Immunopharmacology of Asthma and COPD Flashcards
Describe the characteristics of asthma.
Wheezing and coughing.
INFLAMMATORY - with eosinophils.
Airway obstruction that is reversible (to an extent)
Increased bronchial hyperresponsivness to a variety of stimuli.
What is the principle of asthma treatment?
Important to treat the underlying causes of the disease (inflammation) to alleviate the symptoms.
Explain how a house dustmite could trigger an asthmatic response.
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).
What are the pathological changes that occur in the airways of an asthmatic?
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.
What are the current anti-inflammatory therapies?
- Glucocorticosteroids
- –Inhaled; beclomethasone, budesonide, fluticasone
- –Oral - prednisone
- PDE inhibitors - theophylline.
- Leukotriene receptor antagonists - montelukast
- Anti IgE - omalizumab
- Cromones - sodium cromoglyate, nedecromil
- B agonists
Benefits of GCSs?
Effective, improve lung function, reduce bronchial hyperresponsivness, decrease frequency and severity of exacerbation, few side effects, improve quality of life.
Cons of GCSs?
Local side effects, lung absorption may causes systemic side effects, steroid phobia and poor patient compliance.
Name a short acting B agonist.
Salbutamol
Name 2 long acting B agonist
Salmeterol and Formoterol
Name a short acting anticholinergic
Ipratropium
Name a long acting anticholinergic
Tiotropium
Name 3 fixed combinations.
Salbutamol and ipratropium.
Budesonide and formoterol.
Fluticasone and salmeterol.
Name an ultra long acting B agonist.
Indacaterol - for maintenance - still need a short acting B agonist.
Stats of COPD?
Affects 52 million worldwide.
4th leading cause of death in the USA.
What pathological changes happen in emphysema?
Increase neutrophils.
Larger gap for O2 to blood.
Decrease elasticity of supporting structures.
Plugging - inflammatory narrowing and Obliteration of small airways.
What are the current treatment for symptoms of emphysema?
- Short and long acting B agonists.
- PDE inhibitor.
- Muscarinic receptor antag.
- GCS (NOT EFFECTIVE)
- Oxygen.
- Antibiotics.
Name 3 long acting antimuscarinics
triotropium, NVA237 and darotropium bromide.
Name 2 combinations of long acting B agonists, LAMA and ICSs.
indaceterol, NVA237 and mometasone.
milreterol and darotropium and fluticasone furoate.
Name a PDE4 inihibitor
Roflumilast
What is rhinitus and how would you treat it?
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.
