Asthma and COPD Flashcards

1
Q

When does an FEV1:FVC reading suggest airway resistance?

A

When it is less than 70-80%

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2
Q

What is PEF?

A

. Peak Expiratory Flow

. A person’s maximum speed of expiration

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3
Q

What is FEV1:FVC?

A

The proportion of a person’s vital capacity that they are able to expire in the first second of forced expiration

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4
Q

What is COPD a combination of?

A

Chronic bronchitis and emphysema (also associated with bronchopneumonia)

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5
Q

What is chronic bronchitis? How does it affect FEV1:FVC?

A

. Increased mucus, airway obstruction, intercurrent infections
. FEV1 reduced

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6
Q

What is emphysema?

A

Destruction of alveoli

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7
Q

Describe how a stimulus can lead to the early and late phases of an asthma attack.

A

. Stimulus triggers release of mast cells and mononuclear cells
. Activate spasmogens and chemotaxins
. Spasmogens release histamine, prostaglandins, leukotrienes, which cause bronchospasm (early phase)
. Chemotaxins release leukotrienes, which attract leukocytes (especially eosinophils), which leads to inflammation (late phase)

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8
Q

Describe how the early phase of an asthma attack is activated.

A

. Stimulus activates mast cells and mononuclear cells
. These activate spasmogens, which release histamine, prostaglandin D2, and leukotrienes C4 + D4
. Leads to bronchoconstriction and bronchospasm

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9
Q

Describe how the late phase of an asthma attack is activated.

A

. Stimulus activates mast cells and mononuclear cells
. These activate chemotaxins, which release leukotrienes (B4). These leukotrienes attract leuokocytes, especially eosinophils, and mononuclear cells, which leads to inflammation and airway hyperactivity

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10
Q

What are prostaglandin D2 and leukotrienes C4 and D4?

A

Bronchoconstrictors

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11
Q

What do bronchodilators do? When can they be taken?

A

. Reverse bronchospasm (early phase)
. Rapid relief
. Take when having asthma attack or prior to an event known to cause an attach

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12
Q

What do preventors do? When can they be used?

A

. Prevent asthma attack, can be anti-inflammatory

. Can’t be used during an attack

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13
Q

Describe the mechanism of action of salbutamol.

A

. Binds to B2-adrenoceptor on bronchial smooth muscle

. Causes increase in cAMP (second messenger), which causes bronchial smooth muscle to relax

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14
Q

How is bronchial smooth muscle relaxation stopped?

A

. PDE (phosphodiesterase) breaks down cAMP to AMP

. This stops bronchial relaxation

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15
Q

How is down-regulation of B2-agonists controlled?

A

Patients given steroid to take as well as B2-agonist

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16
Q

What is the difference between salbutamol and salmeterol?

A

Salbutamol is a short-term treatment for asthma, salmeterol is a LABA used for long term treatment

17
Q

Can you give salbutamol long-term?

A

No, as this leads to increased mortality. If long-term treatment needed, should use LABAs such as salmeterol

18
Q

What is first line treatment for asthma?

A

B2-agonists, salbutamol or salmeterol

19
Q

What is second choice treatment for asthma?

A

. Xanthines e.g. theophylline

. These are bronchodilators, not as good as B2-agonists

20
Q

What other choices are there for asthma treatment after first and second line options?

A

Muscarinic M-receptorantagonists, corticosteroids, LTRAs (leukotriene receptor antagonists), omalizumab

21
Q

How do muscarinic M-receptor antagonists work? What are the usually used for?

A

. Block parasympathetic bronchoconstriction (normally ACh would bind to M3-receptors on bronchial smooth muscle to activate bronchoconstriction)
. Usually used for COPD, not asthma

22
Q

What are LTRAs?

A

Leukotriene receptor antagonists, prevent leukotrienes from causing bronchospasm and inflammation

23
Q

Can asthmatics take NSAIDs? Why is this?

A

No because NSAIDs increase leukotriene production, which can provoke asthma

24
Q

Give two examples of NSAIDs.

A

Aspirin and Ibuprofen

25
Name two conditions which for which beta-blockers are contraindicated.
Asthma and COPD because B2-agonists used to induce bronchodilation (beta-blockers would reverse this)
26
Which vertebrae do sympathetic ganglia stem from?
Thoracic and lumbar
27
Which vertebrae do parasympathetic ganglia stem from?
Cervical and sacral
28
Which type of drugs are contraindicated with asthma?
Beta-blockers and NSAIDs
29
What type of drug is beclometasone and what effect does it have? How does it achieve this?
. Corticosteroid, reduces inflammation | . Causes altered gene transcription (takes time to kick in), which reduces cytokine production to reduce inflammation
30
What is the effect of Lipocortin (Annexin)?
. Reduces inflammation | . Inhibits production of arachidonic acid, so no prostaglandins or leukotrienes produced