Asthma – diseases of the respiratory system

The most common symptoms are: wheezing, coughing and coughing up a sticky transparent discharge, shortness of breath, which often worsens at night, and a tight feeling in the chest. The occurrence of these problems is caused by the bronchial hyperreactivity (hypersensitivity) and the excessive tendency to bronchospasm under the influence of various factors – such as chemicals, cold air or drugs. If specific allergens are the factor causing bronchospasm, then we are dealing with allergic asthma. Severe seizures can cause hypoxia and be life-threatening.

Aspirin-induced asthma can also be distinguished, which is defined as asthma with hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs).

This is because acetylsalicylic acid and most NSAIDs are strong inhibitors of COX-1 and COX-2 cyclooxygenase, which are part of the arachidonic acid pathway. In hypersensitive people, prostaglandin synthesis and leukotriene overproduction are inhibited, which in turn trigger the activation of pro-inflammatory cells and are responsible for bronchospasm.

The most commonly used medications in respiratory diseases include:

• glucocorticosteroids (GKS),
• β2- adrenomimetics,
• inhaled cholinolytics,
• anti-leukotriene drugs (montelukast),
• methylxanthines (theophylline),
• phosphodiesterase-4 inhibitors (roflumistat),
• antihistamines,
• mucolytics,
• antitussive drugs (dextromethorphan, butamirate),
• antibiotics (tobramycin).

In the pharmacotherapy of asthma, therapeutic agents have been used that can be divided into many groups:

Controlling Asthma – Used Regularly:

• inhaled glucocorticosteroids (GCs), which include: FLUTICASONE, MOMETASONE, BECLOMETASONE, BUDESONIDE, CYCLEZONIDE. Recommended for medications to control asthma. Their mechanism of action is based on blocking phospholipase A2, thus reducing the release of arachidonic acid and reducing the synthesis of leukotrienes and prostaglandins, thus inhibiting the inflammatory process. They work locally and are ineffective in asthma attacks. The side effects include oral candidiasis, therefore, after taking the dose, rinse your mouth with water and wash your dentures.
• long-acting β2-mimetics (LABA) – FORMOTEROL AND SALMETEROL. They stimulate β2 receptors in the bronchi, thereby relaxing and dilating smooth muscles. They should not be used without inhaled GKS. May cause headache, tremors, hypokalemia, palpitations (but less frequently than in SABA)
• tiotropium (an anticholinergic drug) -tiotropium bromide is a muscarinic receptor antagonist. Long-lasting bronchodilation (up to 24 hours), it is not used in stopping an asthma attack. Used with GKS. May cause dry mouth.
• montelukast (anti-leukotriene), binds selectively and strongly to the leukotriene receptor, the potent eicosanoids released from mast cells. It effectively relieves inflammation in bronchial asthma, and also reduces bronchospasm and mucus secretion. It is used together with GCS in grade 2-3 asthma
• theophylline (methylxanthine). It relaxes the smooth muscles of the bronchi and blood vessels, stimulates the respiratory and vasomotor centers. It has a positive chronotropic effect on the heart and increases diaphragm contractility (COPD). It is contraindicated in acute myocardial infarction, hypertension, tachyarrhythmia, gastric ulcer. Theophylline excretion is increased in smokers.
• Cromones in this group include: DISODIUM CRROMOGLICATE, SODIUM NEDCROMILE. They are ineffective, used less frequently, in less severe cases. Their effectiveness is based on limiting the penetration of calcium ions through the membrane of mast cells and thus inhibit their degranulation. They prevent the occurrence of shortness of breath. They don’t stop the asthma attack, they can even make it worse.

Emergency medications – symptomatic

• Inhaled fast and short-acting β2 agonists (SABA), – fenoterol, salbutamol

Recommended only for asthma symptoms control or for the prevention of exercise-induced bronchospasm. Their onset of action begins after a few minutes and the peak after about 15 minutes, so they quickly relieve symptoms. The pharmacological effect lasts for 4-6 hours. Combined preparations containing formoterol and a low dose of inhaled glucocorticosteroids (budesonide or beclometasone) can be used both regularly (as a control treatment) and on an ad hoc basis.

• bromek ipratropium znalazł zastosowanie u chorych nietolerujących β2-mimetyków, a w zaostrzeniu astmy jako lek dodatkowy. Podany wziewnie działa po 15 min przez 4-6 h.

Used in severe cases:

• oral GCS in this group include prednisone (Encorton), prednisolone (Encortolone), methylprednisolone (Medrol, Meprelon, Metypred). Due to the possibility of serious side effects, the patient should be informed about the consequences of their use, e.g. weight gain, osteoporosis, muscle wasting, skin (the most common complications), menstrual disorders, furunculosis, candidiasis, urinary tract infection. GKS – inhibit wound healing, should not be used on open wounds. It should be administered orally once a day in the morning while continuing to use inhaled glucocorticoids.
• omalizumab (anti-IgE antibody). According to reports, it reduces the histamine surge by 90% after stimulation with an allergen. It is administered subcutaneously
• reslizumab and mepolizumab (anti-IL5 antibodies),

Asthma and other respiratory diseases constitute a large group of diseases in society. Incorrect handling of symptoms can have serious health effects, so if we notice the first symptoms, we should consult a specialist in order to make an appropriate diagnosis and possible implementation of pharmacotherapy.

Literature:

• E. Mutschler, G. Geisslinger, H. K. Kroemer, P. Ruth, Mutschler Pharmacology and Toxicology.
• A. Szczeklik, P. Gajewsk, Interna Szczeklik.
• Pharmacodynamics, a textbook for Students of Pharmacy