Lecture COPD and Asthma

Question 1

Are neutrophils or eosinophils more responsive to corticosteroids?

Answer 1

Eosinophils are more responsive.

Question 2

Inhaled steroids are more effective for COPD treatment if it is administered with?

Answer 2

Beta2-agonist, such as salbutamol.

Question 3

Does inhaled steroids reduce the long term decline of FEV1 seen in COPD?

Answer 3

No

Question 4

What is the risk/adverse effects of taking Seretide for COPD treatment? What is Seretide?

Answer 4

It increases the risk of having pneumonia.

Seretide is a combination drug of corticosteroid and long-acting beta2-agonist.

Question 5

When is oral corticosteroids given for COPD?

Answer 5

During exacerbations

Question 6

What are the treatments available for asthma? State the treatment ladder.

Answer 6

1. Inhaled bronchodilators such as beta2 agonists
2. Inhaled corticosteroids
3. Theophylline or Aminophylline (which is metabolised to Theophylline)
4. Montelukast
5. Oral corticosteroids (prednisolone)
6. Anti-IgE

Question 7

What are the two types of long-acting reliever inhalers?

Give examples of the drugs.

Answer 7

LABA and LAMA
Long-acting beta2 agonists: Salmeterol and Formoterol
Long-acting muscarinic antagonists: Tiotropium bromide

Question 8

What is the additional function LAMA does, as compared to LABA?

Answer 8

In addition to opening the airway by relaxing the muscles, LAMA has shown to reduce the amount of mucus in the airways.

Question 9

Why is it dangerous to have long-acting reliever inhalers without taking steroid preventer inhaler?

Answer 9

long-acting reliever inhaler does not reduce the inflammation of the airways (which is relieved by steroid preventer inhalers). Hence, inflammation will worsen. Inflamed airways will be more sensitive and responsive to triggers of asthma, increasing the risk of asthma attacks.

Question 10

When should the peak expiratory flow rate be taken?

Answer 10

• At least twice a day for 2-3 weeks
• In the morning, upon waking, or in the late afternoon or early evening
• 15 - 20 mins after using an inhaled, quick-acting beta2 agonist.

Question 11

What does a PEFR reading of <50% indicate?

Answer 11

Severe asthma.

Question 12

What is the PEFR reading if the patient has a life-threatening asthma?

Answer 12

PEFR reading will be <33%

Question 13

Give an example of an anti-cholinergic.

Answer 13

Ipratropium

Question 14

Give an example of an Anti-IgE monoclonal antibody.

When will this be prescribed?

Answer 14

Anti-IgE monoclonal antibody –> Omalizumab

Used in highly selective patients with persistent allergic asthma. It is only prescribed by specialists.

Question 15

What is the caution of prescribing Aminophylline?

What measures are taken to monitor patients on Aminophylline?

Answer 15

Aminophylline has a narrow therapeutic ratio and can cause arrhythmia, GI upset and fits in the toxic range.

Check Theophylline levels and do ECG monitoring. Check plasma level after 24 hours if IV therapy is used.

Question 16

What is the FEV1 value and FEV1/FVC value which indicates an obstructive respiratory condition?

Answer 16

FEV1 <80%/70%

FEV1/FVC <0.7

Question 17

State the stages of COPD severity (based on FEV1 values)

Answer 17

Stage 1: Mild - FEV1 <80%
Stage 2: Moderate - FEV1 50-79%
Stage 3: Severe - FEV1 30-49%
Stage 4: Very Severe - FEV1 <30%

Question 18

What is Cor pulmonale?

Answer 18

Cor pulmonale is a complication that results in right ventricular dysfunction. It is usually due to respiratory diseases like asthma and COPD, where there is increased resistance to blood flow in the pulmonary circulation (>20mmHg)

Question 19

What is Symbicort?

Answer 19

Symbicort is a combination of LABA + Corticosteroid (Budesonide + Formoterol)

Question 20

Is Mucolytic used in COPD or asthma?

Give an example of a mucolytic.

Answer 20

Mucolytics are used in COPD. It helps with chronic productive cough.
An example is Carbocysteine.

Question 21

What gas is released by inflamed bronchial epithelial cells in asthma? Which test involves measuring this?

Answer 21

Nitric oxide is released by inflamed bronchial epithelial cells in asthma.
Fractional exhaled NO (FeNO) testing

Question 22

There is severe acute asthma if patient presents with any one of which 4 features?

Answer 22

1. Peak flow 33-50% best or predicted
2. RR >/=25
3. HR >/= 100
4. Inability to complete a sentence in a single breath

Question 23

When should a low dose of inhaled corticosteroid be started as maintenance therapy?

Answer 23

in patients who present with any one of the following features:

a. using an inhaled short-acting beta2 agonist three times a week or more,
b. symptomatic three times a week or more,
c. or waking at night due to asthma symptoms at least once a week

Question 24

Which monoclonal antibody is used for severe persistent allergic asthma?
What does it do?

Answer 24

Omalizumab

Anti-IgE

Question 25

Which monoclonal antibody is used for severe eosinophilic asthma?
What does it do?

Answer 25

Mepolizumab and Reslizumab

Anti-IL5. IL-5 promotes eosinophil production.

Question 26

What is the effects of salbutamol (and Beta sympathomimetics, and catecholamines) on potassium in the body?

Answer 26

Beta-2 sympathomimetics and catecholamines, including all Beta-2 receptor agonists increases the movement of K+ into cells, causing hypokalaemia.