L14- Asthma and COPD

Question 1

What is asthma?

Answer 1

Recurrent reversible obstruction of the airways in response to a stimuli that are not themselves noxious and which do not affect non-asthmatic subjects

Question 2

What are the main characteristics of asthma?

Answer 2

• Airway obstruction
• Airway inflammation
• Increased bronchial hyperresponsiveness to a wide variety of stimuli

Question 3

What does a diseased lung look like?

Answer 3

• Bifurcations not visible
• Inflamed walls of airways
• Mucus filled conducting airways
• Oedema and vascular leakage

Question 4

What is a house dust mite?

Answer 4

• Microorganism found everywhere
• Eats skin scales and uses enzymes to metabolise which are released in inhalable faeces
• Some people are genetically predisposed to produce IgE antibodies towards faeces of HDM and cause allergic response

Question 5

How does hyperresponsiveness occur?

Answer 5

• Epithelium constantly disrupted due to allergen response

* Damaged epithelium exposes sensory nerves which respond to temperature, humidity and irritants in the air

Question 6

What are the short-acting b agonists?

Answer 6

• Salbutamol
• Levalbuterol
• Terbutaline

Question 7

What are the short acting anti muscarinics?

Answer 7

• Ipratropium

* Oxitropium

Question 8

What are the long-acting b agonists?

Answer 8

• Salmeterol

* Indacaterol

Question 9

What are the long acting anti muscarinics?

Answer 9

• Tiotropium

* Aclidinium

Question 10

What are methylxanthines?

Answer 10

• Theophylline

* Doxophylline

Question 11

What are fixed combination LABA/LAMA drugs?

Answer 11

• Salbutamol and ipratropium
• Indacaterol and glycopyrronium
• Vilanterol and umeclidinium

Question 12

What are fixed combination LABA/ICS?

Answer 12

• Formoterol and budesonide

* Salmeterol and fluticasone

Question 13

What do b agonists do?

Answer 13

• Mimic sympathetic nervous system activity and induce bronchiole smooth muscle relaxation (bronchodilation)
• No effect on inflammation
• Immediate relief in asthma attack

Question 14

What do muscarinic antagonists do?

Answer 14

• Block parasympathetic induced bronchiole smooth muscle contraction by blocking Ach muscarinic receptors
• No effect on inflammation

Question 15

How are LABA/LAMA combinations useful?

Answer 15

• Further enhances bronchodilation by amplifying the effects of one another
• Can help overcome intra and inter patient variability

Question 16

What do ICS do?

Answer 16

• Inhaled corticosteroids target inflammation (main cause of hypersensitivity)
• Inhibit eosinophil recruitment and reduce epithelial damage and hyperresponsiveness
• Have side effects

Question 17

What are MABA’s?

Answer 17

Single molecule combining muscarinic antagonism and b2 agonist activity

Question 18

What is COPD?

Answer 18

• Emphysema and chronic bronchitis normally caused by cigarette smoke
• Smoke activates macrophages and they phagocytose it releasing cytokines and inflammatory mediators
• IL-8 secreted and neutrophils recruited
• Enzymes released by neutrophils to destroy bacteria also damage lung tissue and alveoli structure

Question 19

What are differences between COPD and asthma?

Answer 19

• COPD has neutrophils, asthma has eosinophils
• COPD has IL-8
• COPD destruction of peripheral airways, asthma affects conducting airways