Management of Asthma and Chronic obstructive pulmonary disease

Question 1

How do you diagnose Asthma?

Answer 1

Upon demonstration of reversibility.
>12% increase in FEV1
200mL 15-20 min both following an 200-400mcg inhalation of salbutamol
20% improvement for PEF from the baseline

Question 2

Define reliever

Answer 2

short-acting bronchodilators with rapid onset of action providing acute symptomatic
relief.

Question 3

What are controllers?

Answer 3

Drugs with anti-inflammatory and/or sustained bronchodilator action

Question 4

Give examples of short acting B2 agonist relievers.

Answer 4

Salbutamol
Fenoterol
Terbutaine

Question 5

Give examples of Anti-cholinergic relievers.

Answer 5

Ipratroprium bromide

Question 6

Give the class of controllers that can provide sustained bronchodilation action but has weak or unproven anti-inflammatory effects.

Answer 6

Long-acting B2 agonists
Theophylline.

Question 7

Give examples of Long-acting B2 agonists.

Answer 7

Formoterol: Faster acting and long duration of action.
Salmeterol

Question 8

What classes of controllers have anti-inflammatory action that prevents asthma attacks?

Answer 8

Inhaled Corticosteroids
Leukotriene modifiers
Oral Corticosteroids

Question 9

Give examples of inhaled corticosteroids.

Answer 9

Beclomethasone
Budesonide
Fluticasone
Ciclesonide

Question 10

Give examples of leukotriene modifiers.

Answer 10

Montelukast
Zafirlukast

Question 11

Give examples of oral corticosteroids

Answer 11

Prednisone
Prenisolone
Methylprednisone
Methylprednisolone

Question 12

Mode of actions for steroids.

Answer 12

It binds to glucocorticoid receptors
Alters gene expression
anti-inflammatory action

Question 13

When can Short acting B2 agonist be used as the sole therapy?

Answer 13

Mild intermittent Asthma

Question 14

Side effects of inhaled corticosteroids.

Answer 14

Oropharyngeal candidiasis
Hoarseness

Question 15

Mode of actions for Long-acting B2 Agonists

Answer 15

Bind to beta 2 receptors → stimulate adenylyl cyclase → ↑ cAMP:
bronchodilation

Question 16

Side effects of Long acting B2 agonist.

Answer 16

Tremor and Palpitations

Question 17

Mode of action for Leukotriene modifiers.

Answer 17

Block effects of cysteinyl
leukotrines in airways

Question 18

When are Leukotriene receptor antagonists useful as an add on therapy?

Answer 18

when still symptomatic despite already on
corticosteroids and long-acting β2-agonist or patient cannot tolerate longacting β2-agonist

Question 19

Mode of action of Theophylline.

Answer 19

non-selective inhibition of Phosphodiesterases – may result in
bronchodilation and anti-inflammatory effect (inhibits release of
mediators

Question 20

Side effects of theophylline.

Answer 20

gastrointestinal symptoms (nausea & vomiting), cardiac arrhythmias and
central nervous system symptoms (tremor, confusion, seizures)

Question 21

Side effects of oral corticosteroids.

Answer 21

Suppress HPA axis-adrenal atrophy and
inadequate stress response.
Hypertension, fluid and electrolyte
disturbances, hyperglycaemia, inhibits inflammatory response, peptic
ulcer disease, muscle weakness, cataracts, osteoporosis, osteonecrosis,
growth retardation, Cushing’s syndrome, diabetogenic, dyslipidaemia.
Psychiatric-euphoria, behavioral changes, depression.