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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
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

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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
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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

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

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

57
Q

Reliever of choice for beta-blocker induced asthma

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)

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