| Drug
|
Mechanism of action
|
Adverse effects
|
| Beta 2 agonists: albuterol, terbutaline, salmeterol, formoterol
|
Relaxation of smooth muscle in the bronchi by stimulating bronchodilating beta 2 receptors, activation of adenylate cyclase, increased cAMP; Salmeterol and formoterol show greater specificity for beta 2 receptors
|
Tremors, tachycardia, tolerance, cramps, salmeterol can increase the risk of severe asthma attacks and death
|
| Corticosteroids (budesonide, beclomethasone, fluticasone, triamcinolone, prednisone, methylprednisone, prednisolone)
|
Anti Inflammatory, reduce secretions and mucosal inflammation, decrease the severity and frequency of asthma attacks
|
Oral candidiasis, cough, adrenal suppression, osteoporosis, growth suppression, peptic ulcers, myopathy, hypertension, Cushing’s syndrome
|
| Methylxanthines (theophylline)
|
Inhibits phosphodiesterase hence prevents the breakdown of cAMP, increases cAMP and cGMPlevels, bronchodilation, decreased release of inflammatory mediators from mast cells; adenosine receptor antagonist
|
Narrow therapeutic index, tachycardia, arrhythmias, sudden death, CNS excitation, nervousness, insomnia, tremors, seizures, gastric upset
|
| Cromolyn, nedocromil
|
Inhibit release of inflammatory mediators from mast cells, suppression of leukocyte chemotaxis; Used to prevent asthma, prevent exercise and allergen induced bronchoconstriction
|
Cough, unpleasant taste, dermatitis, myositis, generally well tolerated
|
| Zileuton
|
It inhibits the enzyme 5 lipoxygenase that is used in the synthesis of leukotrienes
|
Headache, nausea, gastric upset, myalgia, Churg Strauss syndrome
|
| Leukotriene modifiers (montelukast, zafirlukast)
|
Antagonize the action of leukotriene on the airways by blocking leukotriene receptors; Effective in aspirin induced asthma also
|
Headache, nausea, gastric upset, myalgia, Churg Strauss syndrome, elevation of liver enzymes
|
| Muscarinic antagonists (ipratropium, tiotropium)
|
Block muscarinic receptors in the airways, decrease bronchoconstriction and mucosal secretion
|
Anticholinergic effects especially in elderly, cough, dry mouth, throat irritation, urinary retention, tachycardia, delirium, blurred vision
|
| Monoclonal antibodies (omalizumab)
|
It is a humanized recombinant monoclonal antibody to IgE that blocks the binding of IgE to mast cells, preventing degranulation
|
Injection site reactions, risk of malignancies, rarely anaphylaxis, high cost
|
