Long-Acting Beta Agonists: Salmeterol and Formeterol

Salmeterol and Formeterol
Two long-acting ß 2 -adrenergic agonists (LABAs), salmeterol and formoterol, have been demonstrated to be safe and effective agents in children, both in terms of bronchodilation and prevention of exercise-induced bronchospasm. Their onsets of action differ, with formoterol having an onset similar to albuterol (3 minutes), while salmeterol has a slower onset of action (10–20 minutes). Following a single-dose administration, both agents demonstrate durations of action up to 12 hours. Following regular twice-daily administration, bronchodilation remains effective; however, a level of tolerance (or tachyphylaxis) (more…)

Cromolyn, Nedocromil, Theophylline: Asthma Medications

asthma medications
Cromolyn sodium and nedocromil sodium are inhaled agents that are alternatives to inhaled corticosteroids (ICS) in the management of mild persistent asthma in children. Both drugs have been shown to possess anti inflammatory properties through nonsteroidal mechanisms, although the exact mechanisms for their actions remain unclear. (more…)

Aspirin-Induced Asthma Treatment with Antileukotrienes

Aspirin Asthma
The prevalence of aspirin-sensitive asthma is uncertain although it may exist in up to 20% of all asthmatics patients. The characteristic features include profound bronchoconstriction asthma following aspirin ingestion, rhinosinusitis, nasal polyps, and abdominal cramps. Aspirin and nonsteroidal antiinflammatory drugs selectively inhibit COX-1, which in turn shunts arachidonic acid down the 5-lipoxygenase activating protein pathway, causing overproduction of cysteinyl leukotrienes. As a consequence, elevated levels of cysteinyl leukotrienes can be found in bronchial asthma and nasal aspirates, and in urine following aspirin challenge. (more…)

Requirement for Leukotriene B4 Receptor 1 in Allergen-Induced Airway Hyper-Responsiveness

Airway Hyper-Responsiveness
A role for Leukotriene B4 in the induction of airway hyper-responsiveness was explored through the use of transgenic mice deficient in the BLT1 receptor for LTB4 . Ovalbumin challenge of sensitized wild-type mice resulted in the usual features of experimental asthma, including goblet cell hyperplasia, hyper-responsiveness to inhaled methacholine and elevated BAL fluid concentrations of the Th2 cytokine IL-13. In contrast, BLT1 –/– mice (i.e. genetically modified mice lacking the gene coding for the BLT1 receptor) exhibited significantly lower responses. BLT1 –/– mice also exhibited lower numbers of IL-13-positive T lymphocytes of both the helper (CD4 T Cells) and cytotoxic/suppressor (CD8 + ) types. (more…)

Long Acting Agonist (ß2) Therapy to Inhaled Corticosteroids in Persistent Asthma?

long acting agonist
Current internationally recognized guidelines indicate that symptomatic asthmatics using a low to medium inhaled corticosteroid dose (400–800 µg/day of beclomethasone or equivalent) alone should preferentially be commenced on a long-acting agonist ß2 prior to an leukotriene receptor antagonists LTRA (British guideline on the management of asthma 2003; GINA Workshop Report 2004). However, two recent large trials have performed head to-head comparisons of add-on long-acting ß2 agonist versus LTRA as therapeutic adjuncts to inhaled corticosteroids, using exacerbation frequency (rather than lung function and symptoms) as the primary end point. (more…)

Antileukotriene Drugs for Airway Hyperresponsiveness & Asthma Treatment

antileukotriene
A variety of proinflammatory cells, mediators, and cytokines orchestrate the development of airway hyperresponsiveness, which results in the episodic airflow obstruction characteristic of asthma. As a consequence, modulation of the underlying disease process with antii-nflammatory agents is firmly established as being the cornerstone of successful management. Inhaled corticosteroids are the most potent antiinflammatory agents available and satisfactorily suppress underlying airway inflammation in most individuals. (more…)

Roflumilast Phosphodiesterase 4 Inhibitor, Attenuates Allergen-Induced Asthmatic Reactions

Roflumilast Phosphodiesterase
Roflumilast is an oral, once-daily inhibitor of phosphodiesterase type 4 (PDE4) that prevents the breakdown of cyclic adenosine monophosphate (cAMP) levels, leading to inhibition of pro-inflammatory signalling. This study investigated the effects of repeated doses of 250 or 500 µg of roflumilast on airway asthma responses to allergen. (more…)

Long Acting Beta-Agonist Bronchodilator Tolerance

Regular use of ß-agonists has been known to lead to tolerance to their bronchodilator effects. It is not known how quickly tolerance develops or how long it lasts after stopping ß-agonist therapy.

Bronchodilator tolerance occurs after even a single dose and reaches a maximum after 1 week of regular formoterol. Sensitivity recovers 3 days after stopping treatment. (more…)

Effects Of Treatment With Anti-Immunoglobulin E Antibody Omalizumab

IgE plays an important role in allergic asthma. Reducing IgE in the airway mucosa should reduce airway inflammation. Omalizumab has significant anti-inflammatory effect and reduces serum and airway IgE, but IgE or eosinophils may not be causally linked to airway bronchial hyperresponsiveness to methacholine in mild to moderate asthma. (more…)

Nutrition and Risk of Asthma : Vitamins A, C, D, E, Minerals and Antioxidants

nutrition asthma
There is increasing evidence relating body mass index to the prevalence of asthma and incidence of asthma in children and adults, males, and more consistently, in adolescent females. It is unlikely that the association is attributable to reverse causation, i.e. that asthma and obesity because of exercise-induced asthma symptoms. Rather, weight gain can antedate the development of asthma. Weight reduction among asthmatic patients can also result in improvements of lung function. (more…)

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