asthma and COPD

Question 1

Pathophysiology of asthma

Answer 1

Inflammatory disorder of the airways
- flare ups of breathlessness/SOB, chest tightness, coughing, and wheezing
- can progress to COPD if poorly controlled (loss of normal bronchiole elasticity, increase in bronchiole smooth muscle)
- can be triggered by allergens or environmental factors
- pt diagnosed at an early age - most patient below 35
REVERSED WITH RELIEVERS

Question 2

What immune cell is mostly responsible for inflammation in asthma?

Answer 2

eosinophils

Question 3

Pathophysiology of COPD

Answer 3

chronic and progress condition involving airway inflammation and limitation that is not fully reversible (NOT REVERSED POST-THERAPY)
- persistant and progressive breathlessness
- almost all patients have a smoking history
- most patients above 45
- no allergic component

Question 4

What chronic conditions are including within the COPD buddle?

Answer 4

chronic bronchitis, emphysema

Question 5

What immune cell is responsible for inflammation in COPD?

Answer 5

neutrophils

Question 6

Asthma vs COPD

Answer 6

Similarities:
- both involve inflammation within respiratory tract
- both result in breathlessness, chest tightness, wheeze, and cough

Differences:
- asthma - reversible, eosinophils, most common in pt below 35, triggered by allergens
- COPD - no allergic component, not fully reversible, most pt have smoking history, most common in patients above 40, sputum

Question 7

What drug class worsens asthma?

Answer 7

NSAIDs , aspirin - can trigger bronchospasm and rhinitis

Question 8

Diagnostic tests for asthma vs COPD

Answer 8

spirometry (ratio of forced expiratory volume and forced vital capacity)
- in both asthma and COPD FEV1/FVC is less than 80%
asthma
- FEV1/FVC = over 12% improvement from baseline following bronchodilator

COPD
- less than 80% of predicted value

Question 9

Before stepping up treatment you must always check:

Answer 9

1. medication adherence - do not step up if patient is not correctly following medication regime
2. inhaler technique - often inhaler technique is incorrect, altering preventer/reliever effectiveness

Question 10

Steps in asthma treatment

Answer 10

1. SABA - Salbutamol, terbutaline
2. ICS + SABA
3. ICS + LABA - formoterol, salmeterol, vilanterol
4. ICS medium-high dose + LABA
5. Specialist treatment

Question 11

What are examples of SABA?

Answer 11

salbutamol, terbutaline

Question 12

LABA examples

Answer 12

formoterol, salmeterol, vilanterol

Question 13

ICS examples

Answer 13

Budesonide, fluticasone

Question 14

LTRA examples

Answer 14

Montelukast

Question 15

SAMA examples

Answer 15

Ipratropium

Question 16

LAMA examples

Answer 16

Tiotropium

Question 17

Theophylline examples

Answer 17

theophylline

Question 18

At what type of day is asthma at its worst?

Answer 18

early morning due to cold air

Question 19

Steps in asthma treatment for children

Answer 19

1. PRN reliever - SABA
2. Regular preventer (ICS low dose or montelukast) + PRN reliever
3. ICS (low dose) + montelukast + PRN reliever
4. add on specialist treatment

Question 20

Which drug class can never be used alone in asthma treatment (must always be paired with ICS)?

Answer 20

LABA

Question 21

Adverse effects in SABA overdose

Answer 21

palpations, tachycardia, tremor

Question 22

Asthma medication vs COPD medication

Answer 22

• Less use of ICS in COPD
• LABA can be used on own in COPD
• SAMA and LAMAs more commonly used in COPD (only recently approved in asthma but uncommon)

Question 23

Main medications in COPD

Answer 23

anti-muscarinic drugs (bronchodilators) - SAMA, LAMA (can be used with ICS)
ICS - variable effect against neutrophils

Question 24

What drug class cannot be used on its own in asthma?

Answer 24

LABA
Must be used with ICS or associated w/ worse outcomes

Question 25

Stepping up in paediatric asthma therapy (6-11)

Answer 25

1. SABA as a reliever
2. Montelukast (preventer) OR ICS (low dose) + SABA (reliever)
3. ICS (high paediatric dose) OR ICS/LABA combination (low dose) OR ICS (Low dose) w/ montelukast + SABA (reliever)
4. specialist treatment

Question 26

stepping up in paediatric therapy (1-5)

Answer 26

1. SABA (reliever)
2. ICS (low dose) OR montelukast + SABA (reliever)
3. ICS (low dose) w/ montelukast or ICS (high paediatric dose) + SABA (reliever)
4. specialist treatment