Asthma : According to WHO - Asthma attacks all age groups but often starts in childhood. It is a disease characterized by recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person. In an individual, they may occur from hour to hour and day to day. This condition is due to inflammation of the air passages in the lungs and affects the sensitivity of the nerve endings in the airways so they become easily irritated. In an attack, the lining of the passages swell causing the airways to narrow and reducing the flow of air in and out of the lungs. Classification of drugs 1. Bronchodialators A. Sympathomimetics : Adrenaline, Ephedrine, Isoprenaline, Salbutamol, Terbutaline, Bambuterol, Salmetrol, Formoterol. B. Methylxanthines : Theophylline, Aminophylline, Hydroxyethyl theophylline. C. Anticholinergics: Atropine, Ipratropium bromide 2. Leukotrienne antagonis - Montelukast, Zafirlukast 3. Mast cell stabilizers : Sodium cromglycate, Nedocromil,Krtotifen. 4. Corticosteroids : a) Systemic : Hydrocortisone, Prednisolone and others b) Inhalational : Beclomethasone dipropionate, Budesonide, Flunisolide


Bronchitis : Bronchitis is an inflammation of the mucous membranes of the bronchi (the larger and medium-sized airways that carry airflow from the trachea into the more distal parts of the lung parenchyma) Treatment Conventional treatment for acute bronchitis may consist of simple measures such as getting plenty of rest, drinking lots of fluids, avoiding smoke and fumes, and possibly getting a prescription for an inhaled bronchodilator and/or cough syrup. In some cases of chronic bronchitis, oral steroids to reduce inflammation and/or supplemental oxygen may be necessary.


Emphysema : Emphysema is a long-term, progressive disease of the lung(s) and occurs when the alveolar walls are destroyed along with the capillary blood vessels that run within them. This lessens the total area within the lung where blood and air can come together, limiting the potential for oxygen and carbon dioxide transfer. In early emphysema, there is associated inflammation of the small airways or bronchioles that limits the amount of air that can flow to the alveoli. In more severe emphysema, there is also loss of elasticity in the alveolar walls that have not been destroyed. When the person breathes out, the alveoli and small airways collapse. This loss of elasticity of the lung tissue makes it harder for air into the now closed and also harder for air to exit during exhalation. As emphysema progresses and more and more alveoli are destroyed, bullae can be formed. Bullae are air filled sacs of lung that do not function. They can become extremely large and often are located in the upper parts of the lung. A bulla (plural=bullae) are at risk for rupturing and causing a pneumothorax, or collapse of the lung. MEDICATION • Bronchodilating medications: These medications, which cause the air passages to open more fully and allow better air exchange, are usually the first medications that a doctor will prescribe for emphysema. In very mild cases, bronchodilators may be used only as needed, for episodes of shortness of breath. o The most common bronchodilator for mild cases of emphysema isalbuterol (Proventil or Ventolin). It acts quickly, and 1 dose usually provides relief for 4-6 hours. Albuterol is most commonly available as ametered-dose inhaler or MDI, and this is the form that is used most often for patients with mild emphysema, with intermittent shortness of breath. When used for this purpose, some people refer to their albuterol inhaler as a "rescue" medication. It acts to rescue them from a more serious attack of shortness of breath. o If you have some degree of shortness of breath at rest, a doctor may prescribe the albuterol to be given at regularly scheduled intervals, either through the MDI, or by nebulization. Nebulization involves breathing in liquid medication that has been vaporized by a continuous flow of air (in much the same way a whole-room vaporizer causes liquid droplets to enter the air by the flow of air through water). Nebulized albuterol may be prescribed once scheduled doses via inhaler are no longer adequate to alleviate shortness of breath. o Ipratropium bromide (Atrovent) is another bronchodilating medication that is used for relatively mild emphysema. Similar to albuterol, it is available in both an inhaler and as a liquid for nebulization. Unlike albuterol, however, ipratropium bromide is usually given in scheduled intervals. Therefore, it is not usually prescribed for "rescue" purposes. Atrovent lasts longer than albuterol, however, and often provides greater relief. Tiotropium (Spiriva) is a long acting form of ipratropium. This once a day medicine has shown to result in a fewer hospitalizations and possible increased survival in some patients with COPD. o Methylxanthines (Theophylline) and other bronchodilating medications are available that have varying properties that may make them useful in certain cases. Theophylline (Theo-Dur, Uniphyl) is a medication given orally (tablets). It can have a sustained effect on keeping air passageways open. Theophylline levels must be monitored by blood tests. This medicine is used less frequently today due to its narrow therapeutic window. Too much theophylline can produce an overdose; too little, and there will not be enough relief of shortness of breath. In addition, other drugs can interact with theophylline, altering the blood level without warning. For this reason, doctors now prescribe theophylline after very carefully considering its potential for other drug interactions. If you take theophylline, take the medication as prescribed and check with your doctor before starting any new medication. Some new studies are suggesting that very low dose theophylline may have anti-inflammatory properties as well. Theophylline used to be widely prescribed; currently it is prescribed infrequently and usually only in special circumstances because of its narrow range of effectiveness, necessity of blood level monitoring and its interactions with other drugs. • Steroid medications: They decrease inflammation in the body. They are used for this effect in the lung and elsewhere and have been shown to be of some benefit in emphysema. However, not all people will respond to steroid therapy. Steroids may either be given orally or inhaled through an MDI or another form of inhaler. • Antibiotics: These medications are often prescribed for people with emphysema who have increased shortness of breath. Even when the chest x-ray does not show pneumonia or evidence of infection, people treated withantibiotics tend to have shorter episodes of shortness of breath.