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drug therapy asthma quick relief
inhalative quick-acting b-adrenergic agonists : most effective therapy
onset : 5 minutes or less peak effect : 30 to 60 minutes duration of action : 4 to 6 hours
anticholinergic bronchodilators : not recommend for quick relief
onset : 20 to 30 minutes less effective indication intolerance to all b-agonist bronchodilators asthmatic attacks induced by bets-blocker long-term control achieving good long-term control of asthma avoidance of environmental stimuli monitoring of changes in disease activity use of controller medication inhaled corticosteroids antiinflammatory activity
fewer mast cell, eosinophils, t lymphocytes dendritic cell in the mucosa and submucosa
reduce goblet-cell hyperplasia and epithelial-cell injury
decrease vascularity benefit fewer asthmatic symptoms increase lung function improve asthma-specific qol fewer asthmatic exacerbation
long-term use 가 진행을 막는다는 근거는 부족하다
염증을 억제할 수 있지만 완치는 되지 않으며, 사용중단 2주후에는 반응이 원래의 상태로 돌아온다.
in smoker : less effective
nuetrophilic inflammation : less effective than eosinophilic inflammation
complication skin bruising, cataract, loss of bone mass gross retardation
first year, growth decreases by an average of approximately 1cm
but ultimately reach their normal predicted height
sore throat, coughing, weak or hoarse voice, candidiasis
rinsing the mouth, using a valved holding chamber
dysphonia due to laryngeal edema, mucosal thickening or poosibly myopathy
temporary cessation, change in aerosol generation and flow patern
strategy
achieve asthma control without using high doses of inhaled corticosteroids are desirable and reduction of the inhaled-corticosteroid dose in patients with well-controlled asthma can often be achieved without diminishing asthma control
inhaled long-acting b-agonist bronchodilators potent bronchodilator activity : more than 12 hours
less overdosing complication than theophylline overdosing
long-acting b-agonists should not be used without concomitant antiinflammatory therapy in the treatment of asthma
more effective in reducing daytime and especially night time symptoms, improving lung function, reducing the risk of exacerbations, and minmizing the required dose of inhaled corticosteroids
onset formoterol 5 minutes salmeterol 15 to 20 minutes
combination formoterol-inhaled-corticosteroid inhaler
for quick relief of asthmatic symptoms and for long-term control
formoterol : full agonist b receptor salmeterol : partial agonist leukotriene modifiers
cysteinyl leukotriene-receptor antagonist : montelukast, zafirlukast, pranlukast (이하 생략)
