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Iii) Bronchodilators β2 agonists are used primarily for the management of acute bronchoconstriction in an acute/acute severe attack or a chronic persistent case with an exacerbation. The immediate need in such a case is bronchodilatation along with an anti-inflammatory drug. Not only there is near immediate relief but also better drug delivery through the dilated bronchi. They work by attaching to the β receptors on bronchial smooth muscle, resulting in activation of cyclic AMP. This leads to bronchodilatation, enhanced mucociliary clearance, vascular integrity and inhibits inflammatory mediator release.
They may be used as the first line or alternative to inhaled corticosteroids in mild persistent asthma. However, the experience in various trials have been in children above 12 years of age. Zafirlukast, a leukotriene receptor antagonist also attenuates the late response to inhaled allergen and post allergen induced bronchial responsiveness. Prothrombin time needs to be monitored if given with warfarin. They are available as 20 mgm tablets (Dose: 10 mgm 12 hourly) to be administered 1 hour before or 2 hours after meals in children more than 12 years of age.
Frequent attacks Lung function PEF/FEV1 PB% Variability % < 2 times/ month > 80 >2/ month > 80 < 20 20-30 > 1/week 60-80 30 Frequent > 30 < 60 (i) Corticosteroids Steroids are the most potent and effective long-term control medication for asthma. They suppress the generation of cytokines, recruitment of airway eosinophils and release of airway mediators. Twice a day dosing schedule maintains control of asthma. Their clinical effects include reduction in the severity of symptoms, improvement in PEFR and spirometry, diminished airway hyperresponsiveness, prevention of exacerbations and possibly the prevention of airway wall remodelling.