EFFICACY

SAFETY
SUITABILITY
COST-EFFECTIVENESS
Inhaled ++++
Corticosteroids Act through ANTI-INFLAMMATORY EFFICACY >> INHIBIT
inflammatory cytokine production

MOST IMPOTRTANT function = INHIBIT the infiltration of

asthmatic airways

INHIBIT phospholipase A2
REDUCE expression of cyclooxygenase-2
Long-acting +++
bronchodilators
Achieve duration of action of 12hrs or more due to HIGH LIPID
SOLUBILITY

Dissolve in smooth muscle cell membrane or attach to

molecules in the vicinity of adrenoceptors

NO ANTI-INFLAMMATORY ACTION
Leukotriene- +++
receptor Interrupts the leukotriene pathway: INHIBITION of 5-
antagonists lipoxygenase (prevents leukotriene synthesis) and
INHIBITION OF LTD4 binding to target tissues
Combination ++++
Therapy
(ICS+LABA)

“The combination of rapid-onset LABA (formoterol) and low dose ICS

(budesonide or beclometasone) in a single inhaler as both the controller
and the reliever medication is effective in improving asthma control, and
in at-risk patients, reduces exacerbations requiring OCS, and
hospitalizations” -GINA 2018
Combination ++++
Therapy
(ICS+LABA)
OCS ++++ Act through ANTI-INFLAMMATORY EFFICACY >> INHIBIT
inflammatory cytokine production

MOST IMPOTRTANT function = INHIBIT the infiltration of asthmatic

airways

INHIBIT phospholipase A2
REDUCE expression of cyclooxygenase-2
SUMMARY FOR EFFICACY
DRUG GROUP EFFICACY

ICS ++++

LABA +++

Leukotriene receptor agonists +++

Combination (ICS+LABA)
++++

OCS ++++
EFFICACY
SAFETY
SUITABILITY
COST-EFFECTIVENESS
Inhaled +++
Corticosteroids A special problem caused is the occurrence of oropharyngeal candidiasis
Chronic use may increase risk of osteoporosis and cataracts
Hoarseness may result from direct local effect on the vocal cords
Due to being subject to first-pass metabolism in the liver, other short term
complications are not likely
Source:GINA 2011

Inhaled glucocorticosteroids
have also been associated with cataracts and glaucoma
There is no evidence that use of inhaled glucocorticosteroids increases the
risk ofpulmonary infections, including tuberculosis, and
inhaledglucocorticosteroids are not contraindicated in patients withactive
tuberculosis
Long-acting ++
bronchodilators The regular use of rapidacting β2 -agonists in both short and long acting
forms may lead to relative refractoriness to β2 –agonists

“Therapy with long-acting inhaled β2 - agonists causes fewer systemic

adverse effects—such as cardiovascular stimulation, skeletal muscle
tremor, and hypokalemia—than oral therapy”

“Using LABAs alone to treat asthma without an ICS to treat lung

inflammation is associated with an increased risk of asthma-related
death. Therefore, the Boxed Warning stating this will remain in the labels
of all single-ingredient LABA medicines” FDA Philippines
Leukotriene- +++ All the Cysteinyl leukotrienes (CysLTs) are potent constrictors of bronchial
receptor smooth muscle.
antagonists Zafirlukast and Montelukast- very rarely patients taking these drugs
develop systemic eosinophilia and a vasculitis with features similar to
Churg-Strauss syndrome.
Zafirlucast may interact with warfarin and increase prothrombin times,
which should be monitored in patients subject to this interaction.

Source:GINA
Leukotriene modifiers are well tolerated,and few if any class-related
effects have so far been
recognized. Zileuton has been associated with liver
toxicityand monitoring of liver tests is recommended
during treatment with this medication.
Combination ++++ “Some meta-analyses of studies of long-acting β2 -agonists have shown
Therapy (ICS+LABA) numerically very small increases in the number of deaths in patients receiving
long-acting β2 -agonists in combination with inhaled glucocorticosteroids,
when compared to inhaled glucocorticosteroids alone”
OCS +++

“The systemic side effects of long-term oral or parenteral

glucocorticosteroid treatment include osteoporosis, arterial hypertension,
diabetes, hypothalamicpituitary-adrenal axis suppression, obesity,
cataracts, glaucoma, skin thinning leading to cutaneous striae and easy
bruising, and muscle weakness. Patients with asthma who are on long-
term systemic glucocorticosteroids in any form should receive preventive
treatment for osteoporosis” GINA 2011
SUMMARY FOR SAFETY
DRUG GROUP SAFETY

ICS +++

LABA ++

Leukotriene receptor agonists +++

Combination (ICS+LABA) ++++

OCS +++
EFFICACY
SAFETY
SUITABILITY
COST-EFFECTIVENESS
Inhaled +++ An average daily dose of 800mcg of inhaled beclomethasone is
Corticosteroids equivalent to 10-15mg/d of oral prednisone
Long-acting ++ Foradil capsules for oral inhalation: 12 mcg formoterol fumarate powder,
bronchodilators for use with Aerolizer inhaler. (FDA)
Treatment of asthma in patients ≥5 years: Inhalation of one capsule every
12 hours in addition to concomitant treatment with a long-term control
medication such as an inhaled corticosteroid
Leukotriene- +++
receptor Montelukast is by far most prescribed due to the convenience of once-daily
antagonists treatment and of patient fear of inhaled corticosteroids

Principal advantage is that they are taken orally — children compliance (poor
in inhaled therapy)
Montelukast 10mg (adults) or 4mg (children) OD Zafirlukast 20mg twice
daily; Zileuton 1200mg twice daily

“when used alone as controller, the effect of leukotriene modifiers are

generally less than that of low doses of inhaled glucocorticosteroids, and, in
patients already on inhaled glucocorticosteroids” GINA 2011
Combination ++++
Therapy
(ICS+LABA) “The combination ICS/formoterol inhaler may be taken up to a maximum
total formoterol dose of 72 mcg in a day”
“The benefit of this regiment in preventing exacerbations appears to be
due to intervention at a very early stage of worsening asthma” GINA 2018
“Fixed combination inhalers are more convenient for patients, may
increase compliance, and ensure that the long-acting β2 -agonist is always
accompanied by a glucocorticosteroid” GINA 2011
OCS +++

Typically, a short course of OCS is used (e.g. 40–50 mg/day usually for 5–7 days
The recommended dose for adults is 1 mg prednisolone/kg/day or equivalent up to
a maximum of 50 mg/day
“Long-term oral glucocorticosteroid therapy (that is, for periods longer than two
weeks as a glucocorticosteroid “burst”) may be required for severely uncontrolled
asthma, but its use is limited by the risk of significant adverse effects.” GINA 2011.
SUMMARY FOR SUITABILITY
DRUG GROUP SUITABILITY

ICS +++

LABA ++

Leukotriene receptor agonists +++

Combination (ICS+LABA) ++++

OCS +++
EFFICACY
SAFETY
SUITABILITY
COST-EFFECTIVENESS
Inhaled ++ Budesonide
Corticosteroids BUDECORT 250MCG RESPULES 2ML
(P170)
Source: Rose Pharmacy
Long-acting +++ Formeterol
bronchodilators FORADIL 12MCG CAPSULE
P38.25
Source: Rose Pharmacy
Leukotriene- +++ Montelukast
receptor -10 mg tablet
antagonists = P28.00 (RiteMed)
Source: Rose Pharmacy Jaro
Combination +++ Seretide (25/250mcg (P690)
Therapy Generic name: Salmeterol xinafoate 25 mcg, fluticasone propionate 250
(ICS+LABA) mcg

SYMBICORT 160MCG/4.5MCG TURBUHALER (P1,128.50)

Generic Name: BUDESONIDE 160MG,FORMOTEROL 4.5MG

Source: Watsons Pharmacy (Robinsons Jaro)

OCS ++++ Prednisone 5mg (P4.50)
Source: Rose Pharmacy Jaro
SUMMARY FOR COST
DRUG GROUP COST

ICS ++

LABA +++

Leukotriene receptor agonists +++

Combination (ICS+LABA) +++

OCS ++++
 DRUG EFFICACY SAFETY SUITABILITY COST TOTAL

ICS
++++ +++ +++ ++ 12

LABA
+++ ++ ++ +++ 10

Leukotriene receptor agonists

+++ +++ +++ +++ 12

Combination (ICS+LABA)
++++ ++++ ++++ +++ 15

OCS
++++ +++ +++ ++++ 14