Updated: 5/26/2019

Cromolyn

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Snapshot
  • A 9-year-old girl with a history of asthma presents to her pediatrician complaining that she would like to participate in her gym class at school, but her asthma keeps flaring when she becomes too active. She takes an inhaled corticosteroid daily and rarely has to use her rescue inhaler. She has not had a recent increase in the frequency of her inhaler use. On exam, she is breathing comfortably with lungs clear to auscultation. The pediatrician writes the patient a prescription for cromolyn and instructs the patient to use it 10-15 minutes before gym class. (Mild persistent asthma with exercise-induced bronchospasm)
Introduction
  • One of 7 medications used for asthma aimed to reduce inflammation and obstruction   
    • corticosteroids
    • β-agonists
    • muscarinic agonists
    • methylxanthines   
    • cromolyn
      • sister drug nedocromil used similarly in asthma
    • antileukotrienes 
    • omalizumab

Cromolyn
  • Mechanism of action
    • mast cell stabilizer
      • prevents degranulation and subsequent release of inflammatory mediators
  • Clinical uses
    • asthma
      • inhaled or nebulized form
      • prophylaxis is most common use
        • effective in preventing exacerbations if given 10-15 minutes before a known trigger
          • e.g. exercise, cold air, or animals
      • maintenance
        • considered an alternative first-line therapy in mild persistent asthma
        • less effective than inhaled corticosteroids but fewer side effects
        • useful in patients who cannot tolerate steroid side effects such as recurrent respiratory infections, ear infections, or oropharyngeal thrush
    • systemic mastocytosis
      • oral form
    • allergic rhinitis
      • nasal form
    • vernal keratoconjunctivitis
      • ophthalmic form
  • Adverse effects
    • transient cough (20%)
    • pruritus and/or burning sensation of the nose
 

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