Therapeutics of Obstructive Pulmonary Disease

Question 1

Why can corticosteroids cause pneumonia in COPD patients and which drug does it tend to be?

Answer 1

Due to local immune suppression and imparied mucociliary clearance.
Often Fluticasone. Slide 10

Question 2

What is a an example of an oral and inhaled steroid?

Answer 2

Oral = prednisolone
Inhaled = beclomethasone. Slide 10

Question 3

What size do particles need to be to reach passed the 7th generation of the bronchioles?

Answer 3

less than 2 microns. Slide 13

Question 4

What do spacers do?

Answer 4

Reduce particle size and velocity.
Improves lung deposition.
Avoids coordination problems with the inhaler. Slide 15

Question 5

What are cromones used for, how are they administered and are they effective?

Answer 5

They are used for asthma and are administered through inhalation.
They have poor efficacy.
Slide 17

Question 6

What does the leukotriene LTD4 do in asthma?

Answer 6

Increased mucous secretion, eosinophil influx, airway muscle contraction and proliferation. Slide 19

Question 7

What are leukotriene receptor antagonists used for and what is an example?

Answer 7

It is used in asthma as an anti inflammatory.

E.g. Montelukast and it always administered in addition to something. Slide 20

Question 8

What does EIB mean?

Answer 8

Exercise Induced Asthma. Slide 20

Question 9

When are Anti-IgE monoclonal antibodies used and and are they effective?

Answer 9

They are only used for patients with severe persistent allergic asthma despite having used max therapy.
It is very expensive but reduces exacerbations.
E.g. Omalizumab.
Slide 21

Question 10

What does SMART stand for and what do they do?

Answer 10

Single Maintenance And Reliever Therapy.

Often combination inhalers and targets the full inflammatory cascade. Slide 24

Question 11

What do muscarinic antagonists do and what are examples of them?

Answer 11

They block post junctional end plate M3 receptors and cause bronchodilation.
There are short acting ones e.g. Ipratropium and long acting e.g. Tiotropium. Slide 26

Question 12

What are methylxanthines and when are they used?

Answer 12

They are bronchodilators and anti inflammatory. Some are used to maintain therapy such as theophylline for nocturnal dips. Slide 27

Question 13

What do mucolytics do?

Answer 13

Reduce sputum viscosity and are only used as add on to other treatments. Slide 29

Question 14

What is the best treatment of chronic asthma?

Answer 14

To suppress inflammatory cascade with inh. steroid or using a non steroid anti-inflam therapy.
And stabilise smooth muscle with LABA/LAMA. Slide 30

Question 15

What is the best treatment of acute asthma?

Answer 15

Oral prednisolone,

Nebulised salbutamol, NEVER use inhaled steroids. Slide 31

Question 16

What is the best treatment of COPD?

Answer 16

Reduce exacerbations i.e. smoking
LAMA/LABA mono.
LABA/LAMA combo.
ICS/LABA combo.
ICS/LAMA/LABA combo. Slide 34

Question 17

What is better? Monotherapy or combination therapy?

Answer 17

Combination. Slide 34

Question 18

What is the best treatment of acute COPD?

Answer 18

Nebulised Salbutamol and ipratropium.
Antibiotic if infection.
Non invasive ventilation.
NO INHALED STEROIDS. Slide 37