Paper I
2022 July (Supplementary) (2019 Scheme) · 100 marks · 180 min

Question

Classify drugs used in Bronchial asthma. Discuss the management of Status Asthmaticus. (4+4) (PTO)

Q78 marksShort Essays

Answer

a) Classification of drugs used in bronchial asthma

ClassExamples
Beta-2 agonistsSalbutamol (short-acting), Salmeterol/Formoterol (long-acting)
Inhaled corticosteroidsBudesonide, Fluticasone
AnticholinergicsIpratropium, Tiotropium
Leukotriene receptor antagonistsMontelukast
MethylxanthinesTheophylline
Mast cell stabilizersSodium cromoglycate

b) Management of status asthmaticus A severe, life-threatening acute asthma attack failing to respond to initial standard bronchodilator therapy, requiring escalating, stepwise management:

  1. Oxygen — high-flow, titrated to maintain adequate saturation; hypoxemia is the immediate life threat.
  2. Nebulized SABA (Salbutamol), repeated/continuous, often combined with nebulized Ipratropium — the combination produces greater bronchodilation than either agent alone.
  3. Systemic corticosteroids, given early (IV Hydrocortisone or oral Prednisolone) — no immediate bronchodilator effect, but their anti-inflammatory action is required to interrupt the attack; the delay to onset is why they’re started immediately rather than reserved.
  4. IV Magnesium sulfate — a specific add-on for severe attacks not responding adequately to the above, via smooth muscle relaxation.
  5. IV Aminophylline — a further-line addition in refractory cases, given its narrow therapeutic index.
  6. Mechanical ventilation — reserved for impending or actual respiratory failure, the final escalation.

Anticholinergics, corticosteroids, and magnesium are added on top of continued SABA, not as replacements for it.

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