30 Questions
Which drug is a PDE4 inhibitor?
Roflumilast
What is the predominant PDE isoform in inflammatory cells?
PDE4
Which methylxanthine drug is rarely used now?
Theophylline
What observation led to the discovery of the effects of methylxanthines on asthma?
Consumption of strong coffee reduces asthma symptoms
What is the duration of action of slow-release preparations of theophylline?
16-18 hours
What is the most common adverse effect of theophylline at therapeutic plasma concentration?
Nausea
Which drug is an A1-adenosine receptor blocker?
Theophylline
What is the FDA-approved use of roflumilast?
COPD with severe disease
What is the cost range of roflumilast per month?
$300-$500
Which enzyme inducer reduces the plasma concentration of xanthines?
Barbiturates
Which drugs are used primarily to cure acute asthma attacks?
Bronchodilators
What is the main purpose of Alpha1-antitrypsin Deficiency Augmentation Therapy?
To augment the AAT levels in the blood and lung interstitium
What can an imbalance between neutrophil elastase and the elastase inhibitor AAT lead to in patients with AAT deficiency?
Alveolar wall destruction and emphysema
What is the treatment strategy to avoid bronchoconstriction in asthma?
Identification and avoidance of noxious stimuli
In patients with COPD, what leads to alveolar wall destruction and emphysema?
Imbalance between neutrophil elastase and the elastase inhibitor AAT
What is the primary goal of drugs acting on the bronchi as bronchodilators?
To provide bronchodilation
What is the endogenous protease inhibitor involved in AAT deficiency?
Alpha1-antitrypsin
What is the mechanism of action of bronchodilators in the treatment of asthma?
To relax the smooth muscles of the bronchi
What is the primary purpose of drugs used in the treatment of asthma and COPD?
To avoid bronchoconstriction
What is the main effect of an imbalance between neutrophil elastase and the elastase inhibitor AAT in patients with AAT deficiency?
Alveolar wall destruction and emphysema
Which of the following drugs is indicated for COPD but not for asthma?
Indacaterol
What is the first-line treatment for inducing persistent chronic bronchodilation in COPD?
Long-acting muscarinic antagonists (LAMA)
Which class of drugs is much less effective in COPD due to corticosteroid resistance and the nature of inflammation?
Inhaled corticosteroids (ICSs)
Which drug can result in downregulation of β2 receptors with chronic treatment?
Indacaterol
Which drug class is particularly effective in COPD due to the problem of small airways?
Anticholinergics
Which combination is a fixed LABA/LAMA combination indicated for COPD, not for asthma?
Indacaterol and glycopyrrolate
Which drug decreases the concentration of lymphocytes, monocytes, eosinophils, and basophils, while increasing the concentration of neutrophils, erythrocytes, and platelets?
Fluticasone
Which drug class can sensitize the bronchial smooth muscle for β2 agonists by upregulating β2 adrenergic receptor density?
Inhaled corticosteroids (ICSs)
Which drug class can significantly improve lung function, dyspnea, symptoms, and health status, and reduce exacerbations in COPD?
LABA/LAMA combinations
Which combination is usually preferred for improving lung function and reducing exacerbations in COPD, but not in asthma?
LABA/LAMA combinations
Study Notes
Treatment Strategies for COPD and Asthma
- In COPD, inflammation is largely corticosteroid-resistant, and there are currently no effective anti-inflammatory treatments.
- The most important therapeutic strategy in COPD is to induce persistent chronic bronchodilation, with LAMA or LABA being the first-line treatment.
- Classes of drugs for asthma and COPD include controllers (anti-inflammatory/immune modulators) such as corticosteroids, leukotriene pathway inhibitors, mast cell degranulation blockers, anti-IgE antibodies, IL-5, and PDE-4 inhibitors, as well as rescue agents (bronchodilators) like β2-adrenergic agonists, muscarinic antagonists, methylxanthines, and PDE-4 inhibitor (roflumilast).
- Inhaled corticosteroids (ICSs) are first-line therapy for chronic asthma but are much less effective in COPD due to corticosteroid resistance and the nature of inflammation.
- Glucocorticoids in asthma have various anti-inflammatory actions, including modulation of immune cell function, reduction in cytokine production, and inhibition of lysosomal enzymes and activity.
- Glucocorticoids decrease the concentration of lymphocytes, monocytes, eosinophils, and basophils, while increasing the concentration of neutrophils, erythrocytes, and platelets.
- Inhaled glucocorticoids like fluticasone, flunisolide, beclomethasone, and budesonide can be used as monotherapy in COPD but are usually combined with LABAs in asthma.
- Chronic treatment with long-acting β2 agonists can result in downregulation of β2 receptors, but corticosteroids sensitize the bronchial smooth muscle for β2 agonists by upregulating β2 adrenergic receptor density.
- Anticholinergics, particularly M3 muscarinic receptor antagonists, are particularly effective in COPD due to the problem of small airways, and have indications for COPD and asthma.
- LAMA, such as tiotropium, aclidinium, umeclidinium, and glycopyrrolate, and LABA/LAMA combinations can significantly improve lung function, dyspnea, symptoms, and health status, and reduce exacerbations in COPD.
- Indacaterol and glycopyrrolate combination (Utibron Neohaler) is a fixed LABA/LAMA combination indicated for COPD, not for asthma, and is effective in improving lung function and reducing exacerbations.
- LABAs are usually combined with ICS in asthma, whereas in COPD, LABA/LAMA combinations are preferred for improving lung function and reducing exacerbations.
Test your knowledge of treatment strategies for COPD and asthma with this quiz. Explore the different classes of drugs, therapeutic approaches, and the effectiveness of various medications in managing these respiratory conditions.
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