Asthma treatment

[Brit Girl]

I'm currently studying the cardiopulmonary system and am wondering about the treatment of mild to moderate asthma. It seems that a lot of patients have badly managed asthma with ineffective drugs.
In the UK, the first line treatment is salbutamol for relief, with inhaled steroids for preventative effects. Oral steroids are used in more severe cases. Anti leukotryines have been tried with some success, although they don't seem to be the breakthrough drug everyone was hoping for.
It has been said that over on the US side of the pond, theophylline is still used regulary, when here it's pretty much a last resort. Just wondering if anyone can tell me why ?
Does anyone have any interesting schemes for effective management, with good compliance? Asthma's a really big problem here, and it's always good to hear other ideas.
Thanks for input.

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[UHS2002]

Well, you have been told wrong! Theophylline is hardly used in the US anymore either, probably for the same reasons it is not used in Europe (narrow therapeutic range, a lot better stuff avaliable these days which is more effective and has less side effects).

The anti leuktriene family of drugs (Zafirleukast and the like) are becoming very popular in the management of pediatric
asthma and cromolyn still seems to be a favorite for moderate pediatric asthma.

Oral steroids are reserved for severe asthma and also, short term, for acute exacerbations. Inhaled steroids are used in the management of mild to moderate asthma, with emphasis on the use of spacers, to improve delivery and reduce oropharyngeal Candida). Cromolyn is also used in moderate asthma. Obviously the beta2 agonists are still the mainstay in "rescue medications" and Albuterol (what you guys call Salbutamol) is very popular.

 

[Skip Intro]

Originally posted by Brit Girl
In the UK, the first line treatment is salbutamol for relief, with inhaled steroids for preventative effects. Oral steroids are used in more severe cases. Anti leukotryines have been tried with some success, although they don't seem to be the breakthrough drug everyone was hoping for.

This is the same for the U.S., except we call "salbutamol" by its other name, albuterol.

Theophylline is not used, except when the other treatments above fail. I think it still may be used fairly regularly for patients suffering with Cheyne-Stokes breathing, though.

 

[BellKicker]

That's the same drug?!?

I've always kinda wondered about that (all those mols and rols can get confusing, though).

Skip, do you know any more drugs that aren't called the same in Europe and the US?

I only know of acetaminophen=paracetamol (another mol )

As for theophylline, while it's probably not used anymore, I think it's still a favorite in exams because of the interactions and multi-organ side effects.

Later.

 

[Skip Intro]

Originally posted by BellKicker
Skip, do you know any more drugs that aren't called the same in Europe and the US?

I only know of acetaminophen=paracetamol (another mol )

Yes, acetominophen/paracetamol immediately comes to mind as well. I don't know any others right off the top of my head. But, I did work in international pharmaceutical research for about 7 years, and I know that a lot of drugs that are approved in Europe (via EMEA and individual agencies, like the MCA in Great Britain) are then submitted in the U.S. to the FDA for approval. Actually, it is fairly rare that international companies get FDA approval BEFORE EMEA approval. The IUPAC names, however, are usually the same. Salbutamol/Albuterol seems to be an exception (and, if I'm remembering correctly, it's because salbutamol is actually the free-base of albuterol, but the MOA is the same - namely beta-2 agonism).

Still, there are entire drug classes, like the nootropics, that are not approved in the U.S. at all. Likewise, many of the brand names may be slightly - or even completely - different on a country to country basis, based on restrictions that individual countries have on copyrighted/trade-marked naming.

Originally posted by BellKicker
As for theophylline, while it's probably not used anymore, I think it's still a favorite in exams because of the interactions and multi-organ side effects.

I agree. I think, too, it's because it is the prototype of the methylxanthine class, and there are no other representative drugs from this class. Of course, there is theobromine (naturally occurs in chocolate and tea) and caffeine (which occurs in tea, coffee, and is - we all know - added to sodas) that can be clinically important.

Interestingly, dogs cannot metabolize theobromine as quickly as humans. Therefore, they rapidly develop a toxicity. That's why you shouldn't feed chocolate to dogs. There's your fact for the day!

 

[BellKicker]

Skip, gotta hand it to you; you know your drugs.

 

[MustafaMond]

Originally posted by Skip Intro
This is the same for the U.S., except we call "salbutamol" by its other name, albuterol.

Theophylline is not used, except when the other treatments above fail. I think it still may be used fairly regularly for patients suffering with Cheyne-Stokes breathing, though.

Actually, aminophylline, not theophylline, is used in treatment of Cheyne-Stokes breathing. (if you cant treat the cause)

 

[outforblood]

Don't forget that if all else fails in the treatment of status asthmaticus, IV magnesium sulfate may do the trick.

If that doesn't work, try concentrated mothers milk!!!!

 

[Skip Intro]

Originally posted by MustafaMond
Actually, aminophylline, not theophylline, is used in treatment of Cheyne-Stokes breathing. (if you cant treat the cause)

Isn't aminophylline a theophylline derivative? (Perhaps this is the currently accepted and standard GCP, though. Don't know (?). Not in clinicals yet.) Of course, you always want to try to treat the underlying cause first, if possible, right?

 

[womansurg]

I've always used aminophylline as the IV formulation of theophylline. So, if I've got a big COPD'er that I can't get off the vent, I might add aminophylline to their regimine. Then, when they are off the vent and taking p.o., I switch to theophylline.

'Course, I'm a surgeon. A pulmonologist might have a different approach...

 

[FionaS]

adrenaline (UK) = Epinephrine (US)

And therefore noradrenaline/norepinephrine...