DOCSLIB.ORG

Global Strategy for Asthma Management and Prevention Online Appendix

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Global Strategy for Asthma Management and Prevention Online Appendix DISTRIBUTE OR COPY NOT DO MATERIAL- COPYRIGHTED ASTHMA MANAGEMENT AND PREVENTION ONLINE APPENDIX GLOBAL STRATEGY FOR © 2019 Global Initiative for Asthma UPDATED 2019 DISTRIBUTE OR This online Appendix contains background and supplementary material for the Global Initiative for Asthma (GINA) 2019 Global StrategyCOPY Repor t for Asthma Management and Prevention. The full GINA report and other GINA resources are available at www.ginastNOThma. org DO This document is intended as a general guide for health professionals and policy-makers. It is based, to the best of our knowledge, on current best evidence and medical knowledge and practice at the date of publication. When assessing and treating patients, health professionals are stronMATERIAL-gly a dvised to consult a variety of sources and to use their own professional judgment. GINA cannot be held liable or responsible for healthcare administered with the use of this document, including any use which is not in accordance with applicable local or national regulations or guidelines. COPYRIGHTED GLOBAL STRATEGY FOR ASTHMA MANAGEMENT AND PREVENTION ONLINE APPENDIX DISTRIBUTE 2019 OR COPY NOT DO This online Appendix contains background and supplementary material for the Global Initiative for Asthma (GINA) 2019 Global Strategy Report for Asthma Management and Prevention. The full GINA report and other GINA resources are available MATERIAL-at www.ginasthma.com This document is intended to provide background information for the full GINA 2019 report, as a general guide for health professionals and policy-makers. It is based, to the best of our knowledge, on current best evidence and medical knowledge and practice at the date of publication. When assessing and treating patients, health professionals are strongly advised to consult a variety of sources and to use their COPYRIGHTED own professional judgment, and to take into account local or national regulations and guidelines. GINA cannot be held liable or responsible for inappropriate healthcare associated with the use of this document, including any use which is not in accordance with applicable local or national regulations or guidelines. DISTRIBUTE OR COPY NOT DO MATERIAL- COPYRIGHTED TABLE OF CONTENTS Chapter 1. The burden of asthma .............................................................................................................................. 7 Prevalence, morbidity and mortality ............................................................................................................................... 7 Social and economic burden ........................................................................................................................................... 9 Reducing the burden of asthma ...................................................................................................................................... 9 Chapter 2. Factors affecting the development and expression of asthma...................................................................11 Background .................................................................................................................................................................... 11 Host factors .................................................................................................................................................................... 12 Environmental factors ................................................................................................................................................... 13 Chapter 3. Mechanisms of asthma ...........................................................................................................................17 Airway inflammation in asthma .................................................................................................................................... 17 Structural changes in the airways .................................................................................................................................. 20 DISTRIBUTE Pathophysiology ............................................................................................................................................................ 20 OR Special mechanisms in specific contexts ....................................................................................................................... 21 Chapter 4. Tests for diagnosis and monitoring of asthma ..........................................................................................COPY 23 Measuring lung function ................................................................................................NOT ................................................ 23 Non-invasive markers of airway inflammation .............................................................................................................DO 26 Chapter 5. Asthma pharmacotherapy ......................................................................................................................29 Part A. Asthma pharmacotherapy - adults and adolescents ............................................................................................. 29 Route of Administration ................................................................................................MATERIAL- ................................................ 29 Controller medications .................................................................................................................................................. 29 Add-on controller medications ...................................................................................................................................... 34 Reliever medications ..................................................................................................................................................... 39 Other medications ................................................................................................COPYRIGHTED ......................................................... 40 Complementary and alternative medicines and therapies ........................................................................................... 41 Part B. Asthma pharmacotherapy – children 6–11 years ............................................................................................. 43 Route of administration ................................................................................................................................................. 43 Controller medications .................................................................................................................................................. 44 Add-on controller medications ...................................................................................................................................... 48 Reliever medications ..................................................................................................................................................... 50 Other medications, not recommended for use in children ........................................................................................... 50 Part C. Asthma pharmacotherapy – children 5 years and younger .............................................................................. 51 3 Controller medications .................................................................................................................................................. 51 Reliever medications ..................................................................................................................................................... 54 Chapter 6. Implementing asthma management strategies in health systems ............................................................ 55 Introduction ................................................................................................................................................................... 55 Planning an implementation strategy ........................................................................................................................... 56 Economic value of implementing management recommendations for asthma care ................................................... 61 GINA dissemination and implementation resources ..................................................................................................... 61 DISTRIBUTE OR COPY NOT DO MATERIAL- COPYRIGHTED 4 TABLE OF FIGURES BURDEN OF ASTHMA Box A1-1. World map of the prevalence of current asthma in children aged 13–14 years ............................................. 7 Box A1-2. Prevalence of current asthma in 2000–2003 in children aged 13–14 years (%) ............................................ 8 DEVELOPMENT AND EXPRESSION OF ASTHMA Box A2-1. Factors influencing the development and expression of asthma .................................................................. 11 Box A3-1. Inflammatory cells in asthmatic airways ........................................................................................................ 17 MECHANISMS Box A3-2. Structural cells in asthmatic airways ............................................................................................................. 18 Box A3-3. Key cellular mediators in asthma .................................................................................................................. 19 Box A3-4. Structural changes in asthmatic airways ......................................................................................................
Load more

Recommended publications
  • (CD-P-PH/PHO) Report Classification/Justifica
    COMMITTEE OF EXPERTS ON THE CLASSIFICATION OF MEDICINES AS REGARDS THEIR SUPPLY (CD-P-PH/PHO) Report classification/justification of medicines belonging to the ATC group R01 (Nasal preparations) Table of Contents Page INTRODUCTION 5 DISCLAIMER 7 GLOSSARY OF TERMS USED IN THIS DOCUMENT 8 ACTIVE SUBSTANCES Cyclopentamine (ATC: R01AA02) 10 Ephedrine (ATC: R01AA03) 11 Phenylephrine (ATC: R01AA04) 14 Oxymetazoline (ATC: R01AA05) 16 Tetryzoline (ATC: R01AA06) 19 Xylometazoline (ATC: R01AA07) 20 Naphazoline (ATC: R01AA08) 23 Tramazoline (ATC: R01AA09) 26 Metizoline (ATC: R01AA10) 29 Tuaminoheptane (ATC: R01AA11) 30 Fenoxazoline (ATC: R01AA12) 31 Tymazoline (ATC: R01AA13) 32 Epinephrine (ATC: R01AA14) 33 Indanazoline (ATC: R01AA15) 34 Phenylephrine (ATC: R01AB01) 35 Naphazoline (ATC: R01AB02) 37 Tetryzoline (ATC: R01AB03) 39 Ephedrine (ATC: R01AB05) 40 Xylometazoline (ATC: R01AB06) 41 Oxymetazoline (ATC: R01AB07) 45 Tuaminoheptane (ATC: R01AB08) 46 Cromoglicic Acid (ATC: R01AC01) 49 2 Levocabastine (ATC: R01AC02) 51 Azelastine (ATC: R01AC03) 53 Antazoline (ATC: R01AC04) 56 Spaglumic Acid (ATC: R01AC05) 57 Thonzylamine (ATC: R01AC06) 58 Nedocromil (ATC: R01AC07) 59 Olopatadine (ATC: R01AC08) 60 Cromoglicic Acid, Combinations (ATC: R01AC51) 61 Beclometasone (ATC: R01AD01) 62 Prednisolone (ATC: R01AD02) 66 Dexamethasone (ATC: R01AD03) 67 Flunisolide (ATC: R01AD04) 68 Budesonide (ATC: R01AD05) 69 Betamethasone (ATC: R01AD06) 72 Tixocortol (ATC: R01AD07) 73 Fluticasone (ATC: R01AD08) 74 Mometasone (ATC: R01AD09) 78 Triamcinolone (ATC: R01AD11) 82
    [Show full text]
  • Fasted and Fed State Human Duodenal Fluids: Characterization, Drug Solubility, and Comparison to Simulated Fluids and with Human Bioavailability
    European Journal of Pharmaceutics and Biopharmaceutics 163 (2021) 240–251 Contents lists available at ScienceDirect European Journal of Pharmaceutics and Biopharmaceutics journal homepage: www.elsevier.com/locate/ejpb Fasted and fed state human duodenal fluids: Characterization, drug solubility, and comparison to simulated fluids and with human bioavailability D. Dahlgren a, M. Venczel b,c, J.-P. Ridoux b,c, C. Skjold¨ a, A. Müllertz d, R. Holm e, P. Augustijns f, P.M. Hellstrom¨ g, H. Lennernas¨ a,* a Department of Pharmaceutical Biosciences, Biopharmaceutics, Uppsala University, Sweden b Global CMC Development Sanofi, Frankfurt, Germany c Global CMC Development Sanofi, Vitry, France d Physiological Pharmaceutics, University of Copenhagen, Copenhagen, Denmark e Drug Product Development, Janssen R&D, Johnson & Johnson, Beerse, Belgium f Drug Delivery and Disposition, KU Leuven, Leuven, Belgium g Department of Medical Sciences, Gastroenterology/Hepatology, Uppsala University, Sweden ARTICLE INFO ABSTRACT Keywords: Accurate in vivo predictions of intestinal absorption of low solubility drugs require knowing their solubility in Bioavailability physiologically relevant dissolution media. Aspirated human intestinal fluids (HIF) are the gold standard, fol­ Food effects lowed by simulated intestinal HIF in the fasted and fed state (FaSSIF/FeSSIF). However, current HIF charac­ Drug solubility terization data vary, and there is also some controversy regarding the accuracy of FaSSIF and FeSSIF for Human intestinal fluids predicting drug solubility in HIF. This study aimed at characterizing fasted and fed state duodenal HIF from 16 Drug absorption Drug dissolution human volunteers with respect to pH, buffer capacity, osmolarity, surface tension, as well as protein, phos­ Drug delivery pholipid, and bile salt content.
    [Show full text]
  • Validation of New Analytical Methodology for Determining Fenoterolhydrobromide by HPLC: Application in Pharmaceutical Products
    Artigo Original/Original Article Validation of new analytical methodology for determining fenoterolhydrobromide by HPLC: application in pharmaceutical products Validação de uma nova metodologia analítica para determinação de bromidrato de fenoterol por CLAE: aplicações em produtos farmacêuticos RIALA6/1475 *Helena Miyoco YANO1, Fernanda Fernandes FARIAS1, Marcelo Beiriz DEL BIANCO1, Pedro Lopez GARCIA2 *Endereço para correspondência: 1Núcleo de Ensaios Físicos e Químicos em Medicamentos, Centro de Medicamentos, Cosméticos e Saneantes, Instituto Adolfo Lutz, Av. Doutor Arnaldo, 355, CEP: 01246-902, São Paulo, SP, Brasil. E-mail: [email protected] 2Departamento de Farmácia, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, SP, Brasil. Recebido: 31.10.2011- Aceito para publicação: 20.04.2012 RESUMO Bromidrato de fenoterol é um agente agonista adrenérgico β2-seletivo utilizado para tratamento de asma e doenças pulmonares crônicas obstrutivas. A metodologia analítica por cromatografia líquida de alta eficiência (CLAE) foi desenvolvida e validada para a determinação quantitativa de bromidrato de fenoterol. A condição analítica empregada incluiu coluna em fase reversa C18 (150 mm × 3,9 mm d.i., 5 µm) Thermo®, fase móvel composta de mistura de acetonitrila e água (30:70, v/v) com 0,1% de trietilamina e pH ajustado para 5,0 com ácido fórmico, vazão de 1,0 mL.min-1 e detecção em UV a 276 nm. A faixa de linearidade foi de 0,025 a 0,15 mg.mL-1; a curva analítica mostrou coeficiente de correlação > 0,999. O limite de detecção (LD) foi de 0,003 mg.mL-1 e o limite de quantificação de 0,012 mg.mL-1.
    [Show full text]
  • Comparison of Intramuscular Betamethasone and Oral
    Color profile: Disabled Composite Default screen 100 ORIGINAL ARTICLE 100 95 95 75 75 25 25 5 5 0 Comparison of intramuscular 0 betamethasone and oral prednisone in the prevention of relapse of acute asthma John S Chan MD1, Robert L Cowie MD1, Gerald C Lazarenko MD2, Cinde Little RRT1, Sandra Scott RRT1, Gordon T Ford MD FCCP1 1Division of Respiratory Medicine and 2Department of Emergency Medicine, University of Calgary, Calgary, Alberta JS Chan, RL Cowie, GC Lazarenko, C Little, S Scott, tively) and use of inhaled corticosteroids (46% versus 64.3% GT Ford. Comparison of intramuscular betamethasone respectively) (P<0.05). Using intention-to-treat analysis, the and oral prednisone in the prevention of relapse of acute relapse rates for betamethasone and prednisone at day 7 were asthma. Can Respir J 2001;8(3):147-152. 14.9% (13 of 87 patients) and 25% (21 of 84 patients), respectively (P=0.1), and at day 21, the rates were 36.8% (32 OBJECTIVE: To compare the relapse rate after a single intra- of 87 patients) and 31% (26 of 84 patients), respectively muscular injection of a long acting corticosteroid, betametha- (P=0.4). There were no differences in symptom score, peak sone, with oral prednisone in patients discharged from the flows and adverse effects between the two groups at days 7 emergency department (ED) for acute exacerbations of and 21. asthma. CONCLUSIONS: A single dose of intramuscular betametha- PATIENTS AND METHODS: Patients with acute exacer- sone 12 mg was safe and as efficacious as prednisone in pre- bations of asthma who were suitable for discharge from the venting the relapse of acute asthma.
    [Show full text]
  • Pharmacokinetic Interactions of Pioglitazone
    Department of Clinical Pharmacology University of Helsinki Finland PHARMACOKINETIC INTERACTIONS OF PIOGLITAZONE Tiina Jaakkola ACADEMIC DISSERTATION To be presented, with the permission of the Medical Faculty of the University of Helsinki, for public examination in Auditorium 2 of Biomedicum, on August 24th, 2007, at 12 noon. Helsinki 2007 JJaakkola_Tiina_vaitos.inddaakkola_Tiina_vaitos.indd 1 117.7.20077.7.2007 221:11:231:11:23 Supervisors: Professor Pertti Neuvonen, MD Department of Clinical Pharmacology University of Helsinki Helsinki, Finland Docent Janne Backman, MD Department of Clinical Pharmacology University of Helsinki Helsinki, Finland Reviewers: Docent Kimmo Malminiemi, MD, MSc Department of Pharmacology, Clinical Pharmacology and Toxicology University of Tampere Tampere, Finland Professor emeritus Pertti Pentikäinen, MD Department of Medicine University of Helsinki Helsinki, Finland Opponent: Professor Kari Kivistö, MD Department of Pharmacology, Clinical Pharmacology and Toxicology University of Tampere Tampere, Finland ISBN 978-952-92-2224-7 (paperback) ISBN 978-952-10-4020-7 (PDF, http://ethesis.helsinki.fi ) Helsinki 2007 Yliopistopaino JJaakkola_Tiina_vaitos.inddaakkola_Tiina_vaitos.indd 2 117.7.20077.7.2007 221:11:551:11:55 JJaakkola_Tiina_vaitos.inddaakkola_Tiina_vaitos.indd 3 117.7.20077.7.2007 221:11:551:11:55 CONTENTS CONTENTS ABBREVIATIONS.......................................................................................................................................... 6 LIST OF ORIGINAL PUBLICATIONS.......................................................................................................
    [Show full text]
  • Pharmacokinetic Interactions of Drugs with St John's Wort
    http://www.paper.edu.cn Pharmacokinetic interactions of Journal of Psychopharmacology 18(2) (2004) 262–276 © 2004 British Association drugs with St John’s wort for Psychopharmacology ISSN 0269-8811 SAGE Publications Ltd, London, Thousand Oaks, CA and New Delhi 10.1177/0269881104042632 Shufeng Zhou Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore. Eli Chan Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore. Shen-Quan Pan Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore. Min Huang Institute of Clinical Pharmacology, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou 510089, PR China. Edmund Jon Deoon Lee Department of Pharmacology, Faculty of Medicine, National University of Singapore, Singapore. Abstract There is a worldwide increasing use of herbs which are often cancer patients receiving irinotecan treatment. St John’s wort did not administered in combination with therapeutic drugs, raising the alter the pharmacokinetics of tolbutamide, but increased the incidence potential for herb–drug interactions. St John’s wort (Hypericum of hypoglycaemia. Several cases have been reported that St John’s wort perforatum) is one of the most commonly used herbal antidepressants. A decreased cyclosporine blood concentration leading to organ rejection. literature search was performed using Medline (via Pubmed), Biological St John’s wort caused breakthrough bleeding and unplanned pregnancies Abstracts, Cochrane Library, AMED, PsycINFO and Embase (all from their when used concomitantly with oral contraceptives. It also caused inception to September 2003) to identify known drug interaction with serotonin syndrome when coadministered with selective serotonin- St John’s wort. The available data indicate that St John’s wort is a reuptake inhibitors (e.g.
    [Show full text]
  • Long-Term Budesonide Or Nedocromil Mineral Accretion Over a Period of Years
    term inhaled corticosteroid (ICS) treatment on bone Long-term Budesonide or Nedocromil mineral accretion over a period of years. Treatment, Once Discontinued, Does Not Alter the Course of Mild to Moderate Asthma in STUDY POPULATION. Cohort follow-up study for a median Children and Adolescents of 7 years with 877 children 5 to 12 years of age who Strunk RC, Sternberg AL, Szefler SJ, et al. J Pediatr. had mild-to-moderate asthma and initially were ran- 2009;154(5):682–687 domly assigned in the Childhood Asthma Management Program. PURPOSE OF THE STUDY. To determine whether long-term, METHODS. Serial dual-energy x-ray absorptiometry scans continuous use of inhaled antiinflammatory medications of the lumbar spine to assess bone mineral density were affects asthma outcomes in children with mild-to-mod- performed for all patients. Annual bone mineral accre- erate asthma after use is discontinued. tion was calculated for 531 boys and 346 girls. STUDY POPULATION. A total of 941 children, 5 to 12 years of RESULTS. Oral corticosteroid bursts produced dose- age, who had previously participated in the Childhood dependent reductions in bone mineral accretion (0.052, Asthma Management Program (CAMP). 0.049, and 0.046 g/cm2 per year with 0, 1–4, and Ն5 courses, respectively) and increases in the risk for osteo- METHODS. During the CAMP trial, subjects received treat- penia (10%, 14%, and 21%, respectively) in boys but ment with budesonide, nedocromil, or placebo for 4.3 not girls. Cumulative ICS use was associated with a small years. During the posttrial period, asthma manage- decrease in bone mineral accretion in boys but not girls ment was provided by primary care physicians ac- but no increased risk for osteopenia.
    [Show full text]
  • Ep 2560611 B1
    (19) TZZ Z___T (11) EP 2 560 611 B1 (12) EUROPEAN PATENT SPECIFICATION (45) Date of publication and mention (51) Int Cl.: of the grant of the patent: A61K 9/00 (2006.01) 03.01.2018 Bulletin 2018/01 (86) International application number: (21) Application number: 11719211.2 PCT/EP2011/056227 (22) Date of filing: 19.04.2011 (87) International publication number: WO 2011/131663 (27.10.2011 Gazette 2011/43) (54) "PROCESS FOR PROVIDING PARTICLES WITH REDUCED ELECTROSTATIC CHARGES" VERFAHREN ZUR BEREITSTELLUNG VON PARTIKELN MIT REDUZIERTEN ELEKTROSTATISCHEN LADUNGEN PROCÉDÉ DE PRÉPARATION DE PARTICULES AYANT DES CHARGES ÉLECTROSTATIQUES RÉDUITES (84) Designated Contracting States: • GUCHARDI ET AL: "Influence of fine lactose and AL AT BE BG CH CY CZ DE DK EE ES FI FR GB magnesium stearate on low dose dry powder GR HR HU IE IS IT LI LT LU LV MC MK MT NL NO inhaler formulations", INTERNATIONAL PL PT RO RS SE SI SK SM TR JOURNAL OF PHARMACEUTICS, ELSEVIER BV, NL LNKD- DOI:10.1016/J.IJPHARM.2007.06.041, (30) Priority: 21.04.2010 EP 10160565 vol. 348, no. 1-2, 19 December 2007 (2007-12-19), pages 10-17, XP022393884, ISSN: 0378-5173 (43) Date of publication of application: • ELAJNAF A ET AL: "Electrostatic 27.02.2013 Bulletin 2013/09 characterisation of inhaled powders: Effect of contact surface and relative humidity", (73) Proprietor: Chiesi Farmaceutici S.p.A. EUROPEAN JOURNAL OF PHARMACEUTICAL 43100 Parma (IT) SCIENCES, ELSEVIER, AMSTERDAM, NL LNKD- DOI:10.1016/J.EJPS.2006.07.006, vol. 29, no. 5, 1 (72) Inventors: December 2006 (2006-12-01), pages 375-384, • COCCONI, Daniela XP025137181, ISSN: 0928-0987 [retrieved on I-43100 Parma (IT) 2006-12-01] • MUSA, Rossella • CHAN ET AL: "Dry powder aerosol drug I-43100 Parma (IT) delivery-Opportunities for colloid and surface scientists", COLLOIDS AND SURFACES.
    [Show full text]
  • Antiviral Effect of Budesonide Against SARS-Cov-2
    viruses Communication Antiviral Effect of Budesonide against SARS-CoV-2 Natalie Heinen 1 , Toni Luise Meister 1 , Mara Klöhn 1 , Eike Steinmann 1, Daniel Todt 1,2 and Stephanie Pfaender 1,* 1 Department of Molecular and Medical Virology, Ruhr-University Bochum, 44801 Bochum, Germany; [email protected] (N.H.); [email protected] (T.L.M.); [email protected] (M.K.); [email protected] (E.S.); [email protected] (D.T.) 2 European Virus Bioinformatics Center (EVBC), 07743 Jena, Germany * Correspondence: [email protected]; Tel.: +49-234-32-23189 Abstract: Treatment options for COVID-19, a disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, are currently severely limited. Therefore, antiviral drugs that efficiently reduce SARS-CoV-2 replication or alleviate COVID-19 symptoms are urgently needed. Inhaled glucocorticoids are currently being discussed in the context of treatment for COVID-19, partly based on a previous study that reported reduced recovery times in cases of mild COVID-19 after inhalative administration of the glucocorticoid budesonide. Given various reports that describe the potential antiviral activity of glucocorticoids against respiratory viruses, we aimed to analyze a potential antiviral activity of budesonide against SARS-CoV-2 and circulating variants of concern (VOC) B.1.1.7 (alpha) and B.1.351 (beta). We demonstrate a dose-dependent inhibition of SARS-CoV-2 that was comparable between all viral variants tested while cell viability remains unaffected. Our results are encouraging as they could indicate a multimodal mode of action of budesonide against SARS-CoV-2 and COVID-19, which could contribute to an improved clinical performance.
    [Show full text]
  • Composition for Rectal Administration Combined with an Oral Alpha-Lipoic
    (19) & (11) EP 2 162 125 B1 (12) EUROPEAN PATENT SPECIFICATION (45) Date of publication and mention (51) Int Cl.: of the grant of the patent: A61K 31/136 (2006.01) A61K 31/01 (2006.01) 19.10.2011 Bulletin 2011/42 A61P 1/00 (2006.01) A61K 45/06 (2006.01) A61K 31/56 (2006.01) A61K 31/573 (2006.01) (2006.01) (21) Application number: 08768441.1 A61K 31/606 (22) Date of filing: 13.06.2008 (86) International application number: PCT/US2008/007401 (87) International publication number: WO 2008/156671 (24.12.2008 Gazette 2008/52) (54) Composition for rectal administration combined with an oral alpha-lipoic acid composition for the treatment of inflammatory bowel disease Zusammensetzung zur rektalen Verabreichung kombiniert mit einer oralen Zusammentzung enthaltend alpha Liponsäure zur Behandlung von entzündlicher Darmerkrankung Composition pour l’administration rectale en combinaison avec une composition orale de l’ acide alpha- lipoique pour le traitment des maladies intestinales inflammatoires (84) Designated Contracting States: (56) References cited: AT BE BG CH CY CZ DE DK EE ES FI FR GB GR EP-B1- 0 671 168 WO-A2-02/089796 HR HU IE IS IT LI LT LU LV MC MT NL NO PL PT US-A- 4 657 900 US-A- 5 082 651 RO SE SI SK TR US-A- 5 378 470 (30) Priority: 13.06.2007 US 934505 P • MULDER CJ. ET AL.: ’Beclomethasone 06.02.2008 US 63745 P dipropionate (3mg) versus 5- aminosalicylic acid (2g) versus the combination of both (3mg/2g)as (43) Date of publication of application: retention enemas in active ulcerative proctitis’ 17.03.2010 Bulletin 2010/11 EUR.J.GASTROENTEROL HEPATOL vol.
    [Show full text]
  • ACCOLATE® (Zafirlukast) TABLETS DESCRIPTION
    ACCOLATE® (zafirlukast) TABLETS DESCRIPTION Zafirlukast is a synthetic, selective peptide leukotriene receptor antagonist (LTRA), with the chemical name 4-(5-cyclopentyloxy-carbonylamino-1-methyl-indol-3-ylmethyl)-3-methoxy-N-o­ tolylsulfonylbenzamide. The molecular weight of zafirlukast is 575.7 and the structural formula is: The empirical formula is: C31H33N3O6S Zafirlukast, a fine white to pale yellow amorphous powder, is practically insoluble in water. It is slightly soluble in methanol and freely soluble in tetrahydrofuran, dimethylsulfoxide, and acetone. ACCOLATE is supplied as 10 and 20 mg tablets for oral administration. Inactive Ingredients: Film-coated tablets containing croscarmellose sodium, lactose, magnesium stearate, microcrystalline cellulose, povidone, hypromellose, and titanium dioxide. CLINICAL PHARMACOLOGY Mechanism of Action: Zafirlukast is a selective and competitive receptor antagonist of leukotriene D4 and E4 (LTD4 and LTE4), components of slow-reacting substance of anaphylaxis (SRSA). Cysteinyl leukotriene production and receptor occupation have been correlated with the pathophysiology of asthma, including airway edema, smooth muscle constriction, and altered cellular activity associated with the inflammatory process, which contribute to the signs and symptoms of asthma. Patients with asthma were found in one study to be 25­ 100 times more sensitive to the bronchoconstricting activity of inhaled LTD4 than nonasthmatic subjects. In vitro studies demonstrated that zafirlukast antagonized the contractile activity of three leukotrienes (LTC4, LTD4 and LTE4) in conducting airway smooth muscle from laboratory animals and humans. Zafirlukast prevented intradermal LTD4-induced increases in cutaneous vascular permeability and Reference ID: 3407275 inhibited inhaled LTD4-induced influx of eosinophils into animal lungs. Inhalational challenge studies in sensitized sheep showed that zafirlukast suppressed the airway responses to antigen; this included both the early- and late-phase response and the nonspecific hyperresponsiveness.
    [Show full text]
  • Inhaled Corticosteroid (ICS) Only – Metered Dose Inhalers (MDI)
    Categorisation and Formulary Choices of Inhaled Corticosteroids for Adults Inhaled Corticosteroid (ICS) only – Metered Dose Inhalers (MDI) MDI Beclometasone dipropionate Use with a compatible Fluticasone Propionate spacer device Prescribe by BRAND Clenil Modulite® Qvar®(extrafine) Qvar®(extrafine) Flixotide® Evohaler MDI Easi-Breathe Low Dose 100mcg, two puffs twice a 50 mcg, two puffs twice a day 50 mcg, two puffs twice a day 50 mcg, two puffs twice a day (BDP equivalent day (200 dose) (200 dose) (200 dose) (120 dose) ≤400mcg BDP) £4.45/month £4.72/month £4.64/month £5.44/month Medium Dose 200mcg, two puffs twice a 100 mcg, two puffs twice a day 100 mcg, two puffs twice a day 125mcg, two puffs twice a day (BDP equivalent day (200 dose) (200 dose) (200 dose) (120 dose) 400-1000mcg BDP) £9.70/month £10.33/month £10.17/month £12.50/month High Dose 250mcg, two puffs twice a 100 mcg, four puffs twice a day 100 mcg, four puffs twice a day 250mcg, two puffs twice a day (BDP equivalent day (200 dose) (200 dose) (200 dose) (120 dose) >1000mcg BDP) £9.77/month £20.66/month £20.34/month £20.00/month Simultaneous specialist OR referral recommended 250mcg four puffs, twice a day (200 dose) £19.55/month Prices correct as per Drug Tariff and DM&D December2018 1st line choices (dark green, solid border) 2nd line choices (light green, dashed border) Approved by Hertfordshire Medicines Management Committee – October 2018 Inhaled Corticosteroid (ICS) only – Dry Powder Inhalers (DPI) Beclometasone DPI dipropionate Budesonide Fluticasone Propionate Prescribe
    [Show full text]