Asthma and COPD drug

Question 1

what are the 2 common treatment aim for COPD and asthma

Answer 1

1. bronchodilatation

2. anti-inflammation

Question 2

what are the bronchodilators that can be used in asthma treatment. what are the mechanism of action

Answer 2

1. FIRST LINE: B2 AGONIST
short acting (SABA) - salbutamol
long acting (LABA) - salmeterol, formoterol 
mechanism: GPCR vsm: AC activation, increased cAMO level = relaxation

2. methyxanthine (thophylline)
   PDE inhibitor: inhibit cAMP breakdown = relaxation
   also blocks adenosine receptor on mast cell = prevent degranulation
3. muscarinic receptor antagonist: - tropium
   SAMA and LAMA - ipratropium and totiotropium

Question 3

what are the treatment regime for asthma and COPD

Answer 3

Asthma:
acute attack - SABA (first line) or LABA (formoterol)+inhaled glucocorticoids
maintenance: LABA+ inhaled glucocorticoid,
severe uncontrolled asthmatic: can use biologics

COPD:
dual bronchodilator therapy: LAMA and LABA
triple bronchodilator therapy: LAMA LABA and inhaled glucocorticods

Question 4

what are the 3 biologics used in severe asthma therapy

Answer 4

1 anti-IgE: bound to IgE, reduced free IgE level = cant cross link with mast cell
= downregulation of FCeR1 on mast cell

2. anti-IL4
   - inhibit TH2 response development = inhibit IgE formation and downstream event
3. anti-IL5
   - inhibit eosinophil recruitment and activation

these are expensive treatment, once every 6-12 month IV

Question 5

prevention of mast cell degranulation

Answer 5

cromolyn bromide

Question 6

what are the structural cell effect and inflammatory cell effects of glucocorticoids

Answer 6

Structural cell effects:
- vascular endothelial cell: reduced permeability = odema solved
- AW smooth muscle: INCREASED transcription of B2 receptor: increased BA sensitivity
(prolonged BA use desensitisation: receptor uncoupled, and internalisation degradation)
- mucus glands: reduced secretion = increase lumen diameter
- epithelial cell = reduced inflammatory cytokine release = reduce inflammation

inflammatory cell effects

• inhibit activation and recruitment of cells
• inhibit transcription and synthesis of inflammatory cytokines

Question 7

what are the examples of inhaled and oral glucocorticoids

- side effects

Answer 7

oral: prednisolone, prednisone
- systemic: cushings, immunosupression, osteoperosis, catatracts

inhaled: budesonide, fluticasone

Question 8

what are the 2 leukotriene pathway modifiers

Answer 8

1. montelukast:
   LTC4 and LTD4 receptor blocker
2. 5-lipoxygenase inhibitor zileuton
   no leukotriene made