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asthma-how-treatments-work-and-common-side-effects

Asthma: How Treatments Work and Common Side Effects • Relievers: Used as needed to ↓ symptoms during attacks • Controllers: Used daily to ↓ frequency and severity of attacks Note: Please see slide on Asthma: Pathogenesis • Exacerbation: Used emergently in acute exacerbation Short-acting Beta Agonists (Reliever) Long-acting Beta Agonists (Controller) Short-acting Muscarinic Antagonists (Exacerbation) Long-acting Muscarinic Antagonists (Controller) Magnesium Sulfate (Exacerbation) Monoclonal Antibodies (Controller) Leukotriene Receptor Antagonists (Controller) Inhaled Corticosteroids (ICS) (Controller) Systemic Corticosteroids (Exacerbation) Binding to beta-2 adrenergic receptors and subsequent intracellular signal cascade in bronchial smooth muscle Off-target binding occurs in other systemic cells Inhibition of muscarinic acetylcholine receptors in airway muscle cells ↓ Activation of the inositol triphosphate (IP3) intracellular pathway (IP3 pathway normally functions to mobilize intracellular Ca2+ stores) Inhibition of Ca2+ channels on airway smooth muscle surface ↓ Influx of Ca2+ Binding and inactivation of inflammatory signal molecules (IgE, IL-5) Inhibition of leukotriene receptors in lung and immune cells Steroid binds to nuclear receptors within cells ↓ Gene expression/synthesis of immune mediators (ex. cytokines) Stimulation of Na/K ATPase (which transports K into cells) Hypokalemia Palpitations Tachycardia Muscle cramps Tremor Authors: Chunpeng Nie Reviewers: Sravya Kakumanu, Ben Campbell, *Tara Lohmann * MD at time of publication ↓ Activation of mast cells (by ↓ IgE) and eosinophils (by ↓ IL-5/leukotrienes) ↓ Release of inflammatory cytokines by these cells (↓ Type 2 inflammatory response in airways) ↓ Permeability of airway vasculature ↓ Microvascular leakage into airway Inadvertent sympathetic nervous system activation Bronchial smooth muscle cells have ↓ Ca2+ release from intracellular stores (i.e. from sarcoplasmic reticulum) ↓↓ Cytoplasmic Ca2+ Myosin (muscle protein) unable to be activated for muscle contraction ↓ Smooth muscle contraction in bronchioles Bronchodilation ICS cause ↓ immune cell activity in the oropharynx Susceptibility to infection and irritation of the oropharynx from inhaled particles and pathogens Hoarseness Thrush Systemic corticosteroids cause ↓ immune cell activity in whole body ↑ Susceptibility to any infection Many other side effects Similar effects on other muscles in the body outside bronchi Dry mouth Urinary retention Constipation ↓ Mucosal edema ↓ Airway Mucus Airflow improvement ↑ Peak flow, ↑ Oxygenation, ↓ Dyspnea Legend: Pathophysiology Mechanism Treatment Effect Complications Published October 9, 2022 on www.thecalgaryguide.com

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آسم: چگونگی اثر درمان ھا و عوارض جانبی رایج آنھا