Management of Asthma
of the causative agents from the environment of an allergic asthmatic is the most
successful means available for treating this condition.
drugs in this category consist of the catecholamines, resorcinols, and saligenins.
These agents are analogues and produce airway dilation through stimulation of
beta receptors with the resultant formation of cyclic AMP.
commonly used resorcinols are metaproterenol, terbutaline, and fenoterol, and
the most widely known saligenin is albuterol, or salbutamol.
Their effects are long lasting, exceeding 6 h in many studies. Differences in potency and duration between agents can be eliminated by adjusting doses and administration schedules.
Inhalation is the preferred route of administration because it increases the bronchial selectivity of these drugs and allows maximal bronchodilation to occur with fewer side effects.
This is true not just in maintenance therapy but also during the treatment of severe acute obstruction. In the past it was fashionable to treat episodes of severe asthma with intravenous sympathomimetics such as isoproterenol.
This approach no longer appears justifiable. Isoproterenol infusions clearly can induce myocardial damage, and even the beta selective agents such as terbutaline and albuterol when given intravenously offer no advantages over the inhaled route.
For maintenance therapy, long acting theophylline compounds are available and are usually given twice per day or once daily. The dose is adjusted on the basis of the clinical response with the aid of serum theophylline levels.
Single dose administration in the evening may reduce nocturnal symptoms. In contrast to the large number of oral compounds, aminophylline is the only compound available for intravenous use.
The recommendations for intravenous therapy in children aged 9 16 and young adult smokers not currently receiving theophylline products are as follows: A loading dose of 6 mg is given followed by an infusion of 1.0 mg er hour for the next 12 h and then 0.8 mg per hour thereafter.
The most common side effects of theophylline are nervousness, nausea, vomiting, anorexia and headache. At plasma levels greater than 30 ml, there is a risk of seizures and cardiac arrhythmias.
sodium and nedocromil sodium are not bronchodilators. Their major therapeutic
effects are inhibition of degranulation of mast cells, thereby preventing
the release of the chemical mediators of anaphylaxis.
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