1. Nonsteroidal antiasthma agents
Pharmacology
Anti inflammatory different mechanism of action that corticosteroids

2. What do they do? Prophylactic management of mild persistent asthma
So they can get on with life!!

3. Antigen-antibody reaction
Asthmatics essentially have an allergic response to triggers
Components to reaction
Increased capillary permeability
Increased mucus production
Inflammation and edema
Bronchospasm
Mast cells are the keepers of Histamine. When antigen-antibody reactions happen the mast cells degranulates and release histamine

4. Nonsteroidals
Control, never relieve symptoms for asthmatics that benefit from anti-inflammatory agents
If a patient uses a β2-agonist more than 2/week they need a controller in their regime

5. Extrinsic Asthma
Extrinsic asthma is an allergic asthma that involves mast cells and immunoglobin E (IgE), as well as an antigen antibody complex.
Younger subjects

6. Extrinsic Asthma (cont)
Activation of T-lymphocytes stimulates the production of IgE by B-lymphocytes.
This antibody binds to the antigen which attaches to the mast cell.
The mast cell releases mediators of inflammation
Preventing the allergic reaction from happening

7. Intrinsic Asthma Non-allergic Adults and usually has a late onset
Associated with asthma progressing and releasing cytokines
Cromolyn good prophylactic
Nonallergic asthma attack- cold air, infections, stress, exercise, emotional stimuli and some things we DO NOT know
Something in the body stimulates the mast cells to degranulate and release histamine

8. Mediator Antagonists
Mediator antagonists came around to control inflammation without exposing the patient to all the side effects from systemic steroid use.
Cromolyn Sodium, Nedocromil, Zafirlukast, and Zileuton are examples of mediator antagonists.

9. Cromolyn Sodium Brand name – Intal
Indications – Prophylactic management bronchial asthma, prevention of exercised induced asthma, and allergic rhinitis. Not to be used during acute bronchospasm.
Mode of action – Stabilizes the mast cell.
Dosage – DPI 20 mg capsule, MDI 800 μg/inh 2 puffs, solution for SVN 20mg/2 ml vial, frequency QID
Side effects – very few,
DPI/MDI throat irritation, hoarseness, dry mouth, cough, chest tightness
SVN cough nasal congestion, wheezing, sneezing, nasal itching, epitaxis, or nose burning
Why not used in acute bronchospasm??
DOES NOT OPERATE ON cAMP therefore no alpha or beta receptor site stimulation
Intal is protective. And protection is does dependant 80mg/day. MAY get to reduce to mg/day. If stimulus increases may need more rescue agent use. Use DPI 60 min prior to exercise. Or 2 puffs MDI.
Cromolyn can help with the late phase bronchoconstrtiction
Effectiveness like theophylline, without S/E and narrow therapeutic margin
If attempting to replace oral steroids what things should be taken into consideration? Still must taper steroids. Intal cannot help HPA suppression
This drug can cause bronchospasm. So it goes without saying that in that case administer what prior to Intal.

10. Nedocromil Brand name – TiladeR
Indications – Prophylactic for mild to moderate asthma.
Mode of action – Inhibits activation and activity of numerous inflammatory cells, including mast cells, eosinophils, airway epithelial cells, and sensory neurons. No bronchodilating effect
Dose – MDI 2mg/inh 2 puffs QID
Side effects – unpleasant taste, headache, nausea, vomiting, dizziness.
1992
Prophylactic aerosols to prevent the inflammatory response in asthma
Mast cell stabilizer “Cromolyn like”, with anti-inflammatory. Very useful in extrinsic (allergic) Management chronic bronchitis and asthma
NO bronchodilating ability “Controller”
Neither pass into CNS actually come out of the body in the same form they went in! Yeah less S/E
Absorbed well by the lungs but has LOW bioavailability to the systemic system

11. Zafirlukast Brand name – AccolateR
Indications – Prophylactic treatment of asthma caused by exercise, cold air, allergens or aspirin
Mode of Action – Leukotriene inhibitor.
Dose – 20 mg tablet BID
Side effects – headache, infection, diarrhea, generalized and abdominal pain.
Leukotrienes lipid mediators for inflammation, potent bronchoconstrictors and bully other cells, causing edema and mucus secretions and inhibiting cilliary beat and recruit other inflammatory cells .
Leukotriene receptor antagonist

12. Montelukast Brand name- Singulair
Indications- prophylaxis and control for asthma (approved for kids)
Mode of action- Leukotriene inhibitor.
Dose-10 mg tablet and 4 and 5 mg chewable cherry flavored tablet. To be taken in the evening
Side effects-diarrhea, laryngitis, pharyngitis, nausea, otitis, sinusitis,

13. Zileuton Brand name – Zyflo
Indications – Prophylactic treatment of asthma
Mode of action - Leukotriene inhibitor
Dose – 600mg tablet QID
Side effects – headache, general pain, abdominal pain, loss of strength, and dyspepsia.

14. Anti-leukotriene Controlling asthma from triggers Exercise induced
Aspirin induced
Allergen induced
Exercise induced- cooling and drying of AW’s=leukotrienes-= bronchoconstriction
Increased leukotriene resulting from aspirin
Block early phase and attenuate late phase

15. Why do steroids still exist?
Anitleukotrienes – limited pathway action
Steroids- broader anti-inflammatory response
Used together results in the most improvement and decreases steroid doses necessary.
Less S/E

16. Anti leukotrienes Never acute treatment Alternative to corticosteroids
Decreases corticosteroid doses

17. Getting back to fun!!