Asthma/COPD

Question 1

Chronic asthma management: Stepwise approach

Answer 1

Inhaled corticosteroids are mainstay treatment
with reliever: SABA (salbutamol)

Start beclomethasone (inhaled corticosteroid) 200mcg 12 hourly
* If not controlled increase dose to beclomethasone 400mcg 12 hourly
* If still not controlled, add LABA eg switch to salmeterol + fluticasone
50/250 1 puff 12 hrly
* If still not controlled, referral to specialist:
* (leukotriene receptor antagonist, tiotropium bromide, theophylline)

Question 2

Example of a way in which we can assess asthma control

Answer 2

use of reliever (SABA)

Question 3

when is SABA used as sole therapy

Answer 3

Mild, intermittent asthma

Question 4

other than SABA, what is another short-acting reliever

Answer 4

Ipatropium Bromide (anticholinergic)

Question 5

how do anticholinergics work?

Answer 5

they antagonise muscarinic receptors

therefore, they inhibit bronchoconstriction

additive effect with beta-2-agonists

onset: 30 min

NOT as effective as beta-2-agonists

Question 6

how do inhaled corticosteroids work?

Answer 6

They are anti-inflam
Bind to glucocorticoid receptors, alter gene expression

Question 7

side effects inhaled corticosteroids

Answer 7

oropharyngeal candidiasis, hoarseness

Question 8

How do LABAs work?

Answer 8

Bind to beta 2 receptors → stimulate adenylyl cyclase → ↑ cAMP:
bronchodilation

inhaled

never taken alone, given with inhaled corticosteroid

NO anti-inflam effect

Question 9

side effects LABAs

Answer 9

tremor
palpitations

Question 10

Theophylline MOA

Answer 10

non-selective inhibition of Phosphodiesterases – may result in
bronchodilation and anti-inflammatory effect (inhibits release of
mediators)

Question 11

Which asthma drug causes a narrow therapeutic index

Answer 11

Theophylline

Effects: CNS
arrythmias
GIT symptoms

Question 12

when do we give oral corticosteroids in asthma

Answer 12

after acute exacerbation

Question 13

Management of acute severe asthma

Answer 13

1. Oxygen
   2.Beta2-agonist by MDI with spacer/nebuliser
2. Early systemic corticosteroids: oral prednisone or IV corticosteroids
3. Ipratropium bromide if response to salbutamol poor
4. IV magnesium sulphate
   6.Intubation and ventilation

Question 14

which drugs should be avoided in asthmatics

Answer 14

1. Aspirin
2. Beta-blocker
   3.NSAIDs

Question 15

Stepwise management of chronic asthma

Answer 15

1. SABA
2. ICS low dose
3. ICS low dose plus LABA or Leukotriene Modifier
4. ICD moderate dose plus LABA or LM or Theophylline
5. ICD high dose plus LABA with/out LM with/out Theophylline
6. Same as 5 but add oral corticosteroid

Uncontrolled is 4,5,6

Question 16

Management acute exacerbation COPD

Answer 16

• Nebulised salbutomol
• Add ipratropium bromide if poor response
• Start prednisone (hydrocortisone if cannot take oral therapy)
• Discharge with prednisone 40mg for 5 days
• Amoxicillin 500 mg 8 hrly for 5 days
• If recent amoxicillin exposure; amoxicillin + clavulanic acid for 5 days

Question 17

Chronic management COPD

Answer 17

SABA eg salbutamol with spacer
* If no response, replace with LABA eg formoterol, salmeterol
* If frequent exacerbations (>=2 per year) replace with ICS plus LABA
combination
* If inadequate control add theophylline slow release 200mg at night.
* Oral corticosteroids NOT recommended for stable COPD