Podcast
Questions and Answers
Which respiratory disorder is chronic, reversible, and involves hyperreactive airways leading to episodic obstruction, often underdiagnosed and overtreated?
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?
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?
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?
What are the three main factors causing airflow obstruction in asthma?
In asthma, what does the underlying inflammation lead to?
In asthma, what does the underlying inflammation lead to?
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?
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?
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?
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?
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?
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?
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?
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?
It is recommended to prescribe a Long-Acting Beta-Agonist (LABA) as monotherapy for asthma.
It is recommended to prescribe a Long-Acting Beta-Agonist (LABA) as monotherapy for asthma.
Describe the kinetics of Short-Acting Beta-Agonists (SABAs).
Describe the kinetics of Short-Acting Beta-Agonists (SABAs).
In which asthma scenarios are Short-Acting Beta-Agonists (SABAs) typically used?
In which asthma scenarios are Short-Acting Beta-Agonists (SABAs) typically used?
Name two examples of Short-Acting Beta-Agonists (SABAs).
Name two examples of Short-Acting Beta-Agonists (SABAs).
Name two examples of Long-Acting Beta-Agonists (LABAs).
Name two examples of Long-Acting Beta-Agonists (LABAs).
Describe the kinetics of Long-Acting Beta-Agonists (LABAs).
Describe the kinetics of Long-Acting Beta-Agonists (LABAs).
How are Long-Acting Beta-Agonists (LABAs) used in asthma treatment? Can they be used for acute relief?
How are Long-Acting Beta-Agonists (LABAs) used in asthma treatment? Can they be used for acute relief?
Name four examples of inhaled corticosteroids (ICS) used in asthma.
Name four examples of inhaled corticosteroids (ICS) used in asthma.
What is the drug class of choice (DOC) for long-term control of persistent asthma?
What is the drug class of choice (DOC) for long-term control of persistent asthma?
What is the mechanism of action (MOA) of corticosteroids in asthma treatment?
What is the mechanism of action (MOA) of corticosteroids in asthma treatment?
What are the common routes of administration for corticosteroids in asthma, and which is preferred?
What are the common routes of administration for corticosteroids in asthma, and which is preferred?
What are potential adverse effects (ADEs) of Inhaled Corticosteroids (ICS)?
What are potential adverse effects (ADEs) of Inhaled Corticosteroids (ICS)?
What are potential adverse effects (ADEs) of systemic corticosteroids?
What are potential adverse effects (ADEs) of systemic corticosteroids?
What should a patient always do after using an Inhaled Corticosteroid (ICS)?
What should a patient always do after using an Inhaled Corticosteroid (ICS)?
Name three leukotriene modifier drugs.
Name three leukotriene modifier drugs.
What is the mechanism of action (MOA) of leukotriene modifiers?
What is the mechanism of action (MOA) of leukotriene modifiers?
What is the main use of leukotriene modifiers in asthma management?
What is the main use of leukotriene modifiers in asthma management?
What are potential adverse effects (ADEs) associated with leukotriene modifiers?
What are potential adverse effects (ADEs) associated with leukotriene modifiers?
Describe Cromolyn's mechanism of action (MOA), use in asthma, and its limitation.
Describe Cromolyn's mechanism of action (MOA), use in asthma, and its limitation.
Name a short-acting and a long-acting cholinergic antagonist used in respiratory disorders. Are they first-line for asthma?
Name a short-acting and a long-acting cholinergic antagonist used in respiratory disorders. Are they first-line for asthma?
In which situations might the short-acting anticholinergic ipratropium be used?
In which situations might the short-acting anticholinergic ipratropium be used?
When might the long-acting anticholinergic tiotropium be used in asthma?
When might the long-acting anticholinergic tiotropium be used in asthma?
What are common adverse effects (ADEs) of inhaled cholinergic antagonists?
What are common adverse effects (ADEs) of inhaled cholinergic antagonists?
What is Theophylline, and why is its use limited?
What is Theophylline, and why is its use limited?
What class of drugs may be used for severe persistent asthma that remains poorly controlled despite ICS, LABA, and other standard therapies?
What class of drugs may be used for severe persistent asthma that remains poorly controlled despite ICS, LABA, and other standard therapies?
Name examples of monoclonal antibody drugs used in severe asthma and describe their general mechanisms.
Name examples of monoclonal antibody drugs used in severe asthma and describe their general mechanisms.
What are the two main pillars of COPD treatment?
What are the two main pillars of COPD treatment?
Summarize the first-choice and recommended escalation pharmacotherapy for COPD patient groups A, B, C, and D.
Summarize the first-choice and recommended escalation pharmacotherapy for COPD patient groups A, B, C, and D.
Is an Inhaled Corticosteroid (ICS) considered first-line therapy in asthma or COPD?
Is an Inhaled Corticosteroid (ICS) considered first-line therapy in asthma or COPD?
What drug classes are considered first-line for COPD management?
What drug classes are considered first-line for COPD management?
Name examples of LABAs used in COPD, distinguishing between once-daily and twice-daily agents.
Name examples of LABAs used in COPD, distinguishing between once-daily and twice-daily agents.
Name examples of LAMA drugs used in COPD.
Name examples of LAMA drugs used in COPD.
Short-Acting Beta-Agonists (SABAs) may be used initially for COPD patients with _____ risk and _____ symptoms (Group A).
Short-Acting Beta-Agonists (SABAs) may be used initially for COPD patients with _____ risk and _____ symptoms (Group A).
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?
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?
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.
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.
Which respiratory disorder is chronic, reversible, characterized by hyperreactive airways leading to episodic obstruction, and is often underdiagnosed and overtreated?
Which respiratory disorder is chronic, reversible, characterized by hyperreactive airways leading to episodic obstruction, and is often underdiagnosed and overtreated?
Which respiratory disease is chronic, irreversible, characterized by progressive airflow obstruction due to remodeling, and can be fatal?
Which respiratory disease is chronic, irreversible, characterized by progressive airflow obstruction due to remodeling, and can be fatal?
Which chronic respiratory disease presents with symptoms like red, itchy, watery eyes, and a runny nose?
Which chronic respiratory disease presents with symptoms like red, itchy, watery eyes, and a runny nose?
What are the three main causes of airflow obstruction in asthma?
What are the three main causes of airflow obstruction in asthma?
In asthma, what does underlying inflammation lead to?
In asthma, what does underlying inflammation lead to?
Describe intermittent asthma in terms of symptom frequency, peak flow/spirometry results, long-term control medication, and quick-relief medication.
Describe intermittent asthma in terms of symptom frequency, peak flow/spirometry results, long-term control medication, and quick-relief medication.
Describe mild persistent asthma in terms of symptom frequency, peak flow/spirometry results, long-term control medication, and quick-relief medication.
Describe mild persistent asthma in terms of symptom frequency, peak flow/spirometry results, long-term control medication, and quick-relief medication.
Describe moderate persistent asthma in terms of symptom frequency, peak flow/spirometry results, long-term control medication options, and quick-relief medication options.
Describe moderate persistent asthma in terms of symptom frequency, peak flow/spirometry results, long-term control medication options, and quick-relief medication options.
Describe severe persistent asthma in terms of symptom frequency, peak flow/spirometry results, long-term control medication options, and quick-relief medication options.
Describe severe persistent asthma in terms of symptom frequency, peak flow/spirometry results, long-term control medication options, and quick-relief medication options.
It is safe and effective to prescribe a Long-Acting Beta-Agonist (LABA) as monotherapy for asthma.
It is safe and effective to prescribe a Long-Acting Beta-Agonist (LABA) as monotherapy for asthma.
Describe the pharmacokinetic profile of Short-Acting Beta-Agonists (SABAs) in terms of onset and duration of action.
Describe the pharmacokinetic profile of Short-Acting Beta-Agonists (SABAs) in terms of onset and duration of action.
What are the indications for using Short-Acting Beta-Agonists (SABAs) in asthma management?
What are the indications for using Short-Acting Beta-Agonists (SABAs) in asthma management?
Name two common Short-Acting Beta-Agonists (SABAs) used in asthma treatment.
Name two common Short-Acting Beta-Agonists (SABAs) used in asthma treatment.
Name two common Long-Acting Beta-Agonists (LABAs) used in asthma treatment.
Name two common Long-Acting Beta-Agonists (LABAs) used in asthma treatment.
What is the typical duration of action for Long-Acting Beta-Agonists (LABAs)?
What is the typical duration of action for Long-Acting Beta-Agonists (LABAs)?
What is the role of LABAs in asthma management? Can they be used as monotherapy or for acute relief?
What is the role of LABAs in asthma management? Can they be used as monotherapy or for acute relief?
List four common inhaled corticosteroids (ICS) used in asthma management.
List four common inhaled corticosteroids (ICS) used in asthma management.
What class of drugs is considered the Drug of Choice (DOC) for long-term control of persistent asthma?
What class of drugs is considered the Drug of Choice (DOC) for long-term control of persistent asthma?
Describe the mechanism of action (MOA) of corticosteroids in asthma treatment.
Describe the mechanism of action (MOA) of corticosteroids in asthma treatment.
What are the common routes of administration for corticosteroids in asthma, and when is each route typically used?
What are the common routes of administration for corticosteroids in asthma, and when is each route typically used?
What are the main local adverse effects (ADEs) associated with Inhaled Corticosteroids (ICS)?
What are the main local adverse effects (ADEs) associated with Inhaled Corticosteroids (ICS)?
List potential adverse effects (ADEs) associated with systemic (oral/IV) corticosteroid use.
List potential adverse effects (ADEs) associated with systemic (oral/IV) corticosteroid use.
What important instruction should patients follow after taking an Inhaled Corticosteroid (ICS)?
What important instruction should patients follow after taking an Inhaled Corticosteroid (ICS)?
Name three leukotriene modifier drugs used in asthma management.
Name three leukotriene modifier drugs used in asthma management.
What is the mechanism of action (MOA) of leukotriene modifiers?
What is the mechanism of action (MOA) of leukotriene modifiers?
What is the typical role or use of leukotriene modifiers in asthma management?
What is the typical role or use of leukotriene modifiers in asthma management?
What are some potential adverse effects (ADEs) associated with leukotriene modifiers?
What are some potential adverse effects (ADEs) associated with leukotriene modifiers?
Describe cromolyn in terms of its mechanism of action (MOA), clinical use in asthma, and duration of action (DOA).
Describe cromolyn in terms of its mechanism of action (MOA), clinical use in asthma, and duration of action (DOA).
Name a short-acting and a long-acting cholinergic antagonist (antimuscarinic) used in respiratory diseases. Are they first-line agents for asthma?
Name a short-acting and a long-acting cholinergic antagonist (antimuscarinic) used in respiratory diseases. Are they first-line agents for asthma?
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?
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?
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?
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?
What are common adverse effects (ADEs) associated with inhaled cholinergic antagonists?
What are common adverse effects (ADEs) associated with inhaled cholinergic antagonists?
What is theophylline, and why is its use limited in current asthma management?
What is theophylline, and why is its use limited in current asthma management?
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?
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?
Name some monoclonal antibody drugs used for severe asthma and describe their general mechanisms.
Name some monoclonal antibody drugs used for severe asthma and describe their general mechanisms.
What are the two main pillars of COPD treatment?
What are the two main pillars of COPD treatment?
According to older GOLD patient groups classification (A, B, C, D), outline the initial pharmacologic choices and potential escalation strategies for COPD management.
According to older GOLD patient groups classification (A, B, C, D), outline the initial pharmacologic choices and potential escalation strategies for COPD management.
Are Inhaled Corticosteroids (ICS) considered first-line therapy for asthma or COPD?
Are Inhaled Corticosteroids (ICS) considered first-line therapy for asthma or COPD?
What drug classes are generally considered first-line maintenance therapy for symptomatic COPD?
What drug classes are generally considered first-line maintenance therapy for symptomatic COPD?
List some Long-Acting Beta-Agonists (LABAs) used for COPD, noting their typical dosing frequency (once or twice daily).
List some Long-Acting Beta-Agonists (LABAs) used for COPD, noting their typical dosing frequency (once or twice daily).
List some Long-Acting Muscarinic Antagonists (LAMAs) used for COPD.
List some Long-Acting Muscarinic Antagonists (LAMAs) used for COPD.
According to older GOLD classifications, SABAs (as needed or scheduled SAMA) could be initial therapy for COPD patients with _____ risk and _____ symptoms (Group A).
According to older GOLD classifications, SABAs (as needed or scheduled SAMA) could be initial therapy for COPD patients with _____ risk and _____ symptoms (Group A).
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?
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?
In some older guidelines, adding an Inhaled Corticosteroid (ICS) to a _____ _____ _____ was considered for COPD patients if their FEV1 was less than _____ % predicted.
In some older guidelines, adding an Inhaled Corticosteroid (ICS) to a _____ _____ _____ was considered for COPD patients if their FEV1 was less than _____ % predicted.
Which respiratory disorder is described as chronic and reversible, where hyperreactive airways lead to episodic obstruction, and is often underdiagnosed and overtreated?
Which respiratory disorder is described as chronic and reversible, where hyperreactive airways lead to episodic obstruction, and is often underdiagnosed and overtreated?
Which respiratory disease is chronic and irreversible, characterized by progressive airflow obstruction (remodeling), and can be fatal?
Which respiratory disease is chronic and irreversible, characterized by progressive airflow obstruction (remodeling), and can be fatal?
Which chronic respiratory disease typically presents with symptoms like red, itchy, watery eyes, and a runny nose?
Which chronic respiratory disease typically presents with symptoms like red, itchy, watery eyes, and a runny nose?
What are the three main causes of airflow obstruction in asthma?
What are the three main causes of airflow obstruction in asthma?
In asthma, what does the underlying inflammation lead to regarding airway function and symptoms?
In asthma, what does the underlying inflammation lead to regarding airway function and symptoms?
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?
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?
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?
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?
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?
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?
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?
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?
It is recommended to prescribe a Long-Acting Beta-Agonist (LABA) as monotherapy for asthma.
It is recommended to prescribe a Long-Acting Beta-Agonist (LABA) as monotherapy for asthma.
What are the pharmacokinetic characteristics (onset and duration) of Short-Acting Beta-Agonists (SABAs)?
What are the pharmacokinetic characteristics (onset and duration) of Short-Acting Beta-Agonists (SABAs)?
In which asthma scenarios are Short-Acting Beta-Agonists (SABAs) used?
In which asthma scenarios are Short-Acting Beta-Agonists (SABAs) used?
Name two common Short-Acting Beta-Agonists (SABAs).
Name two common Short-Acting Beta-Agonists (SABAs).
Name two common Long-Acting Beta-Agonists (LABAs).
Name two common Long-Acting Beta-Agonists (LABAs).
What is the duration of bronchodilation provided by Long-Acting Beta-Agonists (LABAs)?
What is the duration of bronchodilation provided by Long-Acting Beta-Agonists (LABAs)?
How are Long-Acting Beta-Agonists (LABAs) used in asthma treatment regarding adjunctive therapy and monotherapy?
How are Long-Acting Beta-Agonists (LABAs) used in asthma treatment regarding adjunctive therapy and monotherapy?
List common inhaled corticosteroid (ICS) drug types used in asthma management.
List common inhaled corticosteroid (ICS) drug types used in asthma management.
For which condition are inhaled corticosteroids (ICS) considered the drug of choice (DOC) for long-term control?
For which condition are inhaled corticosteroids (ICS) considered the drug of choice (DOC) for long-term control?
What is the mechanism of action (MOA) of corticosteroids in asthma treatment?
What is the mechanism of action (MOA) of corticosteroids in asthma treatment?
What are the primary routes of administration for corticosteroids in asthma, and which is preferred?
What are the primary routes of administration for corticosteroids in asthma, and which is preferred?
What are the main adverse drug effects (ADEs) associated with inhaled corticosteroids (ICS)?
What are the main adverse drug effects (ADEs) associated with inhaled corticosteroids (ICS)?
List potential adverse drug effects (ADEs) associated with systemic (oral) corticosteroids.
List potential adverse drug effects (ADEs) associated with systemic (oral) corticosteroids.
What important step should patients always take after using an inhaled corticosteroid (ICS)?
What important step should patients always take after using an inhaled corticosteroid (ICS)?
Name the three main leukotriene modifier drugs.
Name the three main leukotriene modifier drugs.
What is the mechanism of action (MOA) of leukotriene modifiers?
What is the mechanism of action (MOA) of leukotriene modifiers?
What is the therapeutic use of leukotriene modifiers in asthma management?
What is the therapeutic use of leukotriene modifiers in asthma management?
What are common adverse drug effects (ADEs) associated with leukotriene modifiers?
What are common adverse drug effects (ADEs) associated with leukotriene modifiers?
Describe the mechanism of action (MOA), primary use, and duration of action (DOA) limitation for Cromolyn.
Describe the mechanism of action (MOA), primary use, and duration of action (DOA) limitation for Cromolyn.
Name one short-acting and one long-acting cholinergic antagonist used in respiratory disorders.
Name one short-acting and one long-acting cholinergic antagonist used in respiratory disorders.
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?
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?
Which long-acting cholinergic antagonist is used as add-on therapy in adults with severe asthma who have a history of exacerbations?
Which long-acting cholinergic antagonist is used as add-on therapy in adults with severe asthma who have a history of exacerbations?
What are common adverse drug effects (ADEs) of cholinergic antagonists?
What are common adverse drug effects (ADEs) of cholinergic antagonists?
What is Theophylline, and why is its use limited today?
What is Theophylline, and why is its use limited today?
What class of drugs is considered for severe persistent asthma that remains poorly controlled despite treatment with ICS, LABA, and other standard therapies?
What class of drugs is considered for severe persistent asthma that remains poorly controlled despite treatment with ICS, LABA, and other standard therapies?
Identify the main types of monoclonal antibody drugs used in severe asthma and their targets.
Identify the main types of monoclonal antibody drugs used in severe asthma and their targets.
What are the two main, very general treatment approaches for COPD?
What are the two main, very general treatment approaches for COPD?
Describe the first-choice and recommended escalation therapies for COPD patient groups A, B, C, and D.
Describe the first-choice and recommended escalation therapies for COPD patient groups A, B, C, and D.
Is an Inhaled Corticosteroid (ICS) considered first-line therapy in asthma or COPD?
Is an Inhaled Corticosteroid (ICS) considered first-line therapy in asthma or COPD?
What drug classes are considered first-line for most COPD patients (Groups B, C, D)?
What drug classes are considered first-line for most COPD patients (Groups B, C, D)?
List examples of LABA drugs used primarily for COPD, noting their dosing frequency.
List examples of LABA drugs used primarily for COPD, noting their dosing frequency.
List examples of LAMA drugs used primarily for COPD.
List examples of LAMA drugs used primarily for COPD.
In COPD management, Short-Acting Beta-Agonists (SABAs) are typically reserved as the primary choice for patients with _____ risk and _____ symptoms (Group A).
In COPD management, Short-Acting Beta-Agonists (SABAs) are typically reserved as the primary choice for patients with _____ risk and _____ symptoms (Group A).
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?
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?
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.
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.
Flashcards
Asthma
Asthma
A chronic, reversible respiratory disorder with hyperreactive airways leading to episodic obstruction, often underdiagnosed and overtreated.
COPD
COPD
A chronic, irreversible respiratory disease with progressive airflow obstruction and potential fatality due to airway remodeling.
Rhinitis
Rhinitis
A chronic respiratory condition characterized by red, itchy, watery eyes and a runny nose.
Airflow obstruction in asthma
Airflow obstruction in asthma
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Asthma's underlying inflammation leads to...
Asthma's underlying inflammation leads to...
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Intermittent Asthma
Intermittent Asthma
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Mild Persistent Asthma
Mild Persistent Asthma
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Moderate Persistent Asthma
Moderate Persistent Asthma
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Severe Persistent Asthma
Severe Persistent Asthma
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LABA alone?
LABA alone?
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Kinetics of SABA
Kinetics of SABA
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SABA use
SABA use
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Types of SABAs
Types of SABAs
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LABA types
LABA types
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LABA kinetics
LABA kinetics
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LABA Use
LABA Use
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Corticosteroid drug types
Corticosteroid drug types
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Corticosteroids DOC for?
Corticosteroids DOC for?
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MOA of Corticosteroids
MOA of Corticosteroids
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Route of Corticosteroids
Route of Corticosteroids
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ADEs of ICS
ADEs of ICS
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Systemic Corticosteroids ADEs
Systemic Corticosteroids ADEs
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ICS Post-Use
ICS Post-Use
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Leukotriene Modifier Drugs
Leukotriene Modifier Drugs
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Leukotriene Modifiers MOA
Leukotriene Modifiers MOA
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Use of Leukotriene Modifiers
Use of Leukotriene Modifiers
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ADEs of Leukotriene Modifiers
ADEs of Leukotriene Modifiers
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Cromolyn
Cromolyn
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Cholinergic Antagonists
Cholinergic Antagonists
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Ipratropium Use
Ipratropium Use
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Tiotropium Use
Tiotropium Use
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ADEs of Cholinergic Antagonists
ADEs of Cholinergic Antagonists
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Theophylline
Theophylline
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Severe persistent asthma
Severe persistent asthma
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Monoclonal Ab drugs
Monoclonal Ab drugs
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Tx of COPD (General)
Tx of COPD (General)
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COPD drugs based on pt groups
COPD drugs based on pt groups
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ICS first line?
ICS first line?
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First Line for COPD
First Line for COPD
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LABA drugs
LABA drugs
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LAMA drugs
LAMA drugs
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SABA for pts w...
SABA for pts w...
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High risk pts w/ more symptoms drugs
High risk pts w/ more symptoms drugs
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ICS can be added to...
ICS can be added to...
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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
- A (Low risk, fewer symptoms):
- 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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