Asthma Flashcards
What are some of the main differences between asthma and COPD?
- asthma is reversible, and is episodic
- COPD is not reversible, is preventable, and is progressive
Tell me if the following are present in COPD, Asthma or Both:
1) inflammation
2) airway smooth muscle thickening
3) basement membrane thickening
4) Eosinophil mediated
5) T-Lymphocyte mediated
6) Responsive to steroids
7) Mainly in Children
8) Bronchial Hyperreactivity
1) both
2) mainly in asthma, some in COPD
3) Asthma
4) Asthma
5) Both: asthma TH2, COPD TH1
6) asthma
7) asthma
8) asthma
Is asthma more prevalent in males or females? which race is it more common in?
Males, african americans
Which cells are predominately involved in the early response in asthma? Late response?
early-mast cells (IgE)
late- T-cells (TH2)
Which two cells are activated by the smoke or other noxious particles in the initiation of COPD?
- macrophages–>alveolar wall destruction and mucus secretion (through many steps)
- Epithelial cells–>activate fibroblasts–>small airway fibrosis
What are the 2 main categories for therapies of asthma and COPD?
bronchodilators and anti-inflammatory agents
Name the 4 classes/medications that fall into the bronchodilator category of therapy.
- short acting B2 agonists
- long acting B2 agonists
- anticholinergics
- theophylline
Name the 4 classes/medications that fall into the anti-inflammatory category of therapy.
- inhaled corticosteroids
- antileukotrienes
- cromones
- anti-IgE
How do B2 agonists function?
activate G Protein–>activation of adenylyl cyclase–>increase in cAMP–>increase in PKA–>Bronchodilation (in simplified terms)
How do Theophyllines function is asthma treatment?
they inhibit PDE3 which normally breaks down cAMP–> increase in cAMP–>increase in PKA–>bronchodilation
Name 4 medications in the short acting B2 agonist category, when their onset of action is and how long they last.
- albuterol, terbutaline, metoproterenol, pirbutol
- onset-5 minutes
- duration-4-6hrs
How are the short acting B2 agonists used? (albuterol, terbutaline, metoproterenol, pirbutol)
- as needed for acute asthma exacerbation
- prevent exercise induced bronchospasm
What is Levalbuterol?
-R isomer of albuterol
was thought to decrease side effects of albuterol but has not proven to do so in clinical use
What are some of the adverse effects of short acting B2 agonists (albuterol, terbutaline, metoproterenol, pirbutol)?
- tremor
- tachycardia
- hypokalemia (can be used to tx hyperkalemia)
- paradoxical bronchospasm-from downregulation of receptors
- tolerance
- prolonged QTc
- lactic acidosis
Name the 3 long acting B2 agonists used in asthma and COPD.
- Salmetrol, Formoterol, and indacaterol
- onset-10-30mins
- duration-12+ hrs
- *used for long term control of symptoms**
What are the long acting B2 agonists always use din combination with for asthma?
inhaled corticosteroids
FDA Black Box Warning
Which of the following is used only in COPD? -Salmetrol, Formoterol, and indacaterol
Indacaterol
What are the 4 antimuscarinics used in asthma and COPD?
atropine ipratropium bromide tiotropium aclidinium bromide **Block M3 receptor that is present on airway smooth muscle**
Which of the antimuscarinics has a longer half life at the M3 receptor?
Tiotropium (aclidinium bromide is a close 2nd)
What are some of the other effects of Tiotropium?
- inhibits via muscarinic receptors on inflammatory cells–>decreased neutrophil migration and decreased airway remodeling
- decreased mucus production
Which of the antimuscarinic drugs is aclidinium bromide similar to and what is different about it?
- similar to tiotropium
- less systemic and CNS side effects
- higher dose can be given safely
What are some side effects associated with antimuscarinic use?
- dry mouth
- bladder outlet obstruction
- acute angle glaucome
- paradoxical bronchospasm
- possible cardiovascular mortality
What is tiotropium used to treat?
- chronic, stable COPD
- chronic asthma
- NOT for acute exacerbation of asthma or COPD!!
What is Ipratropium bromide used to treat?
Chronic COPD-less preferred than tiotropium
-NOT for chronic asthma!!
What are the 3 methylxanthines and what is their mechanism of action?
- theophylline, theobromine, and caffein
- PDE inhibitor, anti-inflammatory though histone deacetylation, improve contractility of diaphragm in COPD
- *can also restore corticosteroid sensitivity at low doses**
What are some of the problems with using methylxanthines?
- Narrow therapeutic window
- N/V, headache, insomnia, GERD at 15-20mg/l
- arrhythmia and seizure at >40mg/l
- Bronchodilation at 10-20mg/l
What are corticosteroids used for?
- persistent asthma (with long acting B2 agonists)
- Used in COPD but limited proof
- Steroid resistant inflammation
Why are corticosteroids useful with a long acting B2 agonist?
-they increase the transcription of the B2 receptor gene
What are the 3 leukotriene inhibitors? What are the used to treat?
- montelukast, pranlukast, zafirlukast
- mild asthma, aspirin induced asthma, prophylaxis for exercise induced bronchospasm
- *Not used in COPD**
What are some of the side effects of the leukotriene inhibitors? (montelukast, pranlukast, zafirlukast)
- Liver toxicity
- Churg Strauss?–>likely coincidental
What is the mechanism of action of sodium cromoglycate and Nedocromil sodium?
- orevent mast cell degranulation and mediator release from macrophages and eosinophils
- *Used as preventable tx before exercise of unavoidable exposure to known allergens**
Name the 1 anti-IgE monoclonal antibody and what it is used for.
- Omalizumab-given SubQ every 2-4 weeks
- decreases requirement for corticosteroids
- decreases asthma exacerbations
- *Only used for those with very severe asthma who are poorly controlled on oral corticosteroids**
How are acute exacerbations of asthma and COPD treated?
- systemic corticosteroids 5-7 days
- inhaled short acting B2 agonist and anticholinergic (nebulizer)
- Antibiotics for exacerbation of COPD
- *DO NOT use long acting B2 agonists or long acting anticholinergics**
