asthma and COPD

Question 1

what is asthma?

Answer 1

a recurrent and reversible obstruction of the airways in response to stimulants that wouldn’t effect a non asthmatic person e.g excercise

Question 2

describe the early phase of an asthma attack?

Answer 2

antigen binds to IgE-IgE receptor complex which stimulates the release of calcium into mast cells releasing histamine and causing bronchoconstriction

Question 3

describe the late phase of an asthma attack?

Answer 3

the arrival of basophils, neutrophils and lymphocytes causes damage to the epithelium and in turn more constriction and inflammation

Question 4

what tests can be used to diagnose asthma?

Answer 4

spirometry and peak flow

Question 5

what spirometry result would indicate asthma?

Answer 5

less than 70% FEV/PVC ratio

Question 6

what difference does COPD have to asthma?

Answer 6

in asthma, the bronchoconstriction comes only when having an asthma attack, in COPD patients permanently have constricted airways

Question 7

give 5 symptoms of COPD?

Answer 7

breathlessness, cough, frequent lower respiratory tract infections, weight loss, waking at night with symptoms

Question 8

what 3 things must be done for a patient with COPD before offering medicinal treatment?

Answer 8

offer smoking cessation help, offer flu and pneumonia vaccinations, work out a self management plan

Question 9

what Is first line treatment for COPD?

Answer 9

SABA or SAMA to use when needed

Question 10

what is second line treatment for COPD?

Answer 10

if SABA/SAMA aren’t working, offer an ICS (inhaled corticosteroid)

Question 11

talk through the pharmacological treatment of asthma? (long answer question)

Answer 11

• first line treatment: blue SABA inhaler (salbutamol) 1-2 puffs to be used when needed at 100mcg per puff
• if the above is not working well enough, patients are waking at night, or have to use their blue inhaler more than 3 times a week: offer low dose brown inhaler with an ICS e.g beclamethasone 200-400mcg / 4 puffs twice a day
• if the above is not sufficient: offer a LABA (long acting) purple inhaler e.g salmeterol 2 puffs twice a day (total 100mcg) alongside the ICS brown inhaler

Question 12

what treatment is used for a severe asthma or COPD attack?

Answer 12

prednisolone for 5 days (asthma:40-50mg) (COPD: 30mg)

Question 13

give 3 red flag symptoms of respiratory issues?

Answer 13

coughing up blood, breathlessness from the action of breathing, waking at night with a severe cough

Question 14

describe the action of salbutamol on beta 2 adrenoreceptors?

Answer 14

Gs protein coupled receptors are activated which activate adenylate cyclase, increasing cAMP, decreasing intracellular calcium: decreasing muscle contraction and therefore decreasing bronchoconstriction

Question 15

how do glucocorticoids / ICS get to the point of transcribing genes?

Answer 15

steroid hormones are lipophilic so diffuse into the cell, they combine with intracellular receptors to produce a conformational change and then enter the nucleus and bind to DNA

Question 16

how do steroids work as anti inflammatory drugs?

Answer 16

steroids increase liopcortin which inhibits phospholipase A2 (makes it inactive)

Question 17

what does phospholipase A2 do?

Answer 17

produce prostaglandins and leukortines which cause inflammation

Question 18

how do steroids work as immunosuppressants?

Answer 18

inhibition of cytokines which stimulate the proliferation of T and B cells

Question 19

give 2 symptoms of the overuse of salbutamol blue inhaler?

Answer 19

tremor + anxiety