To assess and compare the efficacy and safety of indacaterol acetate and glycopyrronium bromide with salmetrol and fluticasone in patients of bronchial asthma.

BRONCHIALASTHMA:

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

 Inhaled β2-agonistsare the most effective bronchodilatorsfor the prevention and relief ofbronchoconstriction associated with asthma, and therefore have an importantrole 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 combinationwith inhaled corticosteroids (ICS) in patients with moderate or severepersistent asthma**.9**

 Selective β2-agonistswere developed to minimize mediated chronotropic effects that were associatedwith the non-selective agents such as isoprenaline. β2-receptors arealso present in myocardial tissue, and the occurrence of tachycardia andpalpitations has been associated with the use of older generation of selectiveβ2-agonists, especially at higher doses.Other dose-limiting β2-mediatedside effects include skeletal muscle tremor, hyperglycaemia and hypokalaemia.9Thus, an important propertyof newer β2-agonists, is to provide effective bronchodilation at adose that is not associated with these side effects and to have a wide safety.

INDACATEROL

Indacaterol is a novel medicine given once-a-dayin a dosage form of dry powder inhaler, “twisthaler deviceâ€, and fast-acting β2-agonistfor the treatment of asthma and chronic obstructive pulmonary disease (COPD).7Preclinicaldata suggests that, for a given degree of bronchodilator activity, indacaterolhas a greater cardiovascular safety margin than formoterol or salmeterol.10Indacaterolmaleate/acetate delivered by twisthaler in a dose of 150µg has been studied inhealthy volunteers,adult patients with COPD and asthma and found safe and welltolerated.10

                                       GLYCOPYRRONIUM

Glycopyrronium is anticholinergic drug.4It is a long-actingbronchodilator and works by relaxing the airways in the lungs over about 24hours, to make breathing easier. Glycopyrronium does not bring immediate relief; therefore it is not effective for sudden breathlessness .Glycopyrroniumis for inhalation only and must be used with Breezhaler. Common side effects ofglycopyrronium include dry mouth, insomnia, stomach cramps diarrhoea, vomiting,nose and throat irritation and muscle or bone or joint pain. Glycopyrronium is a maintenance treatmentfor 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 otheranticholinergic drug; for example, a reliever such as ipratropium can be used.