DRUGS CONTRA-INDICATED IN ASTHMA;

CLINICAL SIGNIFICANCE
AND APPROPRIATE INTERVENTIONS

DISSCUSSANT: ODOEMENA CHIBUEZE .A

MODERATOR: PHARM . B. IVIENAGBOR
 OUTLINE

 Introduction
 Risk factors
 Drugs contraindicated in asthma; clinical significance and
interventions
 Conclusion
 Reference
 INTRODUCTION

ASTHMA: is a common disease associated with

chronic inflammatory disorder of the airways
which leads to recurrent episodes of wheezing,
breathlessness, chest tightness and coughing.
(Azuka et al 2011).
• It is estimated that approximately 235 million people worldwide
were affected by asthma and roughly 250,000 people die per year
from asthma-related causes. (Gina 2011)
• Low and middle income countries make up more than 80% of the
mortality.(WHO 2007)
 Risk factors

Modifiable risk factors

Allergic conditions. Smoking

Genetics Body mass.

Non-modifiable risk
factors
 DRUGS CONTRAINDICATED IN ASTHMA; CLINICAL SIGNIFICANCE
AND APPROPRIATE INTERVENTIONS

Drug Effect Mechanism of Clinical Interventions

contraindi action significance
cated in
asthma
Nsaids e.g Broncho- Derivative of major • Avoid aspirin
Aspirin,cele constriction arachidonic acid • Desensitiztion of aspirin
-coxib, metabolism. • Recommend Salsate
Diclofenac, Sanfiorenzo et al(2011) paracetamol,chloroquine,
Naproxen are used as alternatives at
ketoprofen recommended dosages.
Scezeklik et al(1975)&
Dahl et al(1986)
 DRUGS CONTRAINDICATED IN ASTHMA; CLINICAL SIGNIFICANCE
AND APPROPRIATE INTERVENTIONS CONTD…
Drug Effect Mechanism of Clinical Interventions
contraindicated action significance
in asthma

ACE inhibitors eg Broncho- Kinins cause Moderate •Avoid angiotensin

Lisinopril, constriction bronchoconstriction converting inhibitors
captopril directly on smooth •Calcium channel
muscle or indirectly blockers like
by inflammatory amilodipine are used
properties as alternatives.
•Angiotensin receptor
blockers like
valsartan can be used
as alternatives.
 DRUGS CONTRAINDICATED IN ASTHMA; CLINICAL SIGNIFICANCE AND
APPROPRIATE INTERVENTIONS CONTD…

Drug Effect Mechanism of Clinical Interventions

contraindicated in action significance
asthma

Beta-blockers e.g Broncho- Blockade of Serious •Avoid propanolol

Propanolol constriction bronchial smooth •If atenolol is the only
Atenolol muscle. option it should be
Nebivolol Piquet et used in low doses. as
Bisoprolol al(2011) it is cardioselective.
Labetalol Sanfiorenzo et
Carvedilol al(2011)
timolol •Calcium channnel
blockers eg
amilodipine are also
alternatives and the
safest.Joel et al(1994)
DRUGS CONTRAINDICATED IN ASTHMA; CLINICAL SIGNIFICANCE AND
APPROPRIATE INTERVENTIONS CONTD….

Drugs Effect Mechanism of Clinical Interventions

contraindicated action significance
in asthma

Cholinesterase Broncho- Increased Serious •Administer

inhibitor e.g constriction activity of glycoprrolate to
neostigmine cholinergic nerve mask or reduce
ambenonium Sanfiorenzo et muscarinic effect
al(2011) of neostigmine.
BNF(2011)
•Edrophonium,
•Sugammadex
sodium is used as
alternative.Juan et
al(2022)
 DRUGS CONTRAINDICATED IN ASTHMA; CLINICAL SIGNIFICANCE AND
APPROPRIATE INTERVENTIONS CONTD…

Drug Effect Mechanism of action Clinical Interventions

contraindicated in significance
asthma

Antiarrhythmic agent Broncho- Powerful vago mimetic Serious •Avoid

(adenosine constriction effect. adenosine
triphosphate) Sanfiorenzo et al(2011) triphosphate
•Slow infusion
of calcium
channel blockers
eg verapamil is
recommended.
S.lim et al(2009)
DRUGS CONTRAINDICATED IN ASTHMA; CLINICAL SIGNIFICANCE AND
APPROPRIATE INTERVENTIONS CONTD….

Drugs Effect Mechanism of Clinical Interventions

contraindicated action significance
in asthma
Opiods eg. Broncho- Activity on the moderate •Paracetamol is
Tramadol, constriction respiratory suggested as drug
Pentazocine center at the base of choice.
Pethidine of the brain •Dexamethasone
Fentanyl can be taken alone
morphine or as an adjuvant
with paracetamol.
BNF(2011)
Smooth muscle Broncho- Not known moderate Suxamethonium,
relaxants eg constriction Pancronium are
Atracurium better alternatives.
Mivacurium BNF(2011)
DRUGS CONTRAINDICATED IN ASTHMA; CLINICAL SIGNIFICANCE AND
APPROPRIATE INTERVENTIONS

Drugs Effect Mechanism of Clinical Intervention

contraindicated action significance
in asthma
Barbiturates eg Broncho- Not known moderate Propofol
Thiopental constriction Ketamine
Halothane
Isoflurane are
alternatives in
asthmatics.
BNF(2011)
 Conclusion

Asthma is characteristically severe and steroid dependent,

desensitization has always been proposed as the first
step to tackle asthma triggered by aspirin . The
cardioselectivity of beta blockers disappears on adminstration
of high doses while low doses of cardioselective beta blockers
should be monitored despite been safer.
 REFERENCE

• Azuka oparah et al, (2011) Essentials of pharmaceutical care

• British national formulary (2011)
• Dahl R et al1986) Sodium salicylate and aspirin disease
35;155-156
• Gina, (2011) Global strategy of asthma management and
prevention
• Joel s. et al (1994) Drug induced asthma.
• World Health Organization. "WHO: Asthma". Archived from the
original on 15 December 2007. Retrieved 2007-12-29.
• Sanfiorenzo et al(2011) Exacerbations of asthma-precipitating
factors; Drugs
• Scezekilik et al(1990) Choline magnesium trisalicylate in
patients with aspirin induced asthma. Pg 535-559