Medications for Asthma and COPD

Question 1

What are the therapeutic goals of asthma and COPD?

Answer 1

• Symptom control w/o excessive use of rescue meds
• Minimize # of exacerbations per year
• Slow the progression of the disease
• COPD: maintain comfort, permit as normal a life as possible

Question 2

Name the classes of bronchodilators

Answer 2

B2 agonists

Muscarinic antagonists (anticholinergics)

Phosphodiesterase inhibits

Question 3

Name the classes of anti-inflammatory agents

Answer 3

Corticosteroids (inhaled and oral)

Leukotriene inhibitors or receptor antagonists

PDE4 inhibitors

Question 4

What does adding a spacer to an MDI help with?

Answer 4

With a spacer, more medication is delivered to the lungs

Question 5

What are the advantages of inhalation delivery of meds? What are some examples of devices used?

Answer 5

• Direct delivery to the site of action
• Limited (but not absent) systemic effects
• Rapid relief possible

MDI - metered dose inhaler
DPI - dry powder inhaler
Nebulizer (solution –> mist)

Question 6

What are the three key points to keep in mind concerning medications for patients with asthma and/or COPD?

Answer 6

Key Point #1: ALL should have a rescue medication
- SABA for intermittent/mild/severe persistent asthma
- SABA or SAMA for COPD
- ICS + LABA for moderate persistent asthma

Key Point #2: People with moderate persistent asthma should be on a daily combo of ICS + LABA
- Designed to be used every day, on a fixed schedule to control symptoms
- This combo can also be used as an as-needed rescue medication

Key Point #3: People with asthma who are prescribed a daily inhaled medication to control their asthma should use that medication every day, even if they feel good
- Controller medication!!

Question 7

What do these abbreviations mean?:

SABA, LABA, SAMA, LAMA

Answer 7

SABA: Short-Acting Beta 2 Agonist

LABA: Long-Acting Beta2 Agonist

SAMA: Short-Acting Muscarinic Antagonist

LAMA: Long-Acting Muscarinic Antagonist

Question 8

Can antibiotics be used to treat exacerbations in COPD?

Answer 8

Abx should be given to COPD patients if:

• Have 3 cardinal symptoms: increased dyspnea, increased sputum volume, and increased sputum purulence (green color)

OR

• Have 2 cardinal symptoms, if increased sputum purulence is one of the symptoms

OR

• Pt. require mechanical ventilation, whether invasive or non-invasive

Question 9

Can antibiotics be used to treat exacerbations in asthma?

Answer 9

Not recommended to use during asthma exacerbations, except to treat comorbid conditions (ex. evidence of pneumonia)

Question 10

Patient teaching for asthma:

Answer 10

1. How to avoid or reduce exacerbations, including avoiding triggers
2. Self-monitoring of symptoms; call or visit provider if deterioration from baseline.
3. How to use inhalers and other meds; the importance of maintaining consistent use of controller medications.
4. Annual flu vaccination; pneumococcal vaccination appropriate for many asthma patients. Pertussis and COVID vaccination.
5. Stop smoking!

Question 11

Patient teaching for COPD:

Answer 11

1. How to avoid or reduce exacerbations, including avoiding triggers
2. Self-monitoring of symptoms; call or visit provider if deterioration from baseline.
3. How to use inhalers and other meds; the importance of consistent use, not just when feeling worse.
4. Education re: energy conservation, nutrition, pursed-lip breathing
5. Annual flu, pneumococcal, pertussis, and COVID vaccinations.
6. Stop smoking if haven’t already done so!