A short review about asthma and COPD and their medication.

1. ASTHMATIC,COPD PATIENT
COUNSELING ( INHALERS AND
MEDICINES )
Students :
Manal alosaimi
Walaa Aljuaid
Supervice :
Dr.Dania Rifqi

2. Introduction
▪ Asthma is a chronic lung disease that
inflames and narrows the airways.
▪ Asthma causes recurring periods of
wheezing ,chest tightness, shortness of
breath, and coughing.
▪ The coughing often occurs at night or early
in the morning.
Reference : American
Academy for Allergy , Asthma
and Immunology reference
guideline for allergy and
asthma medications

3. Differences between asthma and COPD
▪ Chronic obstructive pulmonary disease
(COPD) is a general term that describes
progressive respiratory diseases like
emphysema and chronic bronchitis.
▪ COPD is characterized by decreased airflow
over time, as well as inflammation of the
tissues that line the airway.
Reference : American
Academy for Allergy , Asthma
and Immunology reference
guideline for allergy and
asthma medications

4. Reference :National heart ,
lung and blood institute PDF :
SECTION 2, DEFINITION,
PATHOPHYSIOLOGY AND
PATHOGENESIS OF
ASTHMA, AND NATURAL
HISTORY OF ASTHMA

5. Types of Asthma
Type Causative agents (worsening agent)
Exercise-induced asthma (EIA) Patient develop asthma symptoms only when
exercising
Allergic asthama Peoples who have symptoms when allergean agent
is present
Occupational asthma caused by inhaling fumes, gases, dust or other
potentially harmful substances while on the job.
Drug induce asthma Sensitive to certain drugs like Asprin, NSAIDs, etc
Reference : American
Academy for Allergy , Asthma
and Immunology , How many
types of asthma article .

6. Treatment of Asthama
▪ Aims :
▪ Treatment of infections
▪ Avoidance of allergies and other precipitating
factors
▪ Using Drugs
Reference : National
heart , lung and blood
institute PDF: Asthma
CARE Quick
Reference page 7

7. Classifications of drug
▪ Bronchodilators : B2 agonest ,Anti-cholinergics ,
Theophyllines .
▪ Controllers : ICS , Systemic corticosteroids ,
Antileukotrienes , Cromones ,Anti-Ig-E ,
Immunotherapy .
Reference : National
heart , lung and blood
institute PDF: Asthma
CARE Quick
Reference page 7

8. Stepwise treatment
Reference : National
heart , lung and blood
institute PDF: Asthma
CARE Quick
Reference page 7

10. Short Acting B2 Agonist
▪ Albuterol Inhalation :Albuterol is a bronchodilator that relaxes
muscles in the airways and increases air flow to the lungs.
▪ Brand Name : Ventolin HFA
CASE DOSE
ACUTE
ASTHMA
Metered-dose inhaler: 2
puffs every 4 to 6 hours
as needed.
ACUTE COPD Metered-dose inhaler: 2
puffs every 4 to 6 hours
as needed.
Prophylaxis Metered-dose inhaler: 2
puffs 15 minutes before
exercise.
Maintenance
dose
Metered-dose inhaler: 2
puffs every 4 to 6 hours
as needed.
DOSAGE FORM
METERED DOSE
INHALER
NEBULIZER
COST : Inhaler = 16 RS , solution inhaler=15.55 RS
Reference : National
heart , lung and blood
institute , DRUGS .
com . Saudi FDA .

11. DOSE CASE
ACUTE ASTHMA Metered-dose inhaler: 2 puffs every 4 to 6 hours as needed.
ACUTE COPD Metered-dose inhaler: 2 puffs every 4 to 6 hours as needed.
Prophylaxis Metered-dose inhaler: 2 puffs 15 minutes before exercise.
Maintenance dose Metered-dose inhaler: 2 puffs every 4 to 6 hours as needed.
case Dose
ACUTE
ASTHMA
Nebulizer: 2.5 mg every
6 to 8 hours as needed.
ACUTE COPD Nebulizer: 2.5 mg every
6 to 8 hours as needed.
AGE DOSE
Less than
1 year:
Nebulizer: 0.05 to 0.15 mg/kg/
dose every 4 to 6 hours
1 year to 4
years:
Nebulizer: 1.25 to 2.5 mg
every 4 to 6 hours
5 years or
older:
Metered-dose inhaler (HFA): 2
puffs every 4 to 6 hours as
needed.
5 years to
11 years:
Nebulizer: 2.5 mg every 4 to 6
hours
12 years
or older:
Nebulizer: 2.5 to 5 mg every 6
hours as needed.
Metered dose inhaler (non-
HFA): 2 puffs every (180 mcg)
every 4 to 6 hours.
NEBULIZER DOSES
PEDIATRIC DOSES
Reference : DRUGS .
com . website and
Saudi FDA .

12. SIDE EFFECT AND DRUG-DRUG
INTERACTIONS :
Common albuterol side effects may include:
▪ back pain, body aches;
▪ headache, dizziness;
▪ feeling nervous;
▪ nausea, diarrhea, upset stomach
▪ sore throat, sinus pain, stuffy runny nose.
Reference : DRUGS .
com . website and
Saudi FDA .

13. albuterol Drug-drug interaction :
▪ any other inhaled medicines or bronchodilators
▪ digoxin
▪ a diuretic or "water pill"
▪ an antidepressant - amitriptyline, imipramine, doxepin,
and others.
▪ a beta blocker - atenolol, carvedilol, labetalol, metoprolol,
propranolol, sotalol.
▪ an MAO inhibitor -selegiline
CONTRAINDICATION : hypersensitivity to Albuterol
STORAGE :Store at room temperature away from
moisture, heat, or cold temperatures on its container .
Reference : DRUGS .
com . website and
Saudi FDA .

14. Leukotriene Inhibitor.
▪ Montelukast : is a leukotriene inhibitor Leukotrienes are
chemicals releases when breathe in an allergen .
▪ These chemicals cause swelling and tightening of the
muscles around your airways, which can result in asthma
symptoms.
▪ Brand Name Singulair
▪ COST : 79.4 - 105 RS
DOSAGE FORM :
• Chewable tablet
• Granules
• Film-coated tablet .
Reference : DRUGS .
com . website and
Saudi FDA .

15. DOSES
CASE DOSE
Usual Adult Dose
for Asthma -
Maintenance
10 mg orally once
a day
Usual Adult Dose
for Bronchospasm
Prophylaxis
10 mg orally once
a day at least 2
hours before
exercise.
AGE DOSE
Less than 12
months
Not approved.
12 to 23 months One sachet of 4
mg oral granules
once a day
2 to 5 years 4 mg chewable
tablet or one
sachet oral granules
once a day
6 to 14 years 5 mg chewable
tablet orally once a
day
Pediatric DoseAdult Dose
Reference : DRUGS .
com . website and
Saudi FDA .

16. SIDE EFFECT AND DRUG-DRUG
INTERACTIONS , storage :
SIDE EFFECT :
▪ Cough; diarrhea; headache; mild sore throat; mild
stomach pain; nausea; runny or stuffy nose; stomach
upset; tiredness.
Drug-drug interaction : NO dose adjustment
needed BUT MUST NOT BETAKEN with food .
CONTRAINDICATION : hypersensitivity .
▪ Storage requirements:
▪ -Protect from moisture and light.
▪ -Store in original package.
Reference : DRUGS .
com . website and
Saudi FDA .

17. LONG ACTING B2 AGONIST
▪ Salmeterol bronchodilator works by relaxing
( B2 Agonist ) muscles in the airways to improve
breathing.
Brand name : Serevent
▪ DOSAGE FORM :
▪ inhalation powder ,
▪ inhalation solution
▪ Cost : 78-120 RS.
Reference : DRUGS .
com . website and
Saudi FDA .

18. ADULT DOSE:
CASE DOSE
Usual Adult Dose
for Asthma -
Maintenance
1 puff (50 mcg)
every 12 hours.
COPD 1 puff (50 mcg)
every 12 hours.
Prophylaxis 1 puff (50 mcg)
30 to 60 minutes
before exercise.
PEDIATRIC DOSE
AGE DOSE
Children at least 4
years
( maintenance)
1 puff (50 mcg)
every 12 hours.
Prophylaxis 1 puff (50 mcg) 30
to 60 minutes
before exercise.
Reference : DRUGS .
com . website and
Saudi FDA .

19. SIDE EFFECT and DRUG-DRUG interaction
and STORAGE :
SIDE EFFECT : Headache; nasal or sinus congestion;
nervousness; stuffy or runny nose; throat irritation.
INTERACTION : Beta-Blockers , CYP3A4 Inhibitors
(Strong): May increase the serum concentration of Salmeterol
, Loop Diuretics: Beta2-Agonists may enhance the
hypokalemic effect of Loop Diuretics.
Contraindications :
▪ Hypersensitivity
Storage : store at room temperature and use within 6
weeks period .
Reference : DRUGS .
com . website and
Saudi FDA .

20. CORTICOSTEROIDS
INHALER
Beclomethasone : is a steroid. It prevents
the release of substances in the body that
cause inflammation and used to prevent
asthma attacks .
Generic Name: beclomethasone inhalation
Brand Name: Qvar, Beclovent, Vanceril,
STORAGE: Beclomethasone should be kept at room temperature,
15-30°C (59-86°F). It should be shaken well before each use.
cost: 250/μg 96.3 SR , 50/
μg 21.05 SR from 21.05 to 148.8 SR
Reference : DRUGS .
com . website and
Saudi FDA , DRUG
BANK website

21.
ADULT DOSAGE :
DOSECASE
Initial dose: 40 to 80 mcg-
(puff ) via oral inhalation
twice a day
For patients previously
receiving bronchodilators
:alone
Initial dose: 40 to 160-
mcg ( puff )via oral
inhalation twice a day
For patients previously
receiving inhaled
:corticosteroids
May increase dose in 3 to
4 weeks if response is not
;adequate
:Maintenance dose
mcg twice a day 320Maximum dose
PEDIATRIC DOSAGE :
Age: 5 to 11 years:
DOSE
40 mcg (puff) via
oral inhalation
twice a day
Initial dose:
May increase dose
in 3 to 4 weeks if
response is not
adequate
Maintenance dose:
mcg twice a day 80 :Maximum dose
Reference : DRUGS .
com . website and
Saudi FDA , DRUG
BANK website

22. MECHANISM OF ACTION
Corticosteroid; has multiple anti-inflammatory effects, inhibiting
both inflammatory cells (eg, mast cells, eosinophils, basophils,
lymphocytes, macrophages, neutrophils) and release of
inflammatory mediators (eg, histamine, eicosanoids, leukotrienes,
cytokines)
Uses
Beclomethasone is used to prevent and control symptoms
(wheezing and shortness of breath) caused by asthma .
It works directly in the lungs to make breathing easier by
reducing the irritation and swelling of the airways.
Reference : DRUGS .
com . website and
Saudi FDA , DRUG
BANK website

23. Beclomethasone inhalation may cause side
effects:
1-headache
2-sore throat
3-runny or stuffy nose
4-back pain
5-nausea
6-cough
7-difficult or painful speech
Increased Pressure in the Eye, Increased Pressure in Eyes, inactive
tuberculosis, infection due to a parasite, Decreased Function of
the Adrenal Gland,
Contraindication
Reference : DRUGS .
com . website and
Saudi FDA , DRUG
BANK website

24. Some products that may interact with this drug include: aldesleukin,
other drugs that weaken the immune system (such as azathioprine,
cyclosporine, cancer chemotherapy), mifepristone.
DRUG- DRUG INTERACTIONS :
Precautions
• Safety and efficacy have not been established in patients
younger than 5 years.
• -Use of this drug with a spacer device in children less than 5
years of age is not recommended.
NOTES : This medicine may cause fungus infection of the mouth
or throat (thrush).
Using too much of this medicine for a long period of time can cause
problems with your adrenal gland.
Reference : DRUGS .
com . website and
Saudi FDA , DRUG
BANK website

25. Anticholinergics for Chronic
Obstructive Pulmonary Disease
(COPD)
GENERIC NAME(S):Ipratropium bromide
COMMON BRAND NAME(S): ipravent
atrovent
Store the medication at room temperature
(15 and 30 C), and away from excess heat and
moisture (not in the bathroom).
Cost : 10 - 51.5 SR
Reference : DRUGS .
com . website and
Saudi FDA , DRUG
BANK website

26. Usual Adult Dose for Chronic
Obstructive Pulmonary
Disease - Maintenance
DOSE
puff) inhalations)2
(36 mcg) 4 times
a day up to 12
.inhalations a day
:Inhalation aerosol
puff) inhalations)2
(34 mcg) 4 times a
day up to 12
.inhalations a day
CFC free inhalation
:aerosol
500 mcg (1 unit
dose vial) 3 to 4
times a day.
Nebulized solution:
Usual Pediatric Dose for Chronic
Obstructive Pulmonary Disease -
Maintenance
DOSE
Nebulized solution: 25 mcg/
.kg 3 times daily
Neonates
Nebulized solution: 125 to
.250 mcg 3 times daily
Infants and children:
Inhalation aerosol: : 1 to 2
(puff)inhalations (18 to 36
mcg) 3 times a day, up to 6
.inhalations a day
3 to 12 years:
CFC free inhalation aerosol: 1 to
2(puff) inhalations (17 to 34
mcg) 4 times a day up to 12
.inhalations a day
3 to 12 years:
Reference : DRUGS .
com . website and
Saudi FDA , DRUG
BANK website

27. Ipratropium bromide is an anticholinergic agent it blocks muscarinic
cholinergic receptors, without specificity for subtypes , resulting in a
decrease in the formation of cyclic guanosine monophosphate (cGMP) .
most likely due to actions of cGMP on intracellular cacium ,this results
in decreased contractility of smooth muscle
MECHANISM OF ACTION
Uses
used to control and prevent symptoms (wheezing and shortness of
breath) caused COPD which includes bronchitis and
emphysema ).
It works by relaxing the muscles around the airways so that they
open up and you can breathe more easily.
Reference : DRUGS .
com . website and
Saudi FDA , DRUG
BANK website

28. closed angle glaucoma, Blockage of Urinary Bladder,
Hypersensitivity to atropine or any anticholinergic derivatives.
Contraindication
Ipratropium may cause side effects.
1-dizziness
2-nausea
3-heartburn
4-constipation
5- dry mouth
6-difficulty urinating
7-pain when urinating
8- back pain
Reference : DRUGS .
com . website and
Saudi FDA , DRUG
BANK website

29. Serious Interactions of ipratropium bromide inhalation:
These medications may interact and cause very harmful effects.
Inhaled anticholinergics /pramlintide
Inhaled anticholinergics /solid oral potassium capsules
Inhaled anticholinergics/solid oral potassium tablets
Moderate Interactions of ipratropium bromide
inhalation
drug- drug interactions :
Reference : DRUGS .
com . website and
Saudi FDA , DRUG
BANK website

30. Paradoxical Bronchospasm
ATROVENT HFA can produce paradoxical bronchospasm that can be life
threatening. If this occurs, treatment with ATROVENT HFA should be
stopped and other treatments considered.
Ocular Effects
ATROVENT HFA is an anticholinergic and its use may increase intraocular
pressure. This may result in precipitation or worsening of narrow-angle
glaucoma. Therefore, ATROVENT HFA should be used with caution in
patients with narrow-angle glaucoma
ipratropium bromide inhaler precautions
Reference : DRUGS .
com . website and
Saudi FDA , DRUG
BANK website

31. METHYLXANTHINES FOR CHRONIC
OBSTRUCTIVE PULMONARY DISEASE
(COPD)
Generic Name:( theophylline)
Brand Name: Quibron-T
Cost : 17,15 SR
Proper storage of theophylline: Store theophylline
at room temperature, in a tightly closed container.
Store away from heat, moisture, and light.
Do not store in the bathroom and refrigerate.
Reference : DRUGS .
com . website and
Saudi FDA , DRUG
BANK website

32. Usual Adult Dose for Asthma
– Acute and Maintenance
DOSE
mg/kg loading dose 5:Loading dose
mg/kg/day. Do not 10
exceed 900 mg/day
Otherwise Healthy
:Nonsmoking Adult
.mg/kg/day 16Otherwise Healthy
:Adult Smoker
mg/kg/day. Do not 5
.exceed 400 mg/day
Patient with congestive
heart failure:
Usual Geriatric Dose for
Asthma – Acute and
Maintenance
mg/kg loading dose 5 :Loading dose
mg/kg/day. Do not 10
exceed 900 mg/day
Otherwise healthy,
:nonsmokers
mg/kg/day. Do not 5
exceed 400 mg/day
Patient with congestive
heart failure, and/or
liver dysfunction:
Reference : DRUGS .
com . website and
Saudi FDA , DRUG
BANK website

33. Usual Pediatric Dose for Asthma – Acute and Maintenance
Loading dose:
mcg/mL 10 Loading dose:
.to 24 mg/kg/day 20
:year to 8 years 1
.mg/kg/day 16:years to 11 years 9
.mg/kg/day 13years to 15 years 12
Reference : DRUGS .
com . website and
Saudi FDA , DRUG
BANK website

34. MECHANISM OF ACTION
Theophylline competitively inhibits type III and type IV
phosphodiesterase (PDE), the enzyme responsible for breaking down
cyclic AMP in smooth muscle cells, possibly resulting in
bronchodilation.
Uses
Theophylline is used to treat lung diseases such as asthma and
COPD (bronchitis , emphysema ).
It works in the airways by relaxing muscles, opening breathing
passages, and decreasing the lungs' response to irritants..
Reference : DRUGS .
com . website and
Saudi FDA , DRUG
BANK website

35. SIDE EFFECTS:
nausea
vomiting
headache
trouble sleeping
THEOLAIR (theophylline tablets) Tablets are contraindicated in
patients with a history of hypersensitivity to theophylline or any
other components in these products.
Contraindication:
Reference : DRUGS .
com . website and
Saudi FDA , DRUG
BANK website

36. Other medications can affect the removal of theophylline from
your body, which may affect how theophylline works. Examples
include cimetidine, disulfiram, fluvoxamine, interferon, mexiletine,
propranolol, rifampin, drugs used to treat seizures (such as
carbamazepine, phenytoin), St. John's wort, ticlopidine, among
others
drug- drug interactions :
Theophylline precautions :
hypersensitivity to the drug or its components.
Some forms of cardiac arrhythmias (abnormal heart rate)
Under certain conditions, the drug can remain in your body longer
than normal and build up to unsafe levels, resulting in fatal toxic
reactions.
Reference : DRUGS .
com . website and
Saudi FDA , DRUG
BANK website

37. HOW TO USE INHALERS
and NEBULIZERS?

38. HOW TO USE INHALER
▪ 1- remove the cap from the Inhaler
▪ 2-shake the inhaler
▪ 3-hold the inhaler
▪ 4-set up straight or stand up
▪ 5-tilt head back straight
▪ 6-exhale away from the inhaler.

39. ▪ 7- put the inhaler in your mouth then press the
bottom by your index and breathing at the
same time ( take slow breathing ) .
8- hold your breath , then exhale slowly .
Then repeat 2 to 8 after 30 second if another
dose require , DO NOT forget to rinse your
mouth after using corticosteroid inhaler .

40. HOW TO USE Diskus
inhaler
▪ 1- check dose counter,
▪ 2-holding horizontally , load dose by sliding lever until
it clicks
▪ 3- breathe out gently away from mouth piece
▪ 4- place mouth piece in mouth and seal lips
▪ 5- breathe in steadily and deeply
▪ 6- hold breath for about 10 seconds
▪ 7- breathe out gently away from mouthpiece
▪ 8- close cover to click shut

41. HOW TO USE NEBULIZER

42. THANK YOU