LECUTURE 24 - drugs used in COPD Flashcards
Distinguish the site of asthma vs COPD
asthma - proximal airways
COPD - peripheral airways
Distinguish the onset of asthma vs COPD
asthma - often in childhood
COPD - in late adulthood
Distinguish the symptoms of asthma vs COPD
asthma - episodic attacks
COPD - progressive deterioration of pulmonary functions
Distinguish the immune cells of asthma vs COPD
asthma - mast cells, eosinophils, TH2 cells
COPD - neutrophils, macrophages, TH1 cells
Distinguish the key mediators of asthma vs COPD
asthma - IL-4, IL-5, IL-13
COPD - IL-8, TNF-a, IL-1b, IL-6
What can COPD cause?
fibrosis & alveolar destruction
Explain the pathogenesis of emphysema
Tissue damage by proteases
- Irritants in cigarette smoke cause inflammation in alveoli.
- Neutrophils and macrophages accumulate
- Activated neutrophils and macrophages release proteases, resulting in tissue damage
Oxidative injury by reactive oxygen species (ROS)
- ROS in cigarette smoke deplete antioxidants in the lungs
- ROS inactivates ⍺1-antitrypsin, which normally suppresses the protease activities
- Activated neutrophils also release ROS
Explain the pathogenesis of chronic bronchitis
- Initiated by the exposure to irritants
(cigarette smoke or other air pollutants) - Hypersecretion of the bronchial mucous glands
- Hypertrophy of mucous glands
- Metaplastic formation of mucin-secreting goblet cells
- Inflammation with infiltration of CD8+ T cells, macrophages, and neutrophils (no involvement of eosinophils)
- Frequent viral and bacterial infections may play a role in maintaining inflammation and exacerbating symptoms
Identify the key mediators involved in the pathogenesis of COPD
IL-8
TNF-a
IL-1b
IL-6
Identify the immune cells involved in the pathogenesis of COPD
Neutrophils
Macrophages
CD8+ T-cells (TH1)
List SABA(s) used for treatment of COPD
Albuterol
Levalbuterol (Xopenex®)
List LABA(s) used for the treatment of COPD
Salmetrol (Serevent®)
Formoterol
List Ultra-LABA(s) used for the treatment of COPD
–usually in combination products–
Indacaterol (Arcapta®)
Olodaterol (Strieverdi®)
Vilanterol (Ellipta® plus others)
Bambuterol (Bambec®, Oxeol®)
List antimuscarinic(s) used for the treatment of COPD
Ipratropium (Atrovent®)
Tiotropium (Spiriva®)
Aclidinium (Tudorza®, Pressair®)
Umeclidinium (Incruse Ellipta®)
List methylxanthine(s) used for the treatment of COPD
Theophylline
Lise PDE-4 inhibitor(s) used for the treatment of COPD
Roflumilast (Daliresp®)
Explain the MOA for methylxanthine medications
bronchodilation and anti-inflammatory action
Explain the MOA for PDE-4 inhibitor medications
Increases the intracellular cAMP concentration similar to methylxanthines
Suppresses the release of cytokines and chemokines to reduce airway inflammation
Explain the MOA for corticosteroid medications
- Decrease mucus release by reducing capillary permeability
- Suppress protease release from immune cells
- Suppress prostaglandin production
List combination products used to treat COPD
Fluticasone furoate/vilanterol (Breo Ellipta®)
Fluticasone furoate/umeclidinium bromide/vilanterol (Trelegy Ellipta®)
Explain the contribution of ⍺1-antitrypsin deficiency to COPD
A genetic deficiency in 1-antitrypsin (AATD) for patients with COPD leads to excessive proteolytic damage to lung tissue (i.e. uninhibited MMP9 and elastase)
LABAs can be used as monotherapy for which disease state: asthma or COPD?
COPD only
