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1IBSNBDPMPHZ▯PG▯ "TUINB Name: Ivy Ng Email: ho.ng20@imperial.ac.uk0#+&$5*7&4▯ • Be able to recognize signs and symptoms of asthma • Describe the pathophysiology of asthma • Explain the mechanism of action of drugs used to treat asthma • Recognise the side effects and contraindications of these drugs • Be aware of the treatment pathway for asthma8IBU▯JT▯BTUINB • Chronic inflammatory airway disease with variable REVERSIBLE airway obstruction , hyperresponsive airway and bronchial inflammation • Often linked with a family history of atopy (genetic tendency to develop allergic disease)1BUIPQIZTJPMPHZ▯PG▯BTUINB • Involves a type 1 hypersensitivity reaction which is IgE mediated • Presence of eosinophils and mast cells • Type 2 T helper cells produce cytokines such as IL-4, IL-5 and IL-13 st • Upon 1 exposure to allergens an individual become sensitised • Then when they encounter the allergen again IgE crosslinking on mast cells surface causing them to degranulate and release inflammatory mediators • Inflammation causes airway constriction, hypersecretion and a narrowed lumen1BUIPQIZTJPMPHZ▯PG▯BTUINB4JHOT▯BOE▯TZNQUPNT Symptoms: • Wheeze • Dyspnoea • Cough • Chest tightness • Diurnal variation5SFBUNFOU▯PG▯BTUINB4IPSU▯"DUJOH▯#FUB▯"HPOJTUT Examples : Salbutamol, terbutaline Target: Beta-2 receptor Location: Bronchial smooth muscle Effect: Smooth muscle relaxation and dilatation of the airways4"#"▯$POUSBJOEJDBUJPOT • Beta-2 agonists should be used with caution in people with: • Hyperthyroidism — beta-2 agonists may stimulate thyroid activity. • Diabetes mellitus — there is a rare risk of ketoacidosis (especially after intravenous beta-2 agonist administration). Additional blood glucose measurements are recommended when treatment with a beta-2 agonist is commenced. • Cardiovascular disease (including hypertension) — beta-2 agonists may cause an increased risk of arrhythmias and significant changes to blood pressure and heart rate. • Susceptibility to QT-interval prolongation. • Hypokalaemia — plasma potassium concentration may be reduced by beta-2 agonists (particularly high doses). • Convulsive disorders.4"#"▯TJEF▯FGGFDUT • Palpitations/agitation Salbutamol is not totally • Tachycardia specific for beta-2! • Arrhythmias • Hypokalaemia (at higher doses) /FCVMJTFST • In emergency situations nebulisers are typically the best way of administering salbutamol.4QBDFST Only about 20% of inhaled drugs actually reach the lungs to have the desired effects. This is why spacers are useful especially for patients with poor inhaler technique.*OIBMFE▯$PSUJDPTUFSPJET Examples : Fluticasone, Mometasone, Budesonide Target: Glucocorticoid receptor Location: Eosinophils Effect: Decreased inflammatory cells and decreased number of cytokines *$4▯4JEF▯&GGFDUT Local vs systemic Local: Systemic: • Sore throat • Growth retardation in children • Hoarse voice • Hyperglycaemia • Opportunistic oral infections • Decreased bone mineral density • Immunosuppression • Effects on mood-FVLPUSJFOF▯SFDFQUPS▯BOUBHPOJTU Examples : Montelukast, Zafirlukast Target: CysLT1 receptor Location: Eosinophils, mast cells and airways smooth muscle cells Effect: Decreases eosinophil migration, bronchoconstriction and inflammation-induced oedema-53"▯TJEF▯FGGFDUT Mild: Serious: •Diarrhoea • Mood changes •Fever • Anaphylaxis •Headaches •Nausea or vomiting4#"▯▯▯ Q1: Which of the following drugs can worsen asthma symptoms? A. Paracetamol B. Acetaminophen C. Budosenide D. Aspirin E. Zafirlukast4#"▯▯▯ Q1: Which of the following drugs can worsen asthma symptoms? A. Paracetamol B. Acetaminophen C. Budosenide D. Aspirin E. Zafirlukast"▯OPUF▯PO▯/4"*%T4#"▯▯▯ Q2: Which of the following drugs should not be given to someone with asthma? A. Propranolol B. Omeprazole C. Budosenide D. Aspirin E. Zafirlukast4#"▯▯▯ Q2: Which of the following drugs should not be given to someone with asthma? A. Propranolol B. Omeprazole C. Budosenide D. Aspirin E. Zafirlukast4#"▯▯▯ Q3:A 27-year-old lady presents to the GP with white patches in her mouth and a loss of taste. She has a PMH of asthma which she manages with salbutamol and a new drug which she started recently. Which of these drugs could be causing her symptoms? A. Salmeterol B. Isoniazid C. Inhaled beclometasone D. Oral prednisolone E. Oral montelukast4#"▯▯▯ Q3:A 27-year-old lady presents to the GP with white patches in her mouth and a loss of taste. She has a PMH of asthma which she manages with salbutamol and a new drug which she started recently. Which of these drugs could be causing her symptoms? A. Salmeterol B. Isoniazid C. Inhaled beclometasone D. Oral prednisolone E. Oral montelukast4#"▯▯▯ Q4 : A 27-year-old lady presents to the GP with worsening symptoms of asthma despite being on salbutamol. What is the most appropriate initial management of this patient? A. Prescribe inhaled corticosteroid B. Check inhaler technique C. Prescribe LABA D. Prescribe LAMA E. Prescribe LTRA4#"▯▯▯ Q4 : A 27-year-old lady presents to the GP with worsening symptoms of asthma despite being on salbutamol. What is the most appropriate initial management of this patient? A. Prescribe inhaled corticosteroid B. Check inhaler technique C. Prescribe LABA D. Prescribe LAMA E. Prescribe LTRA4#"▯▯▯ Q5 : Which interleukin promotes eosinophil survival? A. IL-1 B. IL-4 C. IL-5 D. IL-9 E. IL-134#"▯▯▯ Q5 : Which interleukin promotes eosinophil survival? A. IL-1 B. IL-4 C. IL-5 D. IL-9 E. IL-1346.."3:▯ What is asthma? Drug administration • Chronic inflammatory airway disease • Nebulisers are used in emergencies which is REVERSIBLE • Spacers may be easier for children to • Linked with atopy use and to ensure more of the drug reaches the target site Pathophysiology Treatment of asthma • inflammatory mediators which cause • Salbutamol is first line bronchoconstriction • Then add ICS • Then add LTRA (according to NICE)5)"/,▯:06▯ Please fill in the Feedback form! Name: Ivy Ng Email: ho.ng20@imperial.ac.uk