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1ST YR RESP > Obstructive Airways Disease Overview > Flashcards

Obstructive Airways Disease Overview Flashcards

1
Q

What kind of diseases are associated with the airways?

A

Obstructive disease

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2
Q

What kind of diseases are associated with the lungs?

A

Restrictive disease

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3
Q

What are three obstructive airway syndromes?

A
  • Asthma
  • Chronic Bronchitis
  • Emphysema
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4
Q

What does atopic asthma mean?

A

Allergic asthma

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5
Q

What does non-atopic asthma mean?

A

Non-allergenic asthma

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6
Q

What is intrinsic asthma?

A

There is no identifiable cause for the asthma

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7
Q

What is extrinsic asthma?

A

There is an external stimuli that causes the asthma

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8
Q

What are the allergen triggers for asthma?

A
  • Animal dander
  • Dust mites
  • Pollens
  • Fungi
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9
Q

What are non-allergen triggers for asthma?

A
  • Exercise
  • Viral infection
  • Smoke
  • Cold
  • Chemicals
  • Drugs
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10
Q

What are the three main components of COPD?

A
  • Mucociliary Dysfunction
  • Inflammation
  • Tissue Damage
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11
Q

What are two characteristics of COPD?

A
  • Exacerbations

- Reduced Lung Function

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12
Q

What are the features of chronic bronchitis?

A
  • Chronic neutrophilic inflammation
  • Muus hypersecretion
  • Mucociliary dysfunction
  • Altered lung microbiome
  • Smooth muscle spasm and hypertrophy
  • Partially reversible
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13
Q

What are the features of emphysema?

A
  • Alveolar destruction
  • Impaired gas exchange
  • Loss of bronchial support
  • Irreversible
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14
Q

What two classifications can drugs for airflow obstruction be divided into?

A
  • preventers (anti-inflammatory)

- relievers (bronchodilators)

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15
Q

What is a big feature of corticosteroids and what are they used for?

A
  • Anti-inflammatory

- Used to treat asthma

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16
Q

Why aren’t corticosteroids normally used for COPD

A
  • may cause pneumonia
  • corticosteroids cause local immune suppression and impaired mucociliary clearance
  • especially with fluticasone due to prolonged lung retention
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17
Q

What type of corticosteroids is prednisolone?

A
  • oral steroid

- low therapeutic ratio, only used for acute exacerbations not maintenance

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18
Q

Give an example of an inhaled steroid

A

Beclomethasone

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19
Q

What are the features of inhaled steroids?

A
  • high therapeutic ratio

- used for maintenance monotherapy in asthma

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20
Q

In what time frame should corticosteroids be given?

A

Short term only

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21
Q

corticosteroids should be given as

A
  • monotherapy
  • cobination with a ong acting beta agonist/ LAMA/ICS
  • not used as monotherapy in COPD
22
Q

How do COPD and asthma differ in treatments?

A
  • Asthma can be treated with monotherapy of corticosteroids

- COPD cannot, has to be used in combination

23
Q

When does corticosteroids reduce exacerbations?

A

reduces exacerbations in eosinophilic COPD (ACO)

24
Q

What do corticosteroids do to lung delivery?

A

Optimise lung delivery

25
What are the benefits of using a spacer advice?
- avoids coordination problems with pMDI - reduces oropharyngeal and laryngeal side effects - reduces systemic absorption from swallowed fraction - acts as holding chamber for aerosol - reduces particle size and velocity - improves lung deposition
26
Should a metre dose inhaler be used on its own?
No | - only with a spacer
27
What is another anti-inflammatory other than corticosteroids?
Cromones
28
Cromones are only used in what?
In asthma as they only work on mast cells not eosinophils | - only used as add on therapy
29
Cromones can only be taken what way?
Inhaled route only
30
Cromoglycate is effective for what?
Effective in atopic children (EIB)
31
Why are cromones not used much?
Poor efficacy
32
What are the types of anti-inflammatory treatments for asthma an/or COPD?
- Corticosteroids - Cromones - Leukotrine Receptor Antagonists - Anti-IgE - Anti-IL5 - Anti-IL4a (alpha) - PDE4 inhibitors
33
What are the features of leukotrine receptor antagonists?
- only used in asthma - Eg. montelukast (oral route, once daily, high therapeutic ratio) - Less potent anti inflammatory than inhaled steroid - 2nd line treatment (complimentary non steroidal anti-inflammatory additive to inhaled steroid) - effective in EIB and allergic rhinitis
34
What are the features of the Anti-IgE monoclonal antibody?
- injection every 2-4 weeks - asthma only - inhibits binding to high affinity IgE receptor, inhibits TH2 response and assoc mediator release from basophils/mast cells - for severe allergic asthma - expensive
35
Features of the anti-IL5 antibody?
- blocks effect of TH2 cytokine responsible for eosinophilic inflammation in asthma - injection every 4/8 weks - asthma only - for severe eosinophilic asthma - expensive - little effect on symptoms
36
Features of the Anti-IL4a antibody?
- blocks effects of TH2 cytokines responsible for eosinophilic inflammation - injection every 2 weeks - asthma only - severe refractory asthma - suppresses IgE and FeNO - expensive - good effect on pulmonary function
37
What are the types of bronchodilator treatments used to treat asthma and/or COPD?
- B2-agonists - Muscarinic antagonists - Methyl-xanthines
38
What are the features of B2-agonists?
- stimulate bronchial smooth muscle B2-receptors - Short acting: salbutamol - Long acting: salmeterol/formoterol - Combination inhalers - used in asthma - high nebulised dose given in acute attack - high therapeutic ratio by inhaled route
39
What are the features of muscarinic antagonists?
- block post junctional end plate M3 receptors - Short acting: Ipratropium - Long acting: Tiotropium - Inhaled route only - Used mostly in COPD - Also used in asthma as triple therapy at step 4
40
What are the features of methyl-xanthines?
- taken orally for maintenance therapy - used to add to inhaled steroids - act as adenosine antagonist - used in asthma and COPD
41
What are the features of PDE4 inhibitors?
- Used for COPD only - Minimal effect on FEV1 - Reduces exacerbations - Adverse effects are nausea/diarrhoea/headache/weight loss - rarely used
42
What are mucolytics used for?
- to reduce sputum viscosity - aide sputum expectoration in COPD - rarely used
43
What are the aims for the treatment of chronic asthma?
- minimise beta2-use - normalise FEV1 - reduce PEF variability - reduce exacerbations - prevent long term airway remodeling - avoid triggers - suppress inflammatory cascade with inhaled steroid - stabilise smooth muscle with LABA/LAMA
44
What is used to treat acute asthma?
- Oral prednisolone - Nebulised high dose salbutamol - Neb ipratropium - iv aminophylline/magnesium - >60% oxygen - ITU assisted mechanical intubated ventilation if falling PaO2 and rising PaCO2
45
What should you never use for the treatment of acute asthma?
A respiratory stimulant
46
What should the treatment of COPD aim to do?
- Reduce exacerbations - Improve pulmonary function - Improve QOL - Prevent pulmonary heart disease
47
What are the non pharmacological treatments of COPD?
- Smoking cessation - Immunisation - Pharmacotherapy - Pulmonary rehab - Oxygen
48
What are the pharmacological treatments of COPD?
- LABA/LAMA combo | - ICS/LABA/LAMA combo
49
Two bronchodilators as single LABA/LAMA inhaler are better than one for what?
- Symptom and exacerbation control
50
When should you not use an inhaled corticosteroid for COPD?
When it's non eosinophilic and infrequent exacerbator
51
What are the treatments for acute COPD?
- nebulised high dose salbutamol + ipratropium - antibiotic if infection - 24-28% O2 titrated against PaO2/PaCO2 - Physio to aide sputum expectorium - Non invasive ventilation to allow higher FiO2

1ST YR RESP (8 decks)

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