BRONCHIAL ASTHMA:

Bronchial Asthma is a chronic inflammatory disorder of the airway in which many cells and cellular elements play a significant role in its causation.¹The chronic inflammation causes an increase in chest tightness and coughing particularly at night or in early morning.² These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment.

Inhaled β₂-agonists are the most effective bronchodilatorsfor the prevention and relief of bronchoconstriction associated with asthma, and therefore have an important role in managing asthma symptoms.⁸Long-acting β₂-agonists ,such as salmeterol ^[3,9] and formoterol⁹, have 12-h durations of action, and their recommended use is in combination with inhaled corticosteroids (ICS) in patients with moderate or severe persistent asthma^.9

Selective β₂-agonists were developed to minimize mediated chronotropic effects that were associated with the non-selective agents such as isoprenaline. β₂-receptors are also present in myocardial tissue, and the occurrence of tachycardia and palpitations has been associated with the use of older generation of selective β₂-agonists, especially at higher doses.Other dose-limiting β₂-mediated side effects include skeletal muscle tremor, hyperglycaemia and hypokalaemia.⁹Thus, an important property of newer β₂-agonists, is to provide effective bronchodilation at a dose that is not associated with these side effects and to have a wide safety.

INDACATEROL

Indacaterol is a novel medicine given once-a-day in a dosage form of dry powder inhaler, “twisthaler device”, and fast-acting β₂-agonist for the treatment of asthma and chronic obstructive pulmonary disease (COPD).⁷Preclinical data suggests that, for a given degree of bronchodilator activity, indacaterol has a greater cardiovascular safety margin than formoterol or salmeterol.¹⁰Indacaterol maleate/acetate delivered by twisthaler in a dose of 150µg has been studied in healthy volunteers,adult patients with COPD and asthma and found safe and well tolerated.¹⁰

GLYCOPYRRONIUM

Glycopyrronium is anticholinergic drug.⁴It is a long-acting bronchodilator and works by relaxing the airways in the lungs over about 24 hours, to make breathing easier. Glycopyrronium does not bring immediate relief; therefore it is not effective for sudden breathlessness .Glycopyrronium is for inhalation only and must be used with Breezhaler. Common side effects of glycopyrronium include dry mouth, insomnia, stomach cramps diarrhoea, vomiting, nose and throat irritation and muscle or bone or joint pain. Glycopyrronium is a maintenance treatment for people with controlled COPD (mild, moderate or severe).¹² The effects from one inhaled dose of glycopyrronium 50 microgram (capsule) should last for 24hours.Glycopyrronium are avoided: if there is allergic manifestation to the patient .Then other anticholinergic drug; for example, a reliever such as ipratropium can be used.