Drugs for Asthma and COPD Part 1

Asthma

Reversible chronic inflammatory disease of the airways.

1. Bronchial hyperresponsiveness

2. Reversible airflow obstruction

3. Airway inflammation

4. Excess mucus production

Asthma is characterized by (BRAE)

1. Wheezing

2. Shortness of breath

3. Chest tightness

4. Cough (especially at night or early morning)

Asthma symptoms (WSCC)

Chronic Obstructive Pulmonary Disease (COPD)

It is an irreversible progressive disease

1. Persistent airflow limitation

2. Chronic inflammation

3. Poorly reversible obstruction

COPD is a progressive disease characterized by (PCP)

1. Chronic bronchitis

2. Emphysema

COPD includes what two diseases

Airway

In chronic bronchitis, there is inflammation and excess mucus in where

Alveoli/Air sac

In emphysema, there’s a breakdown in what membrane

Asthma

Chronic airway inflammation and bronchial hyperresponsiveness cause exaggerated response to triggers

Bronchoconstriction, airway edema, increased mucus production

Asthma triggers cause (BAI)

Airway obstruction

In asthma, this is variable and usually reversible, spontaneously or with treatment

airway remodeling

persistent inflammation in asthma may cause

COPD

Chronic inflammation caused mainly by cigarette smoke and harmful particles damages the airways and alveoli

Excess mucus
Impaired ciliary clearance
Airway narrowing

Causes airflow obstruction in COPD (EIA)

Alveolar destruction or emphysema

In COPD, this reduces lung elasticity, causing air trapping and impaired gas exchange

Chronic hypoxia

may cause pulmonary hypertension and cor pulmonale (right sided heart failure) in COPD

1. Pulmonary hypertension

2. Cor pulmonale (right-sided heart failure)

In COPD, chronic hypoxia may cause

Blue bloater

Other term for Chronic bronchitis

Pink puffer

Other term for emphysema

Hypoxemia

One of the complications in blue bloater is secondary polycythemia due to

pulmonary hypertension

One of the complications in blue bloater due to reactive vasoconstriction from hypoxemia

Cor pulmonale

One of the complications in blue bloater due to the chronic pulmonary hypertension

1. Chronic, productive cough

2. Purulent sputum

3. Hemoptysis

4. Mild dyspnea initially

5. Cyanosis (due to hypoxemia)

6. Peripheral edema (due to cor pulmonale)

7. Crackles, wheezes

8. Prolonged expiration

9. Obese

Symptoms of Blue bloater (CPHMCPCPO)

Pneumothorax due to bullae
Weight loss due to work of breathing

Complications in emphysema

1. Dyspnea

2. Minimal cough

3. Increased minute ventilation

4. Pink skin, pursed-lip breathing

5. Accessory muscle use

6. Cachexia

7. Hyperinflation, barrel chest

8. Decreased breath sounds

9. Tachypnea

Symptoms of pink puffer (DMIPACHDT)

Bronchodilators (Relievers)

They relax bronchial smooth muscle and rapidly improve airflow

Beta 2 Agonist
Anticholinergic drugs
Methylxanthine

Bronchodilator drug classification

Short-acting Beta 2 Agonist
Long-acting Beta 2 Agonist
Ultra Long-acting Beta 2 Agonist

Beta 2 adrenergic agonists

Albuterol (Salbutamol)
Terbutaline
Levalbuterol

SABA Drugs

Salmeterol
Formoterol

LABA drugs

Indacaterol
Olodaterol
Vilanterol
Bambuterol

Ultra + LABA drugs

Beta 2 adrenergic agonists

stimulate beta 2 receptors in bronchial smooth muscle

Metered dose inhaler
Dry powder inhaler
Nebulizer
Oral tablets
Subcutaneous injection

Beta 2 adrenergic agonists administration

Acute asthma attack
Acute bronchospasm
Exercised induced bronchospasm
Rescue medication
Hyperkalemia
COPD

Clinical Indications of SABA (AAERHC)

Tremor
Tachycardia

Palpitation
Nervousness
Hypokalemia

Adverse effects of SABA

Severe cardiac arrythmias

hyperthyroidism

hypertension

use cautiously in diabetes

contraindications and precaution in saba

12 hours

duration for laba

long treatment of asthma and emphysema
useful in preventing nocturnal asthmatic attacks

clinical indications for laba

long-acting beta 2 adrenergic agonists

improve asthma control when combined with inhaled corticosteroids

inhaled corticosteroids

laba improve asthma control when combined with

Long-acting beta 2 agonists

should never be used alone, monotherapy, for asthma

24 hours (Once daily dosing)

Ultra LABA duration

glycopyrronium bromide

non-selective muscarinic antagonist, usually combined with indacaterol for asthma caused by bronchoconstriction

sialogogue

hyperhidrosis

glycopyrrolate is used to treat these