Asthma

Question 1

What is used in Step 1 of asthma treatment?

Answer 1

Short acting B2 agonists eg. Salbutamol

Question 2

For what purpose is Salbutamol used?

Answer 2

As a reliever

Question 3

How do B2 agonists work?

Answer 3

Ligand binds Gs which increases cAMP
Downstream activation of pKa
Leads to relaxation and inhibition of agonist-induced contraction

Question 4

What are ADRs of B2 agonists?

Answer 4

Tachycardia
Palpitations
Tremors

Question 5

What is Step 2 of Asthma treatment?

Answer 5

Regular preventer therapy

Inhaled corticosteroids

Question 6

How do Inhaled Corticosteroids work?

Answer 6

Reduce the eosinophilic TH2 driven inflammation of airways
Bind to GR alpha protein
Complex binds to DNA and activates infiltration of anti-inflammatory molecules

Question 7

What makes up the concentration of ICS in the systemic circulation?

Answer 7

Absorption from lungs + Active drug from the gut

Question 8

What does Add on therapy involve?

Answer 8

Long Acting B2 Agonists with ICS
Leukotriene Receptor Antagonists
Methylxanthines
Long acting anticholinergics

Question 9

What is the use of LABAs?

Answer 9

Reduce Exacerbations

Improve lung function

Question 10

How do Leukotriene Receptor Antagonists work?

Answer 10

LTC4 is released by mast cells and eosinophils and can induce
Bronchoconstriction, mucus secretion, mucosal oedema, promotion of inflammatory cells
So antagonists block these things

Question 11

What are the ADRs of Leukotriene Receptor Antagonists?

Answer 11

Angioedema
Dry mouth
Arthralgia

Question 12

How do methylxanthines work?

Answer 12

Antagonise adenosine receptors

This inhibits phosphodiesterase which increases cAMP

Question 13

What are the ADRs of Methylxanthines?

Answer 13

Nausea
Headache
Reflux

Question 14

What is an example of a Long Acting Cholinergic?

Answer 14

Tiotropium Bromide

Question 15

When is Tiotropium Bromide used?

Answer 15

COPD

Severe Asthma

Question 16

What are the ADRs of Tiotropium Bromide?

Answer 16

Dry mouth
Urinary retention
Glaucoma

Question 17

What is Step 5 of Asthma treatment?

Answer 17

Oral IgE

Anti-Steroids

Question 18

What is the criteria for Acute Severe Asthma?

Answer 18

Any one of:
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Pulse over 110 bpm
Resp over 25/min
Peak flow of 33-50% of best/predicted

Question 19

What is the Partial pressure of CO2 in near fatal asthma?

Answer 19

Over 6kPa

Question 20

How do you treat acute, severe Asthma?

Answer 20

High flow oxygen 
Nebuliser salbutamol
Oral prednisolone 
Nebuliser Tiotropium Bromide
IV Aminophylline if no improvement

Question 21

What does TH2 driven inflammation do in Asthma?

Answer 21

Mucosal oedema
Bronchoconstriction
Mucus plugging
Airway remodelling

Question 22

When do you start step 2?

Answer 22

When p is using B2 agonists more than 3 times a week
Symptoms present more than 3 times a week
Waking from sleep more than once a week
Any Exacerbations requiring oral steroids in the last 2 years