Airway therapeutics

Question 1

Drugs for airflow obstruction categories

Answer 1

Preventers (anti-inflammatory)

Relievers (bronchodilators)

Question 2

Inflammatory Cascade in asthma

Answer 2

Inherited or acquired factors

• genetic predisposition
• viral, allergens or chemical

Eosinophilic inflammation

Mediators
Th2 cytokines

Twitchy smooth muscle

Question 3

Inherited or acquired factprs

Answer 3

Avoidance of precipitant

Question 4

Eosinophilic inflammation

Answer 4

anti-inflammatory medication

• corticosteroids
• cromones
• theophyline

Question 5

Mediators/ Th2 cytokines

Answer 5

antileukotrienes or antihistmaines
monoclonal antibodies
-anti IgE
-anti-interleukin 5

Question 6

twitchy smooth muscle

Answer 6

bronchodilators

• B2 agonist
• Muscarinic antagonists

Question 7

asthma treatment pyramid

Answer 7

short-acting B2-agonist PRN (reliever)
Inhaled steroid (preventer = 1st line)
Theophyline LTRA LABA/LLAMA Anti-IgE/ Anti-IL5 (controller = 2nd line addictive to ICS)
Oral steroid biologist

Question 8

anti-inflammatory corticosteroids used in…

Answer 8

asthma

COPD

Question 9

anti inflammatory corticosteroids may cause what in COPD

Answer 9

pneumonia

Question 10

anti inflammatory corticosteroids pneumonia COPD link

Answer 10

-local immune suppression

altered microbiome + impaired MC clearance

Question 11

Oral steroids low/high therapeutic response

Answer 11

low

Question 12

Oral steroids are only used for

Answer 12

acute exacerbations not maintenance

Question 13

inhaled steroids low/high therapeutic ratio

Answer 13

high

Question 14

inhaled steroid used for

Answer 14

maintenance monotheraopy in asthma

Question 15

spacer device

Answer 15

avoids coordination problems with pMDI
reduced oropharyngeal and laryngeal side effects
reduces systemic absorption from swallowed fraction
acts a holding chamber for aerosol
reduces particle size + velocity
improves lung deposition

Question 16

anti-inflammatory corticosteroids reduce what

Answer 16

exacerbations in eosinophilic COPD

Question 17

anti-inflammatory: cromones

Answer 17

asthma
mast cell stabiliser- weak anti-inflammatory cf steroids
cromoglycate effective in atopic children
inhaled route only
not used = poor efficacy

Question 18

anti-inflammatory: leukotriene receptor antagonists

Answer 18

asthma - anti-inflammatory
montelukast
less potent anti-inflammatory than inhaled steroids
efective in EIB
effective in allergic rhinitis

Question 19

anti-IgE

Answer 19

omalizumab
inhibits binding to high affinity IgE receptor
inhibits TH2 response
2-4 weeks
severe patient allergic asthma
very expensive

Question 20

anti-IL5

Answer 20

meplizuab
reslizumab
blocks effect of TH2 cytokine IL5
4 weeks
severe refractory eosinophilic asthma
very expensive
little effect on pulmonary function
reduces exacerbations + oral steroid sparing effect

Question 21

B2 agonist

Answer 21

bronchial smooth muscle B2 receptor
increased cAMP
short acting - salbutamol
long acting - bid salmeterol/ formoterol
combination inhalers
asthma + COPD
high therapeutic ratio
b2 down regulation + tachyphylaxia with chronic LABA
Systemic B2 effects
high nebulised doses in acute attack

Question 22

muscarinic antagonists

Answer 22

block post junctional end plate M3 receptors
short acting - Ipratropium
Long acting - od Tiotropium
Inhaled
High therapeutic ratio
COPD = reduce exacerbations
Asthma = triple therapy

Question 23

methylxanthines

Answer 23

oral
maintenance therapy
SR formulation usedul for nocturnal dips
Add to inhaled steroid as complementary non steroidal anti-inflammatory
IV = acute attacks
Non selective phosphodiesterase inhibitor
increase cAMP
adenosine antagonist

low therapeutic ratio - P450 drug interactions
asthma + COPD

Question 24

PDE4 inhibitors

Answer 24

roflumilast - oral
COPd 
min effect on FEV1
reduce exacerbations
-nausea/diarrhoea/headache/weight loss

Question 25

mucolytics

Answer 25

oral carbocistine, erdosteine
reduce sputum viscosity
add on

Question 26

chronic asthma treatment

Answer 26

AIMS

abolish symptoms
min B2-use
normalise FEV1
reduce PEF variability
reduce exac
prevent long term airway remodelling

Question 27

Asthma suppress inflammatory cascase with

Answer 27

inhaled steroids

Question 28

inflamm therapy asthma

Answer 28

+/- non steroid anti-inflammatory therapy

Question 29

LABA/LAMA asthma aim

Answer 29

+/- stabilise smooth muscle

Question 30

role of anti IL5

Answer 30

suppress eosinophils

Question 31

what is used to treat an allergy

Answer 31

anti-IGE

Question 32

4 treatments of acute asthma

Answer 32

oral prednisolone
nebulised high dose, salbutamol +/- ipratropium +/- aminophylline/magnesium

at least 60% O2

ITU assisted mechanical intubated ventilation if falling PaO2 + rising PaCO2

Question 33

COPD treatment aim

Answer 33

reduce exacerbations
improve pulmonary function
improve QOL
prevent pulmonary heart disease

Question 34

Treatment of COPD

Answer 34

smoking cessation
immunisation
pharmacotherapy
pulmonary rehab
oxygen

Question 35

non pharmacological COPD management

Answer 35

smoking cessation +/- nicotine/burpropion/vareniciline
immunisation - influenza/ pneumococcal
physical activity
O2 domiciliary

Question 36

pharmacological COPD management

Answer 36

LABA/LAMA combo
ICS/LABA combo
ICS/LABA/LAMA combo

Question 37

minimal symptoms + few exacerbations

Answer 37

SABA

Question 38

few symptoms + feq exacerbations

Answer 38

ICS/LABA/LAMA or LABA/LAMA

Question 39

more symptoms dew exacerbations

Answer 39

LABA/LAMA

Question 40

more symptoms freq exacerbations

Answer 40

ICS/LABA/LAMA or LABA/LAMA

Question 41

acute COPD treatment

Answer 41

nebuliser high dose salbutamol + ipratropium
oral prednisolone
antibiotic if infection
24-28% O2 titrated against PaO2/PaCO2
Physio = aide sputum expectoration
non invasive ventilation = higher FiO2
ITU intubated assisted ventilation = only if reversible component (e.g. pneumonia)