Asthma and COPD Flashcards
Describe the criteria for good asthma control (3)
- Minimal symptoms day and night
- minimal need for a reliever inhaler
- no exacerbations
- no limitation of physical activity
What 3 factors are important to consider before stepping up asthma treatment?
- good compliance
- Good inhaler technique
- elimination of triggers
Describe the criteria for stepping up asthma treatment?
- using salbutamol >2 times per week
- Symptoms > 2x per week
- waking up 1 or more times per week
- exacerbation needing oral steroids
Describe mild and stage 1 and 2 of asthma control
Mild= Salbutamol PRN (only for very mild asthma) 1= Low dose ICS (budesonide) + salbutamol PRN 2= Low dose ICS + LABA (formoterol, salmeterol)
Describe stage 3, 4 and 5 of asthma control
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
Name one SABA and describe how it works
Salbutamol, terbutaline
Activates B2 receptors, activates AC, increases cAMP, inhibits MLCK, less smooth muscle contraction.
What is the problem with using salbutamol regularly?
Short term secondary action of inhibiting mast cell degranulation, but with regular use they increase sensitivity of mast cell degranulation
Give 3 ADRs of salbutamol
- tachycardia
- palpitations
- tremours
Name 2 inhaled corticosteroids and briefly describe how they work
- beclomethasone
- budenoside
Bind to intracellular glucocorticoid receptor-> transactivation of anti- inflammatory agents (ILR1)
Also inhibit production of inflammatory agents by transrepression (COX2, Il2, Il6)
Name one long acting beta agonist and give one adv and one disadv
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.
Name one leukotriene receptor agonist antagonist and describe how it works
Montelukast.
Blocks effect of cysteinyl leukotrienes on the CysLT1 receptor, this helps in 15% of pts
Give 3 ADRs of montelukast
- dry mouth
- angiodema
- anaphylaxis
- arthralgia
- fever
- Gi upset
- nightmares
- Treatment failure relatively common
Most ADRs reasonably rare
Name 2 methylxanthines and describe how they work
theophylline, aminophylline
They antagonise adenosine receptors
In vitro they also inhibit phosphodiesterase so increase cAMP, but this unlikely to be significant in vivo
Give 3 ADRs of theophylline
- nausea
- headaches
- reflux
- toxic (arrhythmias, fits)
- interactions due to CYP450 metabolism
- Poorly efficacious
Name one long acting anticholinergic/ muscarinic antagonist (LAMA) and name the receptor they inhibit
Tiotriopium, ipratropium bromide
Inhibit M3
common on efficacy of LAMAs in asthma and give 3 ADRs
Poor efficacy.
ADR: dry mouth, urinary retention, glaucoma
Name one biological agent used in severe asthma
Omilazumab (anti IgE) and mepolizumab (anti Il5)
What is optimum particle size of inhalers and why?
1-5 micron particles- inhaled into small airways but not so small that theyre exhaled back out again. This gives best deposition
Give 4 features of severe (but not life threatening (yet)) asthma
- unable to complete sentances
- > 110 BPM
- resp rate > 25/min
- peakflow 33-50% of best
Give 4 signs/ features of life threatening asthma
- 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
How is severe and life threatening asthma treated? (also give administration routes)
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)
Give 3 non pharmacological interventions for COPD
- confirm diagnosis and manage comorbidities
- stop smoking
- offer pulmonary rehab and lifestyle advice
- offer vaccinations
Describe pharmacological treatment of breathless COPD
Give salbutamol, 2 puffs PRN. If breathlessness limits exersize, give LAMA or LABA
Describe pharmacological intervention of COPD with frequent exacerbations
LABA, SABA and ICS
Why do LAMAs work better in COPD than asthma?
greater cholinergic tone in COPD, they think
Describe the difference in potency and duration of action between fometerol and salbutamol
Fometerol is longer acting and more potent