Asthma Meds Side Effects and Asthma COPD Overlap

Asthma Meds

Side effects of beta-adrenoceptor agonists 

• Skeletal muscle tremor

• Cardiac tachycardia-tachyarrhythmias

• Modest prolongation of the QTc interval

• Tachyphylaxis

• Hypokalemia. 

• Nausea, vomiting, headache

Side effects of theophylline

• Positive chronotropic and inotropic effect. 

• Mild cortical arousal. 

• Stimulates secretion of gastric acid and digestive enzymes.

• Can cause hypokalemia, hyperglycemia, skeletal muscle tremors

• Can cause seizure- related to blood levels

• Can cause tachyarrhythmias

Side effects of glucocorticoids

• Linked to route and dosage

• Glucose intolerance, immunosuppression, bone demineralization, increase in weight, increased bp, decreased growth rate (children).

• Suppression of Adreno-pituitary axis (after 2 wks) with parenteral or oral. (use alternative day therapy)

• Throat thrush, oral hoarseness (inhaled preparations). can increase opportunistic infections

• Daily therapy for mild persistent asthma or short, intermittent courses of inhaled or oral corticosteroids 

Asthma COPD Overlap Syndrome (ACOS)

Figure 1. Hypothetical Course of Lung Function in Chronic Obstructive Pulmonary Disease (COPD) and Asthma.

COPD is an inflammatory disease of the small airways in particular and involves chronic bronchitis and tissue breakdown (emphysema). The disease may start with a low level of lung function as early as 25 years of age, followed by an accelerated decline in forced expiratory volume in 1 second (FEV₁) as compared with the normal decline. FEV₁ may decrease to 50% of the predicted (normal) value at 60 years of age and may go as low as 25% of the predicted value. During exacerbations, FEV₁ falls; the fall and recovery are more gradual than in asthma. In asthma, airway obstruction results predominantly from smooth-muscle spasm and hypersecretion of mucus. Exacerbations may accompany an accelerated decline in FEV₁ as well, with a rapid fall and more rapid recovery than in COPD. Progression of disease may occur in a subgroup of persons with asthma, leading to an FEV₁ of 50% of the predicted value at 60 years of age. FEV₁ seldom decreases to the low levels that occur more frequently in COPD. On the basis of an FEV₁ of 55% of the predicted value at 60 years of age, one cannot differentiate asthma from COPD. ACOS denotes asthma–COPD overlap syndrome.

Figure 1. Hypothetical Course of Lung Function in Chronic Obstructive Pulmonary Disease (COPD) and Asthma.

COPD is an inflammatory disease of the small airways in particular and involves chronic bronchitis and tissue breakdown (emphysema). The disease may start with a low level of lung function as early as 25 years of age, followed by an accelerated decline in forced expiratory volume in 1 second (FEV₁) as compared with the normal decline. FEV₁ may decrease to 50% of the predicted (normal) value at 60 years of age and may go as low as 25% of the predicted value. During exacerbations, FEV₁ falls; the fall and recovery are more gradual than in asthma. In asthma, airway obstruction results predominantly from smooth-muscle spasm and hypersecretion of mucus. Exacerbations may accompany an accelerated decline in FEV₁ as well, with a rapid fall and more rapid recovery than in COPD. Progression of disease may occur in a subgroup of persons with asthma, leading to an FEV₁ of 50% of the predicted value at 60 years of age. FEV₁ seldom decreases to the low levels that occur more frequently in COPD. On the basis of an FEV₁ of 55% of the predicted value at 60 years of age, one cannot differentiate asthma from COPD. ACOS denotes asthma–COPD overlap syndrome.

http://www.nejm.org/doi/full/10.1056/NEJMra1411863