Asthma and COPD

Question 1

When does an FEV1:FVC reading suggest airway resistance?

Answer 1

When it is less than 70-80%

Question 2

What is PEF?

Answer 2

. Peak Expiratory Flow

. A person’s maximum speed of expiration

Question 3

What is FEV1:FVC?

Answer 3

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

Question 4

What is COPD a combination of?

Answer 4

Chronic bronchitis and emphysema (also associated with bronchopneumonia)

Question 5

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

Answer 5

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

Question 6

What is emphysema?

Answer 6

Destruction of alveoli

Question 7

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

Answer 7

. 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)

Question 8

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

Answer 8

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

Question 9

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

Answer 9

. 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

Question 10

What are prostaglandin D2 and leukotrienes C4 and D4?

Answer 10

Bronchoconstrictors

Question 11

What do bronchodilators do? When can they be taken?

Answer 11

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

Question 12

What do preventors do? When can they be used?

Answer 12

. Prevent asthma attack, can be anti-inflammatory

. Can’t be used during an attack

Question 13

Describe the mechanism of action of salbutamol.

Answer 13

. Binds to B2-adrenoceptor on bronchial smooth muscle

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

Question 14

How is bronchial smooth muscle relaxation stopped?

Answer 14

. PDE (phosphodiesterase) breaks down cAMP to AMP

. This stops bronchial relaxation

Question 15

How is down-regulation of B2-agonists controlled?

Answer 15

Patients given steroid to take as well as B2-agonist

Question 16

What is the difference between salbutamol and salmeterol?

Answer 16

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

Question 17

Can you give salbutamol long-term?

Answer 17

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

Question 18

What is first line treatment for asthma?

Answer 18

B2-agonists, salbutamol or salmeterol

Question 19

What is second choice treatment for asthma?

Answer 19

. Xanthines e.g. theophylline

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

Question 20

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

Answer 20

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

Question 21

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

Answer 21

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

Question 22

What are LTRAs?

Answer 22

Leukotriene receptor antagonists, prevent leukotrienes from causing bronchospasm and inflammation

Question 23

Can asthmatics take NSAIDs? Why is this?

Answer 23

No because NSAIDs increase leukotriene production, which can provoke asthma

Question 24

Give two examples of NSAIDs.

Answer 24

Aspirin and Ibuprofen

Question 25

Name two conditions which for which beta-blockers are contraindicated.

Answer 25

Asthma and COPD because B2-agonists used to induce bronchodilation (beta-blockers would reverse this)

Question 26

Which vertebrae do sympathetic ganglia stem from?

Answer 26

Thoracic and lumbar

Question 27

Which vertebrae do parasympathetic ganglia stem from?

Answer 27

Cervical and sacral

Question 28

Which type of drugs are contraindicated with asthma?

Answer 28

Beta-blockers and NSAIDs

Question 29

What type of drug is beclometasone and what effect does it have? How does it achieve this?

Answer 29

. Corticosteroid, reduces inflammation

. Causes altered gene transcription (takes time to kick in), which reduces cytokine production to reduce inflammation

Question 30

What is the effect of Lipocortin (Annexin)?

Answer 30

. Reduces inflammation

. Inhibits production of arachidonic acid, so no prostaglandins or leukotrienes produced