Pharmacology of Asthma & COPD

• What is chronic asthma?

  A common chronic inflammatory condition of the airways, associated with airway hyperesponsiveness & variable airflow obstruction
• What is acute asthma?

  Progressive worsening of asthma

  Acute exacerbation is marked by a reduction in baseline objective measures of pulmonary function (peak expiratory flow rate & FEV1)

  SYMPTOMS: breathlessness, wheeze, cough & chest tightness
• What happens histologically in asthma?

  Goblet cell hyperplasia

  Sub basement membrane thickening

  Collagen deposition in submucosal area

  Cellular infiltrate

  
• Why should NSAIDs not be used with asthma patients?

  NSAIDs inhibit COX > diverts arachadonic acid metabolism down the LOX pathway -> increases leukotrienes -> bronchoconstriction

  Increased risk of asthma attack
• Give 4 drug classes that are bronchodilators.

  B2 agonists

  Theophylline

  LTRA

  Anti-muscarinics
• Give 2 drug classes that are anti-inflammatory (asthma).

  Glucocorticoids

  Targeted biologics
• What is COPD?

  Disease of smokers (mainly)

  Impairs normal lung defences -> recurrent infections of airways (bronchitis) and alveoli (pneumonia)

  Inflammatory reaction -> tissue destruction (emphysema)
• What is bronchitis?

  Inflammation of bronchi

  
• What is emphysema?

  Emphysema is a chronic lung disease characterized by the destruction of the air sacs in the lungs, leading to difficulty in breathing.

  
• What are the therapeutic goals in asthma?

  Relief

  • reverse bronchospasm
  • severe attacks -> reduce mucous secretion & suppress airway oedema

  Prophylaxis

  • prevent bronchospasm
  • decrease chronic inflammation
  • decrease airway remodelling
• What are the therapeutic goals in COPD?

  Relief

  • increase airway patency
  • control recurrent infections

  Prophylaxis

  • decrease chronic inflammation
  • control mucous secretion
• What is given for asthma (relief & prophylaxis)?

  Relief

  • bronchodilators - SABA, muscarinic antagonists, theophylline

  Prophylaxis

  • boncodilators - LABA, theophylline, montelukast
  • glucocorticoids
  • Anti-IgE therapies
  • Anti-IL-5 therapies