→ 📷

1. intermittent
2. mild Persistent
3. moderate persistent
4. severe persist.
5. status asthmaticus
‣
💬

1. short acting b2 agonist (salbutamol/albuterol)
2. systemic steroids (methyl-prednisone oral or hydrocortisone i.v.)
3. anticholinergics (iptratropium bromide)
4. Methylxanthines

+Epinephrine

→ 📷

1. Inhaled steroids (fluticasone/budesoide)
2. Long acting b2 agonist (salmeterol/formoterol)
3. Leukotriene Modifier (Montekast; Zileuton)
4. Theophylline
5. Systemic steroids

MABs (Omalizumab) (+ Chromes)

Allergen specific immunotherapy

H1 antagonists

spirometry:

Post-bronchodilator FEV/FVC < 0.7

assessment of airlow limitation

• mMRC = Modified Medical Research Council 📷
• CAT = COPD Assessment Test 📷

SABA + SAMA

steroids

(theophylline i.v.)

(AB if purulent sputum)

block m1 + m3 📷 → bronchodilation + ↓mucous secretion (via vagus)

1. COPD #1 exacerbation (SAMA) + controller ( LAMA (+SAMA in A))
2. Severe asthma attacks (SAMA)
3. Persistent asthma (+b2)

short: ipratropium bromide

long: tiotropim bromide

↑hyperreactivity after treatment stop

(+antimuscuarinic symptoms)

early + late

(1)Non-selective PDE inhibitor

(2) Adenosine receptor antagonist

(3) Histone deacetylases activitation

(∴ ↑ cAMP)

⇒ Bronchodilation

⇒ + anti-inflammatory effect:

inhibits NF-kB translocation, increases IL-10 release, Anti-oxidative, Induces apoptosis of neutrophils and eosinophils)

1. CNS stimulation
2. Diuretic effect * → ↓Preload
3. ↑HR

☕

oral + IV!

iv → asthma + COPD reliever

oral → asthma + (COPD controller)

MAINLY RELIEVER THERAPY never 1st line

(CAVE: narrow therapeutic index! → more of a last resort)

genetic + environmental factors → means inter-personal variability (→ not really predictable)

(1) CNS effects incl. tremor (+agitation, insomnia, seizures)

(2) Tachycardia + Arrhythmias

→ like to much coffee

hypotension (↓preload + ↑HR→ ↓output)+ seizure (refractory; due to ↑CNS)

chest pain + death (heart affected)

>20

seizures (more prone than acute tox)

1. Epilepsy
2. Acute MI + IHD
3. Hypertension
4. Cave: elderly + newborns
5. tea/coffee consumption

Amino-phylline

(1) ↓ Inflammation (2) ↓ Leukocyte infiltration (Importantly, they also upregulate (2 receptors)

T (alone or in combination)

severe + freq. exacerbation (Stage D)

• oral + iv → asthma exacerbation
• iv → status asthmatic, patient is vomiting
• Systemic → COPD exacerbation
• oral → controller in chronic severe asthma (step 5)

oral → methylprednisolone + prednisone

iv → hydrocortisone, methylprednisolone sodium succinate

T

T

• oral candidiasis
• dysphonia
• ↓bone density

1. Fluticasonide
2. Budesonide
3. Flunisolide

• Controller - asthma

• alternative for ICS in NSAID induced asthma

‣

💬

• asthma + allergic rhinitis

LTC4, D4, E4 (Also ↑ Airway vascular permeability and mucus production)

CysLT1. (= Leukotriene receptor)

receptor for LT-D4, -C4, -E4. 📷

Montelukast + Zafirlukast

• Systemic Eosinophilia
• Vasculitis (Churg-strauss)
• Neuro-psychiatric symptoms
‣

💬

esp. in children

nightmares, sleep disturbance, mood disorders, aggressive behavior

Monte ist verrückt rot und reitet auf nem strauss

Zileuton

↓LT A4,B4 + C4,D4,E4

(sie läuten an den Dino-Eiern)

↑Liver enzymes (hepatotox)

Aspirin (NSAIDs in general)

inhibition of COX shifts the AA metabolism to the LOX leukotriene pathway (exaggerated in aspirin-induced asthma)

Mild-moderate asthma persistent

↓bronchial hyperreactivity in (long term)

F → early + later

T

Methylxanthines

inhaled

• lungs: cough + bronchospasm
• more above: laryngeal edema + bitter taste
• headache + nausea

Farbe zu Inhalieren schadet Rachen, Lungen und Kopf

Omalizumab

→ bindings prevents mast cell sensitization (IgE cant bind to mastcells → no degranualation)

moderate - severe persist. asthma (controller)

s.c. (every 2-4weks)

F → well tolerated

children <6y

(Nimm keine Süßigkeiten von Omas an)