Additional respiratory medications

what condition are Leukotriene Receptor Antagonists (LTRA) used for

asthma only

what are leukotrienes

inflammatory mediators released from mast cells

what happens when leukotriene receptors are activated in the airway

bronchoconstriction

how do LTRAs work

prevent activation of leukotriene receptors, reducing bronchoconstriction

besides bronchodilation, what other airway effects do LTRAs reduce

hyperresponsiveness to histamine, increased mucus secretion, edema, ciliary inhibition, recruitment of inflammatory cells

what role do mast cells play in asthma

mast cell degranulation is an integral step in the asthmatic inflammatory response

how are LTRAs classified in asthma therapy

as controller medications

according to GINA, when are LTRAs recommended for children

ages 6-11 as an alternate controller; ICS/LABA is preferred

what do CTS guidelines say about LTRA use in adults

indicated if symptoms persist after ICS/LABA

what are two LTRA medications

Zafirlukast and Montelukast

what is the trade name for Zafirlukast

Accolate

what is the trade name for Montelukast

Singulair

how are LTRAs administered

oral tablets, once or twice daily

what are common uses of magnesium sulfate (MgSO4)

treatment for torsades, labor, and severe asthma exacerbations

how does IV magnesium sulfate help asthmatics

improves bronchodilation, airflow, and reduces hospital admissions in severe cases

what is the mode of action of magnesium sulfate for bronchodilation

calcium antagonist in bronchial smooth muscle and interferes with Ach release at the neuromuscular junction

when is magnesium sulfate indicated in respiratory care

severe acute bronchoconstriction in asthma and COPD exacerbation

how is magnesium sulfate administered for bronchodilation

intravenously (IV, parenteral)

when are inhalational anesthetics used for bronchodilation

in near-fatal or severe asthma cases

which inhalational anesthetic agents have bronchodilator effects

halothane, isoflurane, sevoflurane

what does type 2 (T2) airway inflammation refer to

classification of asthma endotypes based on IgE mediation

what is T2 high asthma

endotype where IgE mediates airway hyperreactivity

what is T2 low asthma

endotype where IgE does not mediate airway hyperreactivity

what is an asthma phenotype

the clinical presentation within an asthma endotype

how many phenotypes exist within the T2 high endotype

atopic, late-onset, and AERD (Aspirin-Exacerbated Respiratory Disease)

why is identifying asthma endotypes and phenotypes important

guides treatment and pharmacology choices, especially in severe asthma

what determines pharmacologic choices in severe asthma

whether the patient has a T2 high or T2 low endotype

when are biologics recommended in COPD according to GOLD 2025

moderate to severe COPD with history of exacerbations, chronic bronchitis, and blood eosinophils >300 cells/uL

what is Dupilumab

an anti-IgE biologic

what is the mode of action of Omalizumab

IgG monoclonal antibody binds IgE, preventing it from attaching to mast cells and basophils, reducing mediator release

what is the trade name for Omalizumab

Xolair

for which asthma endotype is Omalizumab indicated

T2 high (T2 airway inflammation)

how is Omalizumab administered

parenterally, every 2–4 weeks depending on serum IgE levels

what is the mode of action of Reslizumab

binds to IL-5, preventing it from interacting with its receptor, reducing eosinophil proliferation and inflammation

what is IL-5 and where is it produced

a cytokine mainly produced by T-helper cells, mast cells, and eosinophils

what does IL-5 do in the body

stimulates differentiation, proliferation, recruitment, survival, and activity of eosinophils

for which asthma endotype is Reslizumab indicated

T2 high (T2 airway inflammation)

how is Reslizumab administered

intravenously (IV) every 4 weeks

what are prophylactic macrolides used for in COPD

reduce risk of exacerbations in high-risk patients

which antibiotics are considered macrolides

azithromycin and erythromycin

what is the role of PDE-4 inhibitors in COPD

suppress inflammatory and immune cell activity to reduce exacerbation risk

which PDE-4 inhibitor is recommended for COPD

roflumilast

when are PDE-4 inhibitors recommended according to GOLD and CTS

severe COPD to reduce risk of exacerbation

what is a mucoactive agent

any drug that affects mucus, including mucolytics and expectorants

what is a mucolytic

a drug that liquefies or dissolves mucus by breaking bonds within it

what is an expectorant

increases bronchial secretions and helps expel mucus via coughing, spitting, or sneezing

what is the most common mucolytic for COPD

N-Acetylcysteine (NAC)

how does NAC work

reduces mucus viscosity by splitting disulfide bonds in mucus proteins

how is NAC administered for COPD management

oral tablet, once daily

when is NAC recommended according to GOLD and CTS

severe COPD with high risk of exacerbation

what is Dornase alfa used for

prophylactic mucolytic in cystic fibrosis (CF)

what is the trade name for Dornase alfa

Pulmozyme

how does Dornase alfa work

reduces viscosity and adhesivity of infected mucus by breaking down DNA released by neutrophils

why is DNA present in CF mucus

neutrophils release DNA during inflammation, increasing mucus viscosity

how is Dornase alfa administered

SVN (nebulized)

why is Dornase alfa specific to CF

CF mucus contains significant neutrophil-derived pus, which Dornase alfa targets

what is the benefit of Dornase alfa in CF patients

reduces frequency and severity of recurrent chest infections

when is Dornase alfa recommended in CF therapy

as maintenance therapy for patients with recurrent chest infections