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Can't Get A Breath, Can't Get A Breath: LRT & Asthma,…
Can't Get A Breath
Can't Get A Breath: LRT & Asthma
Asthma
Pathophysiology
Allergic (Intrinsic)
Bronchospasm
Hypersensitised bronchiolar smooth muscle
Hyperstimulated parasympathetic muscarinic adrenergic receptors
Bronchiolar smooth muscle hypertrophy
Antigen inhalation
Airway inflammatory cascade
Mast cell degranulation
Eosinophil Recuitment
T-Helper 2 cell infiltration and over expression
Chemotactic gradient
Mucosal Oedema
B-Cell activation
Memory B-Cell
Hyperesponsive airway
Non-Allergic (extrinsic)
Irritant
Neutrophil infiltration with same presentation
Responds poorly to ICS
Aspirin-Induced
Inhibition of COX causes ↓↓ ability of Prostaglandins to modulate Mast Cell degranulation
Leukotrienes free to act readily on cells shown in diagram
Sensitises individuals to cross reactivity with other NSAIDs with repeated exposure
Clinical Presentation
Dyspnoea
Expiratory Wheeze
+/- Mucus production
Pharmacotherapy
Ongoing management on chronic condition
Therapeutic Guidelines - Examples of inhalers with dosages
Short Acting Beta Agonists & Long Acting Muscarinic Antagonist
Inhaled Corticosteroids
Australian Medicines Handbook - Stepwise treatment regimen
Acute Asthma Management
Airway Obstruction
V/Q
Dead Space
Receptor function of the Autonomic Nervous System, drugs acting on them.
Sympathetic Nervous System
Beta Agonist
Non-selective (also has alpha activity): Noradrenaline
Indication: Cardiovascular collapse
Selective B2: Salbutamol
Indication: Bronchoconstriction
Drug name: Salbutamol (SABA)
Considerations: Tachycardia, tremor
Drug name: Salmeterol (LABA)
1 more item...
Beta Antagonist
B1 (Cardioselective)
Indication: Heart Failure
Drug Name: Metoprolol
Considerations: presence of peripheral vascular disease
Non specific Beta-Antagonists (B1 and B2)
Indication: Tetralogy of Fallot
Drug name: Propranolol
Considerations: Bradycardia
Alpha-1 Agonist
Largely vasoconstrictive (arteriolar mostly, venous dependent on magnitude of stimulus)
Indication: In acute management of hypotension ie surgically
Drug name: Metaraminol
Considerations: Hypertensive crisis, kidney function, heart failure.
Indication: orthostatic hypertension
Drug name: midodrine
Alpha-1 Antagonist
Vasodilatory (arteriolar and venous)
Indication: hypertension, benign prostatic hyperplasia
Drug name: Prazosin
Considerations: concurrent treatment with CCB, ARB, other antihypertensives
Alpha-2 Agonist
Inhibits Alpha-1 activity indirectly via ↓regulating neurotransmitter release, +/- vasodilation
Indication: anxyolysis, sedation, withdrawal
Drug name: Clonidine
Considerations: bradycardia, vasospastic PVD
Parasympathetic Nervous System
Cholinesterase
Increases breakdown of ACh
Present on RBCs and nerve endings
Acetylcholinesterase inhibitor (anticholinesterase)
Reduces breakdown of ACh
Indication: reversal of neuromuscular cascade, myasthenia gravis
Drug name: neostigmine
Considerations: presence of asthma
Anticholinergic
M3 receptor antagonist
Indication: COPD, treatment of asthma
Drug name: Tiotropium (LAMA)
Drug name: Ipratropium (SAMA)
Considerations: headache, nausea
Histamine Release, IL-4, IL-5, IL-13
IgE production
Goblet Cell stimulation
Mucus secretion
Goblet cell hyperplasia
ongoing inflammation
Basement membrane changes
Irregularly arranged type IV collagen
