treatment of airways disease

Question 1

nicotine replacements?

Answer 1

Offer nicotine replacement therapy, varenicline or
bupropion (unless contraindicated) combined with a
support programme to optimise quit rates

Question 2

smooth muscle dysfunction

Answer 2

bronchocontriction

bronchia hyper reactivity

hyperplasia

inflammatory mediator release

treated with bronchodilators

Question 3

airway Inflammation

Answer 3

inflammatory cell infiltration/activiation

mucosal oedema

cellular proliferation

epithelial damage

basement membrane thickeninig

treat with corticosteroids

Question 4

bronchoodilators

Answer 4

Short acting b2
-agonist adrenoceptor
Salbutamol / terbutaline

Long acting b2
-agonist adrenoceptor
Salmeterol /eformoterol /formoterol /indacaterol

Anticholinergic
Ipratropium / tiotropium

Question 5

inhaled corticosteroids

Answer 5

• Beclometasone dipropionate
• Budesonide
• Fluticasone propionate
• Ciclesonide

Question 6

other asthma treatment?

Answer 6

Xanthines
• Aminophylline
• SR aminophylline

Anti-leukotreines
• Monteleukast
• zafirleukast

Question 7

side effects of beta 2 agonists?

Answer 7

Muscle tremor
• Muscle cramps
• Tachycardia
• Hypokalaemia
• Restlessness

Question 8

effects of corticosteroids?

Answer 8

Question 9

side effects of inhaled corticosteroids?

Answer 9

Cough
• Oral candidiosis
• Dysphonia

 Bruising
 Growth suppression
 Cataracts
 Glaucoma
 Adrenal suppression
 Osteoporosis
 Psychiatric disturbance

Question 10

side effects of oral corticosteroids?

Answer 10

 Bruising
 Growth suppression
 Cataracts
 Glaucoma
 Adrenal suppression
 Osteoporosis
 Psychiatric disturbance
 Glucose intolerance and diabetes mellitus

Question 11

anticholinergic drugs?

Answer 11

• Inhibit vagally mediated tone
• Small effect in normal airways
• Greater effect in COPD

side effects

• Dry mouth
• Blurred vision
• Glaucoma
• Urinary retention

Question 12

inhaled steroids in COPD?

Answer 12

• Do not affect the rate of decline in FEV1
• Beneficial effect on exacerbation rate in
moderate-severe disease
• Slow the rate of decline in health status
• May improve long term survival

Question 13

drugs and effectd

Answer 13

ics/laba - reduced risk of re-hospitalisatio or dath

salmeterol/flut - cuts the rate of exacerbation in COPD

formoterol/budesonide - cuts the number of oral steroids courses

Question 14

other treatment options

Answer 14

• Pulmonary rehabilitation
• Long term oxygen therapy
• Non-invasive ventilation
• Lung volume reduction surgery
• Cardiovascular complications
• Osteoporosis
• Palliative care