Escolar Documentos
Profissional Documentos
Cultura Documentos
Anticholinergic Agent
Aerosol corticosteroids
Oral corticosteroids
Methylxanthines
Corticosteroids
Overview: Corticosteroids o Corticosteroid Effects: diminish bronchial reactivity increase airway diameter reduced frequency of asthma attacks Mechanisms of Action:corticosteroids o primary: inhibition of eosinophil-mediated airway mucosal inflammation pathway in asthmatic airways o Principal anti-inflammatory action: inhibition of cytokine productionthis or (probably central for inhaled antigen-initiation of inflammatory cascade o secondary: enhancement of beta-receptor agonist effects
1. 2. 3.
Most appropriate way to decrease adverse systemic corticosteroid effects: Effective lipid-soluble corticosteroids -- administered by aerosol: beclomethasone (Banceril) triamcinolone (Aristocort) flunisolide (AeroBid) fluticasone (Flovent) budesonide (Rhinocort)
Toxicities/Cautions/Problems:
in switching from oral to inhaled treatment: taper oral therapy slowly to avoid causing adrenal-insufficiency chronic use of inhaled steroids (may cause adrenal suppression and high dosages); however, the risk is very small with normal doses compared to oral corticosteroid treatment. Inhaled topical corticosteroids: oropharyngeal candidiasis risk reduced by gargling with water and spitting after each inhalation Hoarseness: local effect -- vocal cords Possible concern: inhaled corticosteroids -- does-dependent linear growth slowing in some children/adolescence (perhaps will effect on final adult height); asthma: delays puberty Suppression of hypothalamic-pituitary-adrenal axis Decreased bone density Cataract formation Dysphoria High doses: dermal thinning glaucoma
Advantages of inhaled, chronic use of corticosteroids: Regular use: suppresses inflammation, decreases bronchial hyperresponsiveness, decrease asthma symptoms in patients with chronic disease Reduce symptoms; improve pulmonary function in mild asthma Reduces/eliminates need for oral corticosteroids in patients with severe asthma Bronchioles reactivity reduced: maximal reduction may be delayed (9-12 months) after treatment begins May be used as first-line treatment for mild asthma in combination with beta-agonist PRN (10-12 week treatment course; then re-evaluate); dosages may be with time decreased; some patients may be able to stop using the drug completely. Commonly prescribed (due to efficacy and safety) for patients who more than occasionally require beta-agonist inhalation