Asthma Flashcards
Define: Asthma
chronic inflammatory disorders of the airways which contributes to airway hyperresponsiveness, airflow limitation, respiratory symptoms, and disease chronicity. acute bronchoconstriction, airway edema, mucus plug formation, and airway wall remodeling leading to bronchial obstruction.
How is asthma severity classified?
consider impairment (present), including frequency and intensity of symptoms and quality of life and risk (future), including exacerbations, loss of pulmonary function, risk of adverse drug reactions
What is the use of severity classification of asthma?
initiating controller (long-term control) therapy
What drugs are considered quick relief (“relievers”)?
-short-acting beta2-agonists (SABA)
-short-acting anticholinergics (SAMA)
-systemic corticosteroids (OCS)
-long-acting beta2-agonists/inhaled corticosteroids combo (LABA/ICS combo)
-short-acting beta2-agonist/inhaled corticosteroid combo (SABA/ICS combo)
What drugs are considered long-term controllers?
-inhaled corticosteroids (ICS)
-mast cell stabilizers
-long-acting beta2-agonists (LABA)
-methylxanthines
-leukotriene modifiers (LM)
-long-acting beta2-agonists (LABA)/ inhaled corticosteroid (ICS)
-monoclonal antibodies
-long-acting anticholinergics
What drugs are short-acting beta2-agonists?
-albuterol (Proventil HFA, Ventolin HFA, ProAir Respiclick)
-levobuterol
What are the indications for SABAs use?
-quick relief of acute symptoms
-preventive prescription prior to exercise-induced bronchospasm (EIB)
MOA: Short-acting beta2-agonists (SABAs)
-activation of adenylate cyclase and increase cyclic AMP
-smooth muscle relaxation -> bronchodilation
Side Effects: SABAs
-tremor
-tachycardia, palpitations
-hypokalemia
What is the difference between levalbuterol vs albuterol?
it is suggested that levalbuterol has possible more rapid onset and fewer side effects than albuterol (lacks evidence) but there is no clinically significant difference and levalbuterol can be more expensive
What drugs is most effective for relieving acute bronchospasms?
SABAs (albuterol)
What is the concern of SABA daily use?
daily use is associated with beta-receptor down regulation which can cause hyperresponsiveness to allergens and increased inflammation
How may a patient use their SABA that may indicate the need for long-term control medication ?
if the patient use > 1 canister (1 inhaler) a month or >2 times a week
What are OTC SABAs and why are they NOT recommended?
they are non-selective adrenergic agonists (alpha and beta) with increased side effects such as increased HR, palpitations, HTN, angina, arrhythmias, seizures, hyperglycemia, temor, anxiety/nervousness
What drugs are short-acting anticholinergics (SAMAs)?
ipratropium bromide (Atrovent HFA, nebulization soln)
What is the indication for short-acting anticholinergics (SAMAs)?
relief of acute bronchospasms
no effect of exercise-induced bronchospasms
MOA: SAMAs
bronchodilation via inhibition of muscarinic cholinergic receptors reduction of glandular mucus secretion
Side Effects: SAMAs
anticholinergic side effects, but mostly dry mouth
Can SAMAs be used alone for acute bronchospasms?
no, may be given with albuterol
When may a SAMA be uniquely used for treatment?
it is used in the emergency department (ED) with albuterol for acute exacerbations because it may reduce the likelihood of admission and reduce the length of stay of a patient who may need to be admitted. BUT it is NOT recommended in hospitalized patients!
What is the indication for SYSTEMIC corticosteroids?
moderate to severe exacerbations to prevent the progression of the exacerbation, reverse inflammation, speed recovery, reduce rate of relapse
What is the typically dosing of systemic corticosteroids for an asthma exacerbation?
-adults: prednisone 40mg-60mg po daily (or divided BID) x 3-10 days
-children: prednisolone 1-2mg/kg/day (max=60mg) po x 3-10 days
Side Effects: Systemic Corticosteroids
-abnormalities in glucose metabolism
-increased appetite
-fluid retention
-weight gain
-mood alteration
-hypertension
-peptic ulceration
What is “SMART” therapy?
“single maintenance and reliever therapy” includes the combo product long-acting beta2-agonist/inhaled corticosteroid (LABA/ICS)
What LABA/ICS combo may be given for quick-relief of acute asthma symptoms?
formoterol containing products only (Symbicort and Dulera)
What is “AIR” therapy?
“anti-inflammatory reliever which includes a SABA/ICS combo
What products are short-acting beta2-agonist(SABA)/inhaled corticosteroid (ICS)?
Airspura (albuterol/budesonide)
What products are inhaled corticosteroids (ICS)?
-beclomethasone
-budesonide
-ciclesonide
-fluticasone propionate
-fluticasone furoate
-mometasone furoate
What is the indication of inhaled corticosteroids (ICS)?
-long-term prevention of symptoms in mild-persistent, moderate, and severe asthma
-suppression, control, and reversal of inflammation
-reduce the need for systemic corticosteroids
MOA: inhaled corticosteroids
-reduce synthesis and release of pro-inflammatory cytokines
-reduce inflammatory cell activation, recruitment, and infiltration
-reduce vascular permeability
-may increase number of receptors and may improve receptor responsiveness to adrenergic stimulation (synergistic effect)
Side Effects: inhaled corticosteroids
-cough, dysphonia
-oral thrush (candidiasis)
-possible systemic effects seen at high doses (adrenal suppression/growth suppression, osteoporosis, skin thinning/easy bruising, weight gain/fluid retention)
What are tips for patients to reduce adverse effects of ICS?
-administer with spacer if possible
-rinse mouth thoroughly after inhalation
-use lowest effective dose
-monitor growth
-consider osteoporosis prophylaxis in postmenopausal women
What is ICS place in treatment?
first-line treatment for long-term control regardless of age
What products are mast cell stbilizers?
cromolyn sodium
What is the indication of mast cell stabilizers?
-long-term prevention of symptoms
-preventative treatment prior to exposure to exercise or known allergen
What products are long-acting beta-agonists (LABAs)?
-salmeterol
-formoterol
-vilanterol
-albuterol SR tabs
What are the indications of long-acting beta-agonists (LABAs)?
-long-term prevention of symptoms, especially nocturnal symptoms IN ADDITION TO anti-inflammatory agents
-prevention of exercise induced bronchospasms (EIB)
-relief of acute bronchospasms (off labeled use and FORMOTEROL containing products)
What age is Salmeterol (LABA) approved in?
4 years+
What age is Formoterol (LABA) approved in?
5 years+ (no longer marketed)
What products are Methyxanthines?
theophylline
What is the indication of methylxanthines?
long-term control and prevention of symptoms, especially nocturnal symptoms
Why are Methylxanthines not generally recommended to use for treatment of asthma?
narrow therapeutic window so serum concentration monitoring is required so it is poorly tolerated and numerous drug interactions
What products are leukotriene modifiers (LM)?
-zafirlukast
-zileuton
-montelukast
What is the indication of leukotriene modifiers?
long-term control and prevention of symptoms in persistent asthma
When may leukotriene modifiers (LM) be helpful for treatment?
children or patients with poor inhaler technique
