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