COPD and Asthma Workshop Flashcards
What is Asthma?
Chronic inflammatory disorder of the airways which occurs in susceptibile individuals; inflammatory symptoms are usually associated with widespread variable airflow obstruction and an increase in airway response to a variety of stimuli. Obstruction is often reversible either spontaneously or with treatment.
What are the two main causes of asthma symptoms?
Airway hyperresponsiveness
Bronchoconstriction.
What is airway hyperresponsiveness?
Increased tendency of the airway to react to stimuli or triggers to cause an asthma attack.
What is bronchoconstriction?
The narrowing of the airways that causes airflow obstruction.
The most common causes of drug-induced asthma are:
B-blocker drugs, prostaglandin synthetase inhibitors.
Why must aspirin be given with care to asthma patients?
Between 2% and 20% of the adult asthma population are thought to be sensitive to aspirin.
Aspirin inhibits the enzyme cyclo-oxygenase which normally converts arachidonic acid to (bronchodilatory) prostaglandins.
What are the two different types of asthma?
Extrinsic: an allergen is thought to be the cause.
Intrinsic: adult mostly, triggered by non-allergenic factors such as a viral infection.
Diagnosis of asthma is usually made from
The clinical history confirmed by demonstration of reversible airflow obstruction and measures of lung function.
How do asthma and COPD compare with regard to the age groups they occur in and the proposed causes?
Asthma: Any age, but common in childhood.
COPD: Generally people over 40 years old.
Causes: Genetic and environmental factors for asthma.
For COPD: Smoking usually the main case, but also linked to genetics and environment.
How do asthma and COPD compare with regard to the way they are diagnosed and their respective prognosise?
Asthma diagnosis and prognosis:
After careful-history taking, trials of therapy, lung function and other tests.
Symptoms can be well controlled and patients (except severe pts) can maintain activites of daily life into old age.
COPD diagnosis and prognosis:
Following Spirometry and other tests, symptoms deteriorate over time - patients become increasingly reliant on intesensive health services.
How do asthma and COPD compare with regard to the predictability of the disease and the aims of care?
Asthma is not a progressive disease but it can be unpredictable at time, moving between levels of severity with little warning. The aims of care are to restore and maintain normal lung function and avoid acute attacks.
COPD progression is relatively predictable - function declines with time.
The aim of care is to manage or slow the declining lung function, maximise quality of life and reduce frequency of exacerbations.
What should you consider for each patient when advising on the particular type of inhaler device that should be used?
Whether they have tried any other inhalers.
What is best for them and their lifestyle.
Price - can they use a MDI?
It it licensed for asthma?
Does it contain the right drugs?
Beclometasone dipropionate CFC 400 micrograms is equivalent to what dose Budesonide?
400 micrograms.
Beclometasone dipropionate CFC 400 micrograms is equivalent to what dose Fluticasone?
200 micrograms
Beclometasone dipropionate CFC 400 micrograms is equivalent to what dose Mometasone?
200 micrograms
Beclometasone dipropionate CFC 400 micrograms is equivalent to what dose Ciclesonide?
200-300micrograms
What is the role of maintenance oral corticosteroid therapy in the treatment of COPD?
Not very effective, will reduce the inflammation and provide some symptom control to sufferers.
What is the role of maintenance oral corticosteroid therapy in the treatment of Asthma?
Reduces the inflammation in the airways and therefore reduces asthma exacerbations (reducing the need for SABA).
What are the risks of administering oxygen for COPD?
Fire risk.
Why is the preferred route of administration of the agents used in asthma via inhalation?
This allows the
drugs to be delivered directly to the airways in smaller doses
and with fewer side effects than if systemic routes were used.
Inhaled bronchodilators also have a faster onset of action
than when administered systemically and give better protection
from bronchoconstriction.
When a patient has been stable for at least _________, therapy should be stepped down; for example by ________ the inhaled corticosteroid (ICS) dose.
When a patient has been stable for at least 3 months
(GINA, 2009), therapy should be stepped back down; for
example, by halving the inhaled corticosteroid (ICS) dose.
Salbutamol and terbutaline are what type of B2-agonists?
Selective. They have few side effects - however cardiovascular stimulation resulting in tachycardia and palpitations is still the main dose-limiting toxicity.
An inhaled ___________ is the first-line agent in the management of asthma.
An inhaled β2-agonist is the first-line agent in the management
of asthma. This is used as required by the patient for
the symptomatic relief of breathlessness and wheezing, for
example, salbutamol 200 μcg when required. This may be the
only treatment necessary for those with infrequent symptoms.
There is no advantage to regular administration.
Salbutamol ___microgram whne required is a suitable starting treatment for asthma.
An inhaled β2-agonist is the first-line agent in the management
of asthma. This is used as required by the patient for
the symptomatic relief of breathlessness and wheezing, for
example, salbutamol 200 μcg when required. This may be the
only treatment necessary for those with infrequent symptoms.
There is no advantage to regular administration.
How do inhaled anticholinergic agents work and what role do they play in asthma?
They block muscarinic receptors in bronchial smooth muscle but are generally of little additional value in asthma management. Ipratropium has a slower onset of action than B2 agonists but a longer duration of action. These types of agents may be useful in those patients who have a degree of obstructive airways disease.
Ipratropium is an example of
Anticholinergic agent.
When low-dose inhaled steroids fail to control asthma symptoms, what should occur?
A LABA should be added instead of increasing the steroid dose. But only:
only be added if regular use of standard-dose ICS has
failed to control asthma adequately
• not be initiated in patients with rapidly deteriorating
asthma
• be introduced at a low dose and the effect properly
monitored before considering dose increase
• be discontinued in the absence of benefit
• be reviewed as appropriate; stepping down therapy should
be considered when good long-term asthma control has
been achieved (MHRA, 2008).
What are the benefits of press and breath metered dose inhalers (MDIs)? (3)
- Not dependent on peak inspiratory flow of the patient.
- Portable, compact and convenient - if a spacer isnt need, if a spacer is needed can be bulky and inconvenient.
- Humidity doesn’t affect medication.
What are the problems of MDIs? (3)
- Can result in medication being deposited on back of the throat and tongue, causing oral thrush.
- Some models don’t show how many doses remain, difficult to determine remaining doses.
- Elderly patients/children may find them difficult to use.
