Asthma treatment

One AEROBID Inhaler System is designed to deliver at least 100 metered inhalations. It is a corticosteroid that is several hundred times more potent in animal anti-inflammatory assays than the cortisol standard. Clinical studies have shown therapeutic activity on bronchial mucosa with minimal evidence of systemic activity at recommended doses. The following observations relevant to systemic absorption were made in clinical studies In one uncontrolled study a statistically significant decrease in responsiveness to metyrapone was noted in 15 adult steroid-independent patients treated with 2 A small but statistically significant drop in eosinophils from 11.

A 5% incidence of menstrual disturbances was reported during open studies, in which there were no control groups for comparison. More than 120 patients have been treated in open trials for two years or more. AEROBID inhaler is NOT indicated for the relief of acute bronchospasm. Hypersensitivity to any of the ingredients of this preparation contraindicates its use
After withdrawal from systemic corticosteroids, a number of months are required for recovery of hypothalamic-pituitary-adrenal (HPA) function. During this period of HPA suppression, patients may exhibit signs and symptoms of adrenal insufficiency when exposed to trauma, surgery or infections, particularly gastroenteritis.

To assess the risk of adrenal insufficiency in emergency situations, routine tests of adrenal cortical function, including measurement of early morning resting cortisol levels, should be performed periodically in all patients. An early morning resting cortisol level may be accepted as normal if it falls at or near the normal mean level. Localized infections with Candida albicansor, Aspergillus nigerhave occurred in the mouth and pharynx and occasionally in the larynx.

Positive cultures for oral Candidamay be present in up to 34% of patients. Although the frequency of clinically apparent infection is considerably lower, these infections may require treatment with appropriate antifungal therapy or discontinuance of treatment with AEROBID Inhaler. AEROBIDInhaler is not to be regarded as a bronchodilator and is not indicated for relief of bronchospasm. During such episodes, patients may require therapy with systemic corticosteroids. Transfer of patients from systemic steroid therapy to AEROBID Inhaler may unmask allergic conditions previously suppressed by the systemic steroid therapy. Persons who are on drugs which suppress the immune system are more susceptible to infections than healthy individuals. Chicken pox and measles, for example, can have a more serious or even fatal course in non-immune children or adults on corticosteroids. In such children or adults who have not had these diseases, particular care should be taken to avoid exposure. If exposed to chicken pox, prophylaxis with varicella zoster immune globulin (VZIG) may be indicated. If chicken pox develops, treatment with antiviral agents may be considered.

Particular care should be taken in observing patients post-operatively or during periods of stress for evidence of a decrease in adrenal function. During withdrawal from oral steroids, some patients may experience symptoms of systemically active steroid withdrawal like joint and/or muscular pain, lassitude and depression, despite maintenance or even improvement of respiratory function. In particular, the effects resulting from chronic use of AEROBID on developmental or immunologic processes in the mouth, pharynx, trachea, and lung are unknown
Inhaled corticosteroids should be used with caution, if at all, in patients with active or quiescent tuberculosis infection of the respiratory tract; untreated systemic fungal, bacterial, parasitic or viral infections; or ocular herpes simplex.

Pulmonary infiltrates with eosinophilia may occur in patients on AEROBID Inhaler therapy. Although it is possible that in some patients this state may become manifest because of systemic steroid withdrawal when inhalational steroids are administered, a causative role for the drug and/or its vehicle cannot be ruled out. Information for Patients:Since the relief from AEROBID Inhaler depends on its regular use and on proper inhalation technique, patients must be instructed to take inhalations at regular intervals.

They should also be instructed in the correct method of use. Persons who are on immunosuppressant doses of corticosteroids should be warned to avoid exposure to chicken pox or measles

www.healasthma.com

Drug Interactions of Beclomethasone dipropionate: No interactions have been reported
with Salbutamol. But Salbutamol and non-selective, beta-blocking drugs such as propranolol should not usually be prescribed together. Pregnancy: Administration of this combination of drugs during pregnancy should only be considered if the expected benefit to the mother is greater than any possible risk to the foetus. During lactation this combination should be used only if the expected benefit to the mother is likely to outweigh any potential risk to the neonate. As AEROCORT Inhaler contains salbutamol and beclomethasone dipropionate, the type and severity of side effects associated with each of the compounds may be expected.

Potentially serious hypokalaemia may result from beta 2 agonist therapy
Common undesirable effects are tremor, headache, and tachycardia. Rare side effects are hypokalaemia, and peripheral vasodilatation. Very rare undesirable effects are hypersensitivity reactions including angio-oedema, urticaria, bronchospasm, hypotension and collapse , hyperactivity, cardiac arrhythmias (including atrial fibrillation, supraventricular tachycardia, and extrasystoles), and paradoxical bronchospasm.As with other inhalation therapy, paradoxical bronchospasm may occur, with an immediate increase in wheezing after dosing. This should be treated immediately with an alternative presentation or a different, fast-acting inhaled bronchodilator Therapy should be discontinued immediately, the patient assessed, and, if necessary, alternative therapy instituted. Uncommon undesirable effects are palpitations, mouth and throat irritation, and muscle cramps.

For Beclomethasone dipropionate very common side effects are candidiasis of the mouth and throat, and hoarseness/throat irritation. Candidiasis of the mouth and throat (thrush) occurs in some patients, the incidence of which is increased with doses greater than 400 mcg beclomethasone dipropionate per day. Patients with high blood levels of Candida precipitins , indicating a previous infection, are most likely to develop this complication
Patients may find it helpful to rinse out their mouth with water after using the inhaler.
Symptomatic candidiasis can be treated with topical anti-fungal therapy while continuing with beclomethasone dipropionate treatment. In some patients, inhaled beclomethasone dipropionate may cause hoarseness or throat irritation. It may be helpful to rinse out the mouth with water immediately after inhalation. Very rare undesirable effects are oedema of the eyes, face, lips and throat, respiratory symptoms (dyspnoea and/or bronchospasm), anaphylactoid/anaphylactic reactions, Cushing`s syndrome, Cushingoid features, adrenal suppression, growth retardation in children and adolescents, decrease in bone mineral density, cataract, glaucoma, paradoxical bronchospasm, anxiety, sleep disorders, and behavioural changes, including hyperactivity and irritability (predominantly in children).

As with other inhalation therapy, paradoxical bronchospasm may occur with an immediate increase in wheezing after dosing. This should be treated immediately with a fast-acting inhaled bronchodilator The beclomethasone dipropionate preparation should be discontinued immediately, the patient assessed, and if necessary, alternative therapy instituted Uncommon undesirable effects are rashes, urticaria, pruritis, and erythema.

Beclomethasone dipropionate : Inhalation of the drug in doses in excess of those recommended may lead to temporary suppression of adrenal function. This does not necessitate any emergency action to be taken. Chronic side effects: Use of inhaled beclomethasone dipropionate in daily doses in excess of 1,500 mcg over prolonged periods may lead to adrenal suppression. Monitoring of adrenal reserve may be indicated.

Salbutamol side effects : Hypokalaemia may occur following overdose with salbutamol
The preferred antidote for overdosage with salbutamol is a cardioselective beta-blocking agent, but beta-blocking drugs should be used with caution in patients with a history of bronchospasm. Generic beclomethasone inhalation aerosols are not yet available
What should your health care professional know before you use beclomethasone
They need to know if you have any of these conditions: infection, such as herpes, measles, tuberculosis or chickenpox an unusual or allergic reaction to beclomethasone, other corticosteroids, other medicines, foods, dyes, or preservatives
breast-feeding.

Salbu­tamol is a beta-adrenergic stimulant that has a highly selective action on the recep­tors in bronchial muscle, resulting in bronchodilation Beclomethasone dipropionate is a synthetic gluco­corticoid with a potent anti-inflammatory activity and weak mineralocorticoid acti­vity. This association of salbutamol and beclomethasone dipropionate is specially provided for those patients who require regular doses of both drugs for treatment of their asthma obstructive airways disease.

Pharmacodynamics AEROCORT Inhaler is a combination of beclomethasone dipropionate and salbutamol, which have different modes of action and show additive effects. Salbutamol: The primary action of beta-adrenergic drugs, including salbutamol, is to stimulate adenyl cyclase, the enzyme which catalyses the formation of cyclic-3,5-adenosine monophosphate (cyclic AMP) from adenosine triphosphate (ATP) in beta-adrenergic cells. The cyclic AMP thus formed mediates the cellular responses
Increased cyclic AMP levels are associated with relaxation of bronchial smooth muscle and inhibition of release of mediators of immediate hypersensitivity from cells, especially from mast cells. Glucocorticoids have been shown to inhibit multiple cell types ( mast cells, eosinophils, basophils, lymphocytes, macrophages, and neutrophils) and mediator production or secretion.

 Because of its gradual absorption from the bronchi, systemic levels of salbutamol are low after inhalation at recommended doses Administration of tritiated salbutamol by inhalation to four subjects resulted in maximum plasma concentrations within 2 to 4 hours Due to the insensitivity of the assay method, the metabolic rate and half-life of elimination of salbutamol in plasma could not be determined. However, data from urinary excretion studies indicated that salbutamol has an elimination half-life of 3.
Approximately 72% of the inhaled dose is excreted in the urine within 24 hours - 28% as unchanged drug and 44% as metabolite. Beclomethasone dipropionate when administered via inhalation there is extensive conversion of beclomethasone dipropionate to the active metabolite, beclomethasone 17-monopropionate (B-17-MP), within the lungs prior to systemic absorption. The systemic absorption of B-17-MP arises from both lung deposition and oral absorption of the swallowed dose.

When administered orally in healthy male volunteers, the bioavailability of beclomethasone dipropionate is negligible, but pre-systemic conversion to B-17-MP results in 41% (95% CI 27-62 %) of the dose being available as B-17-MP.Beclomethasone dipropionate is cleared very rapidly from the systemic circulation, owing to extensive first-pass metabolism. The main product of metabolism is the active metabolite (B-17-MP). Minor inactive metabolites, beclomethasone-21-monopropionate (B-21-MP) and beclomethasone (BOH), are also formed, but these contribute little to systemic exposure. The tissue distribution at steady state for beclomethasone dipropionate is moderate (20L), but more extensive for B-17-MP (424L). Following oral administration of tritiated beclomethasone dipropionate, approximately 60% of the dose was excreted in the faeces within 96 hours, mainly as free and conjugated polar metabolites. AEROCORT Inhaler is contraindicated in patients with a history of hypersensitivity to any of the components of the drug product. AEROCORT Inhaler is not for use in acute attacks, but for routine long-term management; so, some patients will require a separate Asthalin Inhaler for relief of acute bronchospasm. For those patients who are steroid-dependent, it is advisable to commence therapy with beclomethasone diproprionate ( Beclate Inhaler ) as a separate inhaler. Patients who have been weaned in the previous few months from long-term systemic corticosteroids need special consideration until the hypothalamic­-pituitary-adrenal system has recovered sufficiently to enable the patient to cope with emergencies such as trauma, sur­gery, or infections. These patients should also be given a supply of oral steroids to use in an emergency when their airways obstruction worsens.

www.healasthma.com

You may need to regularly take long-term control medications to prevent flare-ups and short-term “rescue” medications to control symptoms once they start.  The more you learn about your asthma the better you can manage it by: following a personal written asthma action plan developed with your doctor taking asthma medications as advised by your doctor even when you are well finding out what triggers your asthma and avoiding these triggers where possible seeing your doctor for regular check-ups to monitor and control your asthma Even when you are well, you should see your doctor regularly so that they can review your asthma and change your medication if necessary.  Taking in to account your own level of asthma and your current asthma medications, your doctor will work with you to develop a personalized written asthma action plan.  Research has shown that people who learn and understand more about their asthma, see their doctor regularly, have their own written asthma action plan and take their medications correctly, will feel well and have: better controlled asthma; fewer symptoms; fewer asthma attacks; fewer days off school/work due to asthma; fewer hospital visits due to asthma; and an overall better quality of life. 

Your pediatrician will choose the best medications for your child and talk to you about when to use them.  Signs that your child may have a MILD asthma attack are: Breathing is mildly difficult Breathing is only slightly faster than usual Speaking in complete sentences is easily done Mild complaints of wheezing, cough, shortness of breath or tightness in the chest Skin color is good Peak flow rate is 70 percent to 90 percent of the child’s personal best No “drawing in” of muscles between the ribs is noticeable Awareness of surrounding is normal and the child is alert Signs that your child may have a MODERATE asthma attack are: Breathing is moderately difficult Breathing is faster than usual Speaking is affected because of difficulty breathing (phrases or partial sentences are spoken) Moderate complaints of wheezing, cough, shortness of breath or tightness in the chest Skin color is normal or may be pale Peak flow rate is 50 percent to 70 percent of the child’s personal best Slight to moderate “drawing in” of muscles between the ribs is necessary to breathe

Awareness of surroundings is normal and the child is alert Signs that your child may have a SEVERE asthma attack are: Breathing is extremely difficult Breathing is very fast or very slow with a lot of distress (labored breathing) Speaking is affected because of difficulty breathing (single words or short sentences are spoken) Severe complaints of wheezing, cough, shortness of breath or tightness in the chest Skin color is poor Peak flow rate is less than 50 percent of the child’s personal best “Drawing in” of the neck, abdomen and chest muscles is needed in order to breathe Level of awareness has decreased (child may be drowsy) Signs that your child’s asthma is getting worse: Asthma symptoms, such as cough, wheezing, chest tightness and shortness of breath, occur more frequently and/or get worse Large decreases in your child’s peak flow rate occur Asthma medications do not seem to help your child’s cough or breathing problems You frequently have to take your child to your pediatrician or the hospital emergency room for treatment of acute asthma Your child is admitted to the hospital for asthma treatment Your child is admitted to a hospital intensive care unit for asthma treatment Large changes in peak flow rate measurements occur (more than 20 percent change between morning and evening measurements)Your child’s asthma symptoms increase (cough, wheezing, chest tightness and shortness of breath); symptoms may occur more often at night and awaken the child from sleep Your child’s asthma attacks last longer and do not easily improve with treatment Special oral anti-inflammatory medications, such as steroids, are needed more often to control the asthma Your child’s asthma attacks quickly become severe. Your child has panic attacks with severe confusion and anxiety with the asthma attacks. There is different kinds of asthma medications.  In this case, the patient may be treated for a few weeks with anti-inflammatory medications and then returns for another spirometry test.  Most asthma medications are inhaled (which means that a person takes the medication by breathing it into the lungs), but asthma medications can also take the form of pills or liquids.  Some medications can be used as needed to stop asthma symptoms (such as wheezing, coughing, and shortness of breath) when a person first notices them.
 
 
 

www.healasthma.com