COPD

Question 1

Is Airway obstuxn reversible or irreversible in COPD?

Answer 1

Airway obstruction is not reversible or
incompletely reversible by bronchodilators

Question 2

Features of COPD:

Answer 2

1. Chronic inflammation
2. Bronchitis
3. Small airways fibrosis
4. Emphysema

Question 3

Chronic inflammation involves:

Answer 3

• incr. numbers of macrophages, neutrophils and T lymphocytes
• the inflammatory mediators have not been as clearly defined as in asthma

Question 4

Bronchitis is:

Answer 4

 Attacks of winter morning cough
 Progresses to chronic cough with intermittent
exacerbations
 Often initiated by an upper respiratory
infection

Question 5

Emphysema includes:

Answer 5

 Destruction of alveoli and elastin fibres in the lung
 May be caused by proteases released during the inflammatory response
 Causes respiratory failure (b/c it’s a progressive dx)
 Destruction of alveoli impairs gas transfer

Question 6

What are the principal of tx?

Answer 6

1. Smoking cessation: Slows the progress of COPD
2. Immunizations : Superimposed infections are potentially lethal
3. Current licensed txs: (prevent exacerbations-just symptomatic relief)
    Do not reduce the progression of COPD
    Do not suppress inflammation
    Do not prevent development of emphysema

Question 7

BRONCHODILATORS do what?

Answer 7

Are the main tx.

Provide Symptomatic relief in patients with a reversible component

Question 8

2 classes of drugs that bronchodilate

Answer 8

Short-acting drugs
- Short-acting anti-muscarinic antagonists (SAMA)
- Short-acting beta agonists (SABA)

Long-acting drugs
- Long-acting anti-muscarinic antagonists (LAMA)
- Long-acting beta agonists (LABA)

Question 9

Short- acting drugs:

Answer 9

 Short-acting anti-muscarinic antagonists (SAMA):
Ipratropium (-ium)
 Short-acting beta agonists (SABA): salbutamol
(-ol)

Question 10

Long-acting drugs

Answer 10

 Long-acting anti-muscarinic antagonists (LAMA) :
Tiotropium (-ium)
 Long-acting beta agonists (LABA): salmeterol or
formoterol (LABA)

Question 11

β2-ADRENOCEPTOR AGONISTS
MoA

Answer 11

Dilate the bronchi by a direct action on the β2-
adrenoceptors of smooth muscle
• Independent of spasmogen

Question 12

β2 -ADRENOCEPTOR AGONISTS
Effects

Answer 12

Inhibit mediator release from mast cells
Inhibit TNF-α release from monocytes
Increase mucus clearance by action on cilia

Question 13

RoA of β2 adrenoceptor agonists

Answer 13

Given by inhalation ( to minimise any AE & maximise delivery)

Question 14

Short-acting β2 Adrenergic Agonists (SABA)
Exs. + duration of axn

Answer 14

Salbutamol (albuterol), metaproterenol, terbutaline
 Duration of action is 3–5 h

Question 15

Long-acting β2 Adrenergic Agonists (LABA)
Exs. + Duration of axn

Answer 15

 Salmeterol and formoterol
 Duration of action is 8–12 h

Question 16

AE of β2 Adrenergic Agonists

Answer 16

 Commonest adverse effect is tremor  Other unwanted effects
 Tachycardia (caution for those with CV disease)
 Cardiac dysrhythmia (caution for those with CV
disease)
 Anxiety
 Headache

High doses
 Hypokalemia
 Lactic acidosis

Question 17

CI in β2 Adrenergic Agonists

Answer 17

Pt. W/ angina.
just use an anti muscarinic

Question 18

Clinical uses of SABAS + LABAS

Answer 18

Acute asthma: SABAs
• Chronic asthma: LABAs (in combination with ICS)
• COPD

Question 19

MUSCARINIC RECEPTOR ANTAGONISTS
Exs.

Answer 19

1. Ipratropium (Short-Acting Muscarinic Antagonist-SAMA)
2. Tiotropium (Long-Acting Muscarinic Antagonist-LAMA)

Question 20

‘Ipratropium
- RoA
- when does it work best
- duration of axn

Answer 20

 Inhalational
 Maximum effect: approximately 30 min after inhalation
 Persists for 3–5 h

Question 21

Tiotropium (Long-Acting Muscarinic Antagonist-LAMA)
- RoA
- Duration of axn

Answer 21

• inhalational
• longer-acting (t1/2 = 35 hours)
• more potent than ipratropium

Question 22

AE of Anti-muscarinics:

Answer 22

Well- tolerated.
Dry mouth Dry eyes
Raised intraocular pressure and blurred vision
- !(CI: Caution in glaucoma)
Metallic taste (in mouth) Constipation
Tachycardia - ! CI: Caution in CV disease
Urinary retention - ! (CI: Caution)
Cough/hoarse voice

Question 23

Clinical uses of anti-muscarinics

Answer 23

• Acute severe asthma: SAMAs may
augment bronchodilation of SABAs
• Chronic asthma: LAMAs can be trialled
if control is insufficient despite moderate-
dose inhaled corticosteroid and LABA
treatment. [SO IF LABA+ICS it work= use LAMA]
• COPD

PS don’t use SAMA w/ LAMA

Question 24

PRINCIPLES OF TREATMENT: CORTICOSTEROIDS (CS)

Answer 24

-Inhaled CS (ICS) attempt to temper
inflammation in COPD
- Not as effective as in asthma
- Do not halt lung function deterioration
- Decrease frequency of exacerbations and
improve quality of life

Question 25

CORTICOSTEROIDS how are the used?

Answer 25

-Use of oral steroids in patients with stable COPD is discouraged - '' ICS may be used -Not used as monotherapy

Question 26

Alternatives for COPD

Answer 26

1. Theophylline 2. Long-term oxygen therapy

Question 27

Theophylline - RoA - MoA

Answer 27

 Uncertain benefit (therefore not preferred)  Brochodilator  Respiratory stimulant effect may be useful for patients who tend to retain CO2

Question 28

Long-term oxygen therapy MoA

Answer 28

 Administered at home  Prolongs life in patients with severe disease and hypoxaemia

Question 29

ACUTE COPD EXACERBATIONS tx

Answer 29

1. Inhaled O2 2. Broad-spectrum antibiotics if there is evidence of infection 3. Inhaled bronchodilators for symptomatic improvement 4. Oral prednisolone