Treatment of Obstructive Lung Disease Flashcards
__________ are the most potent anti-inflammatory medications for the treatment of asthma.
inhaled corticosteroids
_________ (type of drug) tend to be the preferred supplementary treatment added to inhaled corticosteroid therapy for asthma and for COPD.
bronchodilators (especially long acting)
short acting bronchodilators are used to relieve symptoms in
a. ) asthma
b. ) COPD
c. ) bronchitis
d. ) a and b
e. ) a and c
D
Use short-acting bronchodilators for help with symptoms in both asthma and COPD
Well-controlled asthma is defined how? How does this compare with ‘not well controlled asthma’ and ‘very poorly controlled asthma’?
- symptoms no more than 2x/wk
- nighttime symtoms no more than 2x/mo
- SABA used less than twice weekly (except for before exercise)
- FEV1 (peak flow) >80% predicted
less important:
-oral steroid and/or urgent care visit no more than once per year
Think about it this way, not well controlled asthma is anything outside of the normal range and Very poorly controlled is if you times those numbers by 8 (exception FEV1
How do we classify severity of asthma?
intermittent= same conditions as well-controlled asthma (outlined in a previous card) (this is step 1 on the managing asthma chart)
Persistant= anything above those values. Persistant is further broken down into mild, moderate, and severe. There is a good table of this in the PDF if you really want to know more (This comprises step 2-6 on the managing asthma chart).
In steps 5 and 6 (most severe persistent asthma) what drug should you consider for patients who have allergies?
omalizumab
What is the progression of dosing as asthma worsens on the managing asthma chart?
SABA–>low dose ICS–>low dose ICS + LABA–>medium dose ICS + LABA–>High dose ICS + LABA–>High dose ICS + LABA + oral corticosteroid
Those are the recommended treatments for patients in steps 1-6.
How do you decide to step someone up or down on the managing asthma chart?
step up: first check adherence, environmental control, and comorbid conditions then step up treatment if necessary. Then check back with them in 2 weeks to make sure that they’re doing ok.
step down: do this if possible. Asthma should be well controlled for at least 3 months before going down
T or F it is a good idea to use LABA in conjunction with an inhaled corticosteroid.
T. LABA should never be used as a monotherapy because LABAs do not reduce inflammation, they are used with an inhaled corticosteroid to control the inflammation component.
What are the two biologics we need to know for the treatment of asthma and what do they do?
Omalizumab- anti-IgE (inhibits binding of IgE to mast cells and basophils. This decreases the allergic response)
Mepolizumab- anti-IL5. (IL5 helps eosinophils grow and survive)
Other options for medications for asthma– describe each of these briefly:
- Allergen immunotherapy
- Tiotropium
- Sustained-release theophylline
- Cromolyn sodium and nedocromil
- Induces specific allergen tolerance in patient
- new medication for people older than 12; its a long-acting anticholinergic
- not used anymore (adverse effects)
- not used anymore (we have better meds now)
How do B-adrenergic agonists work?
stimulate B-adrenergic receptor to cause bronchodilation via smooth muscle relaxation. Also inhibits production of respiratory secretions
How do anticholinergics work?
inhibits cholinergic receptor. Has the same effect as B-agonists (bronchodilation via smooth muscle relaxation and inhibits production of respiratory secretions).
How do Glucocorticoids work?
Exact mechanism is not well known.
They are anti-inflammatory (reduce cell infiltration by eosinophils, mast cells, lymphocytes etc).
They also reduce edema
What can be a negative effect of ICS on youth?
stunted growth
What do leukotriene modifiers do?
- bronchodilators
- anti-inflammatory (because blocks leukotrienes)
- attenuates exercise-induced asthma
They work as a Leukotriene D4 (LTD4) antagonist and a 5-lipoxygenase inhibitor
What particle sizes constitute the “respirable range”?
1-5 um
If it is bigger it can get stuck in the mouth or bigger airways and not go to the lungs but if it is smaller then it will go into the lungs and come out again without being deposited. Drugs that wish to affect the lung should be within this size range.
Whats the difference between COPD and Asthma?
Asthma is intermittent (between episodes you’re normal) and reversible. COPD is not :(
Just about everyone with COPD has _______. This is characterized by an FEV1/FVC
airway obstruction
0.70
How is the GOLD spirometric classification for COPD broken down?
GOLD1: mild = FEV1>80% predicted
GOLD4: very severe = FEV1
How is COPD classified?
A- low risk, low symptoms
B- low risk, high symptoms
C- high risk, low symptoms
D- high risk, high symptoms
A & B = GOLD 1-2 with 0-1 exacerbations per year
C & D = GOLD 3-4 with 2 or more exacerbations per year
What are the most important things for treatment of COPD?
quit smoking
exercise
and refer to pulmonary rehab because can be hard to exercise if lungs are messed up.
According to the way we classified COPD, what are the different ways we treat patients A-D?
A- quit smoking and exercise
B, C, D- same as A but also include pulmonary rehab
What drugs do we use for COPD?
The same ones we use for asthma.
systemic corticosteroids, SABA, LABA etc…
However, in COPD we often start with a short acting anticholinergic (SAMA) instead of with a short acting beta agonist (SABA)
How do we pick what drugs to use for what COPD patients?
A- SAMA
B- LAMA
C- ICS + LAMA
D- ICS + LAMA
Can also substitute SABA for SAMA and LABA for LAMA
