Asthma intro

Question 1

Asthma definition

Answer 1

reversible increases in airway resistance, involving bronchoconstriction and inflammation

Question 2

Characteristics of asthma

Answer 2

reversible decreases in FEV1:FVC
variations in PEF which improve with β2 agonist
decreases in FEV1, reversed by β2 agonist

Question 3

What is COPD

Answer 3

chronic obstructive pulmonary disease
blanket term for chronic bronchitis and emphysema
obstructed airflow form the lungs

Question 4

Chronic bronchitis

Answer 4

increased mucus, airway obstruction, intercurrent infections, airways permanently narrowed

Question 5

Characteristics of COPD

Answer 5

FEV1 reduced, difficult to reverse

little variation in PEF

Question 6

Clinical features of asthma

Answer 6

wheezing
SoB
tight chest
cough (chronic, worse at night/exercise)

Question 7

What would be seen on a normal and asthmatic lung function test graph?

Answer 7

y axis: volume (L)
x axis: time (s)
normal - steep increase, plateau
asthma - steep increase which begins to plateau sooner but gradually rises to same level of normal line

Question 8

Cause of asthma symptoms

Answer 8

stimulus causes mast cells and mononuclear cells in the lungs to release mediators:
spasmogens - immediate, bronchospasms
chemotaxins - later phase, inflammation

Question 9

Examples of spasmogens

Answer 9

histamine
from arachidonic acid in the membrane: leukotrienes and prostaglandins
platelet activating factor

Question 10

Examples of chemotaxins

Answer 10

leukotriene B4, PAF

Question 11

What do chemotaxins do?

Answer 11

attract leukocytes (especially eosinophils and mononuclear cells) to lungs
causes inflammation and airway hyper-reactivity

Question 12

Types of medication to treat asthma

Answer 12

1. bronchodilators - ‘relievers’

2. preventers - may be anti-inflammatory

Question 13

Preferred short acting bronchodilator

Answer 13

salbutamol (Ventolin)

β2-adrenoceptor agonist

Question 14

Action of salbutamol

Answer 14

bind to β2-adrenoceptors on smooth muscle
adenyl cyclase -> cAMP
relaxation

Question 15

Effect of salbutamol

Answer 15

short acting
reduces parasympathetic activity
increases FEV1
prolonged use may lead to receptor down-regulation

Question 16

What is a LABA?

Answer 16

long acting β agonist
eg. salmeterol
given for long-term prevention and control (ie.overnight)
preventer

Question 17

What are xanthines?

Answer 17

bronchodilators, 2nd line use
phosphodiesterase inhibitors
taken orally

Question 18

Example of xanthine

Answer 18

theophylline

Question 19

Action of xanthines

Answer 19

inhibit PDE, inhibiting breakdon of cAMP , therefore effect of salbutamol is enhanced and relaxation increased

Question 20

Give an example of a muscarinic M-receptor antagonist

Answer 20

ipratropium

Question 21

Action of ipratropium

Answer 21

block parasympathetic bronchoconstriction on muscarinic receptors

Question 22

How is ipratropium used?

Answer 22

inhaled to prevent antimuscarinic side effects (blurred vision, constipation)
asthma: only in emergency
mostly used in COPD

Question 23

Example of corticosteroid

Answer 23

beclometasone

Question 24

What are corticosteroids?

Answer 24

anti-inflammatory agents

preventers

Question 25

Action of corticosteroids

Answer 25

activate intracellular receptors, leading to altered gene transcription
decrease in cytokine production and production of lipocortin

Question 26

Action of lipocortin

Answer 26

protein which inhibits synthesis of prostaglandins and leukotrienes
(chops up membrane so reduced arachidonic acid)

Question 27

Pros and cons of prescribing steroids

Answer 27

\+ given with β2 agonists, reduces receptor down -regulation
- side effects: throat infections, hoarseness (inhalation)
                        adrenal suppression (oral)

Question 28

Example of leukotriene receptor antagonist (LTRA)

Answer 28

montelukast

Question 29

Action of LTRAs

Answer 29

preventative and bronchodilator

antagonise actions of leukotrienes

Question 30

Example of monoclonal antibodies

Answer 30

omalizumab

Question 31

Action of omalizumab

Answer 31

prevents free IgE from binding to immune cells, preventing allergen-induced mediator release in allergic asthma

Question 32

Describe stepped care

Answer 32

short acting β2 agonist and regular inhaled steroid
trial of LABA (or LTRA or xanthine)
increased dose of inhaled steroid
add oral steroid

Question 33

How to know when to step up treatment from initial

Answer 33

if salbutamol is used more than twice a week

Question 34

Use of spacer devices

Answer 34

patients with poor technique

reduce steroid impactation on back of throat, reduces side effects

Question 35

How to take medication

Answer 35

bronchodilator before steroid - helps to get steroid to lungs
rinse mouth out after steroid - reduce side effects

Question 36

Treatment for COPD

Answer 36

advice: stop smoking
bronchodilators (β2 agonists + ipratropium)
antibiotics for intercurrent infections
oxygen therapy

Question 37

What are NSAIDs

Answer 37

non-steroidal anti-inflammatory drugs

Question 38

Example of NSAIDs

Answer 38

aspirin, ibuprofen

Question 39

How can NSAIDs affect asthmatics?

Answer 39

may provoke asthma by increasing LT production as PTGs inhibited

Question 40

How can β blockers affect asthmatics and people with COPD?

Answer 40

can cause bronchoconstriction due to non-selectivity and bind to β2 adrenoceptors
therefore are contrindicated for asthma and caution in COPD