Asthma and COPD

Question 1

Autonomical control of bronchial calibre

Answer 1

Parasympathetic

• ACh on M3; Bronchocontrction and increased mucus

Sympathetic

• Adrenalien on B2, smooth muscle relaxation
• Na acts on B2 of paraymp ganglia to inhibit transmission
• B2 inhibits mucus secretion

Question 2

Spasmogens

Answer 2

Histamine

Prostaglandin D2

Leukpotrines C4&D4

Question 3

Chemotaxins

Answer 3

Leukotrine B4, PAF

Lead to late phase, attract leukocytes causing inflammation + airway hyper-reactivity

Question 4

B2-adrenoceptor agonists MOA

Answer 4

E.g. SAlbutamol

• Increases FEV1
• ACts on B2r of smooth muscle to increase cAMP
• Prolonged used may cause receptor downregulation

Question 5

LABA MOA

Answer 5

Salmeterol

• For long term prevention and control e.g .overnight
• Do not relieve attacks
• used in addition to other agents

Question 6

Xanthiens Pros/Cons

Answer 6

Theophylline

• Bronchodilators, but not as good as B agonists (2nd line)
• Oral or IV aminophylline in emergency
• Narrow window, so plasma concentration monitored
• Theophylline; many interactions, heptic removal
  
  • May cause HYPOkalaemia, especially toogether with B2 agoniosts

Question 7

Muscarinic M-receptors ANTAGonists MOA

Answer 7

Block parasymp bronchoconstriction

Inhaled to prevent antimuscarininc side effects

Limited value in asthma, Used in COPD

Question 8

Anti-inflammatories in asthma

Answer 8

• Preventive, dont reverse an attack
• Corticosteroids
  
  • Beclometasone or prednisolone
  • Gene transcription leading to production of lipocortin; inhiibts synthesis of PGs and LTS

Question 9

Steroids in asthma

Answer 9

• Given with B2 agonists, reduce receptor down-regulation
• Side effects:
  
  • Inhalation: throat infections, hoarsness, rinse after use
  • Oral: widespread: adrenal supression, diabetesm osteoporosis, immunosurpression

Question 10

Cromones in asthma

Answer 10

Preventive early & late

Not effective

Question 11

LRTAntagonists in asthma

Answer 11

Montelukas

• Add-on
• Preventive AND bronchodilator

Question 12

BTS guidelines for asthma

Answer 12

Question 13

acute management of asthma

Answer 13

• Oxygen
• Neb B2 agonist
• Oral prednisolone or IV hydrocortisone

Life threatening? add:

• Nebulsied ipratropium
• SubCut B2 agonist
• IV aminophylline
• Magnesium sulphate unlicensed

Question 14

COPD treatment plan

Answer 14

+ ABX for intercurrent infections if 2 of: purulent sputum, increased sputum, breathlessness

Oxygen therapy

Question 15

NSAIDs and asthma

Answer 15

Provoke asthma by increasing LT production

Question 16

Beta-blockers and asthma

Answer 16

Contraindicated in asthma, used in caution with COPD, even applies to B1 selectives