Asthma and COPD

Question 1

Describe the criteria for good asthma control (3)

Answer 1

• Minimal symptoms day and night
• minimal need for a reliever inhaler
• no exacerbations
• no limitation of physical activity

Question 2

What 3 factors are important to consider before stepping up asthma treatment?

Answer 2

• good compliance
• Good inhaler technique
• elimination of triggers

Question 3

Describe the criteria for stepping up asthma treatment?

Answer 3

• using salbutamol >2 times per week
• Symptoms > 2x per week
• waking up 1 or more times per week
• exacerbation needing oral steroids

Question 4

Describe mild and stage 1 and 2 of asthma control

Answer 4

Mild= Salbutamol PRN (only for very mild asthma)
1= Low dose ICS (budesonide) + salbutamol PRN 
2= Low dose ICS + LABA (formoterol, salmeterol)

Question 5

Describe stage 3, 4 and 5 of asthma control

Answer 5

3= increase dose ICS + LABA (if it helps) + LAMA (ipratropium bromide, tiotropium) or leukotriene receptor antagonist (montelukast) or methylxanthine (theophylline, aminophylline) 
4= change to or add LAMA/ LTRA/ methylxanthine depending on what was done in stage 3
5= change to or add LAMA/ LTRA/ Methylxanthine depending on what was done in stage 4 and add oral corticosteroids (prednisolone) and consider biological agent

Question 6

Name one SABA and describe how it works

Answer 6

Salbutamol, terbutaline

Activates B2 receptors, activates AC, increases cAMP, inhibits MLCK, less smooth muscle contraction.

Question 7

What is the problem with using salbutamol regularly?

Answer 7

Short term secondary action of inhibiting mast cell degranulation, but with regular use they increase sensitivity of mast cell degranulation

Question 8

Give 3 ADRs of salbutamol

Answer 8

• tachycardia
• palpitations
• tremours

Question 9

Name 2 inhaled corticosteroids and briefly describe how they work

Answer 9

• beclomethasone
• budenoside
  Bind to intracellular glucocorticoid receptor-> transactivation of anti- inflammatory agents (ILR1)
  Also inhibit production of inflammatory agents by transrepression (COX2, Il2, Il6)

Question 10

Name one long acting beta agonist and give one adv and one disadv

Answer 10

Formoterol and salmeterol.
They reduce exacerbations, lung functions and symptoms and reduce symptoms however have no effect on inflammation and so you need steroids as well.

Question 11

Name one leukotriene receptor agonist antagonist and describe how it works

Answer 11

Montelukast.

Blocks effect of cysteinyl leukotrienes on the CysLT1 receptor, this helps in 15% of pts

Question 12

Give 3 ADRs of montelukast

Answer 12

• dry mouth
• angiodema
• anaphylaxis
• arthralgia
• fever
• Gi upset
• nightmares
• Treatment failure relatively common
  Most ADRs reasonably rare

Question 13

Name 2 methylxanthines and describe how they work

Answer 13

theophylline, aminophylline
They antagonise adenosine receptors
In vitro they also inhibit phosphodiesterase so increase cAMP, but this unlikely to be significant in vivo

Question 14

Give 3 ADRs of theophylline

Answer 14

• nausea
• headaches
• reflux
• toxic (arrhythmias, fits)
• interactions due to CYP450 metabolism
• Poorly efficacious

Question 15

Name one long acting anticholinergic/ muscarinic antagonist (LAMA) and name the receptor they inhibit

Answer 15

Tiotriopium, ipratropium bromide

Inhibit M3

Question 16

common on efficacy of LAMAs in asthma and give 3 ADRs

Answer 16

Poor efficacy.

ADR: dry mouth, urinary retention, glaucoma

Question 17

Name one biological agent used in severe asthma

Answer 17

Omilazumab (anti IgE) and mepolizumab (anti Il5)

Question 18

What is optimum particle size of inhalers and why?

Answer 18

1-5 micron particles- inhaled into small airways but not so small that theyre exhaled back out again. This gives best deposition

Question 19

Give 4 features of severe (but not life threatening (yet)) asthma

Answer 19

• unable to complete sentances
• > 110 BPM
• resp rate > 25/min
• peakflow 33-50% of best

Question 20

Give 4 signs/ features of life threatening asthma

Answer 20

• absent breath sounds
• peak flow of <33% best or predicted
• sPO2<92%, pO2< 8kPa, pCO2> 4.5kPa
• cyanosis signs
• hypotension, bradycardia, arrhythmias
• exhaustion, confusion, coma

Question 21

How is severe and life threatening asthma treated? (also give administration routes)

Answer 21

Oxygen (high flow)
Salbutamol (nebulised continiously)
Hydrocortisone (prenisolone oral)
Ipratropium Bromide (nebulised)
Theophylline (oral) aminophylline (IV)
Magnesium (not really done anymore)
Escalate (send to ITU for intubation if no improvement)

Question 22

Give 3 non pharmacological interventions for COPD

Answer 22

• confirm diagnosis and manage comorbidities
• stop smoking
• offer pulmonary rehab and lifestyle advice
• offer vaccinations

Question 23

Describe pharmacological treatment of breathless COPD

Answer 23

Give salbutamol, 2 puffs PRN. If breathlessness limits exersize, give LAMA or LABA

Question 24

Describe pharmacological intervention of COPD with frequent exacerbations

Answer 24

LABA, SABA and ICS

Question 25

Why do LAMAs work better in COPD than asthma?

Answer 25

greater cholinergic tone in COPD, they think

Question 26

Describe the difference in potency and duration of action between fometerol and salbutamol

Answer 26

Fometerol is longer acting and more potent