Asthma Medications and Biologic Therapies Quiz

Asthma Medications Overview

• Medications for asthma include beta-2 agonists, glucocorticosteroids, leukotriene blockers, mast cell stabilizers, methylxanthines, and biologic agents.
• Beta-2 agonists are the most effective bronchodilators available, with short-acting (SABA) names like Albuterol and Levalbuterol.
• Long-acting LABAs like Formoterol and Salmeterol provide 4-8 hours and 24-hour duration of bronchodilation, respectively.
• LABAs are not for acute attacks and are preferred for nighttime symptoms, but have labeling risks and warnings associated with long-acting beta agonists.
• Other beta agonists include Terbutaline, Isoproterenol, and Epinephrine, each with specific uses and effects.
• Adverse effects of beta-2 agonists include heart rate, tremor, nervousness, hypokalemia, and tolerance with chronic use.
• Inhaled corticosteroids (ICS) are the most effective anti-inflammatory agents for asthma, improving responsiveness to beta2 agonists and lung function.
• ICS are preferred for daily maintenance therapy and have low, medium, and high dose regimens, with adverse effects like oral candidiasis and dysphonia.
• The prescription of low-dose ICS-formoterol involves specific steps based on severity, with as-needed doses before exercise or allergen exposure.
• Systemic corticosteroids are indicated for significant asthma exacerbations and have adverse effects like headache, palpitations, and tachycardia.
• Biologics for asthma include anti-IgE therapy like Omalizumab (Xolair), a monoclonal antibody administered via subcutaneous injection based on IgE levels and weight.
• Omalizumab is used for moderate to severe asthma with poor ICS control.

Biologic Therapies for Severe Asthma and Management

• Omalizumab (Xolair) is an add-on maintenance medication for moderate to severe asthma in adults and children over 6 years old with poorly controlled symptoms and allergic sensitization.
• Common adverse effects of Omalizumab include pain at injection, headache, and upper respiratory infections, with rare cases of anaphylaxis.
• Mepolizumab, a monoclonal antibody to IL-5, is indicated to reduce exacerbations in severe asthma patients with blood eosinophil counts of 150/microL or greater, administered subcutaneously.
• Reslizumab, a monoclonal anti-IL-5 antibody, is indicated as an add-on maintenance therapy for severe asthma in patients over 18 years old with an eosinophilic phenotype, given via IV infusion every 4 weeks.
• Benralizumab, an interleukin-5 receptor antagonist, is an add-on therapy for severe eosinophilic asthma, administered subcutaneously.
• Dupilumab, which blocks the effects of IL-4, is used to reduce exacerbations and improve lung function in moderate-to-severe eosinophilic asthma patients, administered subcutaneously every other week.
• Tezepelumab (Tezspire), a monoclonal antibody, is an add-on maintenance treatment for severe asthma in adult and pediatric patients over 12 years old, administered subcutaneously every 4 weeks.
• Biologics affecting eosinophils are not recommended for patients with parasitic, especially helminthic, infections.
• The Global Initiative for Asthma classifies and manages asthma severity and control based on impairment and risk categories, determining changes in therapy.
• The classification and management of asthma severity includes well controlled, not well controlled, and very poorly controlled categories, with corresponding treatment steps.
• The treatment for severe asthma includes high-dose inhaled glucocorticoid and long-acting beta agonist (LABA) or leukotriene modifier/theophylline, and referral to an asthma specialist.
• Home management of mild to moderate asthma exacerbations involves using SABA beta2 agonists or GC-formoterol for acute symptom relief, with reassessment and appropriate actions based on response.

Asthma Treatment and Management

• Atopy refers to the genetic susceptibility to produce IgE directed toward common environmental allergens.
• IgE causes mast cells and lymphocytes to become activated and sensitized when challenged by allergens, leading to the release of inflammatory mediators.
• The pathophysiology of asthma involves airflow obstruction with edema, bronchoconstriction, hypersecretion, and inflammation.
• Acute inflammation in asthma can be provoked by unknown or known factors such as viral infection, allergens, and irritants.
• Chronic inflammation in asthma involves various cells and clinical consequences like chronic airway hyperreactivity and airway remodeling.
• Parasympathetic (vagal) stimulation provides normal resting airway tone, while catecholamines such as epinephrine cause bronchodilation via activation of Beta-2 receptors on bronchial smooth muscle.
• Treatment of asthma involves aerosol delivery devices, including nebulizers, metered dose inhalers (MDIs), dry powder inhalers (DPIs), and soft mist inhalers (SMIIs).
• Nebulizers, both jet and ultrasonic, are used to produce an aerosol from liquid for efficient drug delivery, with the former requiring flow rates > 6L/Minute for effective delivery.
• Metered Dose Inhalers (MDIs) are the most used and convenient delivery devices, requiring shaking and pressing during inhalation.
• Dry Powder Inhalers (DPIs) are breath-actuated devices that deliver micronized drug particles and are used for several asthma medicines.
• Soft Mist Inhalers (SMIIs) are larger than MDIs, do not contain propellant, and achieve higher pulmonary deposition than MDIs.
• The goals of asthma treatment include symptom control, maintenance of normal lung function, prevention of flare-ups and asthma deaths, and minimizing medication side-effects, with various terminologies and regimens used in the treatment.