Asthma and COPD

Question 1

What is complete control of asthma defined as (6)

Answer 1

1. no daytime symptoms
2. no night-time awakening due to asthma
3. no asthma attacks, no need for rescue medication
4. no limitations on activity including exercise
5. normal lung function
6. minimal side-effects from treatment

Question 2

what non-pharmacological advice can you give to asthmatic patients (5)

Answer 2

1. life style advice
2. weight loss
3. smoking cessation
4. avoiding triggers
5. breathing exercise programmes

Question 3

what is the initial treatment for asthma?

Answer 3

SABA + ICS

Question 4

name two SABAs

Answer 4

salbutamol, terbutaline

Question 5

name two LABAs

Answer 5

salmeterol, formoterol

Question 6

how do beta-2 agonists work?

Answer 6

smooth muscle relaxation

Question 7

what are some side effects of beta-2 agonists (5)

Answer 7

• tachycardia
• palpitations
• anxiety
• tremor
• LABAs can cause muscle cramps

Question 8

name 3 examples of inhaled corticosteroids

Answer 8

beclometasone
budesonide
fluticasone

Question 9

how do ICS work?

Answer 9

down regulate inflammatory cells and upregulate anti-inflammatory proteins.
causes a reduction in mucosal inflammation, widens airways and reduces mucus secretions

Question 10

what is the main side effect from ICS?

Answer 10

oral candidiasis

Question 11

What would you add on to an asthmatic whose asthma is not well controlled by a SABA + ICS

Answer 11

LABA

e.g. salmeterol, formoterol

Question 12

what might you check first if an asthmatic patient comes to you with poorly controlled asthma on a SABA + ICS?

Answer 12

• check adherence and inhaler technique

- offer a spacer device if appropriate

Question 13

which has a faster onset of action: formoterol or salmeterol?

Answer 13

formoterol

think F for Fast

Question 14

if the addition of a LABA in an asthmatic is not working what could you try (class and name of drug)

Answer 14

montelukast - a leukotriene receptor antagonist.
or
Long acting muscarinic receptor antagonists (ipatropium, tiotropium)

Question 15

how do LTRA work?

Answer 15

reduce inflammation and bronchoconstriction

Question 16

what is the mechanism of action of LAMAs?

Answer 16

inhibitor of ACh so they cause the opposite effects of parasympathetic NS so you get smooth muscle relaxation in the respiratory tract and reduced secretions.

Question 17

what is the only SAMA available?

Answer 17

ipratropium

Question 18

name the LAMAs

Answer 18

tiotrpium, glycopyrronium, aclidinium

Question 19

Do LAMAs tend to be more useful in COPD or asthma management?

Answer 19

COPD.

they have a place in asthma when added to a beta-2 adrenoceptor agonist in severe exacerbations of asthma

Question 20

what is the MOA for theophylline?

Answer 20

inhibits phosphodiesterase and blocks adenosine receptors

Question 21

what is the indication for theophylline?

Answer 21

IV for status asthmaticus.

orally for sustained relief

Question 22

what is the problem with prescribing theophylline?

Answer 22

narrow therapeutic window so can result in cardiac arrhythmias, seizures, GI disturbance.
also has lots of drug interactions

Question 23

if a patient comes to you with well controlled asthma what might you do about his medication?

Answer 23

Can consider decreasing dose of ICS but do this slowly by decreasing the dose by 25-50% every 3 months

Question 24

in life-threatening asthma what does the mnemonic 33, 92, CHEST stand for?

Answer 24

33: PEFR <33% predicted
92: sats<92%
Cyanosis
Hypotension
Exhasution
Silent chest
Tachycardia

Question 25

how would you treat an acute asthma attack initially?

Answer 25

Oxygen in non-rebreather
SABA by oxygen driven nebuliser
Prednisolong 40mg for 5 days minimum until symptoms improve orally, or IV hydrocortisone for those unable to take oral meds

Question 26

what could you add in to initial treatment to treat acute severe asthma attack

Answer 26

add nebulised ipratropium bromide
or
IV magnesium under specialist supervision

Question 27

what non-pharmacological measures can you advise for someone with COPD?

Answer 27

• smoking cessation
• pulmonary rehabilitation
• Encourage physical activity
• pneumococcal and influenza vaccination to reduce risk of infection
• co-develop a personalised self-management plan

Question 28

do all people diagnosed with COPD require inhalers?

Answer 28

not if they are not breathless and if it doesn’t interfere with exercise than it’s OK

Question 29

what inhaled therapy would you first offer to a COPD patient?

Answer 29

SABA or SAMA to use when required

Question 30

what is second line COPD in someone who has no asthmatic features or features suggesting steroid responsiveness?

Answer 30

LABA + LAMA

Question 31

What inhalers would you try in a COPD patient already on a LABA and LAMA who is getting day-to-day symptoms that adversely impact quality of life?

Answer 31

add ICS to the current LABA + LAMA for 3 month trial and if it doesn’t improve revert back to LABA +LAMA

Question 32

what would be second line to a COPD patient who showed signs of asthmatic features or features suggesting steroid responsiveness?

Answer 32

LABA + ICS

Question 33

what could you try pharmacologically in a patient with COPD who shows signs of steroid responsiveness but who is already on a LABA + ICS and it is not managing the COPD effectively?

Answer 33

offer LABA + LAMA + ICS