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Combination therapy consist of anti-muscarinic and beta-2 agonists have shown to be useful (to relieve acute symptoms). Results in slightly greater and more prolonged bronchodilation than with either agent alone (synergistic effect)

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Symptoms of Asthma
-Wheezing
-Coughing
-Shortness of breath
-Chest pain/tightness

Symptoms of COPD
-Difficulty of breathing (Dypsnea)
-Coughing
-Sputum production
-Wheezing and chest pain/tightness

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Difficulty in breathing(dyspnea)
Coughing
Sputum production
wheezing and chest tightness

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corticosteroids:
- commonly admistered directly into airway via inhalation
- reduced adverse effects as systemic absorption is minimised

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MOA of beta-2 agonist: activation of beta 2 adrenergic receptors in bronchial smooth muscle, results in direct relaxation of airway smooth muscles, causing bronchodilation

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COPD - a chronic and preventable respiratory disease

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Leukotriene receptor antagonists

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Beta 2 agonists
- SABA (short acting beta 2 agonist)
- used as relievers of acute attacks
- LABA (long acting beta 2 agonist)
- used as controllers to prevent attacks

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Increased sensitivity to irritants and stimuli that cause airways to be constricted.
Results in:
- Airway inflammation
- Bronchoconstriction
- Increases mucus membrane

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Bronchodilator: Beta 2 agonist, anti muscarinics
Anti-inflammatory: corticosteroids
Both: xanthine derivatives, Leukotriene receptor antagonists

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Symptoms if COPD:
- Coughing

-May be productive or unproductive

-Chronic and persistent

- Sputum production

-Result of mucus and exudate production

-Wheezing and Chest tightness / pain

-Can vary between patients and frequency

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xanthane derivatives

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Anti-muscrinic
SAMA
LAMA
Used in combination therapy with beta- agonist

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corticosteroids

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(Preventors)
LABA - Bronchodilator
Xanthin derivatives - Bronchodilator/Anti-inflammation
LTRA - Bronchodilator/anti-inflammation
Corticosteroids - Anti-inflammation

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Pathophysiology of  Asthma:
- Increased mucus production
- Bronchoconstriction
- Airway Inflammation

Pathophysiology of COPD:
COPD Leads to:
Emphysema
Small airway fibrosis

which eventually leads to
- Ineffective gaseous exchange
- Progressive Airflow limitation

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SABA - Reliever
Controller (long-acting)- LABA, SAMA,

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corticosteroids
- targets gene transcription
- agonistic interactions with GR
- GC/GR complex enhance anti-inflammatory effects and inhibits proinflammatory mediator production
E.G. Beclomethasone, Budesonide, Fluticasone, Prednisolone

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Beta-2 agonist (bronchodilator)
- salbutamol (SABA)
- salmeterol (LABA)

Anti-muscarinic (bronchodilator)
- Ipratropium (SAMA)
- Tiotropium (LAMA)

Corticosteroids (anti-inflammatory)
- budesonide

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Controller: prevent attacks (long acting)
Relievers: for symptomatic relief of attacks
3 Pharmacological class:
bronchodilator:
- anti muscarinic: SAMA, LAMA
- b2 agonist: LABA, SABA
anti-inflammatory:
- corticosteroid
both:
- leukotrienes receptor antagonist
- xanthine derivatives

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SABA--> symptomatic relief for asthma

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Symptoms of asthma:
- Wheezing: High pitched wheezing sound that is caused by airflow turbulence
- Coughing: Usually non productive
- Shortness of breath
- Chest tightness / pain

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Asthma is a chronic disease caused by the reversible narrowing of the airways in the lungs, resulting in irritation, inflammation, and difficulty breathing. Possible risk factors of asthma: Smoking and family history

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Beta2 agonists:
- SABA (short-acting)
- LABA (Long-acting)

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Antimuscarinic
SAMA: ipratropium
LAMA: tiotropium

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Chronic obstructive pulmonary disease (COPD) is a common, chronic and preventable respiratory disease

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LABA
beta 2 agonists
-sean