Nebulised Adrenaline in Chronic Obstructive Pulmonary ...

1 ISSN 2395-3411 Available online at 107. _____Review Article Nebulised Adrenaline in Chronic Obstructive Pulmonary Disease and Asthma A Review Anisha Baby1, Siby Joseph1* and Gireesh Kumar2. 1. Department of Pharmacy practice, Amrita School of Pharmacy, Amrita Viswa Vidyapeetam University, AIMS Kochi Campus, Ponekkara , Kochi 682 041, Kerala, India. 2. Emergency Medicine, Amrita Institute of Medical sciences, Amrita Viswa Vidyapeetam University, AIMS Kochi Campus, Ponekkara , Kochi 682 041, Kerala, India.

2 _____. ABSTRACT. Obstructive lung disease, namely Chronic Obstructive Pulmonary Disease and Asthma, are the most frequent causes of respiratory ill health, covering all ages. Acute breathlessness is a common emergency problem that is typically treated with bronchodilators and anti-inflammatory drugs. Nebulized selective, short acting 2 agonist such as salbutamol is the bronchodilators of choice in most cases. Other important treatments in moderate -to-severe cases include systemic and inhaled corticosteroids and in severe cases, addition of anticholinergics such as Ipratropium bromide, intravenous administration of theophylline and magnesium sulfate.

3 Despite aggressive management, some patients do not respond adequately to these treatments. Therapeutic management options in these patients are limited to interventions such as Adrenaline and non-invasive and mechanical ventilation or both. Adrenaline , also known as Epinephrine has earned the title of the doctor's friend . Adrenaline have beneficial effects in acute breathlessness in addition to its direct beta- adrenoceptor mediated bronchodilation, such as alpha receptor mediated reduction in microvascular leakage and oedema, and inhibition of bronchoconstrictor neural pathways.

4 Nebulised Adrenaline offers a number of advantages over pure 2 agonist like salbutamol that ensure its efficacy with fewer side effects. However, close monitoring of patient's condition is necessary when Adrenaline is Nebulised especially in patient suffering from arrhythmia, hypertension or other cardiac problems. This article reviews current evidence regarding safe use of Nebulised Adrenaline in the management of acute breathlessness. Keywords: Asthma, Chronic Obstructive Pulmonary Disease, Adrenaline .

5 INTRODUCTION decade and, according to estimates of the World Asthma and Chronic Obstructive Pulmonary Health Organization (WHO), by 2020 COPD. disease (COPD) are common Obstructive airway shall become the third most frequent cause of diseases characterized by various degrees of death, following coronary and cerebrovascular 3. airflow limitation, inflammation, and tissue disease. remodeling. Bronchial asthma, an allergic Nebulised 2-adrenergic agonists have become disease that develops in childhood, is the drugs of choice for the first-line treatment of physiologically characterized by reversible asthma and Chronic Obstructive Pulmonary 4.

6 Airflow obstruction. It has an episodic course disease. 2 agonists have attributed to the rapid with a generally favorable prognosis, as it onset of a vigorous bronchodilator effect 1. responds well to anti-inflammatory treatment. associated with a large therapeutic index In contrast, COPD is typically caused by tobacco allowing the use of high doses of drugs without 5. smoke or deficiency of 1 antitrypsin, develops side effects. These drugs were developed to in mid-life or later, and is characterized by avoid the cardiac toxicity associated with less incompletely reversible airflow limitation that selective adrenergic agents while retaining a results in a progressive decline in lung function potent relaxant effect on airway smooth muscle 2 6.

7 Leading to premature death. Death rates from 2 receptors. In this instance, nebulized COPD have been rising steadily over the last International Journal of Pharma And Chemical Research I Volume 1 I Issue 2 I Apr Jun I 2015. ISSN 2395-3411 Available online at 108. salbutamol is the most recommended 2 contrast, the intrinsic efficacy of salbutamol is 5. agonist. only 5% of that of Adrenaline . Stated otherwise, Adrenaline (epinephrine) is a potent stimulant of epinephrine will activate 20 times more 2. both - and -adrenergic receptors.

8 In addition adrenoceptors than salbutamol when both drugs 12. to its widespread use in cardiopulmonary occupy the same number of receptors. resuscitation, it is effective in the emergency Nebulised Adrenaline offers a number of 7. management of acute breathlessness. advantages over pure 2 agonist like salbutamol Nebulized epinephrine has been widely used for that ensure its efficacy with fewer side effects: more than 40 years, after the first report of its adrenergic vasoconstrictor action that can effectiveness in 1971.

9 Initial studies published in decongest the mucosa, limit its own absorption, the 1970s and early 1980s suggested that and regulate Pulmonary blood flow, with little epinephrine might be more effective when effect on ventilation perfusion matching; 2. nebulized via intermittent positive pressure adrenergic bronchial muscle relaxant effect; 2. breathing (IPPB) than by nebulization alone. The adrenergic action to suppress release of use of IPPB has now fallen out of favour and it is chemical mediators; physiological antihistamine 8.

10 No longer routinely used. effect that can reverse histamine effects, such Even though Adrenaline was introduced into the as oedema; and it reduces catarrhal 11. treatment of asthma and COPD in the early secretions. However, these advantages may century, it was rapidly superseded by selective be hampered, atleast theoretically, by a 2 agonists, particularly because of its and 1 bronchoconstrictor effect due to the agonist side effects which are mostly related to the properties of Adrenaline and hence need for intravenous route of administration.