Pharmacology - Drugs for Asthma and COPD

Question 1

What are the most prevalent pulmonary diseases in the world?

Answer 1

Asthma and COPD

Question 2

How many individuals are currently suffering from asthma?

Answer 2

262 million people in 2019 (this number continues to grow)

Question 3

How many individuals are currently suffering from COPD?

Answer 3

15.7 million adults in 2014
COPD is the 3rd leading cause of death worldwide, causing 3.23 million deaths in 2019.

Question 4

What causes asthma?

Answer 4

We don’t really know…

There are some correlations with
- Smoking and antibiotic use during pregnancy
- Obesity
- Environmental factors (esp. air pollution, hence why asthma is becoming more common)
- Genetic factors (eg. mutations in cytokines like IL-1, IL-33, IL-17)
- Food allergies
- Antibiotic use and microbiome

Question 5

Why is asthma more commonly seen in children?

Answer 5

Because they are still developing their immunity…

Question 6

Describe the two types of asthma

Answer 6

Extrinsic asthma - triggered by allergic reaction (characterized by higher levels of IgE in blood test)

Intrinsic asthma - triggered by non-allergic factors (e.g. stress, cold air, smoke, anxiety, viruses, infections)

Question 7

Why do asthamatics have thickened parenchyma and abnormal airways?

Question 8

Describe the process by which an allergen triggers inflammation in asthma.

Question 9

Monoclonal antibody treatment of asthma targets different pathways in the inflammatory response

Question 10

How are asthma and COPD diagnosed?

Answer 10

Using spirometry
Both diseases are characterized by decreased FEV1 relative to their FVC, which can be reversed after inhaling a short-acting bronchodilator.

Question 11

What are the 3 main therapeutic benefits of drugs for asthma treatment?

Answer 11

1. Decreased inflammation
2. Bronchodilation
3. Decreased inflammation and bronchodilation (i.e. both)

Question 12

What are the 5 main drug classes for treating asthma?

Answer 12

Corticosteroids
Antileukotrienes
Beta 2 adrenergic receptor agonists
Muscarinic receptor antagonists

Question 13

What are the 3 types of inhaled drug delivery?

Answer 13

1. Metered dose inhalers (with and without spacers)
2. Dry powder inhalers
3. Nebulizers (less specific)

Question 14

Glucocorticoids

Answer 14

Can block ALL inflammation (stop transcription of important inflammatory mediators)
Bind to glucocorticoid receptors

Question 15

Anti-inflammatory actions of glucorticoids

Answer 15

1.
2.

Question 16

Leukotrienes

Answer 16

Leukotrienes are bronchoconstrictors and vasoactive lipid mediators. They are mainly produced by immune cells.

Question 17

Why would we target leukotrienes?

Question 18

What are adrenergic receptors?

Answer 18

A class of G-protein receptors
Targets of many catecholamines

Activators don’t affect inflammation. Drugs targeting these receptors are used to relieve bronchoconstriction

Question 19

What are SABAs?

Answer 19

Short acting beta2 adrenergic receptor agonists

Question 20

What are LABAs?

Answer 20

Long acting beta2 adrenergic receptor agonists

Question 21

How do beta 2 agonists affect adrenergic receptors? How do M3 muscarinic antagonists affect muscarinic receptors?

Answer 21

Agonists: turn on receptors in SNS
Anatgonist: turn off receptors

Question 22

What are LAMAs and SAMAs

Question 23

What are methyxanthines?

Answer 23

Act as bronchodilators AND anti-inflammatory dugs.

Question 24

Name an example of methyxanthine

Answer 24

Theophylline

Question 25

What is the major drug type administered to asthmatics?

Answer 25

Inhaled corticosteroids

Question 26

What type of drug is a reliever of asthmatic symptoms?

Answer 26

SABAs and LAMAs

Question 27

What therapy is prescribed to individuals with severe asthma?

Answer 27

Oral corticosteroids and monoclonal therapy (antibody therapy)

Question 28

Why must monoclonal antibodies be administered in the clinic?

Answer 28

These drugs are not prescribed, because they must be delivered intravenously.

Question 29

Monoclonal antibodies are directed toward...

Answer 29

Interleukin-5 IgE

Question 30

What are two types of monoclonal antibodies used for asthma treatment

Answer 30

Omalizumab Mepolizumab/reslizumab

Question 31

Which drugs need to be inhaled? Which do not?

Question 32

What are some adverse effects of glucocorticoids?

Answer 32

Infection of tongue and mouth - dysphonia and thrush

Question 33

What are some adverse effects of leukotrienes?

Answer 33

Oral glucocorticoids+ antileukotrienes can result in eosinophilic granulomatosis (Churg-Strauss)

Question 34

What are some adverse effects of beta 2 adrenergic receptor agonists?

Answer 34

These drugs work so well at relieving symptoms, that many patients would only take this without their anti-inflammatory medications. Thus, symptoms are relieved but cause is not being treated (bad compliance).

Question 35

What are some adverse side effects of monoclonal antibodies (theophylline)?

Question 36

What are some adverse side effects of muscarinic receptor agonists?

Answer 36

Mostly very well tolerated, very few side effects. However can have small side effects in GI tract.

Question 37

If a patient responds well to a higher level of asthma therapy (good symptom control, no exacerbations for 3 months, what should the clinician recommend in terms of subsequent treatment

Answer 37

Step down...

Question 38

What is the main issue in patients with COPD?

Answer 38

Airways obstruction Emphysema: destruction of alveoli Bronchitis: bronchi

Question 39

What is the main cause of COPD?

Answer 39

Smoking

Question 40

Is it possible to develop COPD if you are not a smoker?

Answer 40

Yes!

Question 41

What are causes of COPD other than smoking?

Answer 41

Environmental factors Age Alpha-1 trypsin deficiency

Question 42

The same exact drugs used for asthma are used to treat COPD!

Question 43

How is COPD diagnosed?

Answer 43

Combination of spirometry and medical history, including symptom history and presence of risk factors FEV1/FVC ratio less than 0.7 (confirms obstructive disease) GOLD classification (?)

Question 44

COPD Assessment Test (CAT)

Answer 44

Missing images in slides!! Did not understand how this whole thing works

Question 45

What is the most effective treatment for COPD?

Answer 45

Bronchodilators (LABAs)! *Corticosteroid treatment is of minimal benefit*

Question 46

What are COPD exacerbations?

Answer 46

Exacerbations of COPD are acute episodes of worsening respiratory symptoms (dyspnea, cough, sputum volume, purulence) that require a change in treatment.

Question 47

How do we control COPD exacerbations?

Question 48

What is the leading symptom for hospital admissions in COPD? What is the trigger for most COPD exacerbations?

Answer 48

Dyspnea = leading symptom Most events are triggered by viral or bacterial respiratory tract infections.

Question 49

Is there a cure for COPD?

Answer 49

No, there is no cure.

Question 50

Smoking is becoming significantly less prevalent, especially in younger populations. So what is the future of COPD?

Answer 50

E-cigarettes (vaping) are becoming significantly more prevalent among children and teenagers. Vaping was found to cause severe lung injury in children due to vitamin E acetate

Question 51

What is EVALI?

Question 52

What is an effective treatment for EVALI?

Answer 52

Corticosteroids might be helpful, but this has not been studied and this treatment should be used with caution!