Krmglkt Chomoglycates Sigurur Ragnarsson stud med Langtma mefer

Krómóglýköt (Chomoglycates) Sigurður Ragnarsson stud. med.

Langtíma meðferð við astma • Barksterar – budesonide – fluticasone • Leukotrien blokkar – safirlukast – montelukast • β 2 -agonistar – langvirkir • formoterol • salmeterol – stuttvirkir (per necesitas) • Methylxanthines – theophylline – aminophylline • Krómóglykat

Krómóglýköt • Fyfirbyggjandi meðferð • Minnka immediate og late-phase astma svörun og minnkar hyperreactivity.

Verkunarmáti • Ekki vitað nákvæmlega hvernig virkar. • Eru ekki bronchodilators, hafa ekki áhrif á slétta vöðva né hindra sléttvöðvastimulants. • “Mast cell stabilizer” • Minnkar neuronal reflexa

Ábendingar • Áhrifarík meðferð í: – antigentengdum (atópískum) astma – irritanttengdum astma – áreynslutengdum astma • Meiri áhrif í börnum en fullorðnum.

Lyfjafræði • Lélegt frásog um meltingarveg • Gefið sem innúði. • T ½ 90 mín. • Rapport um urticariu og anaphylaxa

Krómóglyköt Cromylin sodium börn og fullorðnir Nedochromil fullorðnir

ICS versus SCG inhaled corticosteroids • ICS: færri tilvik af astmaversnunum • betri lungnafunction • færri astmaeinkenni • minni notkun PN berkjuvíkkandi lyfja • lítill munur á alvarleika aukaverkuna vs. sodium cromoglycate

Cochrane og krómóglýköt • Publication bias • Sami fjöldi einkennalausra daga • “no or only minimal benefit for DSCG compared to placebo as maintanance therapy for childhood asthma” • “day cough, day wheezing, use of rescue oral steroids, and hospital admission, failed to reveal any significant group differences between DSCG and placebo”

Heimildir • • Guevara JP. Ducharme FM. Keren R. Nihtianova S. Zorc J. Inhaled corticosteroids versus sodium cromoglycate in children and adults with asthma. [Review] [121 refs] [Journal Article. Meta-Analysis. Review] Cochrane Database of Systematic Reviews. (2): CD 003558, 2006. Spooner CH. Spooner GR. Rowe BH. Mast-cell stabilising agents to prevent exerciseinduced bronchoconstriction. [Review] [79 refs] [Journal Article. Meta-Analysis. Review] Cochrane Database of Systematic Reviews. (4): CD 002307, 2003. van der Wouden JC. Tasche MJ. Bernsen RM. Uijen JH. de Jongste JC. Ducharme FM. Inhaled sodium cromoglycate for asthma in children. [Review] [180 refs] [Journal Article. Review] Cochrane Database of Systematic Reviews. (3): CD 002173, 2003. Kelly K. Spooner CH. Rowe BH. Nedocromil sodium vs. sodium cromoglycate for preventing exercise-induced bronchoconstriction in asthmatics. [Review] [28 refs] [Journal Article. Review] Cochrane Database of Systematic Reviews. (4): CD 002731, 2000. Tasche MJ. Uijen JH. Bernsen RM. de Jongste JC. van der Wouden JC. Inhaled disodium cromoglycate (DSCG) as maintenance therapy in children with asthma: a systematic review. [see comment]. [Review] [58 refs] [Journal Article. Review] Thorax. 55(11): 913 -20, 2000 Nov. UI: 11050259 Chipps BE. Chipps DR. Approach to the difficult pediatric asthmatic. [Review] [32 refs] [Journal Article. Review] Current Opinion in Pulmonary Medicine. 5(1): 52 -7, 1999 Jan. Godfrey S. Konig P. Inhibition of exercise-induced asthma by different pharmacological pathways. [Review] [23 refs] [Clinical Trial. Journal Article. Review] Thorax. 31(2): 137 -43, 1976 Apr.