Respiratory Pharmacology 2 Prof LJ Egan Lecture Outline

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Questions and Answers

What are the local side effects associated with inhaled corticosteroids?

Dysphonia, oropharyngeal candidiasis, cough (correct)

Metabolic abnormalities, psychiatric disturbances, cough

Adrenal suppression, growth suppression, bruising

Osteoporosis, cataracts, glaucoma

Which immune cells are glucocorticoid receptors ubiquitously expressed in?

Adaptive immune cells

Monocytes

T lymphocytes (correct)

Macrophages

What is the main advantage of using inhaled corticosteroids in asthma and COPD?

Provide immediate relief of acute symptoms

Cause no side effects

Target the inflammatory phase of airflow limitation (correct)

Act via the mineralocorticoid receptor

Which medication is an example of a cysteinyl leukotriene receptor antagonist used in asthma?

Montelukast Signup and view all the answers

What is the effect of montelukast on FEV1 in patients with asthma?

Improves airflow in both early and late phases Signup and view all the answers

How do anti-IgE therapies work in the treatment of asthma?

Block IgE receptors to reduce allergic response Signup and view all the answers

What is the main characteristic of asthma patients who are suitable candidates for Omalizumab treatment?

High total serum IgE levels Signup and view all the answers

Which of the following is a common trigger for severe asthma attacks?

House dust mites Signup and view all the answers

What is the recommended initial treatment for severe asthma attacks that are unresponsive to bronchodilators?

Systemic corticosteroids Signup and view all the answers

What is the significance of 'status asthmaticus' in severe asthma attacks?

It signifies an attack unresponsive to initial treatments Signup and view all the answers

In the context of asthma management, what is the role of short-acting Beta agonists?

Providing symptomatic relief Signup and view all the answers

Why are systemic corticosteroids considered life-saving in severe asthma attacks?

They help reduce airway inflammation and improve lung function Signup and view all the answers

What was the historical treatment of asthma in the early 1900s?

Inhaled epinephrine Signup and view all the answers

Which type of drugs focuses on mast cell stabilizers in the treatment of asthma?

Anti-IgE antibody therapy Signup and view all the answers

What did the peaks of asthma mortality in England and Australia in 1966 highlight?

Excessive reliance on inhaled bronchodilators Signup and view all the answers

What was the spirometry result for the 16-year-old girl with asthma mentioned in the text?

FEV1 60% of predicted Signup and view all the answers

Which type of receptor is targeted by corticosteroids to produce their metabolic and immune effects?

Glucocorticoid receptor Signup and view all the answers

What event in New Zealand in 1977 emphasized inadequate treatment due to excessive reliance on certain medications?

Excessive use of inhaled beta agonists and oral theophylline Signup and view all the answers

Study Notes

Anti-Inflammatory Drugs in Asthma

Corticosteroids, cysteinyl leukotriene receptor antagonists, mast cell stabilizers, and anti-IgE antibody therapy are used to treat asthma

Corticosteroids

Act on glucocorticoid receptors in many cells, including innate immune cells, adaptive immune cells, and non-immune cells
Inhaled corticosteroids provide immediate relief of acute asthmatic symptoms, acting via the mineralocorticoid receptor
Systemic corticosteroids are used in severe cases, but have side effects such as adrenal suppression, growth suppression, and metabolic abnormalities

Historical Treatment of Asthma

Early 1900s: inhaled epinephrine (unselective agonist)
1940s: inhaled isoprenaline (selective beta agonist)
1950s: oral corticosteroids
1960s: inhaled corticosteroids
1960s: inhaled salbutamol
Peaks of asthma mortality in England, Australia, and New Zealand due to excessive reliance on inhaled bronchodilators and inadequate treatment

Case Study: 16-Year-Old Girl with Asthma

Diagnosed with asthma at age 7, triggered by cold air and exercise
Recurrent wheeze and dyspnoea when playing football, using lots of salbutamol
Chest hyperinflated, prolonged phase of expiration
FEV1 60% of predicted

Cysteinyl Leukotriene Receptor Antagonists

Inhibit receptors expressed on respiratory epithelium and infiltrating leukocytes
Improve airflow in both early and late phases
Orally administered, well-tolerated, and slow-acting
Example: Montelukast

Anti-IgE Therapy

Used in moderate-to-severe persistent asthma, asthma symptoms inadequately controlled with inhaled glucocorticoids
Total serum IgE level between 30-1500 international units/mL
Allergic sensitization demonstrated by positive skin testing or in vitro testing for allergen-specific IgE
Omalizumab, a recombinant humanized anti-IgE antibody, reduces serum IgE and may be useful in other IgE-mediated diseases

Therapeutic Approach to Asthma Patients

Asthma action plan: "Relievers and Preventers"
Severe asthma attacks: status asthmaticus, severe airflow limitation
Systemic therapy necessary, hospital admission, oxygen, nebulized bronchodilators at high dose, IV corticosteroids

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Description

Explore the outline of a lecture on respiratory pharmacology by Professor LJ Egan, covering topics such as anti-inflammatory drugs in asthma, step-wise therapeutic approaches, historical treatments, and more.