Asthma/COPD
Categories:
- Short-Acting Beta 2 Agonists (SABAs)
- Salbutamol (Albuterol)
- Can cause hypokalemia with muscle weakness, arrhythmias, and tremors
- EKG changes, palpitations, and HA may occur
- Albuterol
- Nebulizer: 2.5-5mg q20mins for 4 doses, then 2.5-10mg q1-4hrs
- MDI (Ventolin HFA, Proventil HFA, ProAir HFA): 4-8 puffs q30mins up to 4hrs, then every 1-4hrs PRN
- Levalbterol MDI (Xopenex, Xopenex HFA)
- Pirbuterol MDI (MaxAir autohaler)
- Terbutaline
- SEs: Tremor (7%), tachycardia, anxiety
- Hypokalemia, angina, tachyarrhythmia
- Salbutamol (Albuterol)
-
Long-Acting Beta 2 Agonists (LABAs)
- Not recommended without ICS in asthma due to increased mortality
- Salmeterol DPI (Serevent Diskus, Aeromax)
- Formoterol DPI (Foradil Aerolizer)
- Oxis
- Serovent
- Onbrex
- SE: Headache (17%), Tremor (8%)
- Hypertension, Rash, dizziness, hyperglycemia
- Inhaled Corticosteroid (ICSs)
- Beclomethasone MDI (QVAR)
- Budesonide DPI (Pulmicort Flexhaler)
- Flunisolide MDI (Aerospan)
- Fluticasone Propionate MDI (Flovent HFA)
- Fluticasone Furoate DPI (Arnuity Ellipta)
- Mometasone DPI (Asmanex Twisthaler)
- Triamcinolone
- Oral Corticosteroid
- Methylprednisolone
- Asthma: 32-64 mg/day PO in 1-2 doses
- 40-80 mg/day IV in 1-2 doses
- Reserve IV for NPO or severe in the ICU
- Depo-Medrol 160mg IM at discharge equal to 8 days PO taper
- Asthma: 32-64 mg/day PO in 1-2 doses
- Prednisolone
- Prednisone
- Asthma: 40-80 mg/day PO in 1-2 doses
- Give until PEF is 70% predicted
- 7–10-day courses do not need to be tapered
- SE: Elevated Uric Acid, Increase or decrease INR w/Warfarin
- Asthma: 40-80 mg/day PO in 1-2 doses
- Methylprednisolone
- Antimuscarinics (SAMA/LAMA)
- Short-Acting Anticholinergics (SAMAs)
- Ipratropium Bromide
- Nebulizer: Must use with albuterol
- MDI (Atrovent HFA): 4-8 puffs PRN every 2-4hrs
- Better tolerated than LAMAs
- SE: Bitter taste (20%), Xerostomia
- Urinary retention, mydriasis
- Ipratropium Bromide
- Long-Acting Anticholinergics (LAMAs)
- Tiotropium Bromide (Spiriva Handihaler)
- SE: Xerostomia (16%), Constipation
- Rash, myalgia, dysphonia
- SE: Xerostomia (16%), Constipation
- Bretaris
- SEEbri
- Incruse Ellipta
- Tiotropium Bromide (Spiriva Handihaler)
- Short-Acting Anticholinergics (SAMAs)
- Combos
- SAMA/SABA
- Ipratropium + Albuterol (Combivent Respimat)
- LAMA/LABA
- Vilanterol/umeclidinium (Anoro)
- LABA/ICS
- Budesonide/Formoterol MDI (Symbicort)
- Fluticasone Furoate/Umeclidinium Bromide/Vilanterol (Trelegy Ellipta)
- Fluticasone/Salmeterol MDI (Advair HFA)
- Fluticasone/Salmeterol DPO (Advair Diskus)
- Fluticasone Furoate/Vilanterol (Breo Ellipta)
- Ipratropium Bromide/Salbutamol (Combivent)
- Mometasone/formoterol (Durela hfa)
- LAMA/LABA/ICS
- Fluticasone/Umeclidinium/Vilanterol (Trelegy Ellipta)
- SAMA/SABA
- Other
- Methylxanthines
- Theophylline
- SE: Caffeine-like, MAT
- Toxicity: vomiting, hypokalemia, hyperglycemia, seizures, tachycardia, ventricular arrhythmias
- SE: Caffeine-like, MAT
- Theophylline
- Eicosanoid Inhibition
- Leukotriene Antagonists
- Montelukast (Singulair): 10 mg QD tablet
- Arachidonate 5-lipoxygenase Inhibitors
- Zileuton (Zyflo CR): 1200mg BID tablet
- Thromboxane Receptor Antagonists
- Non-xanthine PDE4 Inhibitors
- Zafirlukast (Accolate): 20mg BID tablet
- AST/ALT ≥3x normal in 3%, monitor monthly for 3 months when initiating
- Leukotriene Antagonists
- Mast Cell Stabilizers
- Cromolyn Sodium Nebulizer solution
- IgE Inhibitor
- Omalizumab (Xolair): 150mg injection
- PDE-4 Inhibitors
- Roflumilast (Daliresp): 500 ug tablet QD
- Methylxanthines