Asthma Treatment Guidelines and Medications
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Questions and Answers

Which organization is primarily responsible for the preferred guidelines for asthma care?

  • National Heart, Lung, and Blood Institute (NHLBI)
  • World Health Organization (WHO)
  • National Asthma Education and Prevention Program (NAEPP) (correct)
  • Global Initiative for Asthma (GINA)

    • What is the primary purpose of short-acting beta-2 agonists (SABAs) in asthma treatment?

  • To induce long-lasting effects
  • To provide as-needed relief from acute symptoms (correct)
  • To prevent airway inflammation
  • To control chronic asthma symptoms

    • Which technique is emphasized for asthma management according to the guidelines?

  • Use of oral medications only
  • Regular blood tests for airway inflammation
  • Proper use of inhalers and assessment of medications (correct)
  • Increasing physical activity levels

    • What is the purpose of inhaled corticosteroids in asthma treatment?

    <p>To decrease airway inflammation</p> Signup and view all the answers

    Which class of asthma symptoms includes severe persistent asthma?

    <p>Moderate persistent</p> Signup and view all the answers

    What is a potential benefit of Formoterol over traditional short-acting beta-agonists?

    <p>It has a longer duration of action.</p> Signup and view all the answers

    Which medications are considered controllers in asthma management?

    <p>Inhaled corticosteroids and long-acting beta-2 agonists</p> Signup and view all the answers

    What is the primary action of beta-2 agonists in asthma treatment?

    <p>They promote smooth airway muscle relaxation.</p> Signup and view all the answers

    What are the main benefits of using oral corticosteroids in treating acute exacerbations?

    <p>They reduce treatment failure and relapse rates.</p> Signup and view all the answers

    What is a significant risk of chronic oral steroid use during extreme physical stress?

    <p>Risk of death from increased steroid demand.</p> Signup and view all the answers

    Which medication is a phosphodiesterase-4 (PDE4) inhibitor used for COPD, particularly in chronic bronchitis?

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

    What is the primary action of Roflumilast in the management of COPD?

    <p>To increase intracellular cyclic AMP.</p> Signup and view all the answers

    Which of the following is not a common adverse effect associated with Roflumilast?

    <p>Weight gain.</p> Signup and view all the answers

    Which inhalation device delivers a measured dose of the drug with each use but requires hand-breath coordination?

    <p>Metered-dose inhaler (MDI).</p> Signup and view all the answers

    Which inhalation device delivers more drug to the lungs, approximately 20%, and does not require hand-breath coordination?

    <p>Dry Powdered Inhaler (DPI).</p> Signup and view all the answers

    What is an important consideration when using nebulizers compared to inhalers?

    <p>They allow for less drug deposition on the oropharynx.</p> Signup and view all the answers

    What is a reported neuropsychiatric effect of Roflumilast use that healthcare providers should monitor?

    <p>Anxiety and depression.</p> Signup and view all the answers

    Which therapeutic advantage is associated with inhalation as a delivery method for medications?

    <p>More rapid onset of action.</p> Signup and view all the answers

    What is the primary disadvantage of using leukotriene receptor antagonists compared to inhaled corticosteroids?

    <p>They are less effective for asthma control.</p> Signup and view all the answers

    Which type of medication is tiotropium bromide categorized as?

    <p>Long-acting muscarinic antagonist</p> Signup and view all the answers

    What must be monitored when using theophylline due to its potential for toxicity?

    <p>Serum theophylline concentrations</p> Signup and view all the answers

    What is the primary concern regarding the use of long-acting beta-2 agonists in asthma treatment?

    <p>They lead to increased risk of asthma-related deaths when used alone.</p> Signup and view all the answers

    Which of the following side effects is commonly associated with theophylline therapy?

    <p>Rapid heart rate</p> Signup and view all the answers

    Which monoclonal antibody works by inhibiting IgE binding to receptors on mast cells and basophils?

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

    What effect do long-acting muscarinic antagonists have when they block acetylcholine binding?

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

    What is a potential risk associated with the use of monoclonal antibodies for asthmatic patients?

    <p>Immune-type reactions</p> Signup and view all the answers

    What should be ensured when a patient with asthma is prescribed a long-acting beta-2 agonist?

    <p>To combine it with an inhaled corticosteroid</p> Signup and view all the answers

    How does zileuton differ from leukotriene receptor antagonists?

    <p>It causes more adverse effects.</p> Signup and view all the answers

    What is a significant concern when using salmeterol in pediatric patients?

    <p>Risk of prolonged QT interval</p> Signup and view all the answers

    What is the recommended dosing practice for omalizumab used in asthma treatment?

    <p>Based on body weight and total IgE levels</p> Signup and view all the answers

    Which of the following best describes a common use for the methylxanthine theophylline?

    <p>Treatment for severe asthma not controlled with standard therapies</p> Signup and view all the answers

    What is the role of acetylcholine in the pathophysiology of asthma?

    <p>It triggers increased mucus secretion and inflammation</p> Signup and view all the answers

    What is generally not recommended for patients with chronic obstructive pulmonary disease who experience occasional dyspnea?

    <p>Short-acting bronchodilators used regularly</p> Signup and view all the answers

    What is the primary role of pulmonary rehabilitation in chronic obstructive pulmonary disease treatment?

    <p>To improve symptoms and quality of life</p> Signup and view all the answers

    Which medication is used as a last resort for patients with chronic obstructive pulmonary disease due to its side effects?

    <p>Methylxanthine - theophylline</p> Signup and view all the answers

    What is a common side effect of long-acting beta-agonists in COPD treatment?

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

    What is a significant concern associated with long-term use of inhaled corticosteroids in patients with COPD?

    <p>Increased risk of pneumonia</p> Signup and view all the answers

    Which bronchodilator combination is typically prescribed to relieve acute symptoms in COPD patients?

    <p>Short-acting beta-2 agonist plus short-acting muscarinic antagonist</p> Signup and view all the answers

    What major cardiovascular concern is associated with long-acting muscarinic antagonists in COPD treatment?

    <p>Cardiovascular events</p> Signup and view all the answers

    Which condition is not considered a component of chronic obstructive pulmonary disease?

    <p>Acute bronchiolitis</p> Signup and view all the answers

    For which scenario is a combination of inhaled corticosteroids and long-acting bronchodilators appropriate?

    <p>For patients experiencing exacerbations</p> Signup and view all the answers

    What is the primary action of anticholinergic medications in COPD management?

    <p>Bronchodilation and decrease secretions</p> Signup and view all the answers

    Which is a common side effect of theophylline at therapeutic serum concentrations?

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

    What should be emphasized to patients using ipratropium bromide?

    <p>Increased fluid intake</p> Signup and view all the answers

    Chronic obstructive pulmonary disease encompasses which two primary conditions?

    <p>Chronic bronchitis and emphysema</p> Signup and view all the answers

    Which of the following vaccines is recommended for patients with COPD to reduce exacerbations?

    <p>Flu vaccine</p> Signup and view all the answers

    Combining which two types of bronchodilators can be beneficial for patients with persistent symptoms?

    <p>LABAs and LAMAs</p> Signup and view all the answers

    What is the primary reason inhaled glucocorticoids should not be used alone during an acute asthma attack?

    <p>They do not provide immediate relief of bronchoconstriction.</p> Signup and view all the answers

    What is a significant concern regarding the use of inhaled corticosteroids in children?

    <p>They can negatively affect growth velocity.</p> Signup and view all the answers

    Which of the following is a potential side effect of using mast cell stabilizers?

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

    What does Zafirlukast (Accolate) primarily act on?

    <p>Leukotriene receptors</p> Signup and view all the answers

    Which medication class is used as a prophylactic treatment for asthma and allergies?

    <p>Mast cell stabilizers</p> Signup and view all the answers

    In which condition should Zileuton (Zyflo) be used with caution?

    <p>Active liver disease</p> Signup and view all the answers

    What is a common recommendation for patients using inhaled corticosteroids to prevent oral thrush?

    <p>Rinse the mouth after each use.</p> Signup and view all the answers

    Why must inhaled corticosteroids be tapered gradually before discontinuation?

    <p>To avoid systemic withdrawal symptoms.</p> Signup and view all the answers

    What is the main purpose of long-acting beta-agonists (LABAs) in asthma treatment?

    <p>To achieve sustained bronchodilation.</p> Signup and view all the answers

    Which side effect can be exacerbated by the use of beta-agonists in patients with cardiovascular disease?

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

    What can prolonged use of inhaled corticosteroids potentially lead to?

    <p>Bone loss</p> Signup and view all the answers

    Which of the following side effects is a boxed warning for montelukast (Singulair)?

    <p>Psychiatric disturbances</p> Signup and view all the answers

    What is the recommended duration for using high-dose oral corticosteroids before a taper may be necessary?

    <p>More than 10-14 days</p> Signup and view all the answers

    What potential side effect is associated with corticosteroid use, especially with high doses?

    <p>Fluid retention</p> Signup and view all the answers

    What is one of the recommendations for preventing bone loss in patients taking inhaled corticosteroids?

    <p>Calcium and vitamin D supplementation</p> Signup and view all the answers

    What is an effect of leukotrienes in asthma management?

    <p>They are inflammatory mediators.</p> Signup and view all the answers

    How should corticosteroid therapy be managed when transitioning from systemic corticosteroids to inhaled products?

    <p>Gradually reduce systemic corticosteroids to avoid adrenal insufficiency.</p> Signup and view all the answers

    What condition should caution be exercised with when prescribing beta-agonists due to potential serum glucose level increases?

    <p>Diabetes Mellitus</p> Signup and view all the answers

    Which combination in the medication Advair makes it effective for asthma treatment?

    <p>Long-acting B2-agonist and steroid</p> Signup and view all the answers

    What characteristic is required for effective use of the Advair Diskus system?

    <p>Deep inhalation technique.</p> Signup and view all the answers

    Which of the following side effects can result from corticosteroid therapy?

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

    Which condition should corticosteroids be avoided in due to the potential for severe consequences?

    <p>Active tuberculosis</p> Signup and view all the answers

    What is a known risk associated with prolonged corticosteroid therapy?

    <p>Kaposi sarcoma</p> Signup and view all the answers

    What type of corticosteroid therapy is generally given to asthma patients during exacerbations?

    <p>Short-term oral corticosteroids in bursts</p> Signup and view all the answers

    Which of the following are potential psychiatric side effects of corticosteroid use?

    <p>All of the above</p> Signup and view all the answers

    What effect do beta-agonists typically have on the QT interval?

    <p>Prolong it</p> Signup and view all the answers

    What is a common side effect of short-acting beta-agonists?

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

    In what scenario is high-dose oral steroid therapy particularly risky without a proper taper?

    <p>When taken for longer than 14 days</p> Signup and view all the answers

    Which of the following medications should not be used as monotherapy for asthma?

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

    What is the observation period required after the first three injections of omalizumab?

    <p>2 hours</p> Signup and view all the answers

    What potential effect does the class of Interleukin-5 receptor antagonists have relating to eosinophils?

    <p>Decrease the production of eosinophils</p> Signup and view all the answers

    Which side effect is most commonly associated with Interleukin-5 receptor antagonists?

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

    What is the preferred rescue therapy for asthma during pregnancy?

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

    What is not a contraindication for dupilumab use in asthma treatment?

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

    What serious reaction can occur with both Reslizumab and Dupilumab?

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

    What is the primary concern for untreated asthma during pregnancy?

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

    Which inhaled corticosteroid is preferred for asthma management during pregnancy?

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

    What common side effect should patients be cautious about with dupilumab?

    <p>Injection site reactions</p> Signup and view all the answers

    What recommendation should be made to patients regarding symptoms of anaphylaxis after omalizumab administration?

    <p>Seek immediate medical care if symptoms occur</p> Signup and view all the answers

    Which medication has known neonatal side effects, particularly affecting sleep?

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

    What kind of asthma is treated with Interleukin-5 receptor antagonists?

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

    What should be done if signs of serious hypersensitivity reaction occur with dupilumab?

    <p>Discontinue the medication immediately</p> Signup and view all the answers

    How long after drug administration can symptoms of anaphylaxis occur?

    <p>Up to 24 hours or longer</p> Signup and view all the answers

    Study Notes

    Asthma Treatment Guidelines

    • Two main bodies provide asthma treatment recommendations: GINA (Global Initiative for Asthma) and EPR-4 (National Heart, Lung, and Blood Institute).
    • GINA's approach is integrated evidence-based strategies for clinical practice.
    • EPR-4 is the preferred guideline for asthma management.
    • Inhaler technique assessment is crucial.

    Asthma Treatment Approach

    • Two-pronged approach: bronchodilation (rapid onset) and inflammation reduction.
    • Bronchodilation achieved with short-acting beta-agonists (e.g., albuterol) or long-acting beta-agonists (LABAs, e.g., formoterol) and, to a lesser extent, short-acting muscarinic agents.
    • Inflammation reduction done primarily with inhaled corticosteroids.
    • Asthma classified into mild intermittent, mild persistent, moderate persistent, and severe persistent.

    Asthma Medications

    Relievers

    • Used for "as-needed" relief of acute asthma symptoms.
    • Include short-acting beta-2 agonists (SABAs), short-acting muscarinic agents (SAMAs), and oral corticosteroids.

    Controllers/Maintenance

    • Prevent and control symptoms by reducing inflammation.
    • Include inhaled corticosteroids, leukotriene modifiers, or inhaled corticosteroids combined with long-acting beta-2 agonists.

    Beta-2 Agonists

    • Promote airway smooth muscle relaxation.
    • Include SABAs (e.g., albuterol) and LABAs (e.g., salmeterol, formoterol).
    • LABAs used in combination with inhaled corticosteroids, not as monotherapy.
    • Side effects of SABAs include nervousness, shakiness, tremors, palpitations.
    • Increased risk of arrhythmias in patients with cardiovascular disease. -Albuterol has the potential for direct myocardial toxicity or exacerbation of underlying myocardial dysfunction.
    • May prolong QT interval.
    • Use cautiously in patients with diabetes mellitus (increase serum glucose levels).
    • Use cautiously in patients with glaucoma (elevate intraocular pressure).

    Oral Corticosteroids

    • Short-term use (bursts), especially during exacerbations.
    • Used as initial burst along with an inhaled glucocorticoid to cover until the inhaled corticosteroid acts.
    • High doses (>40mg) require tapering if for over 10-14 days.
    • Potential side effects: headaches, dizziness, sleep disturbance, mood swings, hyperglycemia, bone loss.
    • Adrenal suppression, especially in children. Careful withdrawal is crucial.
    • Potential fatalities with adrenal insufficiency following steroid cessation transfer.
    • Use of stress doses during surgical periods
    • Immunosuppression: increased susceptibility to infection, masking infections.

    Inhaled Corticosteroids (ICS)

    • Mainstay of maintenance therapy.
    • Do not provide immediate bronchodilation.
    • Do not use alone for acute asthma.
    • Side effects similar to oral steroids, but at lower rates.
    • Examples: Fluticasone, Budesonide, Advair (fluticasone/salmeterol).
    • Advair's Diskus easier for correct inhalation (deep inhalation needed).
    • Concerns in pediatric patients: possible impact on growth velocity, bone loss; need for calcium and vitamin D, exercise, and smoking cessation.
    • Use cautiously in those with cataracts or glaucoma.

    Mast Cell Stabilizers

    • Anti-inflammatory agents preventing bronchoconstriction.
    • Block histamine and SRS-A release from mast cells.
    • Example: Cromolyn sodium.
    • Requires several weeks for full effect.
    • Not for acute symptoms, but for prophylaxis.
    • Side effects include headaches, nasal irritation, and cough.

    Antileukotrienes

    • Controller medications (do not treat acute symptoms).
    • Prevent airway edema, smooth muscle contraction, and inflammation.
    • Examples: Zafirlukast (Accolate), Montelukast (Singulair), Zileuton (Zyflo).
    • Monitor liver function with zileuton.
    • Singulair has a boxed warning for psychiatric disturbances.
    • Less effective than inhaled corticosteroids.

    Short and Long-Acting Muscarinic Antagonists (SAMAs and LAMAs)

    • Block acetylcholines effect on muscarinic receptors
    • Result in bronchodilation, decreased mucus, and less inflammation.
    • Tiotropium bromide (LAMA) is FDA-approved for asthma (≥6 years old).
    • Adding tiotropium to ICS can improve lung function in moderate to severe asthma.
    • Combination inhaler (Trelegy Ellipta) containing fluticasone furoate, umeclidinium, and vilanterol.

    Methylxanthines (Theophylline)

    • Less commonly used.
    • Monitor blood levels closely (10-15 mcg/mL).
    • Multiple drug interactions.
    • Side effects include stomach upset, sleep disturbance, headache, nervousness, rapid heart rate.
    • Not a preferred agent in COPD exacerbations.

    Long-Acting Beta-2 Agonists (LABAs)

    • Not for monotherapy in asthma (increased risk of asthma-related deaths/hospitalization)
    • Use only in combination with inhaled corticosteroids.

    Monoclonal Antibodies

    • Risk of immune reactions (vasculitis, eosinophilia, hypersensitivity).
    • Anti-IgE antibodies (omalizumab/Xolair): reduce allergen-triggered release of inflammatory mediators.
      • FDA-approved for severe asthma
      • Anaphylaxis risk, observe for 2 hours after first injection, 30minutes after subsequent injections.
    • IL-5 Receptor Antagonists (e.g., reslizumab): decrease eosinophil production. Used in severe eosinophilia-related asthma.
    • IL-4 Receptor Alpha Antagonists (e.g., dupilumab): inhibit IL-4 and IL-13-induced inflammatory responses.

    Asthma and Pregnancy/Lactation

    • Asthma treatment essential, safer than untreated asthma.
    • Uncontrolled asthma increases preeclampsia, preterm birth risk.
    • Albuterol preferred SABA in pregnancy.
    • Budesonide preferred ICS for pregnancy.
    • Most asthma medications considered safe during lactation; consult current data. Minimise exposure via breastfeeding timing.

    Chronic Obstructive Pulmonary Disease (COPD)

    • Includes chronic bronchitis and emphysema.
    • Goal of pharmacologic therapy is symptom reduction, exacerbation prevention, improved exercise tolerance.
    • No medication conclusively changes long-term lung function decline.

    Bronchodilators for COPD

    • Regular use for symptom prevention.
    • Long-acting bronchodilators often preferred over SABAs.

    Inhaled Medications

    • Advantages: direct effect on lungs, minimized systemic effects, rapid relief for acute attacks.
    • Types: Metered-Dose Inhalers (MDIs), Dry Powdered Inhalers (DPIs), Nebulizers.
    • MDIs: hand-breath coordination is needed, limited delivery.
    • DPIs: no hand-breath coordination, higher lung delivery.
    • Nebulizers: provide fine mist, useful for acute attacks.

    Other COPD Treatments

    • Influenza and pneumococcal vaccines.
    • Pulmonary rehabilitation.
    • Antibiotics (e.g., azithromycin) may reduce exacerbations rates in some cases.
    • Mucolytics/N-acetylcysteine may be helpful in reducing exacerbations.
    • Combination inhalers available.

    Anti-inflammatory Therapy in COPD

    • Inhaled corticosteroids (ICS) can reduce inflammation, especially in patients with high eosinophilia or asthma components.
    • ICS not approved as monotherapy for COPD worldwide. Long term use may pose issues.
    • Combination agents with ICS and LABAs are appropriate for COPD exacerbations on long acting bronchodilators.
    • Oral corticosteroids primarily for acute exacerbations.

    Phosphodiesterase-4 (PDE4) Inhibitor

    • Roflumilast (Daliresp) reduces inflammation, slowing COPD progression.
    • Not a bronchodilator, not for acute symptoms.
    • Side effects include diarrhea, nausea, weight loss, sleep disturbances.
    • Monitor liver enzymes. Assess risks and benefits in patients with depression.

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    Description

    This quiz covers essential asthma treatment guidelines provided by GINA and EPR-4, highlighting the importance of proper inhaler techniques. It also discusses the dual approach to asthma management focusing on bronchodilation and inflammation reduction, along with an overview of medications used for asthma relief.

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