Therapy Of Bronchial Asthma Flashcards
Asthma is a heterogeneous disease usually characterized by:
Chronic airway inflammation
Asthma is usually associated with:
1) Airway hyper-responsiveness
2) Airway inflammation
Airway obstruction in asthma may become __.
Irreversible
Why does asthma worsen over time?
Because of airway remodeling
The most common cause of death from asthma is:
Inadequate assessment of the severity of airway obstruction = inadequate therapy.
Airway remodeling presents as:
1) Extracellular matrix fibrosis
2) Increase in smooth muscle and mucus gland mass
3) Angiogenesis
What is tryptase?
A smooth muscle mitogen
What plays a role in airway remodeling?
Tryptase
Airway remodeling represents a(n) ___(reversible /irreversible) process.
Irreversible
Which factors contribute to the severity of asthma?
1) Respiratory infection
2) Allergens
3) Exercise
4) Emotions
5) Occupational stimuli
Which respiratory viruses can increase asthma severity?
1) Respiratory syncytial virus (RSV)
2) Rhinovirus
3) Influenza
4) Parainfluenza
5) Mycoplasma pneumoniae
6) Chlamydia
Asthma is exacerbated in ___(warm and wet/cold and dry) climate.
Cold and dry
Long-term goals of asthma therapy?
1) Adequate symptom control and maintaining normal activity
2) Minimize asthma related death
3) Minimize exacerbations
4) Minimize persistent airflow limitations
5) Minimize drug adverse effects
What are some non-pharmacological asthma interventions?
1) No smoking and environmental tobacco exposure
2) Engage in physical exercise and weight reduction (be careful to prevent exercise-induced bronchoconstriction)
3) Avoid exposure to allergens or irritants
4) Avoid drugs that make asthma worse
5) Healthy diet high rich in fruits and vegetables
6) Breathing exercises
7) Dealing with emotional stress
Which drugs make asthma worse?
1) NSAIDs
2) Aspirin
3) Oral or ophthalmic βblockers
4) Acetaminophen (paracetamol)
What medications can be used to treat asthma?
1) Inhaled corticosteroids (ICS): 2) Short-acting inhaled β2-agonists (SABA)
3) Long-acting inhaled β2-agonists (LABA)
4) Muscarinic antagonists
5) Leukotriene receptor antagonists (LTRA)
6) Biologic therapy
Which drugs are inhaled corticosteroids?
1) Beclometasone dipropionate
2) Budesonide
3) Ciclesonide
4) Fluticasone propionate
5) Monetasone furoate
Which drugs are short-acting inhaled β2-agonists (SABA)?
1) Albuterol (salbutamol)
2) Levalbuterol
3) Terbutaline
Which drugs are long-acting inhaled β2-agonists (LABA)?
1) Formoterol
2) Salmeterol
Which drugs are ultra long-acting inhaled β2-agonists (LABA)?
1) Indacaterol
2) Vilanterol
3) Olodaterol
Which drugs are muscarinic antagonists?
1) Ipratropium bromide
2) Tiotropium bromide (LAMA)
What is the duration of action of Ipratropium bromide?
4-8 hours
What is the duration of action of Tiotropium bromide (LAMA)?
24 hours
Which drugs are Leukotriene receptor antagonists (LTRA)?
1) Zafirlukast
2) Montelukast
What is Omalizumab?
Anti-immunoglobulin E (Anti-IgE)
What is Dupilumab?
Anti-interleukin-4Rα
What is Tezepelumab?
Anti-thymic stromal lymphopoietin (anti-TSLP)
What are Mepolizumab,
Rezlizumab, and Benralizumab?
Anti-interleukin-5/5R
What should you test in acute severe asthma in the ED?
1) Lung function tests (PEF or FEV1)
2) O2 Sat
Which test is reserved for asthma patients who are poorly responsive to initial treatment
or deteriorating?
Arterial blood gases
The primary therapy of acute exacerbations is pharmacologic, which includes giving all of these concurrently:
1) β2-agonists
2) Corticosteroids
3) Inhaled ipratropium
4) O2
Why shouldn’t we use sedatives during an asthma attack?
Anxiety may be a sign of
hypoxemia = worsened by CNS depressants
Should you give antibiotics to a patient suffering from an exacerbation?
No, exacerbations are caused by viruses, not bacteria.
If a patient presents with an asthma attack and has a very high demand for O2, which organisms should you suspect?
1) Mycoplasma
2) Chlamydia
Which drugs can be prescribed as maintenance therapy?
1) ICS
2) ICS-LABA
3) ICS-LABA-LAMA
4) LTRA
5) Biologic therapy
What is asthma maintenance treatment?
Drugs prescribed for use every day or on a regular basis even when the patient does not have asthma symptoms
What is asthma controller treatment?
Targeting both symptom control and future risk
Which drugs can be prescribed as controller therapy?
ICS-containing relievers
What are asthma relievers?
Asthma inhalers taken as needed for quick relief of symptoms (rescue inhalers)
Which drugs can be prescribed as asthma relievers?
1) SABAs
2) ICS-SABA
Which drugs can be prescribed as Anti-inflammatory relievers (AIR)?
1) Low dose ICS
2) SABAs
Which drugs can be prescribed as Maintenance and reliever therapy (MART)?
ICS-Formoterol
What is the initial treatment of asthma ≥ 6 years of age?
ICS-containing treatment at time of diagnosis + reliever inhaler for quick relief of symptoms
Which drugs are given as the initial treatment of asthma ≥ 6 years of age?
1) Budesonide-formoterol
2) Beclomethasone-formoterol
3) ICS-salbutamol
What are the reasons for starting ICS-containing medications?
1) Reduction of risk of severe exacerbations and ER visits or hospitalization
2) Early initiation leads to greater improvement in lung function than delayed use
3) Reduction in long-term decline in lung function
4) For patients with occupational asthma
5)
In patients with occupational asthma, early removal from exposure to sensitizing agent and early ICS-containing treatment increases the probability of:
1) Resolution of symptoms
2) Improvement of lung function
3) Improvement of airway hyper-responsiveness
