TEACHERS’ TOPICS Pharmacotherapy of Asthma
Martin M. Zdanowicz, PhD
South University School of Pharmacy, Savannah, GA
Submitted February 9, 2007; accepted April 23, 2007; published October 15, 2007.
The pharmacotherapy of asthma is a complex and evolving topic. A detailed understanding of the pathophysiologic processesinvolved in the asthmatic response forms the basis for understanding the actions of drugs used to treat this condition. Likewise, a solid comprehension of the medicinal chemistry and pharmacologic properties of the numerous agents involved in the treatment of asthma is critical for rationalizing drug choices and understanding potential side effects. Asthma is addressed at several points in thePharmD curriculum at South University including in the Pathophysiology (quarter 2), Integrated Sequence III (quarter 6), and Critical Care (quarter 9) courses. Various teaching strategies are employed throughout, along with weekly case-based recitations. The content presented here includes a synopsis of the pathophysiology and pharmacology from our Integrated Sequence III block on inﬂammatorydiseases and asthma. A short review of pertinent pathophysiology is followed by a detailed presentation on the various classes of asthma drugs which includes their chemistry, mechanism of action, pharmacokinetics, toxicity, and interactions. This presentation is designed to prepare students for asthma therapeutics, which follows next in the schedule. The complexities of asthma pharmacotherapy arestressed along with current controversies and future drug development.
Keywords: asthma, pharmacotherapy, pathophysiology, pharmacotherapy
Asthma is a chronic disease of the airways that is characterized by exacerbations of significant bronchospasm and marked airway inflammation. In the Unites States alone there are nearly 20 million individuals who have been diagnosed with asthma andapproximately half are children. According to reports from the Centers for Disease Control (CDC), the incidence of asthma and asthma-related mortality and morbidity in the US increased significantly during the period from 19801998.1 During this time, the number of work and school days lost to asthma-related events rose by 50%.1 The yearly cost of asthma on the US healthcare system in 1990 wasestimated at 6.2 billion dollars.2 By 2000 the estimated cost had doubled.3 While the overall costs of emergency room visits and hospitalizations for asthma patients appears to have decreased somewhat in recent years, the cost of medications for the treatment of asthma has increased signiﬁcantly. As future practitioners, it is important that PharmD students not only understand the
CorrespondingAuthor: Martin M. Zdanowicz, PhD, Associate Professor of Pharmacology, Department of Pharmaceutical Sciences, South University, School of Pharmacy, 709 Mall Blvd, Savannah, Georgia 31406. Tel: 912-201-8135. Fax: 912-2018153. E-mail: email@example.com
pathophysiology and therapeutics of asthma but also have an appreciation for the personal, medical, and economic burden of asthma onsociety. In the PharmD program at South University, students are exposed to the disease of asthma at several points in the curriculum. Several hours of detail on the pathogenesis and pathophysiology of asthma are presented to students in quarter 2 during Pathophysiology 2 (ﬁrst-professional year) contained in this manuscript is presented to students in the Integrated Sequence 3 (quarter 6) wherestudents are taught the medicinal chemistry and pharmacology of asthma drugs followed closely by asthma therapeutics. The Integrated Sequence (IS) begins in quarter 2 in the ﬁrst-professional year of the programs and runs through quarter 9 (third-professional year). Each IS module focuses on diseases related to a particular organ system and contains material on the medicinal chemistry, pharmacology,...