week
>60% - < 80%
___________
> 30%
Step4
Severe Persistent
Continual
_________
Frequent
≤ 60%
_____
>30%
Slide5Management approach based on control
Slide6Slide7Therapy of COPD by Staging
Slide8The drug inside an inhaler goes straight into the airways when breath in. This means that much smaller dose is required than to take the drug as a tablet or liquid form by mouth. The airways and lungs are treated, but little of the drug gets into the rest of the body (via the bloodstream). As a result, side-effects are unlikely to occur (and if they do occur, they are usually minor).
Slide9Inhalers can be grouped on the basis of drug inside it into :
Relievers (short-acting bronchodilators)
Preventers (steroid inhalers) Short-acting bronchodilator + Steroids Long-acting bronchodilators + Steroids
Ipratropium
Bromide
Slide10Reliever inhalers
Contain short acting bronchodilator drugs
The two main reliever drugs are Salbutamol
Terbutaline
Slide11Mechanism of Action :
These are selective B2-adrenoreceptor agonist. Aerosal produces
bronchodilation through stimulation of B2-adrenergic receptors in bronchial smooth muscle, thereby causing relaxation of bronchial muscle fibers.
Slide12Therapeutic Indications :
Salbutamol provides short acting 4 – 6 hrs brochodilation
with fast onset (within 5min)Bronchial AsthmaChronic BronchitisEmphysema
Exercise induced asthma
Allergen induced asthma
Other chronic
bronchopulmonary
disorders in which
bronchospasm
is a complicating factor.
Slide13In Asthma it is indicated when symptoms :
Occur less than once a week for 3 monthFewer than two nocturnal episodes/month
Slide14Each puff deliver 100mcg of
salbutamol.
Total daily dose should not exceedAdult
:
8 puffs (800mcg of
salbutamol
)
Paediatrics
:
4 puffs (400mcg of
salbutamol
)
Slide15Brands available in Pakistan :
Aeroline Inhaler GSK 100mcg/puff
Salbo Inhaler Getz Pharma 100mcg/puffInspirol
Inhaler
Mector
Pharma
100mcg/puff
Zeftonyl
Inhaler
Zafa
100mcg/puff
Slide16PREVENTER INHALERS
: Contain a steroid drugThese are taken every day to prevent symptoms from developing. The type of drug commonly used in preventer inhalers is a steroid. Steroids work by reducing the inflammation in the airways.
Slide17The main inhaled steroid preventer medications are:
Beclometasone dipropionate. Brands include Clenil Inh, Bekson Inh, Bekson Forte Inh, Ventide Inh, Salnon Inh, Xaltide Inh.Budesonide. Brand include Pulmicort.
Fluticasone. Brands name Flixotide, Seretide Inh, Salmicort Inh.Triamcinolone Acetonide. Brand name
Azmacort
Slide18In Asthma it is indicated :
Has experienced an exacerbation of asthma in the last 2 years.Uses inhaled B2- agonists three times a week or more.
Reports symptoms three times a week or more.Is awakened by the asthma one night per week.
Slide19Dosage
Adults and Children over 12 years of age:Mild asthma : 200 to 600mcg / day in divided doses.
Moderate asthma : 600 to 1000mcg /day in divided doses.Severe asthma : 1000 to 2000mcg / day in divided doses.Children over 4 years of age :
The usual starting dose is 100mcg twice daily up to 400mcg per day in divided doses.
The dose may be adjusted until control is achieved or reduced to the minimum effective dose according to the individual response.
Slide20Brands available in Pakistan :
Flixotide
Inh (Fluticasone Propionate) GSK 250mcg/puff
Clenil
Inh
(
Beclomethasone
dipropionate
)
Chiesi
250mcg/puff
Bekson
Inh
(
Beclomethasone
dipropionate
)
Getz Pharma 50mcg/puff
Bekson
Forte
Inh
(
Beclomethasone
dipropionate
)
Getz Pharma 250mcg/puff
Mecticort
Inh
(
Beclomethasone
dipropionate
)
Mector
Pharma
250mcg/puff
Slide21Short-acting bronchodilator + Steroids :
Therapeutic Indications :For the long term management of asthma only when the need for inhaled corticosteroid and bronchodilator therapy has been established.
Slide22Dosage
Adults : 2puffs three or four times daily
Children : 1 – 2puffs two to four times daily
Slide23Brands available in Pakistan :
Ventide
Inh (Salbutamol + Beclomethasone
) GSK 100/50mcg per puff
Salnon
Inh
(
Salbutamol
+
Beclomethasone
)
Mector
100/50mcg per puff
Xaltide
Inh
(
Salbutamol
+
Beclomethasone
) Getz
Pharma
100/50mcg per puff
Slide24Long-acting bronchodilators + Steroids :The drugs in these inhalers work in a similar way to relievers, but work for up to 12 hours after taking each dose. This combination is the 1st choice of add on therapy as they consistently improve asthma and reduce the frequency and severity of exacerbations when compared to increasing dose of ICS alone .
Slide25Brands available in Pakistan :
Seretide
Inh (Salmetrol + Fluticasone
propionate) GSK 25/50, 25/125, and 25/250mcg per puff
Salmicort
Inh
(
Salmetrol
+
Fluticasone
propionate)
Mector
25/50, 25/125 and 25/250mcg per puff
Foster
Inh
(
Beclomethasone+Formoterol
)
Chiesi
100/6mcg per puff
Slide26Ipratropium
BromideMechanism of Action :It works by blocking receptors called
muscarinic receptors that are found on the muscle surrounding the airways in the lung. Stimulation of these receptors by acetylcholine normally causes the muscle in the airways to contract and this makes the airways narrow.
Slide27Therapeutic indications :
For maintenance treatment of bronchospasm
associated with COPD .Uses concomitantly with inhaled B2 agonist in asthma.
Slide28Dosage :
Each puff deliver 40mcg of
Ipratropium Bromide.Adults :The usual dose is 1 puff 3 – 4 times daily.
Single dose of up to 80mcg (2puffs) may be required
Children :
Not recommended in children under 12 years of age.
Slide29Brands available in Pakistan :
Optra Inh
Getz Pharma 40mcg/puffAtem
Inh
Cheisi
40mcg/puff
Tropium
Inh
Mector
Pharma
40mcg/puff
Slide30Estimated Equipotent Daily Dose of Inhaled
Glucocorticosteriods for Adults & Children older than 5years
Slide31GSK
Slide32Cheisi
Pharma
Slide33Mector
Pharma
Slide34Getz
Pharma
Slide35TO USE A METERED-DOSE INHALER
Shake the inhaler well before use (3 or 4 shakes)
Remove the cap
Breathe out, away from your inhaler
Bring the inhaler to your mouth. Place it in your mouth between your teeth and close you mouth around it.
Start to breathe in slowly. Press the top of you inhaler once and keep breathing in slowly until you have
taken a full breath.
Remove the inhaler from your mouth, and hold your breath for about 10 seconds, then breathe out.
Slide36THANK
YOU
Slide3737