Asthma, COPD and Rhinitis

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Questions and Answers

Which respiratory disorder is chronic, reversible, and involves hyperreactive airways leading to episodic obstruction, often underdiagnosed and overtreated?

Asthma

Which respiratory disease is chronic, irreversible, involves progressive airflow obstruction (remodeling), and can be fatal?

COPD (Chronic Obstructive Pulmonary Disease)

Which chronic respiratory disease typically presents with symptoms like red, itchy, watery eyes, and a runny nose?

Rhinitis (often allergic rhinitis)

What are the three main factors causing airflow obstruction in asthma?

<ol> <li>Contraction of bronchial smooth muscle (bronchoconstriction)</li> <li>Inflammation of the bronchial wall</li> <li>Increased mucous production</li> </ol> Signup and view all the answers

In asthma, what does the underlying inflammation lead to?

<p>Airway hyperresponsiveness, airflow limitation, respiratory symptoms, and disease chronicity.</p> Signup and view all the answers

For intermittent asthma: How often do bronchoconstrictive episodes occur? What are the typical peak flow/spirometry results? What long-term control and quick relief medications are used?

<p>Episodes: ≤ 2 days/week. Peak flow/spirometry: Near normal. Long-term control: No daily medication needed. Quick relief: SABA (Short-Acting Beta-Agonist).</p> Signup and view all the answers

For mild persistent asthma: How often do bronchoconstrictive episodes occur? What are the typical peak flow/spirometry results? What long-term control and quick relief medications are used?

<p>Episodes: &gt; 2 days/week, but not daily. Peak flow/spirometry: Near normal. Long-term control: Low-dose ICS (Inhaled Corticosteroid). Quick relief: SABA.</p> Signup and view all the answers

For moderate persistent asthma: How often do bronchoconstrictive episodes occur? What are the typical peak flow/spirometry results? What long-term control and quick relief medications are used?

<p>Episodes: Daily. Peak flow/spirometry: 60-80% of normal. Long-term control: Low-dose ICS + LABA (Long-Acting Beta-Agonist) OR medium-dose ICS. Quick relief: SABA OR ICS/formoterol.</p> Signup and view all the answers

For severe persistent asthma: How often do bronchoconstrictive episodes occur? What are the typical peak flow/spirometry results? What long-term control and quick relief medications are used?

<p>Episodes: Continual. Peak flow/spirometry: &lt; 60% of normal. Long-term control: Medium-dose ICS + LABA OR High-dose ICS + LABA. Quick relief: SABA OR ICS/formoterol.</p> Signup and view all the answers

It is recommended to prescribe a Long-Acting Beta-Agonist (LABA) as monotherapy for asthma.

<p>False (B)</p> Signup and view all the answers

Describe the kinetics of Short-Acting Beta-Agonists (SABAs).

<p>They provide quick relief, with an onset of action within 5-30 minutes and a duration of effect lasting 4-6 hours.</p> Signup and view all the answers

In which asthma scenarios are Short-Acting Beta-Agonists (SABAs) typically used?

<p>As monotherapy for mild or intermittent asthma, for exercise-induced bronchoconstriction, and as an adjunct (rescue) therapy in moderate persistent and severe persistent asthma.</p> Signup and view all the answers

Name two examples of Short-Acting Beta-Agonists (SABAs).

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

Name two examples of Long-Acting Beta-Agonists (LABAs).

<p>Salmeterol and Formoterol.</p> Signup and view all the answers

Describe the kinetics of Long-Acting Beta-Agonists (LABAs).

<p>They provide bronchodilation for at least 12 hours.</p> Signup and view all the answers

How are Long-Acting Beta-Agonists (LABAs) used in asthma treatment? Can they be used for acute relief?

<p>LABAs are used as adjunct therapy to Inhaled Corticosteroids (ICS) in moderate and severe persistent asthma. They are <strong>contraindicated</strong> as monotherapy and should <strong>never</strong> be used for acute symptom relief.</p> Signup and view all the answers

Name four examples of inhaled corticosteroids (ICS) used in asthma.

<p>Beclomethasone, Budesonide, Fluticasone, Mometasone.</p> Signup and view all the answers

What is the drug class of choice (DOC) for long-term control of persistent asthma?

<p>Inhaled Corticosteroids (ICS).</p> Signup and view all the answers

What is the mechanism of action (MOA) of corticosteroids in asthma treatment?

<p>They inhibit phospholipase A2, decreasing the release of arachidonic acid. This reduces the inflammatory cascade and decreases the hyperresponsiveness of airway smooth muscle. They are not bronchodilators and are not used for acute relief.</p> Signup and view all the answers

What are the common routes of administration for corticosteroids in asthma, and which is preferred?

<p>Inhaled route (preferred) due to reduced systemic adverse effects (ADEs), although proper technique is important. Oral/systemic (e.g., prednisone, methylprednisolone) route is used for severe exacerbations.</p> Signup and view all the answers

What are potential adverse effects (ADEs) of Inhaled Corticosteroids (ICS)?

<p>Oropharyngeal candidiasis (thrush) and hoarseness.</p> Signup and view all the answers

What are potential adverse effects (ADEs) of systemic corticosteroids?

<p>Osteoporosis, hyperglycemia, hypokalemia, hypertension, peripheral edema, immunosuppression, and increased appetite.</p> Signup and view all the answers

What should a patient always do after using an Inhaled Corticosteroid (ICS)?

<p>Rinse their mouth out with water (and spit).</p> Signup and view all the answers

Name three leukotriene modifier drugs.

<p>Zileuton, Zafirlukast, Montelukast.</p> Signup and view all the answers

What is the mechanism of action (MOA) of leukotriene modifiers?

<p>They inhibit the production (Zileuton) or block the action (Zafirlukast, Montelukast) of leukotrienes. This results in decreased inflammation, arteriolar constriction, and mucus production.</p> Signup and view all the answers

What is the main use of leukotriene modifiers in asthma management?

<p>They are considered second-line agents for the prevention of asthma symptoms and can also be used for the prevention of exercise-induced asthma.</p> Signup and view all the answers

What are potential adverse effects (ADEs) associated with leukotriene modifiers?

<p>Increased liver enzymes (especially with Zileuton and Zafirlukast), headache, and dyspepsia.</p> Signup and view all the answers

Describe Cromolyn's mechanism of action (MOA), use in asthma, and its limitation.

<p>MOA: Inhibits mast cell degranulation and histamine release. Use: Alternative therapy for mild persistent asthma (e.g., if ICS cannot be tolerated). Limitation: Short duration of action (DOA) limits its overall utility.</p> Signup and view all the answers

Name a short-acting and a long-acting cholinergic antagonist used in respiratory disorders. Are they first-line for asthma?

<p>Short-acting: Ipratropium. Long-acting: Tiotropium. They are not considered first-line agents for asthma.</p> Signup and view all the answers

In which situations might the short-acting anticholinergic ipratropium be used?

<p>In COPD-asthma overlap syndrome, often in combination with a SABA in the emergency room setting, or if a patient cannot tolerate SABAs.</p> Signup and view all the answers

When might the long-acting anticholinergic tiotropium be used in asthma?

<p>As an add-on therapy in adults with severe asthma who have a history of exacerbations despite other treatments.</p> Signup and view all the answers

What are common adverse effects (ADEs) of inhaled cholinergic antagonists?

<p>Xerostomia (dry mouth) and a bitter taste.</p> Signup and view all the answers

What is Theophylline, and why is its use limited?

<p>Theophylline is an older bronchodilator previously used for chronic asthma. Its use is limited due to its narrow therapeutic index (TI), poor adverse effect profile, need for drug level monitoring, and numerous drug interactions.</p> Signup and view all the answers

What class of drugs may be used for severe persistent asthma that remains poorly controlled despite ICS, LABA, and other standard therapies?

<p>Monoclonal Antibodies (Biologics)</p> Signup and view all the answers

Name examples of monoclonal antibody drugs used in severe asthma and describe their general mechanisms.

<p>Omalizumab: Binds to and inhibits IgE. Mepolizumab, Benralizumab, Reslizumab: Interleukin-5 (IL-5) antagonists. Their use is often limited by cost, route of administration (injection/infusion), and potential adverse effects.</p> Signup and view all the answers

What are the two main pillars of COPD treatment?

<ol> <li>Smoking cessation.</li> <li>Pharmacologic therapy to relieve symptoms and slow disease progression.</li> </ol> Signup and view all the answers

Summarize the first-choice and recommended escalation pharmacotherapy for COPD patient groups A, B, C, and D.

<p>A (Low risk, fewer symptoms): 1st = Bronchodilator (SABA/LABA/SAMA/LAMA); Esc = Try alternative class. B (Low risk, more symptoms): 1st = LABA or LAMA; Esc = LABA + LAMA. C (High risk, fewer symptoms): 1st = LAMA; Esc = LAMA + LABA or LABA + ICS. D (High risk, more symptoms): 1st = LAMA + LABA; Esc = LAMA + LABA + ICS.</p> Signup and view all the answers

Is an Inhaled Corticosteroid (ICS) considered first-line therapy in asthma or COPD?

<p>ICS is first-line for persistent asthma, but not typically for COPD.</p> Signup and view all the answers

What drug classes are considered first-line for COPD management?

<p>Long-acting bronchodilators: Long-Acting Beta-Agonists (LABAs) and/or Long-Acting Muscarinic Antagonists (LAMAs).</p> Signup and view all the answers

Name examples of LABAs used in COPD, distinguishing between once-daily and twice-daily agents.

<p>Once Daily: Indacaterol, Olodaterol, Vilanterol. Twice Daily: Aformoterol, Formoterol, Salmeterol.</p> Signup and view all the answers

Name examples of LAMA drugs used in COPD.

<p>Aclidinium, Tiotropium, Glycopyrrolate, Umeclidinium.</p> Signup and view all the answers

Short-Acting Beta-Agonists (SABAs) may be used initially for COPD patients with _____ risk and _____ symptoms (Group A).

<p>low, fewer</p> Signup and view all the answers

What medication strategy is recommended for high-risk COPD patients with more symptoms (Group D) or for those with inadequate response to one agent alone?

<p>Combination therapy with a LABA and a LAMA.</p> Signup and view all the answers

In COPD management, an Inhaled Corticosteroid (ICS) can be added to a _____ _____ _______ regimen, particularly if the patient's FEV1 is less than _____ % predicted or they have frequent exacerbations.

<p>long acting bronchodilator, 50</p> Signup and view all the answers

Which respiratory disorder is chronic, reversible, characterized by hyperreactive airways leading to episodic obstruction, and is often underdiagnosed and overtreated?

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

Which respiratory disease is chronic, irreversible, characterized by progressive airflow obstruction due to remodeling, and can be fatal?

<p>COPD (Chronic Obstructive Pulmonary Disease)</p> Signup and view all the answers

Which chronic respiratory disease presents with symptoms like red, itchy, watery eyes, and a runny nose?

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

What are the three main causes of airflow obstruction in asthma?

<p>Contraction of bronchial smooth muscle, inflammation of the bronchial wall, and increased mucus production.</p> Signup and view all the answers

In asthma, what does underlying inflammation lead to?

<p>Airway hyperresponsiveness, airflow limitation, respiratory symptoms, and disease chronicity.</p> Signup and view all the answers

Describe intermittent asthma in terms of symptom frequency, peak flow/spirometry results, long-term control medication, and quick-relief medication.

<p>Symptom frequency: Less than 2 days per week. Peak flow/spirometry: Near normal. Long-term control: No daily medication needed. Quick relief: SABA (Short-Acting Beta-Agonist).</p> Signup and view all the answers

Describe mild persistent asthma in terms of symptom frequency, peak flow/spirometry results, long-term control medication, and quick-relief medication.

<p>Symptom frequency: More than 2 days per week, but not daily. Peak flow/spirometry: Near normal. Long-term control: Low-dose ICS (Inhaled Corticosteroid). Quick relief: SABA.</p> Signup and view all the answers

Describe moderate persistent asthma in terms of symptom frequency, peak flow/spirometry results, long-term control medication options, and quick-relief medication options.

<p>Symptom frequency: Daily. Peak flow/spirometry: 60-80% of normal. Long-term control: Low-dose ICS + LABA (Long-Acting Beta-Agonist) or Medium-dose ICS. Quick relief: SABA or low-dose ICS/formoterol.</p> Signup and view all the answers

Describe severe persistent asthma in terms of symptom frequency, peak flow/spirometry results, long-term control medication options, and quick-relief medication options.

<p>Symptom frequency: Continual. Peak flow/spirometry: Less than 60% of normal. Long-term control: Medium-dose ICS + LABA or High-dose ICS + LABA. Quick relief: SABA or low-dose ICS/formoterol.</p> Signup and view all the answers

It is safe and effective to prescribe a Long-Acting Beta-Agonist (LABA) as monotherapy for asthma.

<p>False (B)</p> Signup and view all the answers

Describe the pharmacokinetic profile of Short-Acting Beta-Agonists (SABAs) in terms of onset and duration of action.

<p>SABAs provide quick relief with an onset of action within 5-30 minutes and a duration of action lasting 4-6 hours.</p> Signup and view all the answers

What are the indications for using Short-Acting Beta-Agonists (SABAs) in asthma management?

<p>SABAs are used as monotherapy for quick relief in mild or intermittent asthma, for exercise-induced bronchoconstriction, and as adjunct rescue therapy in moderate and severe persistent asthma.</p> Signup and view all the answers

Name two common Short-Acting Beta-Agonists (SABAs) used in asthma treatment.

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

Name two common Long-Acting Beta-Agonists (LABAs) used in asthma treatment.

<p>Salmeterol and formoterol.</p> Signup and view all the answers

What is the typical duration of action for Long-Acting Beta-Agonists (LABAs)?

<p>LABAs provide bronchodilation for at least 12 hours.</p> Signup and view all the answers

What is the role of LABAs in asthma management? Can they be used as monotherapy or for acute relief?

<p>LABAs are used as adjunct therapy to Inhaled Corticosteroids (ICS) in moderate and severe persistent asthma. They should <strong>never</strong> be used as monotherapy (contraindicated) or for acute symptom relief.</p> Signup and view all the answers

List four common inhaled corticosteroids (ICS) used in asthma management.

<p>Beclomethasone, budesonide, fluticasone, mometasone.</p> Signup and view all the answers

What class of drugs is considered the Drug of Choice (DOC) for long-term control of persistent asthma?

<p>Inhaled Corticosteroids (ICS).</p> Signup and view all the answers

Describe the mechanism of action (MOA) of corticosteroids in asthma treatment.

<p>Corticosteroids inhibit phospholipase A2, which decreases the release of arachidonic acid. This action reduces the inflammatory cascade and subsequently decreases the hyperresponsiveness of airway smooth muscle. They are not effective for acute symptom relief.</p> Signup and view all the answers

What are the common routes of administration for corticosteroids in asthma, and when is each route typically used?

<p>The preferred route is inhaled (e.g., beclomethasone, fluticasone) for long-term control, as it minimizes systemic adverse effects (ADEs) and requires proper inhaler technique. Oral/systemic corticosteroids (e.g., prednisone, methylprednisolone) are used for managing severe exacerbations.</p> Signup and view all the answers

What are the main local adverse effects (ADEs) associated with Inhaled Corticosteroids (ICS)?

<p>Oropharyngeal candidiasis (thrush) and hoarseness.</p> Signup and view all the answers

List potential adverse effects (ADEs) associated with systemic (oral/IV) corticosteroid use.

<p>Osteoporosis, hyperglycemia, hypokalemia, hypertension, peripheral edema, immunosuppression, and increased appetite.</p> Signup and view all the answers

What important instruction should patients follow after taking an Inhaled Corticosteroid (ICS)?

<p>Rinse their mouth out with water (and spit) after using the inhaler.</p> Signup and view all the answers

Name three leukotriene modifier drugs used in asthma management.

<p>Zileuton, zafirlukast, and montelukast.</p> Signup and view all the answers

What is the mechanism of action (MOA) of leukotriene modifiers?

<p>They inhibit either the production (zileuton, targeting 5-lipoxygenase) or the action (zafirlukast, montelukast, blocking leukotriene receptors) of leukotrienes. This leads to decreased inflammation, arteriolar constriction, and mucus production.</p> Signup and view all the answers

What is the typical role or use of leukotriene modifiers in asthma management?

<p>They are considered second-line agents, used for the prevention of asthma symptoms and the prevention of exercise-induced asthma. They are alternatives or add-ons to ICS.</p> Signup and view all the answers

What are some potential adverse effects (ADEs) associated with leukotriene modifiers?

<p>Increased liver enzymes (especially with zileuton and zafirlukast), headache, and dyspepsia. Rare neuropsychiatric events have also been reported, particularly with montelukast.</p> Signup and view all the answers

Describe cromolyn in terms of its mechanism of action (MOA), clinical use in asthma, and duration of action (DOA).

<p>MOA: Inhibits mast cell degranulation and the release of histamine and other inflammatory mediators. Use: An alternative (though less effective) therapy for mild persistent asthma, particularly in children or patients unable to tolerate ICS; also used for prevention of exercise-induced bronchoconstriction. DOA: Short duration of action, requiring frequent dosing (3-4 times daily), which limits its use.</p> Signup and view all the answers

Name a short-acting and a long-acting cholinergic antagonist (antimuscarinic) used in respiratory diseases. Are they first-line agents for asthma?

<p>Short-acting: Ipratropium. Long-acting: Tiotropium. They are generally not considered first-line agents for asthma but have roles in COPD and specific asthma situations (e.g., acute exacerbations, add-on for severe asthma).</p> Signup and view all the answers

Which short-acting cholinergic antagonist is often used in combination with a SABA in the emergency department for acute exacerbations, in COPD-asthma overlap syndrome, or if SABAs are not tolerated?

<p>Ipratropium.</p> Signup and view all the answers

Which long-acting cholinergic antagonist (LAMA) can be used as an add-on therapy for adults with severe asthma who have a history of exacerbations despite being on ICS/LABA therapy?

<p>Tiotropium (specifically via the Respimat inhaler).</p> Signup and view all the answers

What are common adverse effects (ADEs) associated with inhaled cholinergic antagonists?

<p>Xerostomia (dry mouth) and a bitter taste.</p> Signup and view all the answers

What is theophylline, and why is its use limited in current asthma management?

<p>Theophylline is an older oral bronchodilator (a methylxanthine) used for chronic asthma. Its use is limited due to its narrow therapeutic index (TI), significant potential for toxicity, variable metabolism, poor adverse effect (ADE) profile, the need for drug level monitoring, and numerous drug interactions.</p> Signup and view all the answers

What class of drugs may be considered for severe persistent asthma that remains poorly controlled despite treatment with high-dose ICS, LABA, and other standard therapies?

<p>Monoclonal antibody (biologic) drugs.</p> Signup and view all the answers

Name some monoclonal antibody drugs used for severe asthma and describe their general mechanisms.

<p>Omalizumab binds to and inhibits IgE (targeting allergic pathways). Mepolizumab, benralizumab, and reslizumab are interleukin-5 (IL-5) antagonists (targeting eosinophilic pathways). Dupilumab targets the IL-4 receptor alpha subunit, inhibiting both IL-4 and IL-13 signaling.</p> Signup and view all the answers

What are the two main pillars of COPD treatment?

<p>Smoking cessation (or removal of other inhaled exposures) and pharmacologic therapy aimed at relieving symptoms, reducing exacerbation frequency and severity, and improving exercise tolerance and health status.</p> Signup and view all the answers

According to older GOLD patient groups classification (A, B, C, D), outline the initial pharmacologic choices and potential escalation strategies for COPD management.

<ul> <li><strong>Group A (Low risk, fewer symptoms):</strong> Initial: A bronchodilator (SABA prn, OR maintenance LABA or LAMA or SAMA). Escalation: Try an alternative class of bronchodilator if needed.</li> <li><strong>Group B (Low risk, more symptoms):</strong> Initial: Long-acting bronchodilator (LABA or LAMA). Escalation: Dual long-acting bronchodilators (LABA + LAMA).</li> <li><strong>Group C (High risk, fewer symptoms):</strong> Initial: LAMA. Escalation: LAMA + LABA or LABA + ICS.</li> <li><strong>Group D (High risk, more symptoms):</strong> Initial: LAMA + LABA. Escalation: LAMA + LABA + ICS.</li> </ul> Signup and view all the answers

Are Inhaled Corticosteroids (ICS) considered first-line therapy for asthma or COPD?

<p>ICS are first-line therapy for persistent asthma, but <strong>not</strong> for COPD.</p> Signup and view all the answers

What drug classes are generally considered first-line maintenance therapy for symptomatic COPD?

<p>Long-acting bronchodilators: Long-Acting Beta-Agonists (LABAs) and/or Long-Acting Muscarinic Antagonists (LAMAs).</p> Signup and view all the answers

List some Long-Acting Beta-Agonists (LABAs) used for COPD, noting their typical dosing frequency (once or twice daily).

<p>Once daily: indacaterol, olodaterol, vilanterol. Twice daily: arformoterol, formoterol, salmeterol.</p> Signup and view all the answers

List some Long-Acting Muscarinic Antagonists (LAMAs) used for COPD.

<p>Aclidinium (typically twice daily), tiotropium (once daily), glycopyrrolate (typically twice daily in nebulized form or in combo inhalers), umeclidinium (once daily).</p> Signup and view all the answers

According to older GOLD classifications, SABAs (as needed or scheduled SAMA) could be initial therapy for COPD patients with _____ risk and _____ symptoms (Group A).

<p>low, fewer</p> Signup and view all the answers

What combination therapy is often recommended initially for high-risk COPD patients with more symptoms (formerly Group D), and can also be used as escalation if a single long-acting bronchodilator is insufficient?

<p>Combination LABA + LAMA therapy.</p> Signup and view all the answers

In some older guidelines, adding an Inhaled Corticosteroid (ICS) to a _____ _____ _____ was considered for COPD patients if their FEV1 was less than _____ % predicted.

<p>long acting bronchodilator; 50</p> Signup and view all the answers

Which respiratory disorder is described as chronic and reversible, where hyperreactive airways lead to episodic obstruction, and is often underdiagnosed and overtreated?

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

Which respiratory disease is chronic and irreversible, characterized by progressive airflow obstruction (remodeling), and can be fatal?

<p>Chronic Obstructive Pulmonary Disease (COPD)</p> Signup and view all the answers

Which chronic respiratory disease typically presents with symptoms like red, itchy, watery eyes, and a runny nose?

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

What are the three main causes of airflow obstruction in asthma?

<ol> <li>Contraction of bronchial smooth muscle (bronchoconstriction)</li> <li>Inflammation of the bronchial wall</li> <li>Increased mucous production</li> </ol> Signup and view all the answers

In asthma, what does the underlying inflammation lead to regarding airway function and symptoms?

<p>Airway hyperresponsiveness, airflow limitation, respiratory symptoms, and disease chronicity.</p> Signup and view all the answers

For intermittent asthma: how frequent are bronchoconstrictive episodes, what are the typical peak flow/spirometry results, what long-term control is needed, and what is used for quick relief?

<p>Frequency: Less than 2 days per week Peak flow/spirometry: Near normal Long-term control: No daily meds Quick relief: SABA (Short-Acting Beta-Agonist)</p> Signup and view all the answers

For mild persistent asthma: how frequent are bronchoconstrictive episodes, what are the typical peak flow/spirometry results, what long-term control is needed, and what is used for quick relief?

<p>Frequency: More than 2 days per week, but not daily Peak flow/spirometry: Near normal Long-term control: Low-dose ICS (Inhaled Corticosteroid) Quick relief: SABA (Short-Acting Beta-Agonist)</p> Signup and view all the answers

For moderate persistent asthma: how frequent are bronchoconstrictive episodes, what are the typical peak flow/spirometry results, what long-term control is needed, and what is used for quick relief?

<p>Frequency: Daily Peak flow/spirometry: 60-80% of normal Long-term control: Low-dose ICS + LABA (Long-Acting Beta-Agonist) or Medium-dose ICS Quick relief: SABA or ICS/formoterol</p> Signup and view all the answers

For severe persistent asthma: how frequent are bronchoconstrictive episodes, what are the typical peak flow/spirometry results, what long-term control is needed, and what is used for quick relief?

<p>Frequency: Continual Peak flow/spirometry: Less than 60% of normal Long-term control: Medium-dose ICS + LABA or High-dose ICS + LABA Quick relief: SABA or ICS/formoterol</p> Signup and view all the answers

It is recommended to prescribe a Long-Acting Beta-Agonist (LABA) as monotherapy for asthma.

<p>False (B)</p> Signup and view all the answers

What are the pharmacokinetic characteristics (onset and duration) of Short-Acting Beta-Agonists (SABAs)?

<p>Onset: 5-30 minutes Duration: 4-6 hours</p> Signup and view all the answers

In which asthma scenarios are Short-Acting Beta-Agonists (SABAs) used?

<p>As monotherapy for quick relief in mild or intermittent asthma, or exercise-induced asthma. As an adjunct for quick relief in moderate persistent and severe persistent asthma.</p> Signup and view all the answers

Name two common Short-Acting Beta-Agonists (SABAs).

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

Name two common Long-Acting Beta-Agonists (LABAs).

<p>Salmeterol and Formoterol</p> Signup and view all the answers

What is the duration of bronchodilation provided by Long-Acting Beta-Agonists (LABAs)?

<p>At least 12 hours</p> Signup and view all the answers

How are Long-Acting Beta-Agonists (LABAs) used in asthma treatment regarding adjunctive therapy and monotherapy?

<p>Used as an adjunct to ICS in moderate and severe persistent asthma. Monotherapy is contraindicated (CI). LABAs are <strong>never</strong> used for acute symptom relief.</p> Signup and view all the answers

List common inhaled corticosteroid (ICS) drug types used in asthma management.

<p>Beclomethasone, Budesonide, Fluticasone, Mometasone</p> Signup and view all the answers

For which condition are inhaled corticosteroids (ICS) considered the drug of choice (DOC) for long-term control?

<p>Persistent asthma</p> Signup and view all the answers

What is the mechanism of action (MOA) of corticosteroids in asthma treatment?

<p>They inhibit phospholipase A2, decreasing the release of arachidonic acid. This decreases the inflammatory cascade and reduces the hyperresponsiveness of airway smooth muscle.</p> Signup and view all the answers

What are the primary routes of administration for corticosteroids in asthma, and which is preferred?

<p>Inhaled (preferred) and Oral/Systemic (e.g., prednisone, methylprednisolone).</p> Signup and view all the answers

What are the main adverse drug effects (ADEs) associated with inhaled corticosteroids (ICS)?

<p>Oropharyngeal candidiasis (thrush) and hoarseness.</p> Signup and view all the answers

List potential adverse drug effects (ADEs) associated with systemic (oral) corticosteroids.

<p>Osteoporosis, hyperglycemia, hypokalemia, hypertension, peripheral edema, immunosuppression, increased appetite.</p> Signup and view all the answers

What important step should patients always take after using an inhaled corticosteroid (ICS)?

<p>Rinse their mouth out with water (and spit).</p> Signup and view all the answers

Name the three main leukotriene modifier drugs.

<p>Zileuton, Zafirlukast, Montelukast</p> Signup and view all the answers

What is the mechanism of action (MOA) of leukotriene modifiers?

<p>They inhibit the production (Zileuton) or block the action (Zafirlukast, Montelukast) of leukotrienes, resulting in decreased inflammation, arteriolar constriction, and mucus production.</p> Signup and view all the answers

What is the therapeutic use of leukotriene modifiers in asthma management?

<p>They are considered second-line agents for the prevention of asthma symptoms and can also be used for the prevention of exercise-induced asthma.</p> Signup and view all the answers

What are common adverse drug effects (ADEs) associated with leukotriene modifiers?

<p>Increased liver enzymes (especially with Zileuton), headache, and dyspepsia.</p> Signup and view all the answers

Describe the mechanism of action (MOA), primary use, and duration of action (DOA) limitation for Cromolyn.

<p>MOA: Inhibits mast cell degranulation and histamine release. Use: Alternative therapy for mild persistent asthma (especially if ICS cannot be tolerated). DOA: Short duration of action limits its use.</p> Signup and view all the answers

Name one short-acting and one long-acting cholinergic antagonist used in respiratory disorders.

<p>Short-acting: Ipratropium Long-acting: Tiotropium</p> Signup and view all the answers

Which short-acting cholinergic antagonist might be used alongside a SABA in the Emergency Room, for COPD-asthma overlap syndrome, or if a SABA is not tolerated?

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

Which long-acting cholinergic antagonist is used as add-on therapy in adults with severe asthma who have a history of exacerbations?

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

What are common adverse drug effects (ADEs) of cholinergic antagonists?

<p>Xerostomia (dry mouth) and a bitter taste.</p> Signup and view all the answers

What is Theophylline, and why is its use limited today?

<p>Theophylline is an older bronchodilator used for chronic asthma. Its use is limited due to a narrow therapeutic index (TI), poor adverse effect profile, the need for drug level monitoring, and numerous drug interactions.</p> Signup and view all the answers

What class of drugs is considered for severe persistent asthma that remains poorly controlled despite treatment with ICS, LABA, and other standard therapies?

<p>Monoclonal Antibody (mAb) drugs</p> Signup and view all the answers

Identify the main types of monoclonal antibody drugs used in severe asthma and their targets.

<p>Omalizumab: Binds to and inhibits IgE. Mepolizumab, Benralizumab, Reslizumab: Interleukin-5 (IL-5) antagonists.</p> Signup and view all the answers

What are the two main, very general treatment approaches for COPD?

<ol> <li>Smoking cessation</li> <li>Pharmacologic therapy to relieve symptoms and slow progression</li> </ol> Signup and view all the answers

Describe the first-choice and recommended escalation therapies for COPD patient groups A, B, C, and D.

<p>A (Low risk, fewer symptoms):</p> <ul> <li>1st: SABA or LABA or SAMA or LAMA</li> <li>Escalation: Try alternative bronchodilator class B (Low risk, more symptoms):</li> <li>1st: LABA or LAMA</li> <li>Escalation: LABA + LAMA C (High risk, fewer symptoms):</li> <li>1st: LAMA</li> <li>Escalation: LAMA + LABA or LABA + ICS D (High risk, more symptoms):</li> <li>1st: LAMA + LABA</li> <li>Escalation: LAMA + LABA + ICS</li> </ul> Signup and view all the answers

Is an Inhaled Corticosteroid (ICS) considered first-line therapy in asthma or COPD?

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

What drug classes are considered first-line for most COPD patients (Groups B, C, D)?

<p>Long-acting bronchodilators (LABAs and LAMAs)</p> Signup and view all the answers

List examples of LABA drugs used primarily for COPD, noting their dosing frequency.

<p>Once daily: Indacaterol, Olodaterol, Vilanterol Twice daily: Aformoterol, Formoterol, Salmeterol</p> Signup and view all the answers

List examples of LAMA drugs used primarily for COPD.

<p>Aclidinium, Tiotropium, Glycopyrrolate, Umeclidinium</p> Signup and view all the answers

In COPD management, Short-Acting Beta-Agonists (SABAs) are typically reserved as the primary choice for patients with _____ risk and _____ symptoms (Group A).

<p>low, fewer</p> Signup and view all the answers

What combination therapy is often recommended first-line for high-risk COPD patients with more symptoms (Group D), and can also be used as escalation if response to one agent alone is inadequate?

<p>Combination LABA and LAMA therapy.</p> Signup and view all the answers

In COPD, an Inhaled Corticosteroid (ICS) can be added to _____ therapy, particularly if the patient's FEV1 is less than _____% predicted and they have frequent exacerbations.

<p>long acting bronchodilator, 50</p> Signup and view all the answers

Flashcards

Asthma

A chronic, reversible respiratory disorder with hyperreactive airways leading to episodic obstruction, often underdiagnosed and overtreated.

COPD

A chronic, irreversible respiratory disease with progressive airflow obstruction and potential fatality due to airway remodeling.

Rhinitis

A chronic respiratory condition characterized by red, itchy, watery eyes and a runny nose.

Airflow obstruction in asthma

Bronchoconstriction due to contraction of bronchial smooth muscle, inflammation of the bronchial wall, and increased mucus production.

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Asthma's underlying inflammation leads to...

Airway hyperresponsiveness, airflow limitation, respiratory symptoms, and disease chronicity.

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Intermittent Asthma

Less than 2 days per week; Near normal peak flow/spirometry; No daily meds for long-term control; SABA for quick relief.

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Mild Persistent Asthma

More than 2 days per week, but not daily; Near normal peak flow/spirometry; Low-dose ICS for long-term control; SABA for quick relief.

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Moderate Persistent Asthma

Daily symptoms; 60-80% of normal peak flow/spirometry; Low-dose ICS + LABA or medium-dose ICS for long-term control; SABA or ICS/formoterol for quick relief.

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Severe Persistent Asthma

Continual symptoms; less than 60% of normal peak flow/spirometry; Medium-dose ICS + LABA or High-dose ICS + LABA for long-term control; SABA or ICS/formoterol for quick relief.

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LABA alone?

Always give with a corticosteroid.

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Kinetics of SABA

Quick relief – onset in 5-30 min, duration 4-6 hours.

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SABA use

Monotherapy in mild or intermittent asthma or exercise-induced asthma; adjunct in moderate persistent and severe persistent asthma.

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Types of SABAs

Albuterol and levalbuterol.

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LABA types

Salmeterol, formoterol.

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LABA kinetics

Bronchodilation for at least 12 hours.

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LABA Use

Adjunct to ICS in moderate and severe asthma; NEVER monotherapy (contraindicated); never for acute relief either.

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Corticosteroid drug types

Beclomethasone, budesonide, fluticasone, mometasone.

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Corticosteroids DOC for?

Long-term control of persistent asthma.

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MOA of Corticosteroids

Inhibit phospholipase A2 to decrease release of arachidonic acid, decrease inflammatory cascade, reduce hyperresponsiveness of airway smooth muscle. Not used for acute relief.

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Route of Corticosteroids

Inhaled (preferred): reduced systemic ADEs, technique important. Oral/systemic (prednisone, methylprednisolone): used in severe exacerbations.

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ADEs of ICS

Oropharyngeal candidiasis and hoarseness.

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Systemic Corticosteroids ADEs

Osteoporosis, hyperglycemia, hypokalemia, hypertension, peripheral edema, immunosuppression, increased appetite.

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ICS Post-Use

Rinse mouth out after using - can cause thrush (oropharyngeal candidiasis).

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Leukotriene Modifier Drugs

Zileuton, Zafirlukast, Montelukast.

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Leukotriene Modifiers MOA

Inhibit the production (Zileuton) or action (Zafirlukast, Montelukast) of leukotrienes to decrease inflammation, arteriolar constriction, and mucus production.

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Use of Leukotriene Modifiers

Second line for prevention of asthma symptoms and prevention of exercise-induced asthma.

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ADEs of Leukotriene Modifiers

Increased liver enzymes, headache, dyspepsia.

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Cromolyn

Inhibits mast cell degranulation and histamine release; alternative for mild persistent asthma (e.g., if pt can't tolerate ICS); short DOA limits use.

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Cholinergic Antagonists

Ipratropium (short-acting), tiotropium (long-acting).

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Ipratropium Use

COPD-asthma overlap syndrome, with SABA in ER, or SABA not tolerated.

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Tiotropium Use

Add-on in adults with severe asthma with a history of exacerbations.

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ADEs of Cholinergic Antagonists

Xerostomia, bitter taste.

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Theophylline

Bronchodilator for chronic asthma; narrow TI, poor ADE profile, drug level monitoring, numerous drug interactions. (rarely used anymore)

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Severe persistent asthma

Monoclonal Ab drugs.

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Monoclonal Ab drugs

Omalizumab (anti-IgE); mepolizumab, benralizumab, reslizumab (anti-IL-5). Limited use due to cost, route, ADEs.

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Tx of COPD (General)

Smoking cessation and pharmacologic therapy to relieve symptoms and slow progression.

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COPD drugs based on pt groups

A: SABA or LABA or short-acting anticholinergic or LAMA; escalation: try alternative class. B: LABA or LAMA; escalation: LABA + LAMA. C: LAMA; escalation: LAMA + LABA or LABA + ICS. D: LAMA + LABA; escalation: LAMA + LABA + ICS.

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ICS first line?

Asthma

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First Line for COPD

Long-acting bronchodilators (LABA and LAMA).

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LABA drugs

Indacaterol, olodaterol, vilanterol (once daily); aformoterol, formoterol, salmeterol (twice daily).

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LAMA drugs

Aclidinium, tiotropium, glycopyrrolate, umeclidinium.

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SABA for pts w...

Low risk and fewer symptoms.

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High risk pts w/ more symptoms drugs

Combo LABA and LAMA - also can be used if inadequate response to one agent alone.

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ICS can be added to...

Long-acting bronchodilatory if FEV1<60% predicted.

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Study Notes

Asthma

  • Chronic, reversible respiratory disorder
  • Characterized by hyperreactive airways leading to episodic obstruction.
  • Often underdiagnosed and overtreated
  • Airflow obstruction in asthma caused by:
    • Bronchial smooth muscle contraction
    • Bronchial wall inflammation
    • Increased mucus production
  • Underlying inflammation leads to:
    • Airway hyperresponsiveness
    • Airflow limitation
    • Respiratory symptoms
    • Disease chronicity

COPD

  • Chronic, irreversible respiratory disease
  • Progressive airflow obstruction due to remodeling
  • Can be fatal

Rhinitis

  • Chronic respiratory disease
  • Symptoms include red, itchy, watery eyes and runny nose

Asthma Classification and Treatment

  • Intermittent:
    • Bronchoconstrictive episodes <2 days/week
    • Near-normal peak flow/spirometry results
    • No daily meds needed
    • Use SABA for quick relief
  • Mild Persistent:
    • Bronchoconstrictive episodes >2 days/week but not daily
    • Near-normal peak flow/spirometry results
    • Low-dose ICS for long-term control
    • SABA for quick relief
  • Moderate Persistent:
    • Daily bronchoconstrictive episodes
    • Peak flow/spirometry 60-80% of normal
    • Low-dose ICS + LABA or medium-dose ICS for long-term control
    • SABA or ICS/formoterol for quick relief
  • Severe Persistent:
    • Continual bronchoconstrictive episodes
    • Peak flow/spirometry <60% of normal
    • Medium-dose ICS + LABA or high-dose ICS + LABA for long-term control
    • SABA or ICS/formoterol for quick relief
  • LABA should always be given with a corticosteroid

Short-Acting Beta Agonists (SABAs)

  • Kinetics:
    • Quick relief, onset in 5-30 minutes, duration 4-6 hours
  • Use:
    • Monotherapy for mild or intermittent asthma or exercise-induced asthma
    • Adjunct in moderate persistent and severe persistent asthma
  • Types: Albuterol and levalbuterol

Long-Acting Beta Agonists (LABAs)

  • Types: Salmeterol, formoterol
  • Kinetics: Bronchodilation for at least 12 hours
  • Use:
    • Adjunct to ICS in moderate and severe asthma
    • Never as monotherapy (contraindicated)
    • Not for acute relief

Corticosteroids

  • Types: Beclomethasone, budesonide, fluticasone, mometasone
  • DOC for long-term control of persistent asthma
  • MOA:
    • Inhibits phospholipase A2 to decrease arachidonic acid release
    • Decrease inflammatory cascade
    • Reduces hyperresponsiveness of airway smooth muscle
    • Not used for acute relief
  • Route:
    • Inhaled (preferred): Reduced systemic ADEs, proper technique important
    • Oral/systemic (prednisone, methylprednisolone): Used in severe exacerbations
  • ADEs:
    • Inhaled: Oropharyngeal candidiasis and hoarseness
    • Systemic: Osteoporosis, hyperglycemia, hypokalemia, hypertension, peripheral edema, immunosuppression, increased appetite
  • Always rinse mouth after using ICS to prevent thrush (oropharyngeal candidiasis)

Leukotriene Modifiers

  • Drugs: Zileuton, zafirlukast, montelukast
  • MOA:
    • Inhibit production (Zileuton) or action (zafirlukast, montelukast) of leukotrienes
    • Results in decreased inflammation, arteriolar constriction, and mucus production
  • Use:
    • Second-line for prevention of asthma symptoms and exercise-induced asthma
  • ADEs:
    • Increased liver enzymes
    • Headache, dyspepsia

Cromolyn

  • MOA: Inhibits mast cell degranulation and histamine release
  • Use: Alternative for mild persistent asthma (e.g., if patient cannot tolerate ICS)
  • Short duration of action limits use

Cholinergic Antagonists

  • Not first-line
  • Short-acting: Ipratropium
  • Long-acting: Tiotropium
  • Ipratropium:
    • Used with COPD-asthma overlap syndrome
    • Can be used with SABA in ER or if SABA not tolerated
  • Tiotropium: Add-on for adults with severe asthma with a history of exacerbations
  • ADEs: Xerostomia, bitter taste

Theophylline

  • Bronchodilator for chronic asthma
  • Rarely used due to:
    • Narrow therapeutic index
    • Poor ADE profile
    • Need for drug level monitoring
    • Numerous drug interactions

Monoclonal Antibodies

  • Used for severe persistent asthma poorly controlled on ICS, LABA, and other standard therapies
  • Drugs:
    • Omalizumab: Binds to and inhibits IgE
    • Mepolizumab, benralizumab, reslizumab: Interleukin-5 antagonists
  • Use limited by cost, route, and ADEs

COPD Treatment

  • General:
    • Smoking cessation
    • Pharmacologic therapy to relieve symptoms and slow progression
  • Treatment Groups:
    • A (Low risk, fewer symptoms):
      • 1st: SABA or LABA or short-acting anticholinergic or LAMA
      • Escalate: Try alternative class
    • B (Low risk, more symptoms):
      • 1st: LABA or LAMA
      • Escalate: LABA + LAMA
    • C (High risk, fewer symptoms):
      • 1st: LAMA
      • Escalate: LAMA + LABA or LABA + ICS
    • D (High risk, more symptoms):
      • 1st: LAMA + LABA -Escalate: LAMA + LABA + ICS
  • ICS is first-line in asthma, not COPD
  • First-line for COPD is long-acting bronchodilators (LABA and LAMA)

COPD Drugs

  • LABA:
    • Once daily: Indacaterol, olodaterol, vilanterol
    • Twice daily: Aformoterol, formoterol, salmeterol
  • LAMA: Aclidinium, tiotropium, glycopyrrolate, umeclidinium
  • SABA for low-risk patients with fewer symptoms
  • Combination LABA and LAMA recommended in high-risk patients with more symptoms or inadequate response to a single agent
  • ICS can be added to long-acting bronchodilators if FEV1 <60% predicted

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