Paper I
2023 July (Supplementary) (2019 Scheme) · 100 marks · 180 min

Question

Pharmacological management of Bronchial Asthma.

Q84 marksShort Answers

Answer

  • Reliever (rescue) therapy: short-acting beta-2 agonists (Salbutamol) — rapid bronchodilation for acute symptom relief, used as-needed.
  • Controller (maintenance) therapy: inhaled corticosteroids (Budesonide, Fluticasone) — the cornerstone of persistent asthma control, suppressing the underlying airway inflammation; long-acting beta-2 agonists (Salmeterol) added when ICS alone is insufficient, always combined with ICS, never as monotherapy.
  • Add-on agents: leukotriene receptor antagonists (Montelukast), particularly useful in allergic/exercise-induced asthma; anticholinergics (Tiotropium) as an additional bronchodilator option.
  • Severe/refractory disease: systemic corticosteroids for exacerbations; biologic therapy (anti-IgE Omalizumab, anti-IL5 Mepolizumab) for severe allergic/eosinophilic asthma.

Principle: stepwise therapy is escalated or de-escalated according to symptom control, with inhaled corticosteroids as the pivotal controller drug across essentially all persistent disease severities.

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