Top 200: Asthma & COPD

  1. What is the relevance of asthma?
    • Affects an estimated 17.5 to 20.5 million people (7.7%) in the U.S. alone
    • ~450,000 hospitalizations per year
    • ~1.8 million Emergency Room visits per year
    • 1.1 deaths per 100,000 per year
  2. What is the definition of asthma?
    • Chronic inflammatory disorder characterized by variable and recurring symptoms, airflow obstruction and bronchial hyper-responsiveness.
    • Frequency and severity of symptoms depends on the individual.
    • Some symptoms, such as hyper-production of mucous, cause other symptoms (e.g. non-productive cough).
  3. What are the symptoms of asthma?
    • wheezing
    • shortness of breath
    • chest tightness
    • cough (worse at night)
    • hyper-production of mucous
  4. What are possible triggers of asthma?
    • pollen
    • smoke
    • dust mites
    • pets
    • mold
    • weather
    • exercise
    • food
    • colds/infections
    • bugs (e.g. cockroach feces)
    • toys/stuffed animals
    • house plants
    • cooking (e.g. fumes, heat, smells)
    • flames
  5. What is the relevance of Chronic Obstructive Pulmonary Disease (COPD)?
    • Fourth leading cause of chronic morbidity & mortality in the U.S.
    • 34.2 deaths per 100,000 population per year
    • As far as statistics go, COPD is a bigger deal than asthma
  6. What is the definition of COPD?
    • Chronic Obstructive Pulmonary Disease (COPD)
    • Used to be called emphysema or chronic bronchitis, but now these are lumped together as COPD
    • Progressive airflow limitation (not fully reversible) associated with abnormal inflammation and lung damage
    • gets worse with time
  7. What are the symptoms of COPD?
    • shortness of breath
    • *chronic cough
    • *chronic sputum production
    • *hallmark symptoms
  8. What are the causes of COPD?
    • tobacco (main cause)
    • occupational toxins/hazards (e.g. coal miner)
    • indoor/outdoor pollution
  9. Asthma Treatment
    • Avoid triggers
    • Peak flow meter readings
    • Asthma Action Plan
    • Manage symptoms:
    • -fast-acting (rescue) inhaler for all patients
    • -other medications based on stage of disease (e.g. "step-up therapy")
    • -cornerstone of therapy = inhaled corticosteroids
  10. COPD Treatment
    • Risk reduction
    • -smoking cessation
    • -prevent progression

    • Managing stable disease:
    • -short-acting inhaler for symptom management
    • -other medications based on stage of disease (e.g "step-up therapy")
    • -cornerstone therapy = long-acting bronchodilator

    Manage Exacerbations
  11. What is the cornerstone therapy for asthma?
    inhaled corticosteroids
  12. What is the cornerstone therapy for COPD?
    long-acting bronchodilator
  13. What are the two main drug classes of bronchodilators?
    • Beta agonists:
    • -albuterol
    • -stimulation of beta-2 adrenergic receptor sites
    • -bronchial smooth muscle relaxation
    • -stimulates skeletal muscle resulting in tremor

    • Anticholinergics:
    • -ipratropium
    • -blocks acetylcholine
    • -results in airway dilation
    • Image Upload 1
  14. Other Medications
    • Corticosteroids:
    • -fluticasone
    • -decrease inflammation
    • -an immunosuppressant
    • -inhaled = staple of therapy for persistent asthma, but must rinse mouth after use to prevent thrush
    • -oral = for severe asthma or for exacerbations

    • Leukotriene modifiers:
    • -singulair
    • -blocks body's production of leukotriene, which normally act as signaling molecules to cause contraction in the trachea
    • -decreases inflammation to keep airways open
    • -not recommended or indicated in COPD
  15. Which pharmacological treatment may cause skeletal muscle tremors?
    • beta-2 adrenergic agonists
    • example would be albuterol
  16. Which pharmacological treatment blocks acetylcholine, which is associated with cholinergic PNS transmission?
    • anticholinergics
    • example would be ipratropium
  17. Which pharmacological treatment is the staple of therapy for persistent asthma?
    • inhaled corticosteroids
    • example would be fluticasone
  18. Which pharmacological treatment must one rinse their mouth after using and why?
    • inhaled corticosteroids
    • may cause thrush if medication not rinsed from mouth
    • example would be fluticasone
  19. Which pharmacological treatment is not recommended or indicated for COPD?
    • leukotriene modifiers
    • example would be singulair
  20. Asthma & COPD Drug List
    • Key:
    • SABA = short-acting beta agonist
    • LABA = long-acting beta agonist
    • SAA = short-acting anticholinergic
    • LAA = long-acting anticholinergic
    • ICS = inhaled corticosteroid

    Image Upload 2
  21. Asthma & COPD Combination Drug List
    • Key:
    • SABA = short-acting beta agonist
    • LABA = long-acting beta agonist
    • SAA = short-acting anticholinergic
    • LAA = long-acting anticholinergic
    • ICS = inhaled corticosteroid

    Image Upload 3
  22. What is a Peak Flow Meter?
    Image Upload 4
    A device that measures control of asthma

    • How to use:
    • -use standing
    • -breathe into device quickly
    • -similar to blowing out birthday candles from across the room
    • -should record personal best when feeling well
    • -take multiple measurements to ensure accuracy

    • The device results dictate different zone areas:
    • -red (< 50% of personal best)
    • -yellow (> 50-80% of personal best)
    • -green (80-100% of personal best)

    • Readings vary according to:
    • -age
    • -gender
    • -height
    • -every score is individualized to the person

    Image Upload 5
  23. What is an Asthma Action Plan?
    Uses symptoms and/or peak flow meter readings to guide patient on proper therapy and provide steps to treat asthma.

    Goal is to decrease incidence of attack and decrease # of emergency room visits.

    Image Upload 6
  24. What is the difference in administration between inhalers?
    • Metered dose: uses chemical propellants to expel the medication from the inhaler device. Often called "puffers."
    • Dry powder: release the medication via rapid inhalation instead of using chemical propellants. Often called "diskus."
  25. What is a spacer?
    • Using a spacer with a metered dose inhaler (MDI) has the following benefits:
    • -the technique of using an MDI is easier
    • -more of the drug gets into the lungs
    • -there are less unpleasant side effects
    • -more comfortable for the patient
    • -useful for children

    • However, keep in mind:
    • -often times you need a prescription for a spacer
    • -many times insurance won't cover them
    • -beneficial for metered dose inhalers only
    • Image Upload 7
  26. What is a nebulizer and how is it used?
    • uses a face mask or mouthpiece to deliver medication in the form of a fine mist (aerosol)
    • breathe in the nebulized medication through the mouthpiece or face mask
    • very common to use with children
    • more time consuming...must breathe in until mist is gone, which usually takes 5 to 15 minutes

    Image Upload 8
  27. Counseling points on Metered Dose Inhalers (MDIs)
    • Remove cap and shake well
    • Shake at least 10x
    • Breathe out and then place mouthpiece into mouth
    • Push canister down into case
    • Take a slow, deep breath in
    • When lungs are completely full, hold breath for 10 seconds
    • If second puff needed, wait at least one minute between puffs
  28. Counseling points on Nebulizers
    • open medication and place in cup
    • fasten mouthpiece or mask to cup and attach the tubing of the compressor
    • put lips around mouthpiece
    • turn on nebulizer so that liquid medication vaporized
    • take slow, deep breaths through mouth while holding each breath one to two seconds
    • continue until mist is gone (~10 minutes)
    • If using a corticosteroid in conjunction with another medication, use the corticosteroid first so that the maximum amount of medication gets in through dilated airways
  29. Counseling points on Dry Powder DISK Inhalers
    • Slide lever open only once
    • Put lips around mouthpiece and breathe in steadily and deeply
    • Take a full breath and hold for 10 seconds
  30. Counseling points on Dry Powder HANDIHALER (Spiriva)
    • Open dust cap
    • Open mouth piece
    • Place capsule into center chamber and close mouthpiece (should hear click)
    • Press side button to pierce capsule
    • Breathe out completely (not into mouthpiece)
    • Place lips around mouthpiece (don't block vents)
    • Breathe in slowly and deeply (should hear capsule rattle) until lungs are full
    • Hold for as long as comfortable (~10 seconds)
    • Unique because you must pierce the powder medication for each dose
    • Clean device mouthpiece only with water, but be careful not to get water inside inhaler
  31. What dosage forms are available for albuterol?
    • nebulizer solution
    • oral solution
    • tablet
    • extended-release tablet
    • aerosol solution
  32. What dosage forms are other medications in?
    • levalbuterol: nebulizer, aerosol
    • ipratropium: nebulizer, aerosol
    • tiotropium: capsule pierced for aerosol
    • fluticasone: aerosol, nasal spray, ointment, cream
    • triamcinolone: tablet, aerosol, injection
    • budesonide: aerosol, powder, capsule, oral suspension
    • montelukast: tablet, chewable tablet, oral packet
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Top 200: Asthma & COPD
Top 200: Spring 2011, Asthma & Chronic Obstructive Pulmonary Disease (COPD)