Lecture COPD and Asthma Flashcards
Are neutrophils or eosinophils more responsive to corticosteroids?
Eosinophils are more responsive.
Inhaled steroids are more effective for COPD treatment if it is administered with?
Beta2-agonist, such as salbutamol.
Does inhaled steroids reduce the long term decline of FEV1 seen in COPD?
No
What is the risk/adverse effects of taking Seretide for COPD treatment? What is Seretide?
It increases the risk of having pneumonia.
Seretide is a combination drug of corticosteroid and long-acting beta2-agonist.
When is oral corticosteroids given for COPD?
During exacerbations
What are the treatments available for asthma? State the treatment ladder.
- Inhaled bronchodilators such as beta2 agonists
- Inhaled corticosteroids
- Theophylline or Aminophylline (which is metabolised to Theophylline)
- Montelukast
- Oral corticosteroids (prednisolone)
- Anti-IgE
What are the two types of long-acting reliever inhalers?
Give examples of the drugs.
LABA and LAMA
Long-acting beta2 agonists: Salmeterol and Formoterol
Long-acting muscarinic antagonists: Tiotropium bromide
What is the additional function LAMA does, as compared to LABA?
In addition to opening the airway by relaxing the muscles, LAMA has shown to reduce the amount of mucus in the airways.
Why is it dangerous to have long-acting reliever inhalers without taking steroid preventer inhaler?
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.
When should the peak expiratory flow rate be taken?
- 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.
What does a PEFR reading of <50% indicate?
Severe asthma.
What is the PEFR reading if the patient has a life-threatening asthma?
PEFR reading will be <33%
Give an example of an anti-cholinergic.
Ipratropium
Give an example of an Anti-IgE monoclonal antibody.
When will this be prescribed?
Anti-IgE monoclonal antibody –> Omalizumab
Used in highly selective patients with persistent allergic asthma. It is only prescribed by specialists.
What is the caution of prescribing Aminophylline?
What measures are taken to monitor patients on Aminophylline?
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.
What is the FEV1 value and FEV1/FVC value which indicates an obstructive respiratory condition?
FEV1 <80%/70%
FEV1/FVC <0.7
State the stages of COPD severity (based on FEV1 values)
Stage 1: Mild - FEV1 <80%
Stage 2: Moderate - FEV1 50-79%
Stage 3: Severe - FEV1 30-49%
Stage 4: Very Severe - FEV1 <30%
What is Cor pulmonale?
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)
What is Symbicort?
Symbicort is a combination of LABA + Corticosteroid (Budesonide + Formoterol)
Is Mucolytic used in COPD or asthma?
Give an example of a mucolytic.
Mucolytics are used in COPD. It helps with chronic productive cough.
An example is Carbocysteine.
What gas is released by inflamed bronchial epithelial cells in asthma? Which test involves measuring this?
Nitric oxide is released by inflamed bronchial epithelial cells in asthma.
Fractional exhaled NO (FeNO) testing
There is severe acute asthma if patient presents with any one of which 4 features?
- Peak flow 33-50% best or predicted
- RR >/=25
- HR >/= 100
- Inability to complete a sentence in a single breath
When should a low dose of inhaled corticosteroid be started as maintenance therapy?
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
Which monoclonal antibody is used for severe persistent allergic asthma?
What does it do?
Omalizumab
Anti-IgE
Which monoclonal antibody is used for severe eosinophilic asthma?
What does it do?
Mepolizumab and Reslizumab
Anti-IL5. IL-5 promotes eosinophil production.
What is the effects of salbutamol (and Beta sympathomimetics, and catecholamines) on potassium in the body?
Beta-2 sympathomimetics and catecholamines, including all Beta-2 receptor agonists increases the movement of K+ into cells, causing hypokalaemia.
