Clinical Pharmacology · MU Sofia

30. Rational drug prescribing in patients with bronchial asthma.

Explains rational prescribing for adults with bronchial asthma, starting from the current rule that no patient should rely on a reliever alone and every patient should receive an inhaled corticosteroid. It then walks through the stepwise treatment ladder, with a table by step, followed by a table of drug groups with examples and notes. Practical prescribing points on inhaler technique, control review, drugs to avoid and acute exacerbation management close the note.

Inside: 4 sections · 2 tables · 16 flashcards · 2 min

Topic 30 of 30 in the MU Sofia syllabus for Clinical Pharmacology (Medicine, Year 5). The free AceMed note covers it in 4 sections, about 193 words (2 min of reading), with 16 flashcards.

In this note

  1. Introduction
  2. Key change (GINA since 2019)
  3. Stepwise treatment (GINA, adults, track 1 preferred)
  4. Rational prescribing points

Introduction

Asthma is chronic airway inflammation with variable airflow obstruction (wheeze, breathlessness, cough, chest tightness). Treatment aims at control of symptoms and prevention of exacerbations; the basis is inhaled corticosteroids (ICS), which treat the inflammation.

Key change (GINA since 2019)

No SABA-only treatment for adults and adolescents: relying on salbutamol alone increases the risk of severe attacks and death. Every patient should receive an ICS-containing treatment.

Stepwise treatment (GINA, adults, track 1 preferred)

Track 2: daily ICS (or ICS–LABA such as fluticasone–salmeterol) with SABA as reliever; acceptable when MART is not possible. Leukotriene antagonists (montelukast) are an add-on (neuropsychiatric warnings).

Drugs

Rational prescribing points

  • Check inhaler technique and adherence before stepping up; use a spacer with pressurised inhalers.
  • Assess control every 1–3 months; step down after 3 months of good control (never stop ICS).
  • Written action plan; treat rhinitis, stop smoking, avoid triggers; influenza vaccine.
  • Avoid non-selective β-blockers (propranolol, including eye drops) and be cautious with NSAIDs/aspirin in aspirin-sensitive asthma.

Acute exacerbation

Repeated SABA (spacer or nebuliser), oxygen to SpO₂ 93–95%, systemic corticosteroid (prednisolone 40–50 mg for 5–7 days), ipratropium in severe attacks, IV magnesium sulphate for life-threatening attacks; then review the controller.

Every asthmatic needs an inhaled corticosteroid: as-needed or maintenance-and-reliever budesonide–formoterol is now preferred over salbutamol alone.

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