Asthma Information
Asthma is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath. Asthma is clinically classified according to the frequency of symptoms, forced expiratory volume in 1 second (FEV1), and peak expiratory flow rate. Asthma may also be classified as atopic (extrinsic) or non-atopic (intrinsic).
It is thought to be caused by a combination of genetic and environmental factors. Treatment of acute symptoms is usually with an inhaled short-acting beta-2 agonist (such as salbutamol). Symptoms can be prevented by avoiding triggers, such as allergens and irritants, and by inhaling corticosteroids. Leukotriene antagonists are less effective than corticosteroids and thus less preferred.
Its diagnosis is usually made based on the pattern of symptoms and/or response to therapy over time. The prevalence of asthma has increased significantly since the 1970s. As of 2010, 300 million people were affected worldwide. In 2009 asthma caused 250,000 deaths globally. Despite this, with proper control of asthma with step down therapy, prognosis is generally good.
Medications
Medications used to treat asthma are divided into two general classes: quick-relief medications used to treat acute symptoms; and long-term control medications used to prevent further exacerbation.
Fast acting
- Short acting beta2-adrenoceptor agonists (SABA), such as salbutamol (albuterol USAN) are the first line treatment for asthma symptoms.
- Anticholinergic medications, such as ipratropium bromide, provide additional benefit when used in combination with SABA in those with moderate or severe symptoms.[6] Anticholinergic bronchodilators can also be used if a person cannot tolerate a SABA.
- Older, less selective adrenergic agonists, such as inhaled epinephrine, have similar efficacy to SABAs.[121] They are however not recommended due to concerns regarding excessive cardiac stimulation
Long Term control
- Glucocorticoids are the most effective treatment available for long term control. Inhaled forms are usually used except in the case of severe persistent disease, in which oral steroids may be needed. Inhaled formulations may be used once or twice daily, depending on the severity of symptoms.
- Long acting beta-adrenoceptor agonists (LABA) have at least a 12-hour effect. They are however not to be used without a steroid due to an increased risk of severe symptoms. In December 2008, members of the FDA's drug-safety office recommended withdrawing approval for these medications in children. Discussion is ongoing about their use in adults.
- Leukotriene antagonists (such as zafirlukast) are an alternative to inhaled glucocorticoids, but are not preferred. They may also be used in addition to inhaled glucocorticoids but in this role are second line to LABA.
- Mast cell stabilizers (such as cromolyn sodium) are another non-preferred alternative to glucocorticoids.
Asthma / Respiratory: Medication Information
Advair (Fluticasone/salmeterol)
The combination preparation fluticasone/salmeterol is a formulation containing fluticasone propionate and salmeterol xinafoate used in the management of asthma and chronic obstructive pulmonary disease (COPD). It is marketed by GlaxoSmithKline under various trade names including Advair (US, CA), Seretide (Australia, Colombia, EU, México, New Zealand, South Africa, South Korea, UK), Viani (Germany), Adoair (Japan), ForAir (India) and Foxair (South Africa). Annual worldwide sales approx $7B in 2009. Its US patent expired in 2010 and European patent in 2013. The availability of a generic form of Advair in the United States may be significantly delayed after the expiration of the patent because the Food and Drug Administration has not determined a standard for the bioequivalence for inhaled steroids in multi-dose inhalers or dry powder inhalers.
Fluticasone, a corticosteroid, is the anti-inflammatory component of the combination, while salmeterol treats constriction of the airways. Together, they relieve the symptoms of coughing, wheezing and shortness of breath.
Albuterol (Salbutamol)
Salbutamol (INN) or albuterol (USAN) is a short-acting B2-adrenergic receptor agonist used for the relief of bronchospasm in conditions such as asthma and chronic obstructive pulmonary disease. It is marketed as Ventolin among other brand names.
Salbutamol was the first selective B2-receptor agonist to be marketed — in 1968. It was first sold by Allen & Hanburys under the brand name Ventolin. The drug was an instant success, and has been used for the treatment of asthma ever since.
Salbutamol sulfate is usually given by the inhaled route for direct effect on bronchial smooth muscle. This is usually achieved through a metered dose inhaler (MDI), nebulizer or other proprietary delivery devices (e.g. Rotahaler or Autohaler). In these forms of delivery, the maximal effect of salbutamol can take place within five to twenty minutes of dosing, though some relief is immediately seen. It can also be given orally as an inhalant or intravenously.
