leukotrienes inhibit the action of cAMP resulting in bronchoconstriction.
An increase in the serum level of eosinophils indicates that the inflammatory
response has occurred.
The first line of treatment for an acute asthma attack is administering sympa-
thomimetics (beta-adrenergic agonists), which promote the production of cAMP
and thereby cause bronchodilation.
Long-term management includes controlling extrinsic factors that caused
the attack, educating the patient and the patient’s family, school officials, and
employers about how to reduce exposure to those factors, and using various
combinations of medications depending on the severity of the disease.Medications to treat COPD
There are four types of medications used to treat this disease.Bronchodilator
Bronchodilators relax smooth muscles around the bronchioles restoring airflow to
the lungs. Sympathomimetics are bronchodilators that increase the production of
cyclic AMP, causing dilation of the bronchioles by acting as adrenergic agonistic.
Some sympathomimetics are selective to particular adrenergic receptors,
which are referred to as alpha 1 , beta 2 and beta 2 -adrenergic. Other sympath-
omimetics are non-selective sympathomimetic that affect all types of adrenergic
receptor sites.
Epinephrine (adrenalin) is a non-selective sympathomimetic that is given
subcutaneously, IV, or via an endotracheal tube in emergency situations to
restore circulation and increase airway patency.
Selective beta 2 -adrenergic agonists have fewer side effects then epinephrine
and are given by aerosol or as a tablet. These include albuterol (Proventil,
Ventolin), isoetharine HCl (Bronkosol), metaproterenol sulfate (Alupent),
samleterol (Serevent), and Terbulaline SO 4 (Brethine).
Ipratropium bromide (Atrovent) is an anticholinergic drug that inhibits vagal-
mediated response by reversing the action of acetylcholine, producing smooth
muscle relaxation. It is a newer medication that dilates bronchioles with few sys-
temic effects. Ipratropium bromide (Atrovent) is used five minutes before glu-
cocorticoid (steroid) or cromolyn are inhaled so the bronchioles dilate enabling
the steroids to be deposited in the bronchioles. Sometimes ipratropium bromide
is combined with albuterol sulfate (Combivent) to treat chronic bronchitis for
more effective and longer duration than if each is used alone.
Methylxanthine (xanthine) derivatives are a second group of bronchodilators
used to treat asthma. They include aminophylline, theophylline, and caffeine,(^264) CHAPTER 14 Respiratory Diseases