10 Questions
What is the foundation of therapy for COPD?
Inhaled bronchodilators
What type of agents are used as first-line treatment for COPD?
LABAs and LAMAs
What is the benefit of combining anticholinergic and β2-agonist in COPD patients?
Helpful in patients who have inadequate response to a single inhaled bronchodilator and are at risk of exacerbations
What is the goal of management in asthma?
To provide stepwise management
What is an example of a bronchodilator?
All of the above
What is the benefit of using bronchodilators in COPD patients?
Alleviates symptoms and decreases exacerbations
Which of the following is NOT a part of the management of COPD?
Dietary modifications
What is the primary goal of using LABAs and LAMAs in COPD patients?
To alleviate symptoms
What is the benefit of oxygen therapy in COPD patients?
No specific benefit mentioned
What is the approach to management in asthma?
Stepwise
Study Notes
Corticosteroids
- Have been used to treat asthma since 1950
- Have broad anti-inflammatory efficacy
- Inhibit production of inflammatory cytokines
- Do not relax airway smooth muscle directly
- ↓bronchial reactivity and frequency of asthma exacerbations when taken regularly
- Have an effect on airway obstruction due to:
- Contraction of engorged vessels in the bronchial mucosa
- Potentiation of the effects of β-receptor agonists
- Inhibition of lymphocytic, eosinophilic mucosal inflammation of asthmatic airways
β2 Agonists
- Formoterol: full agonist with an onset of action similar to albuterol
- Salmeterol: partial agonist with an onset of action of ~ 30 minutes
- Indacaterol, Olodaterol, Vilanterol, and Bambuterol: ultralong acting β agonists, need to be taken only once a day
- Cause prolonged bronchodilation, but do not relax airway smooth muscle directly
- Should be used in combination with an ICS for asthma treatment
Methylxanthines
- Theophylline: chronically used, slightly ↓ overall level of bronchial reactivity
- No effect on airway smooth muscle tone, ineffective in reversing asthmatic bronchospasm
- Only of value when taken prophylactically
Monoclonal Antibody
- Anti-IgE: omalizumab (Xolair)
- Prevents binding of IgE to mast cells and basophils
- ↓release of mediators following allergen exposure
- Alternative to initial ICS therapy, but not as effective
- Doses: for moderate-severe allergic asthma not well controlled by CS, ≥ 6 years old, and moderate to severe persistent asthma
Leukotriene Antagonists
- Leukotrienes result from the action of 5-lipoxygenase on arachidonic acid
- Synthesized by inflammatory cells in the airways, including eosinophils, mast cells, macrophages, and basophils
- Leukotriene receptor antagonists (LTD4-receptor antagonists):
- Zafirlukast (Accolate): oral, twice daily
- Montelukast (Singulair): oral, once daily
- 5-lipoxygenase inhibitor: Zileuton (Zyflo): oral, 4x daily (not commonly used)
- Use: improve FEV1, decrease asthma symptoms, rescue drug use, and exacerbations due to asthma
Other Therapies
- Allergen Immunotherapy:
- Treatment option where allergy plays a prominent role, including asthma with allergic rhino-conjunctivitis
- 2 approaches: Subcutaneous immunotherapy (SCIT) and Sublingual (SLIT)
- Most common allergens included: house dust mite and grass pollens
- Vaccines
- Oxygen
- Pulmonary rehabilitation
- Surgery
This quiz covers the use of corticosteroids and beta agonists, such as formoterol and salmeterol, in the treatment of asthma. Learn about their mechanisms of action and onset of action.
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