DRUGS USED IN BRONCHIAL ASTHMA

Defn: Periodic spasm of bronchial smooth muscles, increased secretion, and

oedema of bronchial mucosa. Bec of spasm large volume of air is trapped in the
alveoli which decreases the tidal air and vital capacity leading to dyspnea.

Classification:

1 Bronchodilators
a sympathomimetics Adrenaline
Ephedrine
Isoprenaline
Orciprenaline
salbutamol
b Methyl xanthines Theophylline
c Anticholinergics Atropine
Ipratropium bromide
2 Mast cell stabilizers Disodium
chromoglycate
ketotifin
3 cortiosteriods Beclomethasone
dipropionate

1. Adrenaline: it acts by stimulating beta receptors in bronchial smooth

muscles. It relieves an acute attack of asthma and relieves pulmonary
 congestion by constricting pulmonary artery. Prolong use produces
resistance
Side effects: ventricular tachycardia and ventricular fibrillation.
Dont’s: cardiac asthma, hypertension, hyperthyroidism
Dose: 0.2-0.5 ml of 1 in 1000 solution administrated subcutaneous
injection.
2. Ephedrine: it is a sympathomimetic drug acting on both alpha and beta
adrenergic receptor. It is a weak bronchodilator.
Side effect: sleeplessness, can be prevented by combining it with
phenobarbitone.
3. Isoprenaline: it acts on beta receptor of bronchi.
Side effect: cardiac stimulation
Dose: 10 to 20 mg by sublingually or by inhalation.
4. Orciprenaline: it is a derivative of isoprenaline acting on beta receptors.
It has a long action and produces less cardiac stimulation.
Route of administration: oral, parenteral, inhalation.
5. Salbutamol: it stimulates beta receptor. It is a potent bronchodilator.
Cardiac stimulant effect is less. It is used safely with cardiac disease. The
duration of action is long.
Dose: 100 mg by inhalation, 2 -4 mg by mouth, 0.6 mg every 4 hrs by SC
or IM injection.
6. Theophylline: It is a relatively weak bronchodilator. It acts
synergistically with beta adrenergic agonists. It is effective when
adrenalins fails to relive an acute attack or if the patient is resistant to
adrenaline. It produces a direct relaxant effect on bronchial smooth
muscle.
Side effect: Repeated use of theophylline in children may produce
disturbance in learning and sleep.
 Aminophylline is commonly used in preparation. It is not administrated
by S.C. or I.M. Injection. Usual route is oral or slow I.V. injection at dose
of 250mg to 500 mg.
7. DISODIUM CHROMOGLYCATE (CROMOLYN): It is a synthetic
compound which acts by preventing mast cell degranulation. This
prevents the release of spasmogenic substances like histamine and
serotonin. But it does not have antihistaminic effects. It also inhibits the
enzyme phosphodieesterase.
It is poorly absoberd on oral administration .
Side effect: it does not produce adverse effect except local irritation.
DOSE: 20 mg capsules given by inhalation 3 to 4 times daily by means
of spinhaler.
Uses: allergic bronchial asthma and allergic rhinitis.
8. KETOTIFEN: It has similar effects as disodium chromoglycate. It acts
by inhibiting airway inflammation induced by platelate inhibiting airway
inflammation induced by platelate activating factor. IT has also an
antihistaminic effect.
Side effects: drowsiness and dry mouth.
9. BECLOMETHASONE DIPROPIONATE: It is corticosteroid which is
effective in chronic asthma. It is administrated as an aerosol. It has a
topical action in bronchial asthma. So it does not produce any systemic
effects. In chronic asthma it is prevented over glucocorticoids. Side
effect: Sometimes it produces local infection of Candida in mouth and
throat.
 NASAL DECONGESTANTS
Nasal decongestion can be produced by sympathomimetic drugs which act on alpha
receptors.These drugs produce vasoconstriction and shrinking of the nasal mucosa.

Properties of an ideal nasal decongestant:

1. It should produce prompt,prolonged and reliable effect.

2. It should not produce nasal irritation.

3. It should not damage nasal cilia.

4. It should not produce after congestion.

5. It should not produce tachyphylaxis.

6. It should be free from side effects.

Most of the nasal decongestants do not satisfy all these requirements.

Drugs used:

Only sympathomimetic drugs which have a specific effects on alpha receptors are used
as nasal decongestants.Ephedrine produces nasal decongestion because of its effect on alpha
receptors.But tachyphylaxis ,after congestion and systemic effects are its disadvatages. It is
used as 0.5 percent solution in normal saline. The other drugs (Which act only on alpha
receptors) are:

1. Phenylephrine
2. Xylometazoline hydrochloride
3. Oxymetazoline
4. Taumine sulphate
5. Taumino heptane

Some times the nasal decongestants are combined with antihistamines ,corticosteroids
and antibiotics.These preparations have doubtful efficacy.