1. Drugs For Treating Asthma
Chapter 9

2. Sympathomimetic Agents
Noninfectious respiratory diseases are divided into two groups
Asthma is characterized by reversible airway obstruction
Chronic obstructive pulmonary disease (COPD) is characterized by irreversible airway obstruction
COPD is further divided into emphysema and chronic bronchitis

3. Sympathomimetic Agents - Continued
Beta-Adrenergic Agonists
Nonselective adrenergic agonist drugs stimulate beta receptors in the lungs and heart and alpha receptors in the heart
Epinephrine and isoproterenol are nonselective adrenergic agonists
Today, short- and long-acting β2-agonists are used to treat asthma and COPD
Β2-Agonists stimulate receptors in the lungs.
Stimulation of these receptors produces bronchodilation
Adverse effects include nervousness, tachycardia, and insomnia

4. Respiratory Drugs Beta-Adrenergic Agonists Short-Acting β2-Agonists
These drugs are used to treat acute asthma attacks.
They are usually administered via metered dose inhalers
They are available in tablet and liquid dose forms.
Short-acting β2-agonists are often used as prophylaxis prior to exercise or another known precipitating event

5. Long-Acting β2-Agonists
These agonists have a delayed onset of action and a longer duration of action
Onset of action is within minutes and the duration of action of 12 hours.
These drugs are used as maintenance therapy in the treatment of asthma and COPD

6. Metered Dose Inhalers (MDI)
These devices deliver the medication directly to the bronchioles
The total dose is kept low and side effects should be minimal
The inhaled dose can be accurately measured
Onset of action is rapid and predictable
They are compact, portable, and sterile
They can be difficult to use
Spacers are available which makes the inhaler easier to use
Adverse effects with MDI use include dry mouth

7. Corticosteroids
Steroids reduce the inflammation associated with airway obstruction
They also inhibit the release of inflammatory substances
Steroids are available as MDIs and oral and liquid dose forms
The MDI has become the most common dose form used in treating asthma and COPD

8. Corticosteroids - Continued
Corticosteroids significantly improve pulmonary function with a decrease in wheezing, tightness, and cough
These drugs are not used for acute attacks.
Chronic oral prednisone use is reserved for patients with severe asthma
Adverse effects are dependent upon dose form, frequency of intake, total dose, and any preexisting conditions

9. Corticosteroids - Continued
Prolonged systemic use can lead to adrenal suppression, poor wound healing, and immunosuppression
MDI use can lead to oral candidiasis.
Patients using inhaled steroids should be instructed to brush, floss, rinse, and spit, after each use

10. Leukotriene-Pathway Inhibitors
These drugs work by either preventing the synthesis of leukotrienes or by blocking leukotriene receptors
Leukotriene release produces bronchoconstriction, increased mucus secretion, mucosal edema, and increased bronchial hyperreactivity
These drugs are used to treat asthma and allergic rhinitis
Adverse reactions include irritation of the stomach mucosa, headache, and altered liver function tests

11. Cromolyn Cromolyn inhibits mast cell degranulation.
It is used for the prophylaxis of asthma
It can be used in patients with chronic asthma or taken before exercise-induced asthma
Adverse effects include cough, dry mouth, nausea, and headache
It is available as a nebulizer or in a spinhaler dose form

12. Methylxanthines Theophylline is the main drug in this category
It is a bronchodilator with a narrow therapeutic window
It is used to treat severe asthma and the bronchospasm associated with COPD
Side effects include CNS stimulation, cardiac stimulation, and GI upset

13. Anticholinergic Drugs
Ipratropium bromide is an inhaled anticholinergic drug that is used to treat asthma and COPD
Its anticholinergic effects produce a bronchodilating effect in the lungs
Side effects include dry mouth. The patient should rinse after each inhaler use to minimize dry mouth

14. Role of the Athletic Trainer
Educate the patient in regards to:
The type of medication they are taking
Specific effects in regard to athletic performance
Understand proper inhalation technique
Take action to adjust specific drug through consultation if necessary
Keep medication readily available
Monitor the patient during exercise
Know the medications the athletes are using