Respiratory Treatments

Nota:

• MOA: Reduce Air Inflammation by inhibiting infiltration of inflammatory cells and decrease oedema by an action on vascular endothelium.

1. Beclometasone
2. Budesonide
3. Fluticasone
4. Mometasone
5. Prednisolone

   Nota:

   • ORAL: Morning dose to mimic circadian rhythm, for 3 to 5 days.

1. Candidiasis

   Nota:

   • Use spacer, or rinse mouth (feed infants) after inhaler use. If facemask used, wipe face & apply emollient. Regular new toothbrush. 
2. Cataracts

   Nota:

   • Minimize by applying good seal around inhaler or mask, and use  'lowest effective dose' (LED)
3. Indigestion, Peptic Ulceration

   Nota:

   • Give tablets with breakfast or morning milk
4. Adrenal suppression

   Nota:

   • May occur >1.6mg beclometasone equivalent: Use LED.
5. Cushing Syndrome

   Nota:

   • Use LED
6. Osteoporosis

   Nota:

   • Provide calcium supplements

1. Increase Effects
   1. Ciclosporin

      Nota:

      • Increase Steroid Effect
2. Decrease Effect
   1. Anticonvulsants

      Nota:

      • Decrease steroid effects
   2. Antidiabetics

      Nota:

      • Hypoglycaemic Effect
   3. Antihypertensives

      Nota:

      • Hypotensive effect
   4. Diuretics

      Nota:

      • Decrease Diuretic Effect
   5. Vaccines

      Nota:

      • Decrease immune response
3. Anticoagulants
   1. May enhance or reduce

Nota:

• Leukotrienes D4 (LTD4), LTC4 and LTE4 are potent bronchoconstrictors that contribute to early phase bronchospasm and late phase inflammation

1. Montelukast
2. Zafirlukast

1. GI common
2. Headache
3. Hyperkinesia (in children)
4. Hypersensitivity Reactions