Pharmacotherapy of respiratory illnesses

1. RS-Tutorial
Dr. Anant Khot

2. Case scenario
A 63-year-old man with a past medical history of
hypertension, asthma and tobacco abuse (50 pack–
year history) presents to the clinic complaining of
shortness of breath with moderate physical activity,
a chronic cough of more than 2 years, and difficulty
catching his breath while lying down

3. SH: Smokes 1 pack per day; social intake of alcohol
(2–3 drinks per week); occasional use of marijuana
 Meds: Carvedilol 6.25 mg twice daily, albuterol
MDI one to two puffs every 4 to 6 hours as needed
 Allergies: Anaphylaxis to penicillin and cephalexin

4.  No h/o fever, chills, or night sweats; (–) skin rash; (–)
nasal congestion, drainage (–) chest pain, PND;
 (+) orthopnea; (+) shortness of breath, cough with
clear phlegm
 (–) wheezing; (–) hemoptysis; (–) heartburn, reflux
symptoms, N/V/D, change in appetite, change in
bowel habits; (–) pedal edema
Review of systems

5. Physical Examination
 Afebrile, BP 156/98 mm Hg, PR- 76 beats/min,
 BMI-26.9 kg/m2, RR- 23/min & Purse-lip breathing
 HEENT-WNL, P/A & CVS- WNL
 Clear breath sounds; expiratory phase is
diminished; no crepitations/crackles; (+) rhonchi
 PFT- Post-bronchodilator FEV1/FVC ratio <70% (0.7)

6. Chronic obstructive pulmonary disease
 COPD is defined as a disease state characterized by
persistent respiratory symptoms & airflow limitation
that is not fully reversible
 COPD includes emphysema, chronic bronchitis &
small airway disease
 Risk factors: Smoking, α1 Antitrypsin Deficiency

11. Treatment
 Nonpharmacologic Therapy:
 Smoking Cessation
 Oxygen Therapy
 Pulmonary rehabilitation
 Immunizations- Influenza & pneumococcal vaccine
Pharmacotherapy:
 SABA, SAMA, LABA, LAMA, ICS, Methylxanthines
 Antibiotics: Azithromycin
 α1AT Augmentation Therapy
 Mucoregulators & antioxidant agents

13. Roflumilast
 It an oral PDE4 inhibitor
 Recommended for patients with recurrent
exacerbations despite treatment with triple inhalation
therapy
 Caution: It should not be used with methylxanthines
 A/E: GIT & neuropsychiatric effects

15.  Which is a “Soft steroid” used in bronchial asthma?
a. Budesonide
b. Dexamethasone
c. Ciclesonide
d. Flunisolide
MCQ’s

16.  Identify the device used in the treatment of
respiratory conditions
a. pMDI
b. Nebulizer
c. Rotahaler
d. Spinhaler

18.  M.C dose related side effect of salbutamol is:
a. Nervousness
b. Palpitations
c. Restlessness
d. Tremors

19.  To prevent exercise induced bronchial asthma drug
used is:
a. Sodium cromoglycate
b. Ipratropium bromide
c. Terbutaline
d. Epinephrine

20.  All of the following statements about theophylline
are correct except:
a. ↑ dose is required in cardiopulmonary disease
b. Increases cAMP
c. Increase in dose is required in smokers
d. Inhibits phosphodiesterase

21.  The loading dose of aminophylline is:
a. 50-75 mg/kg
b. 0.5-1 mg/kg
c. 2-3.5 mg/kg
d. 5-6 mg/kg

22.  Leukotrienes inhibitors are very effective in which
one of the following conditions:
a. Exercise induced asthma
b. Antigen induced asthma
c. Aspirin induced asthma
d. Occupational asthma