SABA
| MOA | Relax bronchial smooth muscle by stimulating beta2 adrenoreceptors |
|---|---|
| INDICATIONS | Symptom relief from asthma & COPD |
| Prevention exercise-induced bronchoconstriction | |
| Relief of bronchospasm in anaphylaxis | |
| PRECAUTIONS | HTN, IHD, HF, arrhythmias, hypothyroidism —risk of cardiovascular adverse effects. |
| Diabetes—risk of hyperglycaemia with high doses | |
| Treatment with other sympathomimetic amines—may increase adverse effects (tremor, tachycardia, headache); avoid combination or adjust dose as necessary. | |
| METHOD | § pMDI |
| § Autohaler ® | device does not require a space |
| § Turbuhaler | terbutaline [device does not require a spacer] |
| § Nebulised , Oral liquid, IV | only when nebulisation not possible [limited data critical care use only] |
| FREQUENCY OF ADMI | |
| [Variable – ‘reliver’] | Symptomatic relief COPD: pMDI 1–2 inhalations (100–200 mcg) prn; or 5–15 minutes before exercise. Repeat 3- or 4-times day prn |
| COPD exacerbation: pMDI, 4–8 inhalations (400–800 micrograms) every 1–6 hours; adjust according to response or nebulised 2.5–5 mg every 1–6 hours | |
| EFFECTS | § Onset of action 5-15 minutes |
| § Inhaled route preferred - fewer systemic adverse effects + faster onset of action | |
| SIDE EFFECTS | Common (>1%): tremor, palpitations, headache |
| Infrequent: hyperglycaemia (high dose), tachycardia, muscle cramps, agitation, hyperactivity in children, | |
| Rare (<0.1%): paradoxical bronchospasm, allergic reactions including urticaria, angioedema & anaphylaxis, lactic acidosis [high dose IV] | |
| Serious hypokalaemia may occur with high doses; may be worsened by theophylline, corticosteroids, diuretics, hypoxia. |
LABA
| MOA | Relax bronchial smooth muscle by stimulating beta2 adrenoreceptors |
|---|---|
| INDICATIONS | Maintenance treatment of asthma in those receiving inhaled or oral corticosteroids [except olodaterol] |
| COPD | |
| PRECAUTIONS | HTN, IHD, HF, arrhythmias, hypothyroidism —risk of cardiovascular adverse effects. |
| Diabetes—risk of hyperglycaemia with high doses | |
| Treatment with other sympathomimetic amines—may increase adverse effects (tremor, tachycardia, headache); avoid combination or adjust dose as necessary. | |
| METHOD | § DPI |
| FREQUENCY OF ADMIN | ONCE or TWICE a day |
| EFFECTS | § Eformoterol <3 minute onset of action with a duration of action for >12 hours |
| § Salmeterol 10-15 minute onset of action with a duration of >12 hours | |
| § Improve control | reduce exacerbations |
| § COPD, LABA monotherapy appears safe, however, fixed-dose combination inhalers are more convenient for patients needing a LABA and an ICS and/or a long-acting anticholinergic | |
| SIDE EFFECTS | Common (>1%): tremor, palpitations, headache |
| Infrequent: hyperglycaemia (high dose), tachycardia, muscle cramps, agitation, hyperactivity in children, | |
| Rare (<0.1%): paradoxical bronchospasm, allergic reactions including urticaria, angioedema and anaphylaxis, lactic acidosis [high dose IV] | |
| Serious hypokalaemia may occur with high doses; may be worsened by theophylline, corticosteroids, diuretics, hypoxia. |
LAMA
| MOA | § Promote bronchodilation by inhibiting cholinergic bronchomotor tone; block muscarinic actions of acetylcholine |
|---|---|
| INDICATIONS | § COPD |
| PRECAUTIONS | § Cardiovascular disorders: may increase risk of cardiovascular adverse effects; patients with pre-existing cardiac conditions were often excluded from randomised, controlled trials. |
| § Risk factors for angle-closure glaucoma—acute angle-closure crisis may rarely be precipitated | |
| § Bladder outlet obstruction: symptoms may worsen | |
| § Pregnancy: limited experience; not expected to be a concern | |
| METHOD | § DPI |
| § Mist MDI | |
| FREQUENCY OF ADMIN | § ONCE or TWICE a day |
| EFFECTS | § Tiotropium most extensively studied; strongest evidence for reduction of exacerbations and hospital admissions, in moderate-to-severe COPD. |
| SIDE EFFECTS | Common (>1%): dry mouth, throat irritation |
| Infrequent: blurred vision, urinary retention | |
| Rare (<0.1%): constipation, acute angle-closure crisis, palpitations, allergy (urticaria, rash, angioedema, anaphylaxis) |
ICS
| MOA | Reduce airway inflammation and bronchial hyper-reactivity |
|---|---|
| INDICATIONS | Maintenance treatment of asthma and COPD |
| CONTRAINDICATIONS | See precautions |
| PRECAUTIONS | § Beclomethasone, budesonide, fluticasone propionate preferred in pregnancy - greater experience |
| METHOD | § pMDI |
| § Rinse mouth out with water, gargle & spit it out after each dose | reduce side effects |
| § Nebulised | Budesonide and fluticasone propionate |
| § Available individually or as fixed dose combinations with LABA/anticholinergics | |
| FREQUENCY OF ADMIN | § Once or twice a day dosing |
| EFFECTS | § No good evidence that one is safer vs. other |
| § Flat dose response curve one stable reduces to minimum effective dose to minimise side effects | |
| SIDE EFFECTS | Common: Dysphonia, oropharyngeal candidiasis [rinse mouth], bruising, facial skin irritation [nebulisation] |
| Rare: allergic reactions, bronchospasm, rash, angioedema | |
| Systemic side effects depend on absorption [influenced by dose, duration, delivery system] | |
| § Adrenal suppression, bone density loss, increased risk of glaucoma/cataract, pneumonia, skin thinning, impaired growth velocity |
Brief on other meds: