Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OS 213 Respiratory EXAM 1 > adult asthma > Flashcards

adult asthma Flashcards

1
Q

A heterogenous disease usually characterized by chronic airway inflammation

A

Asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Defined by history symptoms (wheezing, shortness of breath, chest tightness, and cough) that vary over time and in intensity together with variable expiratory airflow limitation

A

Asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Peak of age for asthma

A

3 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Airway narrows easily and too much in response to stimuli

A

Bronchial hyperresponsiveness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Major risk factor of asthma

A

Atopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Factors that influence Asthma Development and Expression

A

Endogenous Factors

Environmental Factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Hygiene hypothesis

A

Lack of early childhood exposure to infectious agents, symbiotic microbes and parasites increases susceptibility to allergic diseases

Preservation of TH2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Top 3 inddor allergens

A

House dust mite, cockroaches, animal allergens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Most common trigger of acute severe exacerbations

A

Upper respiratory tract viral infections

RSV rhinovirus, coronavirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Drugs known to trigger asthma attacks

A

aspirin, beta blockers, coloring agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Asthma pathogenesis

A

Sensitizers -> chronic inflammation (eosinophilic bronchitis) ->cough, dyspnea, wheezing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Th2 cytokines

A

IL-4, IL-5, IL-13: mediate allergic airway inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Proinflammatory response in more severe asthma

A

TNF-a , IL-1B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Eosinophils are attracted by chemokine called_____ and is secreted by epithelial cells

A

Eotaxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Cells that induces bronchospam

A

Mast cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

APC present allergens to T lymphocytes

A

dendritic cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Airflow limitation in Asthma

A

Acute bronchospam
Swelling of the airway wall
Chronic Mucus plug formation
Airway remodeling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Gross pathology in asthma

A

Very red mucous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Distinct histological features of an asthmatic airway

A 
Denuded mucosa/epithelial denudation
Thickened BM/subepithelial fibrosis
Wall/mucosa edema
Hypertrophied and hyperplastic cells
Inflammatory cells
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Lung parenchyma become hyperinflated due to air trapping

A

Fatal hyperinflation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Main effect of fatal hyperinflation

A

Increase in carbon dioxide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Hyperinflation leads to:

A 
Hypoventilation
Respiratory acidosis
Pneumothorax
Hypotension
Respiratory Failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Airway Remodeling Components

A 
Chronic epithelial injury
Subepithelial fibrosis
Smooth muscle hyperplasia
Goblet cell hyperplasia
Angiogenesis
mucus gland hypertrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Airway smooth muscle mass is related to disease severity

A

Smooth muscle mass is higher in severe than in moderate or mild

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Increased probability that symptoms are due to asthma if:

A

> 1 type of symptoms (Wheeze, shortness of breath, cough, chest tightness)
Often worse at night or in the early morning
Vary over time and in intensity
Often with identifiable triggers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Decreased probability that symptoms are due to asthma

A 
Isolated cough with no other RS
Chronic production of sputum
Shortness of breath associated with diziness, lightedheadedness or peripheral tingling
Chest pain
Exercise-induced dyspnea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Wheezing may be absent during severe asthma

A

Silent Chest

28
Q

Variable Airflow Limitation in asthma

A

Low FEV1 and low FEV1/FVC

Positive bronchodilator reversibility test

29
Q

Normal FEV1/FVC ratio

A

> 75-80% in healthy adults

>90% in children

30
Q

Positive bronchodilator reversibility test

A

Adults: increase in FEV1 >12% and >200mL from baseline, 10-15 mins after 200-400 mcg of albuterol or equivalent

Children: increase >12% predicted

31
Q

Confirm variation in lung function

A

Excessive diurnal PED variability over 2 weeks of monitoring:
>10% in adults
>13% in children

Significant increase in FEV1 (>12% +>200ml) or PEF (>20%) after 4 weeks of controller treatment

Positive exercise challenge test
Positive bronchoprovocation test

32
Q

Important biomarkers of TH2-driven aiway inflammation and potential predictors of airway eosinophilia and steroid response

A

Serum Periostin and FeNO

33
Q

Endotypes of Asthma

A 
Endotype 1: Allergen driven
Endotype 2: severe eosinophilic non-allergic
Endotype 3
Endotype 4
Endotypes not yet iddentified or rare
34
Q

Endotype specific medications

A

anti-IL5, anti-IL13, CRTH2 antagonist, new anti-IGE

35
Q

Known asthma phenotypes

A 
Allergic/Exogenous/Extrinsic Asthma
Non allergic asthma/Endogenous/ Intrinsic Asthma
Late-onset asthma
Asthma with fixed airflow limitation
Asthma with Obesity
36
Q

Allergic asthma

A

Most easily recognized
Often begins n childhood
Have eosinophilic airway inflammation, respond well to ICS therapy

37
Q

Non allergic Asthma

A

Cellular profile variable

38
Q

Late onset asthma

A

Tend to be non-allergic, relatively refractory to ICS treatment

39
Q

ASthma with fixed airflow limitation

A

long standing often severe asthma; airway remodeling

40
Q

Asthma with obesity

A

Often very symptomatic, little eosinophilic airway inflammation

41
Q

ASthma-COPD overlap syndrome

A

persistent airflow limitation with several features usually associated with both asthma and COPD

42
Q

ASthma control: 2 domains

A

Assess symptom control over the last 4 weeks

Assess risk factors for poor outcomes, including low lung function

43
Q

GINA assessment of asthma control

A

In the past 4 weeks:

  • Daytime sx >2/week
  • Night waking
  • reliever >2x/week
  • Activity limitation

Well controlled : none
PArtly controlled: 1-2
Uncontrolled: 3-4 of these

44
Q

Categories of asthma severity and their treatment

A

Mild: Steps 1 or 2
Moderate: Step 3
Severe: Step4/5

45
Q

first line controllers

A

ICS only

ICS/LABA

46
Q

First line Reliever

A

SABA

47
Q

Anti-IGE

A

Omalizumab

48
Q

Anti IL5

A

Mepolizumab, reslizumab

49
Q

Reduce airway inflammation and BHR

A

Controllers

50
Q

ICS treatment response assessment and dose assessment

A

sputum/blood eosinophilia and/or INH FeNO

51
Q

Provide long term protection againts bronchoconstrictor stimuli and for EIA. Preferred add-on therapy for asthmatics who remain symptomatic despite the use of ICS

A

LABA

52
Q

Fixed dose combinations of LABA

A

Budesonide/fluticasone/Beclomethasone-formeterol

FLuticasone-salmeterol

53
Q

Drug of choice for aspirin induced asthma

A

Oral anti-leukotrienes

54
Q

Zileuton

A

5-lipoxygenase inhibitor

55
Q

Activates histone deacetylase-2 to swtich off activated inflammatory genes, reducing steroid insensitivity

A

Oral theophylline

56
Q

Drug of choice for treatment of acute asthma exacerbations and episodes

A

SABA

57
Q

Reliever of choice for beta-blocker induced asthma

A

SAMA

58
Q

Add on therapies for severe asthma

A

Tiotropium
Phenotype-guided add-on treatment
Low dose oral steroid
Bronchial thermoplasty

59
Q

Inhibits M1, M2 and M3 receptors but dissociates more quickly from pre-junctional M2 receptors

A

Tiotropium

60
Q

For patients >12 y/o with a hx of exacerbations despite Step 4 Tx

A

Tiotropium

61
Q

Delivers radiofrequency energy to the airways via FOB.

A

Bronchial thermoplasty

62
Q

Add on for patients >6y/ with moderate to severe allergic asthma (high serum IgE) that is uncontrolled on GINA step 4 treatment

A

Omalizumab

63
Q

Add on therapy for patients aged >12 years with severe eosinophilic asthma that is uncontrolled on GINA Step 4 treatment

A

SQ Mepolizumab or IV Reslizumab

64
Q

Long term goals of asthma management

A

Symptom control

Risk reduction

65
Q

Add on in adult HDM-sensitive patients with allergic rhinitis who have exacerbations despite ICS treatment, provided FEV1 is 70% predicted

A

SILT (Sublingual immunotherapy)

66
Q

COnsider stepping down if symptom is____

A

controlled for 3 months + low risk of exacerbations

OS 213 Respiratory EXAM 1 (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions