Immunopharmacology of Asthma and COPD

Question 1

Describe the characteristics of asthma.

Answer 1

Wheezing and coughing.
INFLAMMATORY - with eosinophils.
Airway obstruction that is reversible (to an extent)
Increased bronchial hyperresponsivness to a variety of stimuli.

Question 2

What is the principle of asthma treatment?

Answer 2

Important to treat the underlying causes of the disease (inflammation) to alleviate the symptoms.

Question 3

Explain how a house dustmite could trigger an asthmatic response.

Answer 3

House dust mite faecal pellets contain enzymes to degrade skin scale. Faecal pellet is inhaled. Detected by IgE receptor - release histamine which causes contraction of smooth muscle and an decrease in lung function and then after a while it goes back to normal. BUT after 7 hours - another decrease in lung function because eosinophils have invaded the lung. (4am wake up for asthmatics).

Question 4

What are the pathological changes that occur in the airways of an asthmatic?

Answer 4

Epithelial damage (no cilia).
Thickened basement membrane.
Mucus plug containing inflammatory cells and plasma exudate.
Increase SM.
Inflammatory cell infiltration.
Vasularisation, vasodilation and plasma exudation.

Question 5

What are the current anti-inflammatory therapies?

Answer 5

• Glucocorticosteroids
• –Inhaled; beclomethasone, budesonide, fluticasone
• –Oral - prednisone
• PDE inhibitors - theophylline.
• Leukotriene receptor antagonists - montelukast
• Anti IgE - omalizumab
• Cromones - sodium cromoglyate, nedecromil
• B agonists

Question 6

Benefits of GCSs?

Answer 6

Effective, improve lung function, reduce bronchial hyperresponsivness, decrease frequency and severity of exacerbation, few side effects, improve quality of life.

Question 7

Cons of GCSs?

Answer 7

Local side effects, lung absorption may causes systemic side effects, steroid phobia and poor patient compliance.

Question 8

Name a short acting B agonist.

Answer 8

Salbutamol

Question 9

Name 2 long acting B agonist

Answer 9

Salmeterol and Formoterol

Question 10

Name a short acting anticholinergic

Answer 10

Ipratropium

Question 11

Name a long acting anticholinergic

Answer 11

Tiotropium

Question 12

Name 3 fixed combinations.

Answer 12

Salbutamol and ipratropium.
Budesonide and formoterol.
Fluticasone and salmeterol.

Question 13

Name an ultra long acting B agonist.

Answer 13

Indacaterol - for maintenance - still need a short acting B agonist.

Question 14

Stats of COPD?

Answer 14

Affects 52 million worldwide.

4th leading cause of death in the USA.

Question 15

What pathological changes happen in emphysema?

Answer 15

Increase neutrophils.
Larger gap for O2 to blood.
Decrease elasticity of supporting structures.
Plugging - inflammatory narrowing and Obliteration of small airways.

Question 16

What are the current treatment for symptoms of emphysema?

Answer 16

• Short and long acting B agonists.
• PDE inhibitor.
• Muscarinic receptor antag.
• GCS (NOT EFFECTIVE)
• Oxygen.
• Antibiotics.

Question 17

Name 3 long acting antimuscarinics

Answer 17

triotropium, NVA237 and darotropium bromide.

Question 18

Name 2 combinations of long acting B agonists, LAMA and ICSs.

Answer 18

indaceterol, NVA237 and mometasone.

milreterol and darotropium and fluticasone furoate.

Question 19

Name a PDE4 inihibitor

Answer 19

Roflumilast

Question 20

What is rhinitus and how would you treat it?

Answer 20

Hayfever, like asthma but in the nose (erectile tissue - BV vasodilate) therefore treat with VASOCONSTRICTOR.
Inflammatory response to allergen,
Grass pollen, fungal spores cant get into lung.
Treatment is a topically applied steroid.