Asthma Treatments

Question 1

Acute severe asthma

Answer 1

Status asthmaticus

Not easily reversed by drugs and can be fatal

Question 2

Features of asthma

Answer 2

Inflammation of airways
Hyper reactivity of the bronchioles

Results in…

Bronchoconstriction
Mucus secretions

Question 3

Stimuli that trigger an attack are….

Answer 3

Intrinsic (non atopic)
Excercise, cold air, respiratory infection, atmospheric pollution

Allergic trigger (atopic)
Pollen
Dust
Animal hair

Question 4

The two phases of an asthma attack are…

Answer 4

Early phase
Bronchospasm
Mast cells release inflammatory mediators

Drugs used- bronchodilator

Late phase
Progressing inflammatory reaction

Drugs used- anti inflammatory

Question 5

Bronchodilators relax smooth muscle in walls. The types available are… (4)

Answer 5

B2 adrenergic receptor agonists

Theophylline

Muscarinic receptor antagonists

Leukotriene receptor antagonists

Question 6

B2 adrenergic receptor agonists

Answer 6

Relax smooth muscle
Stop mediator release from mast cells

Salbutamol -short acting
Salmeterol-long acting

Inhaled to increase action in lungs and limit systemic effects

SE: tremor, headaches, tolerance

Question 7

Theophylline

Answer 7

Inhibits PDE

Second line drug when b2 inadequate

Sustained release tablet

Iv in acute asthma attack

SE: cns stimulating
Cv
Gi tract

Question 8

Muscarinic receptor antagonists

Answer 8

Ipratropium

Used with b2 and steroids when insufficient

Effect in 30 mins last 5 hours

Inhalation

Well tolerated

Block action of acetylcholine at receptors so relaxation and low secretions.

Question 9

Acetylcholine in asthma….

Answer 9

Low acetylcholine = few muscarinic receptors activated = smooth muscle relaxed= open airway

Question 10

Leukotriene receptor antagonists

Answer 10

Montelukast
Zafirlukast

Orally
Prevent exercise /asthma induced asthma

Use in uncontrollable mild to moderate asthma

Prevent actions of LTC4 and LTD4 which are bronchial spasmogens and stimulate mucous

SE: headache , gi problems

Question 11

Chronic asthma is…

Answer 11

Recurrent attacks of reversible airway obstruction of air flow

Can be controlled with drugs

Question 12

Glucocorticoids in asthma reduce the production of…..

Answer 12

Cytokines
Spasmogens (TLC4/LTD4)
Leukocyte chemotaxins (LTB4/PAF)

They reduce bronchospasm and the recruitment and activation of inflammatory cells.

Question 13

Mechanism of glucocorticoid action…

Answer 13

Enter cells
Binds to intracellular receptors GRa GRb 
Receptor complex moves to nucleus 
Binds to DNA
Alters gene transcription

Question 14

Clinical use of glucocorticoids…

Answer 14

Patients requiring regular bronchodilators to control attacks
Severe asthma
With iv hydrocortisone for acute exacerbations
Short course for deterioration
Long term for some patients

Question 15

Side effects of glucocorticoids…

Answer 15

Oropharyngeal thrush

Adrenal suppression

Question 16

Cromoglicate

Answer 16

Anti inflammatory drug

Reduce bronchial hyper reactivity

Effective in asthma caused by antigen/excise

Unpredictable, children respond better

Question 17

Mechanism of cromoglicate

Answer 17

Not fully understood

Mast cell stabiliser

Reduce neuronal sensitivity to irritants
Inhibit T cell cytokine release
Affect inflammatory cells and mediators

Few side effects

Question 18

Clinical use of cromoglicate

Answer 18

Inhalation

Prophylactic use

Question 19

Biological agent used in asthma treatment…

Answer 19

Omalizumab (xolair)

Recombinant DNA-derived humanised igG1 monoclonal anti body

Sub cut injection every 2-3 weeks

Question 20

Mechanism of omalizumab

Answer 20

Binds to igE

Inhibits binding of this to its receptor on mast cells or basophils

Inhibits igE mediated cascade of asthma

SE: few but severe

Anaphylaxis
Malignancies

Question 21

Treatments offered for mild asthma

Answer 21

Inhaled b2 agonists when required

Question 22

Treatment of mild asthma with frequent attacks

Answer 22

Glucocorticoid prophylaxis

B2 agonist when required

Question 23

Treatment of moderate to severe asthma

Answer 23

B2 agonist with glucocorticoid

In combined inhaler

Plus other drugs when these fail to work