2 - asthma

Question 1

asthma: definition

Answer 1

chronic inflammatory pulmonary disorder that is characterized by reversible obstruction of airways

Question 2

changes in airway morphology in asthma?

Answer 2

mucous gland hypertrophy, edema, thickening of basement membrane, epithelial damage, airway smooth muscle becomes hyper-responsive. inflammatory cell infiltration. vascular dilation.

Question 3

what test can be used to look at airway hyper reactivity?

Answer 3

methacholine: increase concentration and look at reduction in FEV1% –> cut off at 20%

Question 4

immunologic mechanisms in asthma: what are the cells involved? difference in children vs. adults?

Answer 4

mast cells. macrophages, eosinophils. adults = more neutrophils and less responsive to anti-inflammatories.

Question 5

risk factors for asthma

Answer 5

maternal smoking. atophy. family history. males more than females if <14, females more if >14. pollution like NO2, ozone. obesity. viral infections maybe

Question 6

children and wheezing? how does that related to asthma?

Answer 6

50% of all children wheeze by age 6 –> some will never wheeze again, some will develop asthma. 50% children with asthma will outgrow it

Question 7

predictors of poor outcomes in asthma?

Answer 7

persistent symptoms, long duration. high levels of hyper reactivity. decreased inhaled corticosteroid use. environmental smoke. females;.

Question 8

examples of asthma triggers

Answer 8

allergens. resp infections. strong expression of emotion like laughing or crying. vigorous exercise. cold air. dust, air pollution. cigarette smoke. drugs. pets. household products.

Question 9

cardinal symptoms that suggest asthma: 3?

Answer 9

cough (exp after exertion, cold air, at night, after colds and paroxysmla). wheezing. breathlessness.

Question 10

asthma management continuum

Answer 10

confirm diagnosis, do environmental control, education, written action plan. fast acting bronchodilator on demand. inhaled corticosteroids. then can add: LABA, LTRA, prednisone with increasing severitys

Question 11

benefits of ICS? delay in ICS therapy associated with?

Answer 11

best efficacy for asthma therapy: improves lung function, decreases B2 agonist usage, decreases mortality/hospitalization, airway hyper responsiveness, etc. associated with decreased ultimate lung function

Question 12

benefits vs. risks of using corticosteroids for asthma

Answer 12

+: reduces inflammation, most effective long term control medication, decreases morbidity and mortality. -: risks are dose, drug and route dependent

Question 13

long term use of ICS and growth?

Answer 13

poorly controlled asthma more detrimental to growth than long term ICS use

Question 14

LABA: examples? use?

Answer 14

salmerterol, formoterol: add to inhaled steroid therapy = more effective than increasing dose of steroid