Therapeutics of Obstructive Airways Disease

Question 1

Which drugs are described as controllers in asthma?

Answer 1

Theophylline
Leukotriene-antagonist Increasing
Long-acting β2-agonist

Question 2

What corticosteroids are used to treat asthma?

Answer 2

Prednisalone (orally) for ACUTE therapy

Beclomathasone (inhaled) for MAINTAINED therapy

Question 3

What should be used in intermittent asthma?

Answer 3

SABA

Question 4

What should be used in mild intermittent asthma?

Answer 4

SABA + inhaled steroid

Question 5

What should be used in moderate to severe intermittent asthma?

Answer 5

SABA + inhaled steroid + LABA + LTRA/Theo

Question 6

What are cromones e.g. cromoglycate and who are they effective in?

Answer 6

Mast cell stabiliser - weak anti-inflammatory compared to steroids
Useful in atopic children (exercise asthma)

Question 7

How is cromoglycate delivered?

Answer 7

inhalationally

Question 8

Describe treatment of acute asthma.

Answer 8

Oral prednisolone (or iv hydrocortisone )
•  Nebulised high dose salbutamol, ± Neb ipratropium, ± iv
aminophylline/magnesium
•  60% O2
•  ITU Assisted mecahnical intubated ventilation if falling
PaO2 and rising PaCO2
- never use respiratory stimulant

Question 9

Describe treatment of acute COPD.

Answer 9

Nebulised high dose salbutamol + ipratropium
•  Oral prednisolone
•  Antibiotic (amoxycillin/doxycycline) if infection
•  24-28% O2 titrated against PaO2/PaCO2
•  Physio to aide sputum expectoration
•  Non invasive ventilation to allow higher FiO2
•  ITU Intubated assisted ventilation only if reversible
component (eg pneumonia)