Asthma & COPD

Question 1

What are delivery & absorption dependent on?

Answer 1

• Compliance
• Inhaler Technique
• Particle/droplet size
• Lipid Solubility
• Absorp. into pulm circulation

Question 2

What is Asthma and symptoms of it?

Answer 2

• Chronic inflamm disease leading to reversible narrowing of the airways
  Symptoms:
• Breathing issues
• Wheezing, Chest tightness
• Coughing
• pulsus paradoxus -> decreased BP on insp.

Question 3

What is Extrinsic Asthma?

Answer 3

• involves IgE antibodies & mast cell degranulation
• triggered by re-exposure to allergen

Question 4

What is Intrinsic Asthma?

Answer 4

• Hyperresponsive airways -> airways contract too much and too easily
• Triggered by exercise, cold, infection

Question 5

Types of Asthma

Answer 5

T2-type Asthma = Extrinsic
Non-T2-type Asthma = Intrinsic

Question 6

What drugs target different stages of Asthma?

Answer 6

Inflammation targeted by:
- Glucocorticoids
- Biologics
Smooth muscle shortening targeted by:
- B2-adrenoceptor agonists

Question 7

Why do we use B2-Adrenoceptor Agonists?

Answer 7

• target immediate phase of asthma
• relieve airway smooth muscle spasm

Question 8

Why do we use ICS (Inhaled Corticosteroids)?

Answer 8

• target late phase of asthma
• reduce ongoing eosinophilic and Th2 Inflamm.
• used only for extrinsic asthma

Question 9

Describe what Short-acting B2-Adrenoceptor Agonists (SABAs) do

Answer 9

• Eg -> Salbutamol, Albuterol
• Used to protect against exercise-induced asthma

Question 10

What is the MoA of SABAs?

Answer 10

Contract to ACh, Histamine, Activation of Phospholipase C

Question 11

Adverse Effects of SABA

Answer 11

• tachycardia
• muscle tremors

Question 12

What is the MoA of ICS (decreases 3 things)

Answer 12

• decrease cytokine synthesis -> decrease eosinophils
• decrease pro-inflammatory proteins (COX-2, PLA2, etc)
• decrease IgE -> decreased mast cell activation and less histamine

Question 13

Adverse effects of ICS

Answer 13

Chronic use can cause:
- Cushing’s Syndrome
- Growth suppression
- Metabolic effects
- Suppress response to infection & injury

Question 14

What are the steps to Treat Asthma

Answer 14

Question 15

What is Omalizumab (a biologic) and what does it do?

Answer 15

= recombinant monoclonal Ab against IgE
- inhibits IgE-induced release of mast cell mediators (histamine)
- only used for severe allergic asthma

Question 16

What is Mepolizumab (a biologic) and what does it do?

Answer 16

• recombinant monoclonal Ab against IL-5
• can reduce airway eosinophils by 50%
• only used for severe eosinophilic asthma

Question 17

What is Dupilumab (a biologic) and what does it do?

Answer 17

• recombinant monoclonal antibody against IL-4/IL-13 receptor
• only for severe allergic asthma

Question 18

What is COPD?

Answer 18

= umbrella term for group of conditions that cause obstruction to airflow in the airways of the lung

Question 19

Symptoms & Severity of COPD

Answer 19

Question 20

How is COPD different to Asthma?

Answer 20

COPD can lead to emphysema

Question 21

Describe the pathology of COPD

Answer 21

• destruction of alveoli
• narrowed bronchioles
• mucus hypersecretion in airways

Question 22

What are treatments for COPD?

Answer 22

• SABA
• SAMA
• LABA
• LAMA
• ICS

Question 23

Describe a SAMA -> functions, example, AEs

Answer 23

= Short acting Muscarinic Antagonists
- Eg -> Ipatropium
Functions:
- block parasymp input
- lengthen duration of SABA
- decrease contraction and mucus
AEs:
- dry mouth
- urinary retention

Question 24

When is ICS used in COPD

Answer 24

used in combination w other therapies

Question 25

Treatment Plan for COPD

Answer 25