1. Krómóglýköt ( Chomoglycates) Sigurður Ragnarsson stud. med.

2. Langtíma meðferð við astma Barksterar Barksterar –budesonide –fluticasone Leukotrien blokkar Leukotrien blokkar –safirlukast –montelukast β 2 -agonistar β 2 -agonistar –langvirkir formoterolformoterol salmeterolsalmeterol –stuttvirkir (per necesitas) Methylxanthines Methylxanthines –theophylline –aminophylline Krómóglykat Krómóglykat

3. Krómóglýköt Fyfirbyggjandi meðferðFyfirbyggjandi meðferð Minnka immediate og late-phase astma svörun og minnkar hyperreactivity.Minnka immediate og late-phase astma svörun og minnkar hyperreactivity.

4. Verkunarmáti Ekki vitað nákvæmlega hvernig virkar.Ekki vitað nákvæmlega hvernig virkar. Eru ekki bronchodilators, hafa ekki áhrif á slétta vöðva né hindra sléttvöðva- stimulants.Eru ekki bronchodilators, hafa ekki áhrif á slétta vöðva né hindra sléttvöðva- stimulants. “Mast cell stabilizer”“Mast cell stabilizer” Minnkar neuronal reflexaMinnkar neuronal reflexa

5. Ábendingar Áhrifarík meðferð í:Áhrifarík meðferð í: –antigentengdum (atópískum) astma –irritanttengdum astma –áreynslutengdum astma Meiri áhrif í börnum en fullorðnum.Meiri áhrif í börnum en fullorðnum.

6. Lyfjafræði Lélegt frásog um meltingarvegLélegt frásog um meltingarveg Gefið sem innúði.Gefið sem innúði. T ½ 90 mín.T ½ 90 mín. Rapport um urticariu og anaphylaxaRapport um urticariu og anaphylaxa

7. Krómóglyköt Cromylin sodium Nedochromil fullorðnir börn og fullorðnir

8. ICS versus SCG inhaled corticosteroids vs. sodium cromoglycate ICS: færri tilvik af astmaversnunumICS: færri tilvik af astmaversnunum betri lungnafunctionbetri lungnafunction færri astmaeinkennifærri astmaeinkenni minni notkun PN berkjuvíkkandi lyfjaminni notkun PN berkjuvíkkandi lyfja lítill munur á alvarleika aukaverkunalítill munur á alvarleika aukaverkuna

9. Cochrane og krómóglýköt Publication biasPublication bias Sami fjöldi einkennalausra dagaSami fjöldi einkennalausra daga “no or only minimal benefit for DSCG compared to placebo as maintanance therapy for childhood asthma”“no or only minimal benefit for DSCG compared to placebo as maintanance therapy for childhood asthma” “day cough, day wheezing, use of rescue oral steroids, and hospital admission, failed to reveal any significant group differences between DSCG and placebo”“day cough, day wheezing, use of rescue oral steroids, and hospital admission, failed to reveal any significant group differences between DSCG and placebo”

10. Heimildir Guevara JP. Ducharme FM. Keren R. Nihtianova S. Zorc J. Inhaled corticosteroids versus sodium cromoglycate in children and adults with asthma. [Review] [121 refs] [Journal Article. Meta-Analysis. Review] Cochrane Database of Systematic Reviews. (2):CD003558, 2006.Guevara JP. Ducharme FM. Keren R. Nihtianova S. Zorc J. Inhaled corticosteroids versus sodium cromoglycate in children and adults with asthma. [Review] [121 refs] [Journal Article. Meta-Analysis. Review] Cochrane Database of Systematic Reviews. (2):CD003558, 2006. Spooner CH. Spooner GR. Rowe BH. Mast-cell stabilising agents to prevent exercise- induced bronchoconstriction. [Review] [79 refs] [Journal Article. Meta-Analysis. Review] Cochrane Database of Systematic Reviews. (4):CD002307, 2003.Spooner CH. Spooner GR. Rowe BH. Mast-cell stabilising agents to prevent exercise- induced bronchoconstriction. [Review] [79 refs] [Journal Article. Meta-Analysis. Review] Cochrane Database of Systematic Reviews. (4):CD002307, 2003. van der Wouden JC. Tasche MJ. Bernsen RM. Uijen JH. de Jongste JC. Ducharme FM. Inhaled sodium cromoglycate for asthma in children. [Review] [180 refs] [Journal Article. Review] Cochrane Database of Systematic Reviews. (3):CD002173, 2003.van der Wouden JC. Tasche MJ. Bernsen RM. Uijen JH. de Jongste JC. Ducharme FM. Inhaled sodium cromoglycate for asthma in children. [Review] [180 refs] [Journal Article. Review] Cochrane Database of Systematic Reviews. (3):CD002173, 2003. Kelly K. Spooner CH. Rowe BH. Nedocromil sodium vs. sodium cromoglycate for preventing exercise-induced bronchoconstriction in asthmatics. [Review] [28 refs] [Journal Article. Review] Cochrane Database of Systematic Reviews. (4):CD002731, 2000.Kelly K. Spooner CH. Rowe BH. Nedocromil sodium vs. sodium cromoglycate for preventing exercise-induced bronchoconstriction in asthmatics. [Review] [28 refs] [Journal Article. Review] Cochrane Database of Systematic Reviews. (4):CD002731, 2000. Tasche MJ. Uijen JH. Bernsen RM. de Jongste JC. van der Wouden JC. Inhaled disodium cromoglycate (DSCG) as maintenance therapy in children with asthma: a systematic review. [see comment]. [Review] [58 refs] [Journal Article. Review] Thorax. 55(11):913-20, 2000 Nov. UI: 11050259Tasche MJ. Uijen JH. Bernsen RM. de Jongste JC. van der Wouden JC. Inhaled disodium cromoglycate (DSCG) as maintenance therapy in children with asthma: a systematic review. [see comment]. [Review] [58 refs] [Journal Article. Review] Thorax. 55(11):913-20, 2000 Nov. UI: 11050259 Chipps BE. Chipps DR. Approach to the difficult pediatric asthmatic. [Review] [32 refs] [Journal Article. Review] Current Opinion in Pulmonary Medicine. 5(1):52-7, 1999 Jan.Chipps BE. Chipps DR. Approach to the difficult pediatric asthmatic. [Review] [32 refs] [Journal Article. Review] Current Opinion in Pulmonary Medicine. 5(1):52-7, 1999 Jan. Godfrey S. Konig P. Inhibition of exercise-induced asthma by different pharmacological pathways. [Review] [23 refs] [Clinical Trial. Journal Article. Review] Thorax. 31(2):137-43, 1976 Apr.Godfrey S. Konig P. Inhibition of exercise-induced asthma by different pharmacological pathways. [Review] [23 refs] [Clinical Trial. Journal Article. Review] Thorax. 31(2):137-43, 1976 Apr.

11. Skammtíma meðferð í astma Stuttvikir β 2 -agonistar (per necesitas)Stuttvikir β 2 -agonistar (per necesitas) –salbutamol Andcholinergisk lyfAndcholinergisk lyf –ipratropium Barksterar per os (3-10 dagar)Barksterar per os (3-10 dagar) –prednisolone