asthma and COPD

Question 1

Asthma

Answer 1

• Chronic, inflammatory condition of the airways
• Narrowed airway (limited airflow)
• Recurrent episodes of wheezing, breathlessness, coughing, chest tightness
• Widespread BUT variable airflow obstruction, which is often reversible
• Inflammation associated with bronchial hyper-reactivity
• Inflamed, thickened airway walls
• Mucous
• Night time waking with breathlessness/wheeze
• Significant diurnal or day to day variability of symptoms
• Allergic component – other allergic conditions e.g. allergic rhinitis, eczema
• Diagnosis usually at younger age
• Inflammation of airways leads to permanent changes/airway remodelling – loss of normal bronchial elasticity, increase in bronchial smooth muscle
• Triggers: mould, dust, household products, pets, chemicals (detergents, cleaners)
• Reversibility post bronchodilator
• Eosinophils

Question 2

COPD

Answer 2

• Umbrella term for chronic bronchitis + emphysema
• Chronic, pressive condition
• Airway inflammation and limitation that is not fully reversible
• Nearly all patients have smoking history
• Breathlessness – persistent + progressive
• Chronic productive cough, sputum plugs, SOB
• Later onset in life
• Environmental/occupational exposure
• Lack of reversibility post bronchodilator
• Neutrophils

Question 3

Short-acting beta-agonist (SABA): salbutamol (Ventolin), terbutaline (Bricanyl) (reliever)

Answer 3

• Asthma: every asthmatic should have a SABA. Doesn’t influence the underlying pathological process in asthma
• Effective bronchodilator for COPD and asthma
• Main reliver medications
• When used systemically, adverse effects (tachycardia, tremor) more common

Question 4

Long-acting beta-agonist (LABA): formoterol, salmeterol (Serevent), vilanterol controller

Answer 4

• Asthma – never used alone, always used with an ICS
• COPD – can be used alone
• Available in combination with ICS e.g. Symbicort, Seretide
• LABA/LAMA combination = Brimica
• LABA/LAMA/ICS combination = Trelegy

Question 5

Inhaled Corticosteroids (ICS): budesonide (Pulmicort), fluticasone (Flixotide) preventer

Answer 5

• COPD: not as effective
• Some are available as combination products with a LABA
• Spacer devices can be helpful
• Risk of mouth sources, oral thrush – rinse mouth after

Question 6

Leukotriene receptor antagonist (LTRA): montelukast

Answer 6

• Asthma: used in kids – tablet, often preferred by parents

- Not usually used in adults

Question 7

Short-acting muscarininc antagonists (SAMA): ipratropium

Answer 7

• Used in acute asthma attacks

- Can be used as a main bronchodilator/reliever medication in COPD

Question 8

Long-acting muscarinic antagonists (LAMA): tiotropium

Answer 8

• COPD: often the main symptom controller

- Not used regularly in asthma

Question 9

Cromones (Nedocromil Sodium)

Answer 9

• For asthma, rarely used
• Omalizumab – newly available
• Not used for COPD

Question 10

Theophyllines

Answer 10

• Narrow therapeutic range, has adverse effects, rarely used