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Medical Studies 1 > 6.6 Management of Asthma and COPD > Flashcards

6.6 Management of Asthma and COPD Flashcards

1
Q

List some non-pharmacological treatment methods for asthma

A
  • Trigger avoidance
  • Vaccinations
  • Education
  • Action plan
  • Exercise + Pulmonary Rehab
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2
Q

Fundamentally, what is the mechanism of action of SABAs and LABAs (short/long acting beta agonists)

A
  • Activate B2 receptors
  • Promote bronchodilation
  • Help with airway obstruction by allowing flow of air
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3
Q

LAMA (long-acting muscarinic agonist) mechanism

A
  • Blocks M3 receptors
  • inhibits bronchoconstriction
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4
Q

Mechanism of ICS (inhaled corticosteroids)

A
  • Reverse acetlyation of histones
  • Decrease gene expression
  • Decrease synthesis of inflammatory regulators
  • Decrease local inflammation in airways
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5
Q

What does SMART therapy stand for?

A

Single Maintenance and Reliever Therapy (both in one)

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6
Q

Should you ever give a LABA alone in asthma?

A

No. Increased mortality risk.

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7
Q

Why is SABA-only treatment not preferable?

A
  • Because it doesn’t address the underlying airway inflammation; it only reduces constriction of the bronchioles
  • And, it trains the patients to think that that’s the primary treatment
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8
Q

What adverse effects are associated with frequent SABA use?

A
  • Beta receptor downregulation
  • Decreased bronchodilator response
  • Increased allergic response
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9
Q

What adverse clinical outcomes are associated with frequent SABA use?

A
  • > 1.7 puffs per day associated with increased ED presentations
  • > 12 cannisters associated with higher risk of death
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10
Q

Track 1 vs Track 2 asthma treatment

A

Track 1: ICS + LABA
Track 2: ICS (preventer) + SABA (reliever)

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11
Q

What percentage of people with asthma have severe asthma?

A

3-10%

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12
Q

Upper airway comorbidities of asthma

A
  • Allergic rhinitis
  • Chronic rhinosinusitis
  • Vocal cord dysfunction
  • Sleep apnoea
  • Dysfunctional breathing
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13
Q

Lower airway comorbidities of asthma

A
  • COPD
  • Bronchiectasis
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14
Q

Extrapulmonary complications of asthma

A
  • Obesity
  • Anxiety and depression
  • Osteoporosis
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15
Q

Severe asthma therapies add-ons (not monoclonal antibodies)

A
  • LAMA therapy
  • Leukotriene receptor antagonists
  • Macrolides
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16
Q

Describe airway thermoplasty

A
  • Bronchoscope into airways
  • Apply radio-frequency light to decrease smooth muscle bulk in airways
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17
Q

Which different professionals supervise a pulmonary rehab program?

A
  • Doctor
  • Nurse
  • Physio
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18
Q

What does pulmonary rehab involve?

A
  • Exercise training
  • Education (medication/health)
  • Inhaler techniques
  • Breathing techniques
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19
Q

Is pulmonary rehab repeatable?

20
Q

How can room temperature affect COPD?

A
  • 21°C is optimal
  • Lower (e.g. England) and higher (e.g. Australia) increase chance of exacerbations
21
Q

“Exacerbator”/”Frequent Exacerbator” frequency? in COPD

A

Exacerbator: 1/year
Frequent: 2 or more

22
Q

Drugs that are useful for COPD

A
  • LAMAs
  • LABAs
  • ICSs
  • Mucolytics (depending on patient)
23
Q

A patient with COPD cannot have LAMAs. What is the recommended treatment, and what investigation does this warrant first?

A
  • Give LAMAs alone
  • BUT, this is forbidden in asthma; do not do it unless you are sure the patient doesn’t have asthma
24
Q

If a COPD patient has taken a LAMA or a LABA, but could still be better, what would you give?

A

You would give a LAMA/LABA combination

25
What is a "triple" in COPD patients?
LAMA + LABA + ICS
26
Are higher or lower eosinophil levels associated with needing ICS?
Higher (>300/micro L)
27
How does Chartis test if a lung area is worth isolating with a valve
- Inflates, preventing air from flowing in - Tests air coming out - If it stops coming out gradually with time, then area is dead, and you can isolate with a valve - Otherwise, don't
28
What are some signs that a COPD exacerbation could be occurring?
- Increased dyspnoea - Increased cough - Increased sputum volume - Increased sputum purulence
29
Describe the treatment of COPD flare-ups
- Establish goals (Palliation? Throw everything we've got at it?) - Apply oxygen if sats below 89% - Consider systemic corticosteroids and antibiotics - Non-invasive ventilation (e.g. BiPAP)
30
Why is communication crucial in multi-disciplinary teams
- Not all people use shared databases - It is crucial to keep all team members up to date about a patient to ensure correct decisions can be made about treatment - Avoids duplication of care
31
Why are GPs crucial in multi-disciplinary teams?
- They "see the bigger picture" - Connect patients with other health professionals/specialists - Access to medicare benefits where applicable - Building a team based on their knowledge of the patient
32
Role of respiratory specialist in multidisciplinary COPD teams
- Deal with more severe cases - Diagnostic uncertainty
33
Role of respiratory nurses in multidiscplinary COPD teams
- Action plan development - Education - In-home care - Emotional support - Long-term planning
34
Role of physios in multidisciplinary COPD teams
- Rehabilitation - Airway clearance techniques - Exercise testing and training
35
Preventers vs relievers
Preventers: used daily to stop symptoms Relievers: used when necessary to relieve symptoms
36
Beta agonist mechanism
- Bind to B2 receptors - Cause airway dilation
37
LAMA mechanism
- Inhibit M3 receptorsd - Prevent bronchoconstriction
38
Inhaled glucocorticoid mechanism
- Bind intracellular glucocorticoid recptors - Increased expression of anti-inflammatory genes - Suppression of pro-inflammatory genes
39
Mucolytics mechanism of action
They break the disulfie bonds within mucous molecules
40
Why can't all ICS-LABA puffers be used in SMART asthma treatment?
Because not all LABAs are short-acting enough to be used as an acute reliever
41
Three levels of inhaler treatment in COPD
1: LAMA 2: LAMA + LABA 3: LAMA + LABA + ICS ("triple")
42
List some people who may be in a multi-disciplinary team for a COPD patient
- Physio - OT - Respiratory specialist - Respiratory nurse - Psychologist
43
Benefits of multi disciplinary teams
- more efficient use of resources - improved communication
44
Features of a good multi disciplinary team
- patient-centred - trusting relationships - ongoing professional development
45
What is a COPD self-management plan?
A structured but personalised plan that empowers patients to control their own condition as much as possible, improving quality of life and mental health in the process. It helps patients to: - Understand the severity of their symptoms - Control these symptoms themselves, where possible - Know when to seek help
46

Medical Studies 1 (90 decks)

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