Adult Asthma Flashcards
Add-on therapy for patients > 12 y/o with a history of exacerbations despite Step 4 treatment
TIOTROPIUM
・Inhibits M1, M2, M3 receptors
Add-on therapy for patients with high IgE concentrations (Allergic Asthma)
OMALIZUMAB
・Anti-IgE
・Inhibits IgE mediated reactions
Add-on therapy for patients > 6 y/o with moderate to severe allergic asthma (high serum IgE) that is uncontrolled on GINA Step 4 treatment
Anti-IgE - OMALIZUMAB
Add-on therapy for patients ages > 12 y/o with severe eosinophilic asthma that is uncontrolled on GINA Step 4 treatment
SQ Meplizumab or IV Reslizumab
・Anti-IL5
Components for GINA Assessment of Asthma Control
1) Daytime symptoms
2) Nightime awakening
3) Reliever
4) Limitation of activity
ASTHMA
Airflow obstruction that varies markedly, both spontaneously and with treatment
Bronchial Hyperresponsiveness
Airway narrows too easily and too much
Major risk factor for asthma
ATOPY
Defined as the lack of shift to protective TH1 immune response
HYGIENE HYPOTHESIS
Top 3 Indoor Allergens
1) House dust mite
2) Cockroaches
3) Animal allergens
Most common trigger of acute, severe exacerbations
Upper respiratory tract viral infections
Four Key Events in Asthma
Bronchoconstriction
Edema
Airway remodelling
Mucus plug formation
Histological features of an asthmatic airway
Denuded mucosa/epithelial denudation Thickened basement membrane/subepithelial fibrosis Wall/mucosa edema Hypertrophied and hyperplastic cells Inflammatory cells
Goal of Asthma Therapy
Treat inflammation (CONTROLLER) and hyperresponsiveness (RELIEVER) to prevent remodelling
Fatal Hyperinflation
Air trapping leading to increased CO2; inability to efficiently expel CO2
Hyperinflation can lead to: ・Hypoventilation ・Respiratory acidosis ・Pneumothorax ・Hypotension