Asthma and COPD

Question 1

b2 agonist

Answer 1

Albuterol, Salmeterol

Question 2

Leukotriene antagonist

Answer 2

Montelukast

Question 3

Muscarinic antagonist

Answer 3

Ipratropium (nonselective), Tiotropium (M1, M3 but not M2 inhibitor) – quaternary amine derivatives of atropine

Question 4

Inhaled corticosteroid

Answer 4

Fluticasone

Question 5

Monoclonal Anti-IgE antibody

Answer 5

Omalizumab

Question 6

Increased Raw – Obstructive Lung Disease

Answer 6

Decreased airflow	(decreased FEV1)
Airflow is limited during expiration (E)

Question 7

decreased L-CW compliance – Restrictive Lung Disease

Answer 7

Parenchyma fibrosis

Decreased forced vital capacity (decreased FVC)

Question 8

Asthma

Answer 8

spasmodic contraction of smooth muscle in the bronchi;
airflow obstruction (bronchospasm), bronchial hyperresponsiveness, and an underlying inflammation

Question 9

Chronic obstructive pulmonary disease

Answer 9

Bronchitis - inflammation of the bronchi and bronchioles
Emphysema – alveolar destruction
Combination!;
Progressive decrease in lung function (clinically relevant in aged population)
↓ FEV1
Limited reversibility

Question 10

FACTORS THAT DETERMINE AIRWAY RESISTANCE

Answer 10

Structure of the airways
Airway smooth muscle contraction
Lumen obstruction (mucus)
Elasticity of lung parenchyma

Question 11

“Hallmark” of asthma

Answer 11

reversibility with bronchodilator

Question 12

Positive correlation of asthma symptoms with

Answer 12

Total IgE levels

Question 13

asthma involves

Answer 13

INFLAMMATION, REMODELING, and NERVE HYPER-REFLEXIVITY

Question 14

what leads to decreased airflow in COPD?

Answer 14

↓ aveoli structure: ↓ elastic recoil: ↓ structural support: bronchiole collapse: ↑ Resistance: ↓ Airflow

Question 15

asthma cell infiltration

Answer 15

Eosinophils, Mast Cells, Basophils

Question 16

COPD cell infiltration

Answer 16

Neutrophils, Macrophages

Question 17

b-adrenoceptor agonists

Answer 17

Actively cause bronchodilation

Question 18

leukotriene and muscarinic antagonists

Answer 18

Inhibit specific inflammatory mediators

Question 19

corticosteroids

Answer 19

Reduce inflammation

Question 20

anti-IgE antibodies

Answer 20

Prevent inflammation – for asthma only

Question 21

b Adrenoceptor agonists MOA

Answer 21

Activation of β2 adrenoceptors on bronchial smooth muscle – ↑ cAMP ->relaxation -> bronchodilation
Facilitates sequestration of Ca2+
Inactivates MLCK
Inactivates MLC20

Question 22

b Adrenoceptor agonists Therapeutic Uses

Answer 22

Short-acting (e.g. albuterol)
Rescue for asthma and COPD
Long-acting (LABA) (e.g. Salmeterol)
Control for asthma and COPD

Question 23

Leukotriene Antagonist MOA

Answer 23

CysLT1 antagonist

Prevents Cys-LT-induced bronchospasm, ↓ immune cell infiltration, no ↓ AHR, very mild reversal of remodeling

Question 24

Leukotriene Antagonist Therapeutic Uses

Answer 24

Control for asthma

Question 25

Muscarinic Antagonists MOA

Answer 25

Blocks acetylcholine-induced activation of muscarinic receptors on:
Airway smooth muscle (M3) –↓ bronchospasm
Epithelial mucosal glands (M3) –↓ mucus secretion

Question 26

Muscarinic Antagonists Therapeutic Uses

Answer 26

Rescue for asthma

Control for COPD

Question 27

ACh activates neuronal M2 receptor

Answer 27

as negative feedback control of ACh release

Question 28

Inhaled Corticosteroids MOA

Answer 28

Anti-inflammatory, ↓ infiltration of eosinophils/basophils/mast cells, minor ↓ AHR, mild reversal of remodeling
↓ pro-inflammatory protein production (e.g. IL-4 and IL-5)
↑ anti-inflammatory protein production
MODULATION OF PROTEIN EXPRESSION IS SLOW-ONSET (>12 hours)

Question 29

Inhaled Corticosteroids therapeutic use

Answer 29

Control for asthma (inhalation, nasal)

Control for COPD – limited relief

Question 30

Corticosteroid: Mechanism of Action – COPD

Answer 30

Corticosteroids have little effect on neutrophilia

Corticosteroids have no effect on MORTALITY

Question 31

Anti-IgE Antibodies MOA

Answer 31

Binds to free IgE (Fc region), promotes destruction
↓ IgE from binding to FCeR1 and FCeR2
↓ expression of FCeR1 on mast cells/basophils
↓ allergen-induced IgE crosslinking on mast cells/basophils
Prevents allergen-induced bronchospasm, ↓ immune cell infiltration, ↓ exacerbations, no ↓ AHR, effect on remodeling is unclear.

Question 32

Anti-IgE Antibodies Therapeutic Uses

Answer 32

Control for severe, steroid-resistant asthma

Question 33

Anti-IgE Antibodies Rate of onset

Answer 33

Circulating IgE destroyed in hours/days

Takes more than a week for mast cell-attached IgE to reduce