Now, I keep putting in the title
both asthma airway problems, both asthma
airway problems, both asthma airway problems.
Because, you have to have the first step, foundational
understanding of treating someone with asthma.
And so i'm gonna have to give them medications that
treat the bronchoconstriction and the inflammation.
So in that first big green bar, you
see the word bronchoconstriction.
Make sure you label that number 1.
That's what we're gonna deal with first.
So, we have different types of inhalers.
By breathing in that medication,
I'm gonna get the medication right to
my lungs where I need it the most.
So I have emergency rescue inhalers
and I have long term inhalers.
Now they've laid this out
for you here beautifully.
You have to know the difference.
This truly is the difference, between
life and death for somebody,
if you know the difference between their emergency
rescue inhaler and their long term inhaler.
Now, the reason we've named them
emergency rescue and long term
that's because they're short
acting or long acting.
Now you see the letters there, S-A-B-A,
Under emergency rescue inhalers,
That's the short hand for saying
Short Acting Beta 2 Agonist.
Now you know that you have receptors all
over your body and they do amazing things.
But you have Beta 1 receptors on your
heart, Beta 2 receptors on your lungs.
Now when an agonist connects to a receptor, then
it does what that receptor's intended to do.
Beta 2 receptors are meant to
bronchodilate and if I can't breathe,
I need you to give me
a short acting one.
I don't want one that's gonna
take forever to kick in.
That would be a long acting,
beta 2 adrenergic agonist.
So critically important, right
your note on this slide that says,
"Know which meds are SABAs
and which ones are LABAs."
We give people long acting Beta 2s, we give
them to those everyday to prevent attacks.
But they will not save
someone in an emergency.
You have to be crystal
clear on this point.
You must know what is a short acting beta 2
adrenergic agonist, an emergency or a rescue inhaler.
It's important that you know it
and it's critically important that you teach a patient
and the patient's family if that's appropriate,
which one to use in an emergency.
Now a couple other choices
we have for bronchodilators
are methylxanthines and you see
that we've got anticholinergics.
Those are also very helpful and
we'll talk about how we use those.
But the most important part of this slide when
we're talking about one of the two asthma problems,
bronchodilators, knowing the difference
between emergency and long term inhalers.
I promise you, that could be the difference
between life and death for your patients.
Now problem number 2, we're moving into inflammation
where we can use inhaled glucocorticoids.
Glucocorticoids suppress inflammation.
So by inhaling them, I'm gonna get the
medication right down into my lungs
which is where, exactly where I
wanna target the inflammation.
I can also use, uh-oh look at that,
Remember that last slide that you
did all that workin' and seeing like
all of those thing were released and we have those
nasty beasties and one of them was leukotrienes.
So to deal with that inflammatory process, after
your patient has been exposed to an allergen,
there you have it, there's one of our friends,
They're against what the leukotrienes
normally do in the body.
With blocking leukotrienes, I'm gonna have less of
that inflammation and nasty respiratory response.
Mast cell stabilizers.
Cool. Again, back to that slide.
Remember the allergen and IgE connects to the
mast cell and that stuff starts being released?
If I can stabilize that mast cell membrane,
I'll prevent those things from being released.
And last we have IgE antagonists.
Brilliant! that is so cool.
Because remember the very first step
was IgE connecting to the mast cells.
So, here is where it pays off with all the
hardwork that you did on that slide,
looking at the inflammatory process.
Inhaled glucocorticoids, that will directly
suppress the inflammatory response.
will block leukotrienes.
Mast cells stabilizers will calm that
mast cell down so it won't release those things.
And IgE would stop it earlier at step 1.
So there is almost a complete
overview right there.
Now we just need to go back in
and fill in the name of the drugs.
So if you're feeling like you've really
worked hard up to this point, you have.
But you have a very soild
understanding of how we treat asthma,
both of the problems,
bronchoconstriction and inflammation.
Now I want you to think, if
someone just rolled into the ER,
just take your finger and
your pencil right now
and I want you to put it on the
place on the diagram that you feel
What would be the most important
medication category to give to a patient
who rolled into your ER and in an extreme
respiratory asthma attack crisis.
I hope you went right to the section
that said, "Emergency/rescue inhalers"
That's what we're gonna do first.
That is our top priority 'cause
we have to get that airway open.
Then we'll address the inflammation
and all the other problems
but I want you to be very
solid on that concept.
That you don't even know any
names yet, that's okay.
We'll lay that in next.
Okay, so we've got meds to treat,
how many problems? Right.
Both asthma airway problems.
In your mind, define right now what
are the two asthma airway problems?
Write it in the margin of your
notes to help your brain remember.
One should be bronchoconstriction,
two should be inflammation.
So with bronchoconstriction, we talked
about the emergency rescue inhalers.
You want the short
acting beta 2 agonists.
You see two examples on your screen now:
Albuterol and Levalbuterol.
Look they end in -erol, so we know
those are gonna be beta 2 agonists.
Now the longer acting ones.
These are inhaled long acting ones.
These are LABAs, they hit the same
receptors, the beta 2 receptors
but they take a lot longer to kick in.
But look at the names there,
uh-oh, okay end in -erol, too.
But what you have to remember is,
all that tells us E-R-O-L,
just underline that in the names of
the drugs to help you remember that.
That tells us they are beta 2 agonist, it does
not tell you if it's fast or longer acting.
So you wanna keep that in mind.
Now remember we talked about the beta
agonist that's cholinergic antagonist?
This is a combination of a beta 2 agonist,
a short acting one:
Albuterol and then a
Now I want you to look
back at that other slide.
Remember we had that combination that big green
box of bronchoconstriction and inflammation?
Look for cholinergic antagonist and
that's where Ipratropium fits in.
Put those two together and we've got
a really effective medication.
Okay. now let's look at
the inflammatory meds.
We're gonna inhale glucocorticoids
like beclomethasone dipropionate.
You've got, look at this one ends in:
Budesonide and you've got Ciclesonide.
So start to look for a common
theme in these medications.
They end in S-O-N-E or N-I-D-E.
Those are the inhaled
Now anti-leukotriene modifiers.
You can take these by mouth.
Remember the role of why we
want to block leukotrienes?
because they're the one, that nastiness
in that inflammatory response.
So these medications are antagonists, they will
block the action of leukotrienes in your body.
So you see the names there, they
end in, first two end in -lukast.
The third one doesn't so, those are a little
trickier to remember but that is the role.
They block leukotrienes.
Now the mast cells stabilizers, are like
probably the oldest drug out there: Cromolyn.
This one I'll tell you now, I just want
you to write a quick note by this one.
Mast cell stabilizer like
Cromolyn is an old school drug.
You inhale it, but this is pretty
good because it's really safe.
So make sure you put the word "safe'
down there, has minimal adverse effects
and it's really good for
If a patient, like if they go to run,
they get an asthma attack when they run,
if they will take Cromolyn 15-20 mins
before they go and do their exercise,
they will likely have less of a response
from that exercise-induced asthma.
So if a patient is going to do something
that exacerbates or kicks in their asthma,
if they medicate before that time, we're
gonna helpfully minimize that reaction.