DRUGS USED IN ASTHMA
AND OTHER
BRONCHODILATORS
Prof. Dr. Zeliha Yazıcı
REGULATION OF THE AIRWAY
 Drugs affect the respiratory system in a number of
ways
Airway smooth muscle tone depends on the balance
between the:
 Parasympathetic input
 Inhibitory influence of circulating epinephrine
 NANC inhibitory nerves
 Sympathetic innervation of the parasympathetic
ganglia
 Efferent pathways
o Parasympathetic innervation
 Airway & vascular smooth muscles,
glands
 M3 rec. bronchial
smooth&glands,
bronchoconstriction&muc
us secretion
 M1 rec.
ganglia&postsynaptic cells,
nicotinic neurotransmission
 M2 rec. inhibitory
autoreceptors, negative
feedback on ach release
o Sympathetic innervation
 Tracheobronchial blood vessels &
glands
 β2-rec. airway smooth muscle, mast
cells, epithelium, glands, alveoli
o NANC nerves
 Inhibitory: VIP, NO; bronchodilation
 Excitatory: substance P, neurokinin A;
neuroinflammation
 Afferent pathways
o Slowly adapting strech rec. control
respiration via respiratory center
o Rapidly adapting irritant rec.
o Unmyelinated sensory C fibres
Inhalated irritants:
 May trigger the release of mediators from mast cells
 May stimulate afferent receptors to initiate reflex
bronchoconstriction or to release tachykinins that directly
stimulate smooth muscle contraction
ASTHMA
 Inflammation of the airway
 Bronchial hyper-reactivity
 Reversible air way obstruction
o Allergic (extrinsic)
o Idiosyncratic (intrinsic)
 Occupational asthma
 aspirin-induced asthma
 exercise-induced asthma
 Exposure to allergen causes synthesis of IgE
 On reexposure to allergen, antigen-antibody interaction
triggers release of mediators of anaphylaxis which cause
bronchospasm (Early reaction)
 Reexposure to allergen causes the synthesis and release
of cytokines
 Cytokines activate eosinophils (ECP, eosinophil cationic
protein; MBP, major basic protein) and neutrophils
(Proteases, PAF)
 These mediators cause the edema, smooth muscle
contraction, mucus hypersecretion (Late reaction).
 Bronchial hyperreactivity quantitated by measuring the fall
in forced expiratory volume in 1 second (FEV1)
Aspirin-sensitive asthma
 <10% of asthmatic subjects
 associated with nasal polyps
 usually sensitive to other chemicals (paracetamol)
 abnormal LT production & sensitivity
 directly activate eosinophils and mast cells
CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
 Inflammation of the airway with a pattern that
differs from that of asthma
 Neutrophils, macrophages, and cytotoxic Tlymphocytes are predominance
 Progressive small airway narrowing and fibrosis
(chronic obstructive bronchiolitis)
 Destruction of the lung parenchyma and alveolar
walls (emphysema)
 These pathological changes result in airway
closure on expiration, leading to air trapping and
hyperinflation particularly on exercise (dynamic
hyperinflation)
 Bronchodilators are mainstay of treatment in
COPD
 Inflammation is largely corticosteroid resistant
 Patient have systemic manifestation (skeletal
muscle wasting, weight loss, depression,
osteoporosis, anaemia) and comorbid disease
(ischemic heart disease, hypertension,
congestive heart failure, diabetes)
ROUTES OF DRUG DELİVERY TO
THE LUNG
Inhaled route
 ~ 10-20% of drug enters the lower airways
 Optimum particle size 2-5 μm, ~ 1 μm in COPD and
severe asthma
o Pressurized metered-dose inhalers
o Spacer chambers
o Dry powder inhalers
o Nebulizers
Oral
 Dose is higher than the inhaled dose
 Systemic side effects are more common
Parenteral
 Preferred in severely ill patients
 Systemic side effects are generally frequent
DRUGS
Bronchodilators
 β-receptor agonist
 Antimuscarinics
 Xanthines (theophylline)
 LOX inhibitors and cysteinyl lekotriene receptor
antagonists
Anti-inflammatory agents
 Glucocorticoids
 Mast cell stabilizer (Cromolyn, nedocromil)
β-receptor agonists
 β2-selective drugs are the most widely used (non
selective sympathomimetics cause more cardiac
stimulation)
 stimulate adenylyl cyclase-cAMP system and relax
airway smooth
Molecular mechanisms:
 Lowering Ca+2 concentration by active removal of
Ca+2 from the cytosol into intracellular stores and
out of cell
 Acute inhibition of the PLC-IP3 pathway and its
mobilization of cellular Ca+2 (prolonged use can
upregulate expression of PLCβ1)
 Inhibition of myosin light chain kinase activation
 Activation of myosin light chain phosphatase
 Opening of a large conductance Ca+2 activated
K+ channel which repolarizes the smooth muscle
cell
 β2 receptors may couple to KCa via Gs so that
smooth muscle relaxation may occur
independently of an increase in cAMP
Indirect effects of β2-agonists
 Prevention of mediator release from lung mast
cells (via β2-receptor)
 Prevention of microvascular leakage and thus the
development of bronchial mucosal edema after
exposure to the mediators
 Increase in mucus secretion from submucosal
glands and ion transport across airway epithelium
 Reduction in neurotransmission in cholinergic
nerves by an action at presynaptic β2-receptors to
inhibit ach release
Side effects: Skeletal muscle tremor, tachycardia,
tolerance, decrease in PaO2 (reduced when inhalers
are used), hypokalemia, hypoxemia, death with cardiac
arrest in excessive amounts
Causes of the tolerance: 1) desensitising of receptors
2) receptor down-regulation 3) decrease in the binding
of β2-receptor synthesis coding gene to CREB (cAMP
response element binder) 4) induction of PDE
Chemical structure
Non-selective betamimetics
Adrenaline
 β1 and β2 agonist
 Bronchodilator and vasoconstrictor
 For acute asthma attack: 0.25-0.5 mg sc or im; for
child: 0.01mg/kg/4 h
 Side effects: Tachycardia, arrhythmias and
worsening of angina pectoris
Izoproterenol
 A potent bronchodilator
 80-120 µg causes maximal bronchodilation within
5 mins when inhaled
 Inhalation (aerosol and solution)
Ephedrine (Ephedra equisetina)
 Has a longer duration, oral activity, more
pronounced central effect and much lower
potency, compared with adrenaline
Selective β2-agonists
Albuterol (Salbutamol), metaproterenol,
terbutaline
 Short-acting β2 –selective agonists
 inhalers and also in tablet form, terbutaline is
available for sc injection
 Side effects: Skeletal muscle tremor, nervousness,
occasional weakness
Salmeterol, Formoterol
 Long-acting β2 –selective agonists (12 hrs or
more)
 Salmeterol also binds to an exo-receptor in the
vicinity of the β2 –receptor on airway smooth
muscle
 Inhaler
 Useful for treating nocturnal asthma
 Interact with inhaleted corticosteroids (bronchial
hyperactivity ↓↑, CREB-GR protein-protein
complex)
 They are not recommended as the sole therapy for
asthma, should only be used as adjuvant therapy
in patient not adequately controlled on inhaled
corticosteroids or whose disease require two
maintenance therapies.
 Side effects: Tremor, dizziness, headache,
tolerance, an increase in asthma mortality
Antimuscarinics
 They cause bronchodilation by binding to
muscarinic receptors on airway smooth muscle
 Do not prevent all type of bronchospasm
 Are effective against irritant-induced changes in respiratory
function
 Increase FEV1
 Decrease mucus secretion
 Available muscarinic antagonists do not discriminate
between M2 and M3 receptors
 Atropine causes bronchodilation at a lower dose
than that needed to cause an increase in heart
rate
 Ipratropium and oxitropium are used by the
inhaled route to reduce systemic adverse effects;
poorly absorbed into the circulation; do not cross
the blood-brain barrier
 Their efficacy in asthma is modest compared with
in chronic obstructive pulmonary disease (COPD)
Xanthines
Theophylline
 Bronchodilator (inhibit phosphodiesterase 3 and 4
and block adenosine A2B receptors)
 anti-inflammatory (IL-10↑, cytokines↓, release of
mediators from mast cell↓)
 Tolerans dose not develop
 The major problem is that they have a very narrow
therapeutic window
 Plasma concentration over 10µg/ml are required
for effective bronchodilation, but over 20µg/ml are
associated with an increased likelihood of adverse
effects (nausea, arrhythmias, convulsions)
Inhibition of airway smooth muscle relaxation
Change in FEV1
Inhibition of phosphodiesterase activity
 The dose should be adjusted to give a serum
concentration of 5-15µg/ml
 Metabolised by CYP1A2
Factors affecting clearance of Theophylline
 Increased: barbiturates, ethanol, smoking via
CYP1A2 induction, high protein diet, lowcarbohydrate diet, barbecued meat, childhood
 Decreased: cimetidine, erythromycin,
ciprofloxacin, allopurinol via CYP inhibition,
congestive heart failure, liver disease,
pneumonia, viral infection and vaccination, highcarbohydrate diet, old age
Adverse effects: anorexia, nausea, vomiting,
abdominal discomfort, headache, anxiety, seizures,
arrhytmias, insomnia
Aminophylline (theophylline-ethylenediamine
complex)
Dyphylline (synthetic analog of theophylline)
 Less potent and shorter acting than theophylline
LOX inhibitors and cysteinyl
lekotriene receptor antagonists
Montelukast
 LTD4 and LTE4 (cisLT1) receptor inhibitor
 Metabolised by CYP3A4
 Are effective in aspirin-induced asthma and exerciseinduced asthma
 Orally active
Zafirlukast
 LTD4 and LTE4 (cisLT1) receptor inhibitor
 Metabolised by CYP3A4
 Orally active
Zileuton
 5-LOX inhibitor
 Orally active
Corticosteroids
 Broad anti-inflammatory efficacy (inhibit PLA2 activity, the
expressions of COX-2, 5-LOX, NO-synthase, and
endothelin-1 synthase cytokines)

 Reduce edema formation
 potentiate the effects of beta-receptor agonists
 do not relax airway smooth muscle
 reduce bronchial reactivity and the frequency of asthma
exacerbation
 increase airway caliber
 effective in improving all indices of asthma
 first-line therapy for moderate to severe asthma
 Urgent treatment: oral 30-60 mg/day prednisone or iv 1
mg/kg/6 hrs methylprednisolone; daily doses is decreased
gradually
 Administered early in the morning after endogenous ACTH
secretion has peaked; inhaled corticosteroids (lipidsoluble) are more effective in the late afternoon in
nocturnal asthma
 Lipid-soluble corticosteroids (Beclomethasone,
Fluticasone, Budesonide, mometasone, flunisolide,
triamcinolone) are relatively safe.
 Side effects: adrenal suppression, oropharyngeal
candidiasis, congenital resistance
Beclomethasone
 Lipophilic, Aerosol
 Dysphonia, sore throat, dry mouth, oral candidiasis and
systemic side effects
 the death may have lost the quick
Dosage:
Metered-dose inhaler -hydrofluoroalkane propellant-: 40–80 mcg/puff
Adult 80–240 mcg 240–480 mcg Greater than 480 mcg
Child 80–160 mcg 160–320 mcg Greater than 320 mcg
Fluticasone
 Lipophilic
 Aerosol and dry powder inhalation
Dosage:
Metered-dose inhaler: 44, 110, or 220 mcg/puff)
Adult 88–264 mcg 264–660 mcg Greater than 660 mcg
Child 88–176 mcg 176–440 mcg Greater than 440 mcg
Budesonide
 Lipophilic
 Aerosol and dry powder inhalation
Use: Maintenance treatment of underlying airway
inflammation, bronchial asthma showing the need for
glucocorticoids
Adverse reactions: Rhinitis, eczema may reappear, fatigue,
headache, muscle and joint aches, nausea, vomiting, throat
irritation, hoarseness, oral candidiasis, bronchial narrowing,
irritation, cough, irritability, skin reactions, hyperactivity,
depression, behavioral disorders
Cont: Pulmonary tuberculosis, fungal or viral
respiratory tract infection, pregnancy, breast-feeding.
Pregnancy risk category C / B
Dosage:
Dry powder inhaler: 200 mcg/inhalation
Adult 200–600 mcg 600–1200 mcg Greater than 1200 mcg
Child 200–400 mcg 400–800 mcg Greater than 800 mcg
Budesonide solution for inhalation (250 mcg or 500 mcg/2 mL)
Child 0.5 mg 1 mg 2 mg
Flunisolide
Metered-dose inhaler -chlorofluorocarbon-: 250 mcg/puff
Adult 500–1000 mcg 1000–2000 mcg Greater than 2000 mcg
Child 500–750 mcg 1000–1250 mcg Greater than 1250 mcg
Mometasone furoate
Dry powder inhaler: 200 mcg/inhalation
Adult 200–400 mcg 400–800 mcg Greater than 800 mcg
Child — — —
Triamcinolone acetonide
Metered-dose inhaler -chlorofluorocarbon-: 100 mcg/puff
Adult 400–1000 mcg 1000–2000 mcg Greater than 2000 mcg
Child 400–800 mcg 800–1200 mcg Greater than 1200 mcg
Mast cell stabilizers
Cromolyn (disodium cromogylcate)
Nedocromil
 Are anti-allergic drugs used prophylactically in the
treatment of asthma
 Inhibit mast cell degranulation in lung
 Decrease inflammation
 Block the bronchoconstriction caused by antigen,
exercise, aspirin and by a variety of causes of
occupational asthma
 Have no effect on airway smooth muscle tone and
are ineffecting in reversing asthmatic
bronchospasm
 Are effective in young patients with extrinsic
asthma and some older patient with intrinsic
asthma
 Reduce of allergic conjunctivitis
 Active by inhalation
 Adverse effects: reversible dermatitis, myositis,
gastroenteritis, anaphylaxis
Ketotifen
 Orally active
 H1- blocker
OTHER DRUGS
Anti-IgE monoclonal Antibodies (Omalizumab)
 Inhibit the binding of IgE to mast cells
 inhibit IgE synthesis by B lymphocytes
 lower plasma IgE level and reduce the
magnitude of both the early and late
bronchospastic responses to antigen challenge
 repeated iv or sc injection of anti-IgE MAb
reduces the corticosteroid requirement in
moderate to severe diseases , lessens asthma
severity, and improves nasal and conjunctival
symptoms in allergic rhinitis
Ca channel blockers (Nifedipine and verapamil)
 limited affect
Nitric oxide donors
 inhaled as a gas in acute asthma dilates the
pulmonary blood vessels and the airway smooth
muscle
Potassium channel openers (Cromakalim)
 conflicting results have been obtained in
asthmatic patients
Anti-Th2 monoclonal antibodies
 directed against Th2 cytokines (IL-4, IL-5)
Macrolide antibiotics
 effective in chronic airway infection with
Chylamydia pneumonia or Mycoplasma
pneumonia
Acute Asthma
 mild attacks: inhalation of β2- receptor agonist, sc
epinephrine
 severe attacks: oxygen, aerosolized albuterol,
and systemic prednisone or methylprednisolone
Case History
 A 45-year old woman was referred to the
outpatient asthma clinic after receiving outpatient
therapy with oral steroids for her third
exacerbation of disease that winter.
 She reported having had asthma since childhood,
with a period of frequent childhood hospitalization.
Typical asthma symptoms had reappeared when
she was in her late twenties and persisted.
 She had been using inhaled salbutamol
(albuterol) on an as needed basis for many years
and for 8 years had used inhaled fluticasone 250
µg twice daily a week. When stable, she resorted
to salbutamol once or twice daily and awoke with
asthma symptoms once or twice a week.
 She avoided aerobic exercise because it typically
triggered episodes of wheezing. Exacerbations
characterized by increased cough, wheeze, and
breathlessness occurred at the rate of one to
three episodes a year and typically responded to
therapy with a short course of oral prednisone at
a dosage of 40 mg daily for 7 days. She was a
non-smoker and kept no pets.
 On assessment in the clinic, her physical
examination was unremarkable, with no finding in
the chest. However spirometry showed moderate
airflow obstruction with a brisk but incomplete
response to inhaled bronchodilator. Her metereddose inhaler technique was found to be
suboptimal.
 She was advised to replace inhaled corticosteroid
monotherapy with a combination of inhaled
fluticasone 500 µg and salbutamol 50 µg to be
inhaled via dry powder devise twice daily.
 At a follow-up visit 3 months later, her nocturnal
asthma symptoms had disappeared and her need
for quick relief bronchodilator had decreased to
one administration every 2 or 3 weeks, but her
spirometry test showed that mild airflow limitation
was still present. No exacerbation had occurred in
this interval.
PREPARATIONS (In Turkey)
Non-selective betamimetics
EPHEDRIN (Palmer) (Merck Sharp & Dohme)
Tablet - Efedrin 0.05 g/Amb. 20 adet.
EFEDRİN (Biosel)
Ampul - Efedrin 50 mg/ml/ Amb. 100 adet.
EFEDRİN ARSAN (Bilim)
Tablet - Efedrin HCl 50 mg/ml/Amb. 20 adet.
ASTEROL
(Günsa)
Sublingual tablet - Isoproterenol HCl 10 mg/Amb. 20 ve
30 adet.
Selective betamimetics
FORADİL (Novartis)
Aerosol - Formoterol fumarat 12 mcg, /1 dozda/Amb. 50
veya 100 dozluk ambalajda.
FORADIL COMBI (Novartis)
İnhaler kapsül - Bir Foradil kapsül (Formoterol fumarat
12 mcg), bir Miflonide kapsül (budesonid 200 mcg veya
400 mcg)/Amb. 60 adet.
OXIS
(Astra Zeneca)
Turbuhaler (İnhalasyon toz) - Formoterol fumarat
dihidrat 4.5 mcg veya 9 mcg/Amb. 60 doz. (Her 4.5 mcg
doz 6 mcg, 9 mcg veya 12 mcg ölçülü doza eşittir).
VENTOFOR (Bilim)
İnhaler kapsül - Formoterol fumarat 12 mcg/Amb. 60
adet.
SYMBICORT (Astra Zeneca)
Turbuhaler - Formoterol 4.5 mcg, budesonid 160
mcg/Amb. 60 veya 120 doz.
Turbuhaler Forte - Formoterol 9 mcg, budesonid 320
mcg/Amb. 60 doz.
AIROMIR (Medsan)
İnhalasyon aerosolu - Salbutamol 0.1 mg/her dozda.
SALBUTAM SR
(Nobel)
Kapsül - Salbutamol 4 mg/Amb. 14 ve 56 adet ve 8
mg/Amb. 14 adet.
SALBUTOL (Sandoz)
Tablet - Salbutamol 2 mg/Amb. 100 adet.
Şurup - Salbutamol 2 mg/5 ml/ Amb. 100 ml.
Inhalasyon aerosolu - Salbutamol 0.1 mg/her dozda.
SALBULIN INHALER
(Health Care) (Medsan)
Sprey - Salbutamol 4.821 mg/ml/Amb. 400 doz 1 doz 1
mcg Salbutamol.
VENTODISKS (Glaxo Smith Kline)
Sprey - Salbutamol 200 mcg/Amb. 8 dozluk 7 veya 14
rotadisk içeren kutularda.
VENTOLIN
(Glaxo Smith Kline)
Tablet - Salbutamol 2 mg ve 4 mg/ Amb. 100 adet.
Şurup - Salbutamol 2 mg/5 ml/ Amb. 150 ml.
İnhaler - Salbutamol 100 mcg 1 püskürtmede/Amb.
Özel uygulayıcı ile 200 dozluk şişede.
Nebules - Salbutamol sülfat (1mg salbutamole eşdeğer)
% 0.1/ml serum fizyolojik içinde plastik ampulde/Amb.
2.5 ml. (1 ampulde 2.5 mg salbutamol).
Ampul - Salbutamol 0.5 mg/ml ve 1 mg/ml/Amb. 5
adet/1 mg.
VOLMAX (Glaxo Smith Kline)
Tablet - Salbutamol 4 mg ve 8 mg/ Amb. 14 adet.
VENT-O-SAL (Bilim)
Inhaler - Salbutamol 100 mcg/doz/ 200 Doz.
VENTIDE INHALER
(Glaxo Smith Kline)
Spray - Salbutamol 100 mlcg, beklometazon 50 mcg/1
ölçülü dozda/Amb. 200 ölçülü doz.
ASTMATEROLE INHALER (Fako) (Glaxo Smith
Kline)
Inhaler - Salmeterol ksinafoat 25 µg/doz./Amb. 60 ve
120 dozluk 1 adet ambalaj.
Maksihaler - Salmeterol ksinafoat 50 µg/doz/Amb. 28
ve 60 dozluk 1 adet ambalaj.
SERETIDE
(Glaxo Smith Kline)
Diskus - Salmeterol 50 mcg, flutikason propionat 100,
250 veya 500 mcg/ Amb. 60 adet.
SEREVENT (Glaxo Smith Kline)
Diskus - Salmeterol (ksinafoat halinde) 50 µg (1
dozda)/Amb. 60 dozluk ambalajda.
Serevent İnhaler Sprey - Salmeterol (ksinafoat halinde)
25 mcg (1 dozda) /Amb. 60 veya 120 dozluk ambalajda.
BRICANYL
(Astra Zeneca)
Tablet - Terbutalin sülfat 2.5 mg/Amb. 50 adet.
Ekspektoran Şurup-Terbutalin sulfat 1.5 mg,
gayafenesin 66.5 mg/Amb. 100 ml.
Drules Tablet -Terbutalin sulfat 5 mg/Amb. 50 adet
yavaş salınımlı tablet.
İnhalasyon için sprey süspansiyon - Terbutalin sulfat
0.25 mg/1 doz/ Amb. 400 doz.
Turbuhaler - Terbutalin sulfat 0.5 mg/Amb. 200 doz toz
inhalatör.
Mast cell stabilizers
INTAL INHALER/INTAL 5 INHALER
(Fisons) (Azim)
İnhaler - Sodium kromoglikat 1 mg/1 doz /Amb. 112
doz.
5 İnhaler - Sodium kromoglikat 5 mg/1 doz /Amb. 112
doz.
Nebülizer - Sodium kromoglikat % 1 /Amb. 2 ml’lik 48
ampül.
ASTAFEN
(Sandoz)
Tablet - Ketotifen fumarat 1 mg/ Amb. 30-100 adet.
Şurup - Ketotifen fumarat 1 mg/5 ml/Amb. 100 ml.
FUMAST (Biochem)
Tablet - Ketotifen 1 mg/Amb. 30 adet.
Şurup - Ketotifen 1 mg/5 ml/ Amb. 100 ml.
ZADITEN (Novartis)
Tablet - Ketotifen fumarat 1 mg/ Amb. 30 adet. Çentikli
tablet.
SRO Tablet - Ketotifen fumarat 2 mg/Amb. 30 adet.
Şurup - Ketotifen fumarat 0.2 mg/ml/Amb. 100 ml.
Damla - Ketotifen fumarat 1 mg/ml/Amb. 25 ml
TILADE (Rhone-Poulenc) (Eczacıbaşı)
Mint aerosol - Nedokromil sodyum 2 mg/1 doz /Amb.
112 doz.
Xsanthines
AMINOCARDOL (Novartis)
Tablet - Aminofilin 100 mg/Amb. 20 adet.
Ampul - Aminofilin 240 mg/10 ml /Amb. 3 adet.
CARENA (Biofarma)
Ampul - Aminofilin 240 mg/10 ml/Amb. 6 ve 100 adet.
ASMAFILIN FORT (Casel)
Kapsül - Teofilin etilendiamin 200 mg/Amb. 24 adet.
BRONKOLIN (Trommsdorff) (Adeka)
Retard Tablet - Teofilin anhidr 300 mg/Amb. 50 adet.
TALOTREN
(Novartis)
Kapsül - Teofilin 200 mg ve 350 mg/Amb. 30 adet.
THEO-DUR (Key) (Azim)
Tablet - Teofilin 100 mg, 200 mg ve 300 mg/Amb. 30
adet.
TEOKAP (Nobel)
Kapsül - Teofilin 100 mg, 200 mg, 300 mg/Amb. 30
adet.
SR Kapsül - Teofilin 100 mg/ 200 mg/ ve 300 mg/Amb.
30 adet.
XANTHIUM (Galepharma) (Lab. SMB) (Medsan)
Kapsül - Teofilin 200 mg (Mono-hidrat şekli)/Amb. 60
adet.
ASTMADIN (İlaçsan)
Şurup - Diprofilin 200 mg/5 ml/ Amb. 100 ml.
BRODİL (Sanovel)
Şurup - Efedrin HCl 20 mg, teofilin 300 mg, potasyum
iyodur 400 mg/15 ml/Amb. 150 ml.
BROKSİN
(Tripharma)
Şurup - Efedrin HCl 0.02 g, diprofilin 0.2 g, potasyum
iyodür 0.3 g, potasyum sulfogayakolat 0.3 g/15 ml/Amb.
150 ml.
BROX
(İlaçsan)
Şurup - Efedrin HCl 6.666 mg, gayafenesin 100 mg/5
ml/Amb. 150 ml.
FENASTHMA (Biokem)
Şurup - Teofilin 25 mg, potasyum iyodür 75 mg,
sodyum benzoat 50 mg/5 ml/Amb. 200 ml.
HYDRYLLIN
(Searle) (Ali Raif)
Şurup - Difenhidramin 8 mg, aminofillin 32 mg,
ammonium klorur 30 mg, şeker 2.8 g/4 ml/Amb. 100 ml.
PIRASMIN
(Carlo Erba) (Deva)
Tablet - Teofilin 250 mg/Amb. 20 adet.
Glucocorticoids
BECLOFORTE
(Glaxo Smith Kline)
Sprey - Beklometazon dipropionat 250 mcg/Amb. 80 ve
200 doz.
BECODISKS (Glaxo Smith Kline)
Disk - Beklometazon dipropiyonat 200 mcg/Amb. 8 doz
7 disk.
BECOTIDE INHALER (Glaxo Smith Kline)
Sprey - Beklometazon dipropionat 50 mcg/püskürtme/
Amb. 200 doz.
BECLOMET (Orion)
Aeresol inhalasyon - Beklometason dipropionat 1
mg/ml/Amb. 50 µl dozörlü.
FILAIR
(Medsan) (3 M Heal Care Ltd.)
Forte İnhaler - Beklometazon dipropionat 250 mcg/1
doz/Amb. 200 doz.
FLIXOTIDE (Glaxo Smith Kline)
İnhaler - Flutikazon propionat 25, 50, 100 ve 250
mcg/1 doz/ Amb. 60 inhalasyonlük 1 tüp, 1
inhalasyonluk 60 blister.
MIFLONIDE (Novartis)
Kapsül inhaler - Budesonid 200-400 mcg/Amb. 60 adet.
PULMICORT (Astra Zeneca)
Sprey inhalasyon için - Budesonid 50 mcg ve 200
mcg/Amb. 100 dozluk.
Nebulizer süspansiyon -Budesonid 0.25 ve 0.50
mg/ml/Amb. 2 ml 20 adet.
Turbuhaler - Budesonid 100 mcg, 200 mcg ve 400
mcg/Amb. 200 dozluk. Toz inhalatör.
SYMBICORT (Astra Zeneca)
Turbuhaler - Budesonid 160 mcg, formoterol 4.5
mcg/Amb. 60-120 doz.
Turbuhaler Forte - Budesonid 320 mcg, formoterol 9
mcg/Amb. 60 doz.
Leukotriene receptor antagonists
NOTTA
(Sanovel)
Tablet - Montelukast sodyum 4 mg veya 5 mg çiğneme
tableti, 10 mg film tablet/Amb. 28 adet.
ONCEAIR
(Abdi İbrahim)
Tablet - Montelukast sodyum 4 mg ve 5 mg çiğneme
tableti, 10 mg film tablet/ Amb. 28 adet.
SINGULAIR (Merck Sharp & Dohme)
Tablet - Montelukast 5 mg (çiğneme tableti) Film Tablet
10 mg/Amb. 28 adet.
ZESPİRA
(Bilim)
Tablet - Montelukast sodyum 10 mg /Amb. 28 adet.
ACCOLATE (Astra Zeneca)
Tablet - Zafirlukast 20 mg/Amb. 28 ve 56 adet
CARROX (Sanovel)
Tablet - Zafirlukast 10 mg veya 20 mg/Amb. 56 adet.
Antimuscarinics
ATROVENT (Boehringer)
Ölçülü doz inhalatörlü aerosol - İpratropyum bromür
250 mcg/doz ölçülü /Amb. 15 ml. 300 ölçülü doz.
Flakon İnhalasyon Çözeltisi - İpratropyum bromür 500
mcg/2 ml/Amb. 20 ve 60 adet tek dozluk flakonlar.
COMBIVENT (Boehringer)
Aeresol - İpratropyum bromür 20 µg, salbutamol 100 µg
(sulfat şeklinde) her ölçülü dozda/Amb. 200 ölçülü doz.
Flakon (inhalasyon solüsyonu) - Ipratropyum bromür
500 µg, salbutamol sülfat 3.01mg/Amb. 1 adet 2.5 ml’lik
flakon.
SPIRIVA (Pfizer-Boehringer)
İnhalasyon kapsülü - Tiotropium Br 18 mcg/Amb. 30
adet.