Jiří Slíva M.D.

Absolute number of patients suffering from AB in Czech. Rep. Period Number of patients

THE MOST IMPORTANT ALERGENES

JANUARY FEBRUARY MARCH APRIL MAY 1. DEC. 2. DEC. 3. DEC. Pollen situation of„Alnus glutinosa“ in the Europe

DIAGNOSIS 1. ANAMNESIS 3. LABORATORY TESTS 2. CLINICAL FEATURES 4. ALLERGOLOGICAL TESTS

own pharmacoterapy life style specific imunotherapy symptomatic antiinflammatoric preventive

sympatomimetics anticholinergics corticosteroides methylxantines antileucotriens antihistamines Groups of drugs:

β-mimetics - nonselective - adrenaline, isoproterenol, orciprenaline, ephedrine - selective - metaproterenol, albuterol, salbutamol, terbutalin, fenoterol => more effective via inhalation then per os administration => increase of cAMP Parasympatolytics ipratropium Antiasthmatics with rapid effect:

theophylline - myotropic influence via inhibition of phosphodiesterase and via influence on the adenosine receptors A 2 => bronchodilatation => prevention from bronchoconstriction caused by histamine, cholinergic agonists (metacholine) or exertion. Aminophylline = theophylline + ethylendiamine Methylxantines :

 inhibition of degranulation of mastocytes after exposition to specific agents  full effect after 4-6 weeks Drugs used for prevention and maintained treatment: cromoglycate sodium nedocromil similar to cromoglycate in mechanism of action

β 2 -mimetics with long-term effect: via inhalation salmeterol and formoterol via per os ( tabl, sirup) klenbuterol, prokaterol, salbutamol Teophylline with prolonged releasing

zafirlukast zileuton montelukast Antileucotriens = Leucotriene Receptor Antagonists (LTRAs):

beklometasone budesonide flunisolide fluticasone triamcinolone  potent antiinflammatory effect  decrease of number of inflammatory potent cells  inhibition of bronchoconstrictory mechanisms  direct relaxation of smooth muscle cells Corticosteroids:

astemizole (Hismanal) clemastine terphenadine ketotifen (Zaditen)  reversible competitive antagonists of H-receptors Antihistamines:

verapamile (Isoptin) nifedipine others  inhibition of calcium influx => inhibition of contraction of smooth muscle cells  induction of bronchodilatation  used experimentaly Inhibitors of calcium channels:

Comparison of numbers of drugs used in therapy of bronchial asthma