Tag: preventers

Cromoglycate and Amiodarone

The surprising connection between cromoglycate and amiodarone

Cromoglycate is a mast cell stabiliser administered by inhalation as a preventer in the prophylactic control of asthma. It is also used for prophylactic control of allergic rhinitis and allergic conjunctivitis. Amiodarone is a  class III antiarrhythmic agent, which prolongs repolarization of the cardiac action potential thus increasing the cardiac action potential duration.

Pharmacologically there is no obvious connection between cromoglycate and amiodarone. However, both drugs were first synthesised as derivatives of khellin the active ingredient obtained from plant extracts of khella (Ammi visnaga).

Controllers versus preventers for asthma

Sometimes there is confusion over the usage of the term “controllers” in the treatment of asthma.

The term “controllers” can refer to the long-acting beta agonists (LABAs). But sometimes it is used to refer to both the LABAs and the anti-inflammatory drugs such as corticosteroids. As the LABAs and anti-inflammatory drug have different roles in asthma treatment, the term “preventers” can be used to refer specifically to the anti-inflammatory drugs.

The situation can be further confused by the fact that LABAs are no longer used alone as controllers. They are now always prescribed together with corticosteroids, often in combination inhalers.  This is because the use of beta-2 agonists alone leads to beta-2 adrenoceptor tolerance and increased risk of asthma-related death. Concomitant use of a corticosteroid helps to reduce beta-2 adrenoceptor tolerance and treats the underlying inflammatory disease.

In our lectures, we will use the terminology as follows:

Preventers reduce swelling and inflammation in the airways, stopping them from being so sensitive and reducing the risk of severe attacks. Thus they prevent the risk of recurrent attacks.

Controllers are long-acting beta-adrenoceptor agonists (LABAs) taken regularly at the same time daily to provide long-acting bronchodilation.

Relievers are short-acting beta-2 adrenoceptor agonists (SABAs) used “as needed” to relieve asthma attacks.

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