Wk 4 Asthma & COPD

Question 1

Describe the pathophysiology, epidemiology, typical presenting features and consequences of asthma & chronic obstructive pulmonary disease (COPD)

Answer 1

Asthma:
Patho: chronic inflammatory condition of the airway, reversible airway obstruction
Epide: triggered by mould, dust, pet, drugs (aspirin/NSAIDs induce bronchoconstriction)
S/S: SOB, wheezing, chest tightness, coughing
Dx: FEV1 (↑ 12% with bronchodilator), FEV1/FVC < 80%

COPD:
Patho: a chronic progressive condition, irreversible
Epide: environmental/occupational exposure
S/S: productive cough, sputum plugs, SOB
Dx: FEV1 < 80%

Question 2

Demonstrate an understanding of evidence-based pharmacotherapy for asthma & COPD, including potential adverse effects, precautions and appropriate monitoring

Answer 2

Short-acting beta-agonist/SABA
- salbutamol, terbutaline
- MOA: effective bronchodilator for COPD and asthma
- AEs: tachycardia, tremor, headache
- CON:
> CVD - risk of cardiovascular AEs, worsen ie HTN, ischaemic heart disease, HF, arrhythimas
> diabetes - high dose SABA may induce hyperglycaemia

Long-acting beta-agonist/LABA

• salmeterol, formoterol
• NP: never used alone in asthma, always used with an ICS [can use alone in COPD]
• AEs: tachycardia, tremor, headache
• CON: CVD, diabetes (hyperglycaemia with high dose)

Inhaled corticosteroids/ICS
- budesonide, fluticasone
- NP: rinse mouth, use with LABA, not as effective in COPD
- AEs: adrenal suppression, osteoporosis, dyspepsia, hyperglycaemia
- CON:
> latent TB - may reactivate tuberculosis
> peptic ulcer - may worsen the ulcers
> diabetes - cause hyperglycaemia with high dose
> CVD (HTN, HF) - may be worsened due to Na+, H20 retention
> retard growth - adrenal suppression
> osteoporosis - long term use

Leukotriene receptor antagonist/LTRA

• montelukast
• Indication: always used in kids in tablet form
• headache, abdominal pain, diarrhoea

Short-acting muscarinic antagonists/SAMA

• ipratropium
• Indication: used in acute asthma attack, also used as a main bronchodilator in COPD
• CON: CVD
• AEs: headache, nausea

Long-acting muscarinic antagonist/LAMA

• tiotropium
• Indication: main symptom controlled in COPD, not used in asthma
• CON: CVD
• AEs: dry mouth, throat irritation

Question 3

What is the treatment to asthma/COPD exacerbation?

Answer 3

• most often give nebulisation, ie SABA.salbutamol, SAMA.iprotropium
• Pt is given systemic steroids
• oxygen therapy, antibiotics
• ventilator support for Pt with respiratory failure