asthma and COPD Flashcards
Pathophysiology of asthma
Inflammatory disorder of the airways
- flare ups of breathlessness/SOB, chest tightness, coughing, and wheezing
- can progress to COPD if poorly controlled (loss of normal bronchiole elasticity, increase in bronchiole smooth muscle)
- can be triggered by allergens or environmental factors
- pt diagnosed at an early age - most patient below 35
REVERSED WITH RELIEVERS
What immune cell is mostly responsible for inflammation in asthma?
eosinophils
Pathophysiology of COPD
chronic and progress condition involving airway inflammation and limitation that is not fully reversible (NOT REVERSED POST-THERAPY)
- persistant and progressive breathlessness
- almost all patients have a smoking history
- most patients above 45
- no allergic component
What chronic conditions are including within the COPD buddle?
chronic bronchitis, emphysema
What immune cell is responsible for inflammation in COPD?
neutrophils
Asthma vs COPD
Similarities:
- both involve inflammation within respiratory tract
- both result in breathlessness, chest tightness, wheeze, and cough
Differences:
- asthma - reversible, eosinophils, most common in pt below 35, triggered by allergens
- COPD - no allergic component, not fully reversible, most pt have smoking history, most common in patients above 40, sputum
What drug class worsens asthma?
NSAIDs , aspirin - can trigger bronchospasm and rhinitis
Diagnostic tests for asthma vs COPD
spirometry (ratio of forced expiratory volume and forced vital capacity)
- in both asthma and COPD FEV1/FVC is less than 80%
asthma
- FEV1/FVC = over 12% improvement from baseline following bronchodilator
COPD
- less than 80% of predicted value
Before stepping up treatment you must always check:
- medication adherence - do not step up if patient is not correctly following medication regime
- inhaler technique - often inhaler technique is incorrect, altering preventer/reliever effectiveness
Steps in asthma treatment
- SABA - Salbutamol, terbutaline
- ICS + SABA
- ICS + LABA - formoterol, salmeterol, vilanterol
- ICS medium-high dose + LABA
- Specialist treatment
What are examples of SABA?
salbutamol, terbutaline
LABA examples
formoterol, salmeterol, vilanterol
ICS examples
Budesonide, fluticasone
LTRA examples
Montelukast
SAMA examples
Ipratropium
LAMA examples
Tiotropium
Theophylline examples
theophylline
At what type of day is asthma at its worst?
early morning due to cold air
Steps in asthma treatment for children
- PRN reliever - SABA
- Regular preventer (ICS low dose or montelukast) + PRN reliever
- ICS (low dose) + montelukast + PRN reliever
- add on specialist treatment
Which drug class can never be used alone in asthma treatment (must always be paired with ICS)?
LABA
Adverse effects in SABA overdose
palpations, tachycardia, tremor
Asthma medication vs COPD medication
- Less use of ICS in COPD
- LABA can be used on own in COPD
- SAMA and LAMAs more commonly used in COPD (only recently approved in asthma but uncommon)
Main medications in COPD
anti-muscarinic drugs (bronchodilators) - SAMA, LAMA (can be used with ICS)
ICS - variable effect against neutrophils
What drug class cannot be used on its own in asthma?
LABA
Must be used with ICS or associated w/ worse outcomes
Stepping up in paediatric asthma therapy (6-11)
- SABA as a reliever
- Montelukast (preventer) OR ICS (low dose) + SABA (reliever)
- ICS (high paediatric dose) OR ICS/LABA combination (low dose) OR ICS (Low dose) w/ montelukast + SABA (reliever)
- specialist treatment
stepping up in paediatric therapy (1-5)
- SABA (reliever)
- ICS (low dose) OR montelukast + SABA (reliever)
- ICS (low dose) w/ montelukast or ICS (high paediatric dose) + SABA (reliever)
- specialist treatment
