6.6 Management of Asthma and COPD Flashcards
List some non-pharmacological treatment methods for asthma
- Trigger avoidance
- Vaccinations
- Education
- Action plan
- Exercise + Pulmonary Rehab
Fundamentally, what is the mechanism of action of SABAs and LABAs (short/long acting beta agonists)
- Activate B2 receptors
- Promote bronchodilation
- Help with airway obstruction by allowing flow of air
LAMA (long-acting muscarinic agonist) mechanism
- Blocks M3 receptors
- inhibits bronchoconstriction
Mechanism of ICS (inhaled corticosteroids)
- Reverse acetlyation of histones
- Decrease gene expression
- Decrease synthesis of inflammatory regulators
- Decrease local inflammation in airways
What does SMART therapy stand for?
Single Maintenance and Reliever Therapy (both in one)
Should you ever give a LABA alone in asthma?
No. Increased mortality risk.
Why is SABA-only treatment not preferable?
- Because it doesn’t address the underlying airway inflammation; it only reduces constriction of the bronchioles
- And, it trains the patients to think that that’s the primary treatment
What adverse effects are associated with frequent SABA use?
- Beta receptor downregulation
- Decreased bronchodilator response
- Increased allergic response
What adverse clinical outcomes are associated with frequent SABA use?
- > 1.7 puffs per day associated with increased ED presentations
- > 12 cannisters associated with higher risk of death
Track 1 vs Track 2 asthma treatment
Track 1: ICS + LABA
Track 2: ICS (preventer) + SABA (reliever)
What percentage of people with asthma have severe asthma?
3-10%
Upper airway comorbidities of asthma
- Allergic rhinitis
- Chronic rhinosinusitis
- Vocal cord dysfunction
- Sleep apnoea
- Dysfunctional breathing
Lower airway comorbidities of asthma
- COPD
- Bronchiectasis
Extrapulmonary complications of asthma
- Obesity
- Anxiety and depression
- Osteoporosis
Severe asthma therapies add-ons (not monoclonal antibodies)
- LAMA therapy
- Leukotriene receptor antagonists
- Macrolides
Describe airway thermoplasty
- Bronchoscope into airways
- Apply radio-frequency light to decrease smooth muscle bulk in airways
Which different professionals supervise a pulmonary rehab program?
- Doctor
- Nurse
- Physio
What does pulmonary rehab involve?
- Exercise training
- Education (medication/health)
- Inhaler techniques
- Breathing techniques
Is pulmonary rehab repeatable?
Yes
How can room temperature affect COPD?
- 21°C is optimal
- Lower (e.g. England) and higher (e.g. Australia) increase chance of exacerbations
“Exacerbator”/”Frequent Exacerbator” frequency? in COPD
Exacerbator: 1/year
Frequent: 2 or more
Drugs that are useful for COPD
- LAMAs
- LABAs
- ICSs
- Mucolytics (depending on patient)
A patient with COPD cannot have LAMAs. What is the recommended treatment, and what investigation does this warrant first?
- Give LAMAs alone
- BUT, this is forbidden in asthma; do not do it unless you are sure the patient doesn’t have asthma
If a COPD patient has taken a LAMA or a LABA, but could still be better, what would you give?
You would give a LAMA/LABA combination
What is a “triple” in COPD patients?
LAMA + LABA + ICS
Are higher or lower eosinophil levels associated with needing ICS?
Higher (>300/micro L)
How does Chartis test if a lung area is worth isolating with a valve
- Inflates, preventing air from flowing in
- Tests air coming out
- If it stops coming out gradually with time, then area is dead, and you can isolate with a valve
- Otherwise, don’t
What are some signs that a COPD exacerbation could be occurring?
- Increased dyspnoea
- Increased cough
- Increased sputum volume
- Increased sputum purulence
Describe the treatment of COPD flare-ups
- Establish goals (Palliation? Throw everything we’ve got at it?)
- Apply oxygen if sats below 89%
- Consider systemic corticosteroids and antibiotics
- Non-invasive ventilation (e.g. BiPAP)
Why is communication crucial in multi-disciplinary teams
- Not all people use shared databases
- It is crucial to keep all team members up to date about a patient to ensure correct decisions can be made about treatment
- Avoids duplication of care
Why are GPs crucial in multi-disciplinary teams?
- They “see the bigger picture”
- Connect patients with other health professionals/specialists
- Access to medicare benefits where applicable
- Building a team based on their knowledge of the patient
Role of respiratory specialist in multidisciplinary COPD teams
- Deal with more severe cases
- Diagnostic uncertainty
Role of respiratory nurses in multidiscplinary COPD teams
- Action plan development
- Education
- In-home care
- Emotional support
- Long-term planning
Role of physios in multidisciplinary COPD teams
- Rehabilitation
- Airway clearance techniques
- Exercise testing and training
Preventers vs relievers
Preventers: used daily to stop symptoms
Relievers: used when necessary to relieve symptoms
Beta agonist mechanism
- Bind to B2 receptors
- Cause airway dilation
LAMA mechanism
- Inhibit M3 receptorsd
- Prevent bronchoconstriction
Inhaled glucocorticoid mechanism
- Bind intracellular glucocorticoid recptors
- Increased expression of anti-inflammatory genes
- Suppression of pro-inflammatory genes
Mucolytics mechanism of action
They break the disulfie bonds within mucous molecules
Why can’t all ICS-LABA puffers be used in SMART asthma treatment?
Because not all LABAs are short-acting enough to be used as an acute reliever
Three levels of inhaler treatment in COPD
1: LAMA
2: LAMA + LABA
3: LAMA + LABA + ICS (“triple”)
List some people who may be in a multi-disciplinary team for a COPD patient
- Physio
- OT
- Respiratory specialist
- Respiratory nurse
- Psychologist
Benefits of multi disciplinary teams
- more efficient use of resources
- improved communication
Features of a good multi disciplinary team
- patient-centred
- trusting relationships
- ongoing professional development
What is a COPD self-management plan?
A structured but personalised plan that empowers patients to control their own condition as much as possible, improving quality of life and mental health in the process.
It helps patients to:
- Understand the severity of their symptoms
- Control these symptoms themselves, where possible
- Know when to seek help
