Pulmonary pharmacology 2:

Question 1

how do you manage acute asthma attacks?

Answer 1

Quick relief = inhaled short acting beta 2 agonists

A&E= oxygen mask, nebulized beta 2 agonists(salbutamol), or oral prednisolone

Life threatening= magnesium sulphate through IV or IV aminiphylline, or intubation and ventilation

Question 2

describe your management of asthma and the treatment steps

Answer 2

Question 3

what is COPD?

Answer 3

chronic obstructive pulmonary disease = commonly a complication of cigarette smoking- damaged respiratory cilia and chronic colonization of lower airways by bacteria

• leads to persistant airflow limitation, progressive and largely irreversible

*COPD patients have sputum production, asthma patients do not

Question 4

what is the difference between chronic bronchitis and emphysema?

Answer 4

CHRONIC BRONCHITIS

Decreased bronchial luminal diameter

–Wall thickening (increased mononuclear cells, increased muscle mass & interstitial fibrosis)

–Intraluminal mucus and mucus plugs (hypertrophy and hyperplasia of bronchial mucus secreting glands, increased goblet cells)

• hyperextention of the lungs

EMPHYSEMA

Enlargement of airways distal to terminal bronchioles

–Acinar distruction - loss of gaseous exchange

Loss of lung recoil – chest hyperexpansion

Question 5

what are the stages of COPD?

Answer 5

stage 1 = 80% lung function - more frequent chest infections etc- aim is to keep it at this stage

stage 2= moderate COPD - 50-80% of lung function

stage 3= severe restratint of respiration, shortness of breath and frequent exacerbations

Stage 4= very severe and risky and decreased quality of life less than 30% lung function

Question 6

what is the management for acut COPD?

Answer 6

1. quick relief= inhaled beta 2 agonists -antibiotics for acute exacerbations with purulent sputum - course of oral prednisolone may be needed
2. A&E= oxygen mask- antbiotics, nebulised beta 2 agonists , oral or IV steroids
3. life threatening = add IV aminiphylline or salbutamol -

Question 7

what are the management methods for chronic COPD?

Answer 7

• SMOKING CESSATION
• Avoid occupational inhaled pollutants
• Vaccinations
• Bronchodilator
• b2 adrenoreceptor agonists
• Muscarinic (M3) antagonists
• Xanthines

•Anti-inflammatory Drugs

• Inhaled Glucocorticoids
• Selective PDE4 inhibitors (Roflumilast, Cilomilast)
• Long-Term Oxygen therapy (24%)
• Pulmonary Rehabilitation / Nutrition / Air Travel
• Surgery

Question 8

what is Alpha 1 antitrypsin deficiency

Answer 8

• a1 antitrypsin, a serine protease inhibitor, has a major role in inactivating neutrophil elastase, and is a major defense against the elastolytic burden in the lower airways posed by neutrophil elastase.
• In addition to emphysema and bronchiectasis patients with a1-antitrypsin deficiency also at risk of liver disorders, skin disease and vasculitis

Question 9

describe type 1 and type 2 respiratory failure

Answer 9

Type 1= ventilation-perfusion mismatching- so they have low plasma oxygen but their CO2 is normal or low - cuases include asthma, pulmonary embolism etc - hyper dose oxygen

Type 2= hypoventilation throughout lungs, PO2 is low and PCO2 is high causes include COPD and sedative overdose - give los dose oxygen

Question 10

what are the reasons for a chronic cough?

Answer 10

• Acute respiratory infection (URTI, Pneumonia)
• Chronic respiratory infections (Cystic fibrosis, Bronchiectasis, Postnasal drip)
• Airways disease (Asthma, COPD)
• Parenchymal disease (Interstitial fibrosis)
• Irritant (cigarette smoke, inhaled foreign body)
• Drug-induced (ACE-inhibitors, inhaled drugs)
• Bronchopulmonary malignancy

Question 11

what Antitussives can we use to suppress coughs?

Answer 11

codeine = good cough suppressnat but decreased mucociliary clearance and decreases secretions

dextromethorphan = synthetic opioid. does not cause addiction, decrease mucociliary clearance or constipation

peripherally acting drugs reduce sensitivity of cough receptors

• local anaethetics (used during bronchoscopy and nebulized for chronic cough)
• mentol vapor and lozenges impregnated with mentol or eucalyptus oil

Question 12

what do expectorants do?

Answer 12

they increase the fluidity of secretions - most act as gastric mucosa irritants and reflex timulation of bronchial globlet cells and submucosal glands

*putting your head over a bucket of steam is a better expectorant than any of the expectorants you can buy from a pharmacy- boiling water and menthol vapor works better than the lot of them - the drug companies push them because they don’t have to prove efficacy, just safety to sell them

*the exception to this is mucolytics = which break disulphide cross-linking and reduce bronchial secretions viscosity= they actually breakdown cells themselves and the DNA - it’s not available over the counter