Asthma vs. COPD Overview

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Questions and Answers

Which of the following correctly describes a mechanism by which bronchodilators function?

They prevent the release of histamines from mast cells.

They inhibit cyclooxygenase enzymes to reduce inflammation.

They relax bronchial smooth muscle through adrenergic receptor stimulation. (correct)

They work by enhancing the action of phosphodiesterase enzymes.

In the treatment of asthma, how do short-acting agents differ from long-acting agents?

Short-acting agents are used for quick relief while long-acting agents are for maintenance. (correct)

Long-acting agents are typically used for acute relief, unlike short-acting agents.

There is no difference; both types of agents are interchangeable.

Short-acting agents have a longer duration of action than long-acting agents.

Which of the following is a potential adverse effect of antiasthmatic medications?

Hypotension due to peripheral vasodilation.

Systemic hypertension due to vasoconstriction.

Increased sputum production and congestion.

Dysrhythmias caused by excessive beta-agonist stimulation. (correct)

What is the significance of monitoring blood eosinophil counts in the treatment of COPD?

It indicates the appropriateness of ICS therapy. Signup and view all the answers

What is the primary benefit of using long-acting bronchodilators in COPD management?

They reduce the frequency of exacerbations over time. Signup and view all the answers

Which treatment approach is recommended in advanced COPD management?

Long-term oxygen therapy administered at home. Signup and view all the answers

What is the primary action of Cysteinyl leukotriene receptor antagonists like montelukast?

Act on leukotriene receptors in respiratory mucosa Signup and view all the answers

In the context of asthma management, what role does glucocorticoid therapy primarily play?

It reduces inflammation and airway hyperresponsiveness. Signup and view all the answers

Which statement accurately describes the role of theophylline in asthma management?

It serves as a corticosteroid-sparing agent, though with less reliability. Signup and view all the answers

Which statement correctly contrasts asthma and COPD regarding their genetic predisposition?

Asthma has a higher genetic component than COPD. Signup and view all the answers

What distinguishes a short-acting bronchodilator from a long-acting one in asthma therapy?

Short-acting agents are used solely for acute exacerbations. Signup and view all the answers

Which of the following is a potential adverse effect associated with long-term corticosteroid use in asthmatic patients?

Development of adrenal insufficiency Signup and view all the answers

What is the purpose of monitoring treatment effectiveness in asthmatic patients?

To evaluate symptom control and adjust medications accordingly Signup and view all the answers

Which biologic therapy specifically targets human IgE in asthma patients?

Omalizumab Signup and view all the answers

In the stepwise approach to asthma management, what is recommended if asthma remains uncontrolled after Step 2?

Introduce a long-acting bronchodilator Signup and view all the answers

What mechanism allows leukotriene receptor antagonists to reduce asthmatic symptoms?

They block the action of leukotrienes on specific receptors. Signup and view all the answers

What is the primary mechanism of action of bronchodilators like salbutamol?

Activation of β2 adrenoreceptors Signup and view all the answers

During the management of chronic obstructive pulmonary disease (COPD), which class of medication is best used for long-term control?

Long-acting beta-agonists Signup and view all the answers

Which of the following is a common adverse effect associated with the use of antiasthmatic medications?

Tachycardia Signup and view all the answers

Which measure is most effective for monitoring treatment effectiveness in patients with severe acute asthma?

Pulmonary function tests (PEFR or FEV1) Signup and view all the answers

What is a distinguishing feature of short-acting beta-agonists compared to long-acting beta-agonists in asthma management?

They provide rapid relief of acute symptoms. Signup and view all the answers

What is one major consideration when treating anaphylaxis in a patient?

Administration of adrenaline via IM or IV route Signup and view all the answers

In the context of COPD, what does pulmonary hypertension commonly lead to?

Cor pulmonale or heart failure Signup and view all the answers

What factor primarily contributes to the pathogenesis of COPD?

Fibrosis of small airways and destruction of alveoli Signup and view all the answers

Study Notes

Asthma vs. COPD

Asthma is triggered by viruses, allergies, while COPD is triggered by smoking and pollutants.
Asthma is more common in young ages/adults, while COPD is more frequent in older individuals.
Asthma has associated pathologies such as rhinitis, conjunctivitis, and dermatitis while COPD does not.
COPD is genetically linked, Asthma is not.
Asthma inflammatory cells are eosinophils, COPD inflammatory cells are neutrophils.
Asthma obstructions are reversible while COPD obstructions are not.
Asthma responds to glucocorticoids by inflammation reduction, COPD responses can vary.

COPD Treatment

Stopping smoking slows the progression of the disease.
Patients should be immunized against influenza and Pneumococcus.
Initial treatment involves long-acting bronchodilators.
Patients with high blood eosinophil counts (>300 cells per μL) should be treated with ICS combined with LABA.
Advanced COPD requires long-term oxygen therapy at home.

COPD Acute Exacerbations Treatment

Inhaled oxygen is administered in a concentration.
Blood gases and tissue oxygen saturation should be monitored.
Broad-spectrum antibiotics such as ceftaroline are used if an infection is present.
Inhaled bronchodilators are used for symptom management.
Inhaled steroids improve quality of life.
A systemically active glucocorticoid such as IV hydrocortisone or oral prednisolone is also administered, although efficacy is modest.

Antiasthmatic Drugs

Cysteinyl Leukotriene Receptor Antagonists:
- Act on leukotriene receptors CysLT1 and CysLT2.
- Decrease acute reactions to aspirin in sensitive patients.
- Inhibit exercise-induced asthma.
- Used as an add-on therapy to inhaled corticosteroids and long-acting β2 agonists.
Biologic Therapy:
- Anti-IgE: Omalizumab, a humanized monoclonal antibody that binds to human immunoglobulin E.
- IL-5 Antagonists: Mepolizumab and reslizumab, monoclonal antibodies that inhibit IL-5 signaling and reduce eosinophil production.
- IL-4/IL-13 Antagonist: Dupilumab, binds to the alpha subunit of the IL-4 receptor and suppresses type 2 inflammation biomarkers.
- Thymic Stromal Lymphoprotein (TSLP) Antagonist: Tezepelumab, a cytokine that mediates the immune system and structural cells of the airway.

Asthma Treatment Steps

Step 1: Short-acting bronchodilator alone (SABA or SAMA)
Step 2: Add a regular inhaled corticosteroid (ICS)
Step 3: Add a long-acting bronchodilator (LABA or LAMA)
Step 4: Consider theophylline or leukotriene antagonists (e.g., montelukast).
Step 5: Add a regular oral corticosteroid (e.g., prednisolone).
Consider Biologic treatment

Severe Acute Asthma (Status Asthmaticus)

A medical emergency requiring hospitalization.
Treatment includes:
- Oxygen
- Nebulized salbutamol
- IV hydrocortisone
- Oral prednisolone
Additional measures may include:
- Nebulized ipratropium
- IV salbutamol
- Aminophylline
- Antibiotics if bacterial infection is present.
Monitoring of PEFR or FEV1, arterial blood gases, and oxygen saturation is crucial.

Allergic Emergencies

Anaphylaxis and angio-oedema are emergencies involving acute airways obstruction.
Adrenaline is potentially life-saving and can be administered IM or IV.
Patients at risk of acute anaphylaxis may self-administer IM adrenaline using a spring-loaded syringe.
Oxygen, antihistamine treatment (chlorphenamine), and glucocorticoids are also indicated.

Chronic Obstructive Pulmonary Disease (COPD)

Third leading cause of death worldwide, causing 3.23 million deaths in 2019.
Cigarette smoking is the main cause.
Air pollution may contribute to the etiology.
Clinical features:
- Initial attacks of morning cough during winter.
- Chronic cough with intermittent exacerbations.
- Progressive breathlessness.
- Pulmonary hypertension as a late complication, leading to heart failure (cor pulmonale).
- Exacerbations may be complicated by respiratory failure requiring hospitalization and intensive care.

COPD Pathogenesis

Fibrosis of small airways, leading to obstruction.
Destruction of alveoli and elastin fibers in the lung parenchyma, hallmark of emphysema.
Emphysema causes respiratory failure by impairing gas transfer.
Chronic inflammation (bronchitis) in small airways and lung parenchyma, characterized by increased macrophages, neutrophils, and T lymphocytes.

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Description

This quiz explores the key differences between asthma and chronic obstructive pulmonary disease (COPD), including triggers, demographics, inflammatory responses, and treatment options. Prepare to test your understanding of these common respiratory conditions and their management strategies.