Asthma And COPD Flashcards
Asthma
A chronic condition that causes inflammation and narrowing of the bronchial tubes
2 types: allergic or non allergic
Symptoms: coughing, sob, chest tightness, wheezing
Triggers: outdoor/indoor allergens, smoke, colds,
Prevention of symptoms is the best strategy of long term manage
Asthma attacks
Chronic inflammation causes the build up of mucous, the tightening of bronchial muscles and swelling. triggers provoke this chronic inflammation to worsen during exposure and it becomes hard to breath
Categories of asthma severity / determining severity
Intermittent, mild persistent, moderate persistent, severe persistent
Determined by
- reported symptoms over the las 2-4 weeks
- current level of lung function ( peak flow)
- # of exacerbations requiring systemic CS ( prednisone ) in the previous year
Components of asthma management
Routine monitoring of symptoms and lung function ( peak flow )
Pt education to create a partnership
Controlling environmental triggers and comorbid conditions
Want to control few nighttime awakenings and minimal need of SABA
Quick relief medication
Relieve asthma symptoms when they occur
- SABA ( short acting beta agonist)
- Anticholinergics
- combination quick relief
Long term control medication for asthma
Prevent and control asthma symptoms
Take every day
- inhaled corticosteroid
- inhaled long acting beta agonist (LABA)
- combination inhaled ( advair)
- Omalizaumab
- luekotriene midifiers
Anticholinergics
Quick relief
Alternative bronchodilators to or additive benefit to SABA
Ex. Ipratriopium
Adverse: dry mouth
Pearl: treatment of choice due for bronchospasm due to beta-blocker medication, does not modify reactions to antigens
SABA’s
Quick relief
- relax smooth muscle
- albuterol , levalbuterol ( better in the older pt)
Adverse: hypokalemia
Pearl: uses > 2 days a week = inadquate control
Systemic corticosteroids
Not entirely short-acting but used for moderate-severe exacerbations adjunctively to SABA’s to speed recovery and prevent recurrence of exacerbations
3-10 days
Prednisone
Adverse: hyperglycemia, growth suppression, fluid retention, watch for co-existing conditions
Pearl: use lowest effective dose for shortest period of time , if needed employ alternate -day AM dosing
LABA’s
Long term control
Not used as monotherapy
Used in combination with ICS in moderate or severe persistent asthma ( > 5 years old)
Not used for acute symptoms or exacerbations
Ex. Slameterol, Formoterol
Adverse: hypokalemia, QTc prolongation in overdose
Methylxanthines
Theophylline
Mild-moderate bronchodilator
Used as na adjunctive therapy to ICS
Pearls: maintain routine blood levels between 5-15 , GI upset
Leukotriene Modifers
Singulair
Mild-persistent, alt not preferred
Adverse: hepatic failure
Pearls: do NOT administer with food, watch for liver dysfunction
Corticosteroids
Most effect and potent agents available
Flovent
Decrease airway hyper-responsiveness and inhibits inflammation/black late -phase reactions to allergens
Pearls: rinse mouth after use
Adverse: cough, oral thrush
Mast cell stabilizers and immune modulators
MCS- not see that much
IM: very expensive done in allergist office
Seasonal allergies
Start long term control medication > 1 month before allergy season starts
Cough variant asthma
Trial bronchodilator
Excerise induced asthma ( EIA)
Most asthmatics have EIA
Short-acting beta agonist 15 min before exercise ( 2-3)
Mask or scarf
Leukotriene Modifers may help ( singulair)
Pediatrics - asthma
Treatment from 0-4 and 5-11 is different
LABA therapy given with ICS
Try not to dose during the school day
Pregnancy - asthma
Inhaled beta -agonist - SABAS
Long term - ICS
Geriatrics - asthma
Reversible symptoms = asthma
Irreversible = COPD
Increased risk of adverse drug reaction
COPD
Common respiratory condition characterized by airflow limitation
Associated with high morbidity
Management : decrease symptoms, decrease frequency and severity and improve health status, exercise capacity and prolong survival
COPD : Subtypes
Emphysema
Chronic Bronchitis
Emphysema: structural changes including abnormal and permanent enlargement fo the airspace along with destruction of the airspace walls
Chronic Bronchitis : chronic productive cough for three months in each of two successive in a patient
ACOS: asthma may eventually be considered COPD when symptoms are NOT fully reversible
Clinical risks factors ( how to minimize them )
Smoking cessation, exposure avoidance , physical activity, anti-inflammatory pharmacotherapy
Diagnosis and staging
Global Initiative for COPD : GOLD guidelines or CAT guideline - cheaper
- combined assessment of airflow limitation with an assessment of symptoms and exacerbations to guide therapy
Airflow limitation = .70 for FEV / FVC
Actions for risk reduction
Smoking cessation, annual influenza and pneumococcal vaccine
Long term O2 therapy
Pulmonary rehab
Issues with compliance
Older age,
multiple devices ,
Lack of education
Inproper use inhaler ( always review)
Pharm rule for COPD therapy
Used to reduce symptoms, reduce the frequency , severity of exacerbations and improve exercise tolerance / health status
Bronchodilators
Increase FEV1
Given on a regular basis to prevent or reduce symptoms
Combination bronchodilator therapy
Combining bronchodilators with different mechanisms and duration of action may increase bronchodilation with a lower risk of side effects
Combinations of SABA and SAMA = superior to monotherapy in improving FEV1 and symptoms
Combining LABA and LAMA’s significantly improves lung function ( FEV), dyspnea, health status and reduces exacerbations rates
Inhaled corticosteroid + LABA
Advair
Increase lung function and decrease exacerbations ( moderate to severe COPD)
Increases risk of pneumonia
Adverse: oral candidiasis ( rinse and spit)
Triple inhaled therapy
Trelegy Ellipta
ICS/LAMA/LABA
PDE4 inhibitors
Daliresp
Used in patient with chronic bronchitis and severe COPD
Antibiotics - COPD
Azithromycin/ erythromycin
Associated to decrease exacerbations over 1 year
May cause hearing resistance
Formoterol and Salmetrerol
Beta agonist - improve FEV1, lung volume, number of hospitalizaitons , but NO effect or rate of decline of lung function
Adverse: tremors, higher doses of beta 2 agonist in older people
LAMA + LABA
Relaxes bronchial smooth muscle causing bronchodilation
Best with GOLD category B w/ uncontrolled symptoms on 1 bronchodilator
Anoro Ellipta
