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Respiratory 2 > Adult Asthma > Flashcards

Adult Asthma Flashcards

1
Q

Asthma

A

Chronic inflammation of the airways.

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2
Q

What immune cells has a key role in triggering the inflammation response of asthma?

A

Th2

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3
Q

What is the atopic triad?

A

Asthma
Atopic dermatitis
Allergic rhinitis

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4
Q

How does activation of Th2 cause inflammation?

A
  1. Secretion of Interleukin 4 (IL4) stimulates production of IgE antibodies, these activate of mast cells stimulating them to secrete histamine, prostaglandins and leukotrienes.
  2. Secretion of Interleukin 5 (IL5) stimulates eosinophils to secrete cytokines and leukotrienes.
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5
Q

Why was asthma considered to be a obstructive pulmonary disease?

A

Smooth muscles spasms which narrow the airway.

Increased mucus secretion which also narrows the airway.

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6
Q

What are the long term problems of asthma?

A

Chronic asthma results in edema, scarring, and fibrosis which leads to thickening of the basement membrane.

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7
Q

How may the sputum of someone with asthma be different to the sputum of someone without.

A

Curschmann spirals

Charcot-leyden crystals

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8
Q

Curschmann spirals

A

Curschmann spirals are mucus plugs formed from casts of small bronchi - they are dangerous as they block air exchange and medication.

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9
Q

What are charcot-leyden crystals

A

Formed from breakdown of eosinophils.

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10
Q

How is asthma classified?

A 
Frequency of symptoms 
FEV1
PEFR
Frequency of use of asthma medication
IgE blood levels
Peripheral blood eosinophils
FENO test
Bronchodilator reversibility
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11
Q

FEV1

A

Forced expiratory volume in 1 second

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12
Q

PEFR

A

Peak expiratory flow rate

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13
Q

What are the treatments and ways of managing asthma?

A
  1. Avoiding contact with triggering substance.

2. Medication

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14
Q

What are the methods to avoid contact with triggering substance of asthma?

A

Vacuuming
Removal of carpets and rugs
Changing environment

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15
Q

Asthma medications:

A 
SABA's 
LABA's 
Anti-muscarinics
Daily corticosteroids
Leukotriene antagonists
Magnesium sulphate
Oxygen therapy
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16
Q

How is adult asthma different to paediatric asthma?

A

Adult asthma is generally caused by environmental factors.

Paediatrics asthma often has a more genetic cause.

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17
Q

What is skin prick testing used for in asthma?

A

Check for allergies.

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18
Q

What is the FENO test?

A

A FeNO test or exhaled nitric oxide test, in patients with allergic or eosinophilic asthma, is a way to determine how much lung inflammation is present and how well inhaled steroids are suppressing this inflammation.

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19
Q

How is nitric oxide concentration affected in asthma?

A

Concentrations of nitric oxide are increased due to increased release from epithelial cells during inflammation.

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20
Q

What are the different phenotypes of asthma?

A 
Allergic asthma
Non-allergic asthma
Late-onset asthma
Asthma with fixed airflow limitation
Asthma with obesity
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21
Q

Non-allergic asthma:
Differences in sputum
Response to ICS

A

Asthma not associated with allergy.
Sputum may be neutrophillic, eosinophillic / contain only a few inflammatory cells.
Respond less well to ICS treatment.

22
Q

Late onset asthma

A

Commonly women - present with asthma for the first time in adult life. Patients tend to be non-allergic and require higher doses of ICS.

23
Q

How is asthma that is linked to obesity different to eosinophillic asthma?

A

Obese patients have prominent respiratory symptoms without the eosinophillic ariway inflammation.

24
Q

Why type of wheeze is seen with asthma and why?

A

Polyphonic wheeze as asthma is a widespread condition.

> monophonic wheeze suggests more localised problem.

25
Q

What changes are seen in an asthmatic ariway compared to a normal airway?

A 
Loss of epithelium at surface
Fibrosis
Increased smooth muscle mass
Goblet and mucus gland hyperplasia
Angiogenesis
Inflammation
26
Q

Allergic asthma usually commences when?

A

Childhood

27
Q

ICS

A

Inhaled corticosteroid

28
Q

The respiratory symptoms of asthma are?

A

Wheeze, breathlessness, cough, chest tightness.

29
Q

What FEV1/FEV ratio is considered evidence of obstructive airway disease?

A

70%

30
Q

BHR

A

Bronchial hyper-responsiveness

31
Q

Bronchial hyper-responsiveness

A

Manifestation if reversible airflow obstruction due to smooth muscle contraction. BHR reprresents an exaggerated constrictor response to a variety of physical or chemical stimuli.

32
Q

Occupational asthma

A

Asthma may be induced or (more commonly) aggravated by exposure to allergens or other sensitising agents at work, or sometimes from a single, massive exposure.

33
Q

What is characteristic of development of non-allergic asthma?

A

Asthma develops later in life, most common in obese women, and is associated with chronic rhinitis and nasal polyps.

34
Q

Bronchial thermoplasty

A

Bronchial thermoplasty is a treatment for severe asthma involving the delivery of controlled, therapeutic radiofrequency energy to the airway wall, thus heating the tissue and reducing the amount of smooth muscle present in the airway wall.

35
Q

What is meant by endotyping in asthma?

A

Endotype refers to subtypes of a condition. Asthma is now seen as a syndrome with many different endotypes.

36
Q

Explain the function of muscarinic receptors and thus the role of antimuscarinics.

A

Parasympathetic stimulation via Ach stimulates muscarinic receptors such as M3. Stimulation of muscarinic receptors causes airway constriction and mucus secretion.

> anti-muscarinics are antagonists to these receptors.

37
Q

In asthma phenotyping may help personalise treatment and drug choices; a high level of what predicts a likely response to anti-IL5 therapy?

A

Peripheral blood eosinophils.

38
Q

Peripheral eosinophilia indicates inflammation at what concentration?

A

> 0.3x10^9

39
Q

Define asthma attack (exacerbation).

A

An acute or sub-acute worsening of symptoms and lung function compared to the patients usual status.

40
Q

What is indicates a life-threatening asthma attack?

A 
Sats <92%
Hypotension
Cyanosis
Decreased breathing sounds
Peak flow <33% of normal
ABG - normal CO2 concerning, high CO2 = near fatal.
41
Q

What is used in a bronchoprovocation test for asthma?

A

Methacholine

42
Q

What are the problems with using long term oral steroids to treat asthma?

A

Cushing’s symptoms (weight gain, moon face, water retention).
Immunosuppression
GI problems

43
Q

What % of change is diagnostic of asthma on a bronchodilator reversibility test?

A

12%

44
Q

What is the FeNO test?

A

A test used to measure the fractional NO exhaled aids asthma diagnosis.

45
Q

How does fractional NO exhaled change in asthma patients?

A

NO is RAISED in asthmatic patients.

46
Q

ACOS

A

Asthma COPD overlap syndrome

47
Q

Example of a common LAMA…

A

Tiotropium / Ipatropium

48
Q

Example of a LRA (Leukotriene receptor antagonist)

A

Montelukast

49
Q

What are the side effects to monitor when using theophylline?

A

Watch nausea, tachycardia, tachyarrhythmias, toxicity.

50
Q

Explain how the long term management of asthma is escalated:

A 
SABA + Low Dose ICS
SABA + Low Dose ICS + LABA
Increase ICS Dose
SABA + Low Dose ICS + LABA + LRA
\+ LAMA 
\+ Theophylline

Respiratory 2 (22 decks)

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