Asthma and COPD Overview
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Questions and Answers

Which of the following symptoms is NOT commonly associated with asthma?

  • Chest tightness
  • Shortness of breath
  • Wheezing
  • Fever (correct)

    • What physiological change is primarily responsible for asthma symptoms?

  • Increased airway smooth muscle relaxation
  • Increased lung volume
  • Reversible narrowing of the bronchial airways (correct)
  • Decreased production of mucus

    • Which of the following factors is considered a common provoker of asthma attacks?

  • Regular exercise
  • Cold air (correct)
  • High humidity
  • High protein diet

    • What differentiation is made between early-phase and late-phase allergic reactions in asthma?

    <p>Early-phase reactions involve IgE-mediated mast cell activation.</p> Signup and view all the answers

    Which of the following does NOT contribute to the pathological changes observed in asthma?

    <p>Decrease in IgE production</p> Signup and view all the answers

    Which statement about allergen exposure in asthma is accurate?

    <p>Not all adults with asthma exhibit allergic sensitivity.</p> Signup and view all the answers

    What type of molecule is primarily released by mast cells during the early-phase allergic reaction?

    <p>Histamine</p> Signup and view all the answers

    What is a significant characteristic of the airway wall in asthma?

    <p>Narrowing of the airway lumen</p> Signup and view all the answers

    What is the recommended treatment for patients with persistent symptoms of exertional dyspnea?

    <p>Regular use of a long-acting bronchodilator or the combination of both LABA and anticholinergic</p> Signup and view all the answers

    What is a key consideration when using theophylline in COPD treatment?

    <p>It may improve diaphragmatic function</p> Signup and view all the answers

    Why is the use of ICS in COPD treatment less effective compared to asthma?

    <p>ICS have lower efficacy and associated risks in COPD</p> Signup and view all the answers

    Which of the following statements about roflumilast is correct?

    <p>It reduces exacerbation frequency in COPD</p> Signup and view all the answers

    What is a recommended treatment for patients with a history of two or more exacerbations?

    <p>Daily treatment with an ICS</p> Signup and view all the answers

    Which class of medications is primarily used for short-term relief of bronchoconstriction in asthma?

    <p>Short-acting β2 agonists</p> Signup and view all the answers

    What is the mechanism of action of β2-adrenoceptor stimulants in asthma management?

    <p>Inhibit the release of broncho-constricting mediators</p> Signup and view all the answers

    Which type of drug is contraindicated for acute asthma episodes due to slow onset of action?

    <p>Long-acting β2 agonists</p> Signup and view all the answers

    What is the primary benefit of inhaled corticosteroids in asthma management?

    <p>Long-term inflammation control</p> Signup and view all the answers

    Which medication is categorized as a short-acting β2 agonist?

    <p>Albuterol</p> Signup and view all the answers

    Which of the following is a side effect associated with sympathomimetic agents in asthma treatment?

    <p>Increased cardiac contraction</p> Signup and view all the answers

    What role do leukotriene receptor antagonists play in asthma treatment?

    <p>They block the action of inflammatory mediators.</p> Signup and view all the answers

    Which medication is known for causing maximal bronchodilation within 5 minutes when inhaled, but is not commonly used today?

    <p>Isoproterenol</p> Signup and view all the answers

    What is the primary characteristic of the late asthmatic response?

    <p>It involves an influx of inflammatory cells into bronchial mucosa.</p> Signup and view all the answers

    Which cytokines produced by TH2 lymphocytes are particularly involved in the late-phase allergic reaction?

    <p>Interleukins 5, 9, and 13</p> Signup and view all the answers

    How do cytokines like interleukins 5, 9, and 13 affect eosinophils?

    <p>They recruit and activate eosinophils.</p> Signup and view all the answers

    What is the main goal of long-term controllers in asthma treatment?

    <p>To reduce inflammation and prevent asthma attacks.</p> Signup and view all the answers

    Which of the following treatments is primarily used to relieve acute bronchoconstriction?

    <p>Bronchodilators</p> Signup and view all the answers

    What is a common characteristic of mild asthma?

    <p>Symptoms occur only occasionally.</p> Signup and view all the answers

    What links increased responsiveness in asthma pathology?

    <p>Airway inflammation.</p> Signup and view all the answers

    Which of the following is NOT a strategy for managing late-phase allergic reactions in asthma?

    <p>Administering bronchodilators immediately after exposure.</p> Signup and view all the answers

    What is the primary mechanism of action of inhaled corticosteroids in asthma treatment?

    <p>Inhibiting the expression of COX-2</p> Signup and view all the answers

    Which of the following is a local inhaled corticosteroid commonly used for asthma management?

    <p>Budesonide</p> Signup and view all the answers

    What potentially serious side effect is associated with long-term use of inhaled corticosteroids?

    <p>Osteoporosis</p> Signup and view all the answers

    Inhaled corticosteroids are now considered appropriate for which of the following cases?

    <p>Moderate to severe asthma</p> Signup and view all the answers

    Which of the following strategies may help prevent candidiasis associated with inhaled corticosteroids?

    <p>Gargling water and spitting after inhalation</p> Signup and view all the answers

    What is the common initial treatment for severe asthma patients before discharge?

    <p>Daily systemic prednisone followed by inhaled therapy</p> Signup and view all the answers

    What is one of the benefits of inhaled corticosteroids compared to systemic corticosteroids?

    <p>Fewer systemic effects</p> Signup and view all the answers

    What is an effect of corticosteroids on β-adrenoceptors in the airway?

    <p>They increase responsiveness</p> Signup and view all the answers

    What is the expected effect of inhaled corticosteroid therapy on children's growth in the first year of treatment?

    <p>Slows growth by about 1 cm</p> Signup and view all the answers

    Which side effect is NOT associated with systemic corticosteroid therapy?

    <p>Hypoglycemia</p> Signup and view all the answers

    What is the typical initial oral dose of prednisone for urgent treatment in severe asthma?

    <p>30-60 mg per day</p> Signup and view all the answers

    What is a characteristic difference between COPD and asthma?

    <p>COPD is associated with neutrophilic inflammation</p> Signup and view all the answers

    When are corticosteroids ideally administered to minimize side effects?

    <p>Early in the morning</p> Signup and view all the answers

    Which of the following statements about systemic corticosteroids is TRUE?

    <p>They may result in worsened symptoms upon dose reduction</p> Signup and view all the answers

    Which medication is primarily used for acute relief of COPD symptoms?

    <p>Short-acting anticholinergic</p> Signup and view all the answers

    How does the inflammation characterize COPD compared to asthma?

    <p>COPD demonstrates neutrophilic inflammation</p> Signup and view all the answers

    Study Notes

    Asthma and COPD

    • Asthma is clinically characterized by shortness of breath, chest tightness, wheezing, and often associated with coughing.
    • Physiologically, asthma involves widespread, reversible narrowing of the bronchial airways, significantly increasing responsiveness to inhaled stimuli.
    • Pathologically, asthma is marked by lymphocytic and eosinophilic inflammation of the bronchial mucosa.
    • Asthma is further characterized by remodeling of the bronchial mucosa, with thickening of the lamina reticularis beneath the airway epithelium. It also includes hyperplasia of airway wall cells, including smooth muscle, vessels and secretory glands and goblet cells.
    • Common asthma triggers are allergen proteins (e.g., dust mites, cockroaches, animal dander, molds, and pollens), genetic predisposition to IgE antibody production, and viral respiratory infections.
    • Most asthma attacks are not triggered by inhaling allergens. Some adults with asthma have no allergy to specific allergens. The severity of symptoms does not perfectly correlate with allergen levels in the environment.
    • Other non-allergic stimuli like distilled water, exercise, cold air, sulfur dioxide, and rapid respiratory maneuvers can evoke asthma attacks. Distilled water aerosol can stimulate C-fiber afferents and rapidly adapting receptors in the airway due to its low chloride ion concentration.

    Pathogenesis

    • Asthma pathogenesis involves an early-phase and a late-phase allergic reaction.
    • The early phase allergic reaction involves IgE antibodies binding to allergens, activating mast cells and macrophages. These cells release pro-inflammatory mediators such as histamine and eicosanoids, causing airway smooth muscle contraction, mucus secretion, vasodilation, and plasma exudation in the airways. Plasma protein leakage leads to airway wall thickening, engorgement, edema, reducing mucus clearance.
    • Late-phase reactions occur 6–12 hours later, involving the recruitment of inflammatory cells (eosinophils, basophils, monocytes, lymphocytes, and neutrophils) into the bronchial mucosa. These cells contribute to a sustained increase in bronchial reactivity. Cytokines, especially interleukins 5, 9, and 13, from TH2 lymphocytes, drive this late response. These cytokines also stimulate IgE production by B lymphocytes and mucus production by bronchial epithelial cells.

    Treatment

    • Treatment for acute bronchoconstriction focuses on short-term relievers to reverse the airway obstruction. Bronchodilators are most effective.
    • Long-term control aims at managing inflammation to reduce symptoms and prevent future attacks. Inhaled steroids are most effective.
    • Other treatment strategies include avoiding allergens, using anti-IgE antibodies, and mast cell stabilizers.
    • For late-stage asthma management, reducing allergen exposure and prolonged treatment with anti-inflammatory agents, especially inhaled corticosteroids, are crucial.
    • Treatment of acute bronchoconstriction includes short-acting bronchodilators.
    • Treatment of inflammation involves inhaled corticosteroids, reducing allergen exposure, mast cell stabilizers, and leukotriene antagonists.

    COPD

    • COPD is now the third most common cause of death in the United States.
    • COPD is similar to asthma, exhibiting airflow limitation, but the obstruction is not fully reversible with treatment.
    • COPD results from an abnormal inflammatory response in the lungs to noxious particles or gases, particularly cigarette smoke.
    • COPD differs from asthma in that it typically affects older patients, shows neutrophilic instead of eosinophilic inflammation, and is less responsive to standard asthma treatments, especially high-dose inhaled corticosteroids. COPD is an underlying condition with persistent symptoms. The lung pathology results in loss of pulmonary function progressively over time.
    • COPD is diagnosed with a smoking history, chronic cough, and shortness of breath.

    Classification of Drugs Applied

    • Bronchodilators, such as β2-sympathomimetics, methylxanthines, and anticholinergics.
    • Leukotriene antagonists, mast cell stabilizers, corticosteroids, and anti-IgE antibodies as anti-inflammatories.

    General Approach to Treatment

    • Treatment options for both asthma and COPD are similar.
      • For acute exacerbations, short-acting bronchodilators and, sometimes, even anticholinergic drugs may be helpful.
      • Long-term management emphasizes long-acting bronchodilators (LABAs) or long-acting anticholinergics, depending on the case.
      • Inhaled corticosteroids (ICS) are often a cornerstone of long-term management, particularly in COPD
    • Other agents that may have roles in COPD include theophylline, and roflumilast.

    Side effects of treatments

    • Both systemic and inhaled corticosteroids can have a range of side effects including adrenal suppression, growth inhibition, muscle wasting, osteoporosis, and salt retention, along with other issues.
    • Short and long-term β2 agonists can cause side effects such as skeletal muscle tremors, tachycardia, and even arrhythmias. Excessive dosage can result in dependence in some cases. In general, LABA drugs have a longer period of effectiveness and are often preferred over SABA drugs.
    • Methylxanthines like theophylline can cause gastrointestinal distress, tremor, and insomnia, and in high doses, can lead to cardiac arrhythmias, seizures, nausea, and vomiting, and hypotension.
    • Inhaled corticosteroids can cause oropharyngeal fungal infections (candidiasis), hoarseness, and increased risk of osteoporosis and cataracts over time, as well as impacting growth.

    Additional Notes

    • The choice of specific drug classes and individual agents for both asthma and COPD management depends on the severity, underlying causes, and individual patient characteristics.

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    Description

    This quiz covers the key characteristics and physiological aspects of asthma and COPD. It explores the pathophysiological mechanisms behind asthma, including airway inflammation and remodeling. Additionally, common triggers and the role of genetic factors in asthma management are discussed.

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