Ume clidinium incruse ellipta dry powder inhaler long

Ume clidinium
- Incruse® Ellipta® dry powder inhaler) – long-acting anticholinergic for COPD- once daily
Ume clidinium /Vilan terol (long acting terol group drug)
- Anoro® Ellipta® dry powder inhaler) – adds a long-acting β
2
-agonist- once daily (COPD)

Quiz 10 will start here
Long-term Control Drugs for asthma – Achieving long-term control of asthma requires a multi-faceted approach:
1.
avoiding environmental stimuli
2.
possibly introducing allergen immunotherapy
3.
treatment with drugs, especially the use of appropriate Controller Medications , most commonly, inhaled
corticosteroids (ICS ) or long-acting β -agonist (LABAs) (added in step therapy to treat more severe asthma)
in combination with inhaled corticosteroids.
Inhaled Corticosteroids (ICS) – for suppression of airway inflammation. ICS produce the best results in reducing
airway inflammation and achieving and maintaining effective asthma control. Sufficient for mild to moderate
asthma, if the need for rescue drug is frequent  increase the dose, or LABA combination
- Are systemic effects a problem with the long-term use of inhaled corticosteroids? Usually not a problem,
unless using CS for long term/high dose, may lead to catabolic effect etc.
- Side effects of CS
- IOP (Intraocular pressure) ↑ 
Glaucoma
- Catabolic effects especially in children
 growth stunt/ diminishing bone
mass
- Dysphagia: difficulty in swallowing
- Dysphoria: voice change
- Avoiding the side effects of long-term or repeated use of inhaled corticosteroids –
1. Use lowest effective dosage
2.
Use spacer devices to avoid candida albicans (Candidiasis infection)/ rinse out to remove the CS in the
oral cavity
3. Switching to different inhalation devices
- Methods of delivery of corticosteroid inhalations – clinical outcomes don’t vary a lot
Inhaled Long-acting β
2
- Agonist Bronchodilators (TEROLs) – [do not confuse LABA “TEROLs” with SABA “TEROLs”
[Note: LABAs are only safe to use in combination with ICS !!!]
Current status compared with p.o. albuterol or controlled release medications or p.o. theophylline – The LABA-
TEROLs have largely replaced the older therapies (PO albuterol, PO Theophylline: classical asthma drug) , including
extended-release or long-acting p.o. forms of Albuterol or Theophylline.
Potent bronchodilators –
- sustained activity – lasts ≥ 24 hrs, advantage over SABA
- mild tachyphylaxis (decreasing effectiveness of drugs upon continuous, long term use), increasingly
visible with EIB, not seen in Albuterol
- Drug-drug interactions – no major DDIs or food-drug interactions Also not NTI drugs.
Effect on SABAs – The quick symptom relief provided by SABAs is not impeded by the regular use of LABAs. Of
course, LABAs are not intended for relief of the acute symptoms and exacerbations of acute bronchoconstriction
and acute bronchospasm. LABAs are not “rescue medications.”
Genetic polymorphisms – 20 % of population only get limited effect of LABA  genetic testing could be helpful
Combination therapy is a requirement!!: