L14 - inhaled therapies

Question 1

Obstructive lung disease

Answer 1

show reduced FEV1/FVC ratio under 0.7

reduction in expiratory flow rate

Question 2

Asthma age of onset

Answer 2

usually less than 30

Question 3

COPD age of onset

Answer 3

usually 35+

Question 4

Asthma smoking history

Answer 4

no clear aertiology

Question 5

COPD smoking history

Answer 5

usually 10+ pack-years

Question 6

Asthma sputum production

Answer 6

infrequent

Question 7

COPD sputum production

Answer 7

common in chronic bronchitis

Question 8

Asthma allergies

Answer 8

often in early onset

Question 9

COPD allergies

Answer 9

1/3 of general population

Question 10

Asthma disease course

Answer 10

stable with exacerbations

Question 11

COPD disease course

Answer 11

progressive with exacerbations

Question 12

Asthma spirometry

Answer 12

likely to normalise with treatment

Question 13

COPD spirometry

Answer 13

may improve but never normal

Question 14

Asthma symptoms

Answer 14

intermittent and variable

Question 15

COPD symptons

Answer 15

persistent and variable

Question 16

Asthma treatment response

Answer 16

responds well to therapy, especially corticosteroids

Question 17

COPD treatment response

Answer 17

less responsive to therapy

Question 18

atopic asthma

Answer 18

fungal allergy, common aeroallergens, occupations, pets exposures

Question 19

Non-eosinophilic asthma

Answer 19

non-smoking non-eosinophilic, smoking-associated, obesity-related

Question 20

COPD

Answer 20

incomplete reversible airways obstruction, usually with a background of smoking or other fume/dust exposures, variable in individual presentations/specific phenotypes

Question 21

COPD phenotypes

Answer 21

emphysema vs. chronic bronchitis
frequent exacerbations of 2 or more years
eosinophilic.non-eosinophilic inflammation

Question 22

Asthma and COPD

Answer 22

increasing recognition of coexistence of diseases aka ACOS

Question 23

Inhaled therapies

Answer 23

targeting for specific airway locations, minimises adverse effects

Question 24

Drug deposition dependent on…

Answer 24

particle size, device delivery, drug nature, flow rates, underlying disease and regional differences in lung ventilation

Question 25

Bronchodilators

Answer 25

beta agonists and muscarinic receptors

short-acting bronchodilators open up constricted smooth muscle in both asthma and COPD, nebulisers for high dose therapy

Question 26

B2 agonist mechanism

Answer 26

Stimulation of B2-adrenoreceptors results in activation of adenylate cyclase, increased intracellular cAMP and subsequent airway smooth muscle relaxation

Question 27

B2 agonist adverse effects

Answer 27

rising cAMP may activate Na+/K+ exchange pump

tachycardia, hyperglycaemia, loss of insulin selectivity, increased liver glucose release

Question 28

Long acting B2 agonists

Answer 28

valuable bronchodilators with possible anti-inflammatory actions

Question 29

Long-acting anti-muscarinics

Answer 29

parasympathetic nervous system regulates airway tone, these block ACh action on the muscarinic receptors which leads to bronchodilator and reduced mucus secretion

Question 30

COPD without exacerbations

Answer 30

bronchodilator is the mainstay of treatment, LABA/LAMA with SABA as needed

Question 31

Corticosteroids mechanism of action

Answer 31

Steroids treat the processes that drive remodelling. airway smooth muscle proliferation, epithelial injury
inhibit inflammation and promote epithelial integrity

Question 32

Inhaled corticosteroids

Answer 32

minimise systemic absorption, reduce side effects to mostly localised adverse effects, range of inhaled steroids with varying potency

Question 33

ICS in asthma

Answer 33

prescribed to almost all sufferers

ICS/LAVA combinations are common and effetive

Question 34

ICS in COPD

Answer 34

more controversial, reduces exacerbation frequency, may increase pneumonia frequency, may be useful in ACOS

Question 35

Asthma-COPD overlap

Answer 35

common, variable airway obstruction but not completey reversible, smoke exposure and infections, more symptomatic with greater healthcare burden

Question 36

Fundamentals of treatment

Answer 36

concordance with therapy is poor - supervised trials using inflammatory markers to monitor
inhaler eduction is key
device selection is vital

Question 37

Treatment goals

Answer 37

most patients have poor control, aim to improve control, address important issues for patients, maximum symptom relief with minimal side effects

Question 38

Immediate management

Answer 38

oxygen up to 60%, salbutamol nebulise,r prednisolone and magnesium or aminophylline IV