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OS 213 Respiratory EXAM 1 > adult asthma > Flashcards

adult asthma Flashcards

1
Q

A heterogenous disease usually characterized by chronic airway inflammation

A

Asthma

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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

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3
Q

Peak of age for asthma

A

3 years old

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4
Q

Airway narrows easily and too much in response to stimuli

A

Bronchial hyperresponsiveness

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5
Q

Major risk factor of asthma

A

Atopy

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6
Q

Factors that influence Asthma Development and Expression

A

Endogenous Factors

Environmental Factors

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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

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8
Q

Top 3 inddor allergens

A

House dust mite, cockroaches, animal allergens

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9
Q

Most common trigger of acute severe exacerbations

A

Upper respiratory tract viral infections

RSV rhinovirus, coronavirus

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10
Q

Drugs known to trigger asthma attacks

A

aspirin, beta blockers, coloring agents

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11
Q

Asthma pathogenesis

A

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

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12
Q

Th2 cytokines

A

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

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13
Q

Proinflammatory response in more severe asthma

A

TNF-a , IL-1B

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14
Q

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

A

Eotaxin

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15
Q

Cells that induces bronchospam

A

Mast cells

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16
Q

APC present allergens to T lymphocytes

A

dendritic cells

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17
Q

Airflow limitation in Asthma

A

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

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18
Q

Gross pathology in asthma

A

Very red mucous

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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
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20
Q

Lung parenchyma become hyperinflated due to air trapping

A

Fatal hyperinflation

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21
Q

Main effect of fatal hyperinflation

A

Increase in carbon dioxide

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22
Q

Hyperinflation leads to:

A 
Hypoventilation
Respiratory acidosis
Pneumothorax
Hypotension
Respiratory Failure
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23
Q

Airway Remodeling Components

A 
Chronic epithelial injury
Subepithelial fibrosis
Smooth muscle hyperplasia
Goblet cell hyperplasia
Angiogenesis
mucus gland hypertrophy
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24
Q

Airway smooth muscle mass is related to disease severity

A

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

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25
Increased probability that symptoms are due to asthma if:
>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
26
Decreased probability that symptoms are due to asthma
``` 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 ```
27
Wheezing may be absent during severe asthma
Silent Chest
28
Variable Airflow Limitation in asthma
Low FEV1 and low FEV1/FVC | Positive bronchodilator reversibility test
29
Normal FEV1/FVC ratio
>75-80% in healthy adults | >90% in children
30
Positive bronchodilator reversibility test
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
Confirm variation in lung function
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
Important biomarkers of TH2-driven aiway inflammation and potential predictors of airway eosinophilia and steroid response
Serum Periostin and FeNO
33
Endotypes of Asthma
``` Endotype 1: Allergen driven Endotype 2: severe eosinophilic non-allergic Endotype 3 Endotype 4 Endotypes not yet iddentified or rare ```
34
Endotype specific medications
anti-IL5, anti-IL13, CRTH2 antagonist, new anti-IGE
35
Known asthma phenotypes
``` Allergic/Exogenous/Extrinsic Asthma Non allergic asthma/Endogenous/ Intrinsic Asthma Late-onset asthma Asthma with fixed airflow limitation Asthma with Obesity ```
36
Allergic asthma
Most easily recognized Often begins n childhood Have eosinophilic airway inflammation, respond well to ICS therapy
37
Non allergic Asthma
Cellular profile variable
38
Late onset asthma
Tend to be non-allergic, relatively refractory to ICS treatment
39
ASthma with fixed airflow limitation
long standing often severe asthma; airway remodeling
40
Asthma with obesity
Often very symptomatic, little eosinophilic airway inflammation
41
ASthma-COPD overlap syndrome
persistent airflow limitation with several features usually associated with both asthma and COPD
42
ASthma control: 2 domains
Assess symptom control over the last 4 weeks | Assess risk factors for poor outcomes, including low lung function
43
GINA assessment of asthma control
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
Categories of asthma severity and their treatment
Mild: Steps 1 or 2 Moderate: Step 3 Severe: Step4/5
45
first line controllers
ICS only | ICS/LABA
46
First line Reliever
SABA
47
Anti-IGE
Omalizumab
48
Anti IL5
Mepolizumab, reslizumab
49
Reduce airway inflammation and BHR
Controllers
50
ICS treatment response assessment and dose assessment
sputum/blood eosinophilia and/or INH FeNO
51
Provide long term protection againts bronchoconstrictor stimuli and for EIA. Preferred add-on therapy for asthmatics who remain symptomatic despite the use of ICS
LABA
52
Fixed dose combinations of LABA
Budesonide/fluticasone/Beclomethasone-formeterol FLuticasone-salmeterol
53
Drug of choice for aspirin induced asthma
Oral anti-leukotrienes
54
Zileuton
5-lipoxygenase inhibitor
55
Activates histone deacetylase-2 to swtich off activated inflammatory genes, reducing steroid insensitivity
Oral theophylline
56
Drug of choice for treatment of acute asthma exacerbations and episodes
SABA
57
Reliever of choice for beta-blocker induced asthma
SAMA
58
Add on therapies for severe asthma
Tiotropium Phenotype-guided add-on treatment Low dose oral steroid Bronchial thermoplasty
59
Inhibits M1, M2 and M3 receptors but dissociates more quickly from pre-junctional M2 receptors
Tiotropium
60
For patients >12 y/o with a hx of exacerbations despite Step 4 Tx
Tiotropium
61
Delivers radiofrequency energy to the airways via FOB.
Bronchial thermoplasty
62
Add on for patients >6y/ with moderate to severe allergic asthma (high serum IgE) that is uncontrolled on GINA step 4 treatment
Omalizumab
63
Add on therapy for patients aged >12 years with severe eosinophilic asthma that is uncontrolled on GINA Step 4 treatment
SQ Mepolizumab or IV Reslizumab
64
Long term goals of asthma management
Symptom control | Risk reduction
65
Add on in adult HDM-sensitive patients with allergic rhinitis who have exacerbations despite ICS treatment, provided FEV1 is 70% predicted
SILT (Sublingual immunotherapy)
66
COnsider stepping down if symptom is____
controlled for 3 months + low risk of exacerbations

OS 213 Respiratory EXAM 1 (19 decks)

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