ACUTE ASTHMA TREATMENT
Acute asthma
treatment can be done by internists and family doctors.Although drug therapy has
been placed there are also several non pharmalogical therapies.The drug therapy
can be divided into two cathegories. One is called bronchodilatator therapy,
the other one is controller therapy.Bronchodilator therapies give rapid
treatment that give rapid relief of symptoms.On the other hand controller
therapies control the symptoms for longterm.
Bronchodilator Therapies
Bronchodilators rapidly
relief the symptoms of asthma. Bronchodilators act on smooth muscles of airway
and reverse the bronchoconstriction which means rapid relief of airways.There
are effective bronchodilators in treatment.B2-adrenergic agonists,
anticholinergics, and theophylline are the treatment choices.Of these,
B2-adrenergic agonists are the most effective choice of asthma treament.
B2-Agonists
There are many B2-adrenergic
receptors through airways.B2- agonists target B2-adrenergic receptors.It gives rapid
relief of symptoms by reversing bronchoconstriction.In clinical pratice B2
agonists is given by inhalation.Because inhalation treatment reduce the certain
side effects such as arithymia.
Short acting B2
agonists(SABA) such as albuterol and terbutaline give rapid relief of symptoms
in 3-6 hours. They can be given by either nebulizer or via a metered dose inhaler(MDI).
Long acting B2 agonists(LABA) are salmeterol and formoterol which both have duration over 12 hours and they are given twice per day.On the other hand other long acting B2 agonists such as indacaterol, olodaterol, and vilanterol are given once a day.Long acting B2 agonists(LABA) are together with inhaler corticosteroids(ICS).Because unlike inhaler cortisiteroids, long acting B2 agonist(LABA) can not reduce underlying inflammation.
B2 agonists have
several side effects.Most of them are muscle tremors an palpitaitons.Because B2
agonist are given by inhalation, side effects are not usually become a problem.
Anticholinergics
Anticholinergics
effect on muscarinic receptors which are widely dispersed through airways.Anticholinergics
shut downs muscarinic receptors.So it is called muscarinic receptors
antagonists.Ipratropium bromide which is an anticholinergic, prevent mucus
secretion and bronchoconstriction by anti muscarinic receptor effect.Long acting
muscarinic antagonists(LAMA) can be given with inhaler corticosteroids + short
acting b2 agonists if they can not reduce bronchoconstriction and inflamation.
Theophylline
Thephyline has used as
an oral bronchodilatator.Theophylline is not used for several years because of
common side effects.Also inhaled B2 agonist are much more effective than
theophylline for asthma treatment.In clinical practice, theophylline can be give
once or twice a day by slow release preperation.Theophylline can be used in
severe asthma patients as an additional bronchodilatator.
Best wishes…
Dr. Rıdvan…