1. EBL Oral Presentation - Asthma By: Arun Khurana, Rachel O’Neill, Elizabeth Warnock, Zunnair Alam, Wing Chan Academic Advisor : Karen Hassell

2. Adrenoreceptor agonists Adrenergic receptor agonists are a class of drugs used to treat asthma and other pulmonary diseases. These drugs act on the adrenogenic receptors causing smooth muscles to relax, which results in dilation of bronchial passages. Adrenoreceptor agonists are most commonly used to treat asthma. Beta-2 adrenergic agonists are most often administered by inhaling from a pressurized- metered dose inhaler.

3. Orciprenaline Sulphate Form: A white crystalline powder MW: 2(C 11 H 17 NO 3 ). H 2 SO 4 = 520.29 Melting point: about 205°C When treating asthma it is given by mouth in a dose of 20mg four times daily. Orciprenaline sulphate also comes in the form of an inhaler or in severe cases of bronchiospasm it can be administered directly as an intramuscular injection. Orciprenaline suphate, being only partially selective, affects receptors elsewhere in the body and can cause many undesirable side-effects such as arrhythmias, tachycardias and anxiety attacks. A Public Assessment report published by the MHRA (Medicines and Healthcare products Regulatory Agency) in November 2009 decided that orciprenaline sulphate (Alupent®) should no longer be used in the treatment of asthma. The MHRA is currently working with the manufacturer to carry out a voluntary withdrawal of Alupent® over the next year.

4. Salbutamol Metabolism: Hepatic Half-Life: 1.6 hours Excretion: Renal Formula: C 13 H 21 NO 3 = 239.311 It is marketed by GlaxoSmithKline as Ventolin, Aerolin or Ventorlin. Salbutamol was the first selective Β2-receptor agonist to be marketed — in 1968. It was first sold by Allen & Hanburys under the brand name Ventolin. Salbutamol is specifically indicated by Acute asthma. The most common side effects are of fine tremor, nervousness, headache, muscle cramps, dry mouth and palpitation. The selectivity of Salbutamol depends on the dose given. Inhalation of drugs aids selectivity as it delivers small but effective doses to the airways thus helping in minimizing systemic exposure. After inhalation, the onset of drug action takes an intermediate amount of time ( bronchodilation is produced for about 6 hours ).

5. Ephedrine Hydrochloride Melting Point: 216 o C-222 o C Molecular formula: C 10 H 15 NO,HCl =201.7 It exists as colourless crystals or a white crystalline powder. Ephedrine hydrochloride helps to relieve the symptoms caused by asthma. It helps to relax the smooth muscles present in the lungs, this is turn allows the bronchial discharge to flow out from the bronchial tubes to generate more cough. Dosage: This medication should be taken 3 times a day, by mouth. It may take a few hours before the full benefit of the drug takes effect. Athletes all over the world use ephedrine chloride not only to boost energy levels, but to help lower their weight by the reduction of body fat. Ephedrine noticeably stimulates the central nervous system, increasing the heart rate and has an overall heat producing effect on most tissues in the body.

6. Salmeterol (Severent) Salmeterol helps to treat and manage Bronchospams, Nocturnal asthma, Chronic Asthma and Chronic obstructing pulmonary disease (COPD). It is known as a “LABA”. Salmeterol works by attaching itself to particular beta 2 receptors. Specific secondary binding sites on the beta 2 receptors are targeted by Salmeterol molecules. As a result of this bronchial muscle is relaxed, bronchodilatation is promoted The dosage of Salmeterol depends on which problem it is being used to treat. In the form of Inhalers it can treat: Asthma- 50 micrograms (1 blister/2 puffs) twice daily. COPD- 50 micrograms (1 blister/2 Puffs) twice daily. Salameterol in all forms costs £29.26. C 25 H 37 NO 4

7. Terbutaline Sulphate Form: white to greyish-white crystalline powder. MW:(C 12 H 19 NO 3 ) 2,H 2 SO 4 =548.6 M.p.:246° to 248° Dose: 500micrograms (1 inhalation), up to 4 times daily. The inhaled form of terbutaline starts working within 15 minutes and can last up to 6 hours. Mode of action: Terbutaline works by acting on receptors in the lungs called beta-2 receptors. When salbutamol stimulates these receptors it causes the muscles in the airways to relax. This allows the airways to open. When a patient gets an asthma attack, it is difficult for air to get in and out of the lungs. By opening the airways, salbutamol makes it easier to breathe. Methods: By mouth, subcutaneous or slow intravenous injection, continuous intravenous infusion, inhalation of powder (Turbohaler®) and inhalation of nebulised solution. Side Effects: Fine tremor, nervous tension, headache, peripheral vasodilation (widening of the veins) and fast heart rate.

8. DrugStatepKa Terbutaline SulphateA white to greyish-white crystalline powder 8.7, 10.0, 11.0 Orciprenaline SulphateA white crystalline powder 9.0, 10.1, 11.4 SalbutamolA white powder9.3, 10.3 Ephedrine Hydrochloride Colourless crystals or a white crystalline powder 9.6 SalmeterolA white to off-white powder 9.9 Drug Comparisons

9. The economic impact of asthma Direct costs Hospital costs Costs of home care Alternative medicine Nursing home costs Ambulance callouts Indirect costs Time spent by others caring for sick relatives Physical resources – e.g. the number of missing days lost or the number of premature deaths Short-term absence due to sickness Long-term absence such as early retirement The value of a lost school day Costs of unpaid input

10. The social impact of asthma There were 1,200 deaths from asthma in the UK in 2006. On average, three people per day or one person every seven hours dies from asthma. The effects of asthma on children and adolescent’s social lives are very profound, as they interfere with the children’s ability to play, participate in school activities and form friendships and relationships. Studies show that one in three 7 year old children who suffered from asthmatic symptoms had missed more than 50 days' schooling as a direct result of asthma. Some adults find their asthma is made worse by dust or fumes at work. This is known as work-aggravated asthma.

11. Thank you for listening to our presentation. We hope you found it informative. Please feel free to ask any questions.