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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
Q

What are the benefits of using a spacer advice?

A
  • 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
Q

Should a metre dose inhaler be used on its own?

A

No

- only with a spacer

27
Q

What is another anti-inflammatory other than corticosteroids?

A

Cromones

28
Q

Cromones are only used in what?

A

In asthma as they only work on mast cells not eosinophils

- only used as add on therapy

29
Q

Cromones can only be taken what way?

A

Inhaled route only

30
Q

Cromoglycate is effective for what?

A

Effective in atopic children (EIB)

31
Q

Why are cromones not used much?

A

Poor efficacy

32
Q

What are the types of anti-inflammatory treatments for asthma an/or COPD?

A
  • Corticosteroids
  • Cromones
  • Leukotrine Receptor Antagonists
  • Anti-IgE
  • Anti-IL5
  • Anti-IL4a (alpha)
  • PDE4 inhibitors
33
Q

What are the features of leukotrine receptor antagonists?

A
  • 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
Q

What are the features of the Anti-IgE monoclonal antibody?

A
  • 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
Q

Features of the anti-IL5 antibody?

A
  • 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
Q

Features of the Anti-IL4a antibody?

A
  • 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
Q

What are the types of bronchodilator treatments used to treat asthma and/or COPD?

A
  • B2-agonists
  • Muscarinic antagonists
  • Methyl-xanthines
38
Q

What are the features of B2-agonists?

A
  • 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
Q

What are the features of muscarinic antagonists?

A
  • 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
Q

What are the features of methyl-xanthines?

A
  • taken orally for maintenance therapy
  • used to add to inhaled steroids
  • act as adenosine antagonist
  • used in asthma and COPD
41
Q

What are the features of PDE4 inhibitors?

A
  • Used for COPD only
  • Minimal effect on FEV1
  • Reduces exacerbations
  • Adverse effects are nausea/diarrhoea/headache/weight loss
  • rarely used
42
Q

What are mucolytics used for?

A
  • to reduce sputum viscosity
  • aide sputum expectoration in COPD
  • rarely used
43
Q

What are the aims for the treatment of chronic asthma?

A
  • 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
Q

What is used to treat acute asthma?

A
  • 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
Q

What should you never use for the treatment of acute asthma?

A

A respiratory stimulant

46
Q

What should the treatment of COPD aim to do?

A
  • Reduce exacerbations
  • Improve pulmonary function
  • Improve QOL
  • Prevent pulmonary heart disease
47
Q

What are the non pharmacological treatments of COPD?

A
  • Smoking cessation
  • Immunisation
  • Pharmacotherapy
  • Pulmonary rehab
  • Oxygen
48
Q

What are the pharmacological treatments of COPD?

A
  • LABA/LAMA combo

- ICS/LABA/LAMA combo

49
Q

Two bronchodilators as single LABA/LAMA inhaler are better than one for what?

A
  • Symptom and exacerbation control
50
Q

When should you not use an inhaled corticosteroid for COPD?

A

When it’s non eosinophilic and infrequent exacerbator

51
Q

What are the treatments for acute COPD?

A
  • 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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