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part 2c > asthma > Flashcards

asthma Flashcards

1
Q

what is asthma?

A
  • Inflammatory disease of the airway○ Recurrent reversible airway obstruction - in response to irritant stimuli
    ○ Hypersecretion- mucus by bronchial epithelial cells
    ○ Eosinophil ( disease fighting white blood cells) infiltration
    Bronchial smooth muscles cells hyperplasia causing airway hyper- responsive (increased sensitivity of airways to chemicals, cold airway- abnormal) and bronchospasm ( abnormal contraction causing obstruction in airway)
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2
Q

what is the differences between healthy airway, asthma, asthma attack?

A

Smooth muscles increase - lumen becomes smaller - constricted airway

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3
Q

What is the pathogenesis of asthma ( what is causing asthma)?

A

Exact causes are unclear but could be genetic, environmental or combination factors

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4
Q

What factors increases the chance to develop the condition?

A
  • born prematurely
  • born with bronchochiltis
  • exposure to tabacco smoke
  • job
  • family/genetics
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5
Q

what triggers asthma

A
  • pollen
  • excerise
  • stress
  • mould
  • food
  • cold environment
  • salicylic acid
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6
Q

how is asthma diagnosed? - symptoms

A
  • breathlessness/SOB
  • chest tightness
  • wheezing
  • coughing - occasionally
  • daily or seasonal variations
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7
Q

What are the tests which needs to be done (objective test)

A
  • lung function test
  • airway inflammation measurement
  • airway hypersensitivity measurement
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8
Q

what is airway inflammation measurement

A
  • Measure Fractional exhaled nitric oxide in the breath (FeNO)
    When you have asthma there is an increase in intake of nitric oxide synthesis due to imflammation
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9
Q

what is lung function test

A
  • Obstructive spirometry-

Measure lung volumes and capacity to determine the presence of an obstructive or a restrictive diseases. FEV1 and FVC changes will differ depending on the type of diseases

less than 70% = obstructive airway disease

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10
Q

What is bronchodilator reversibility test?

A

• Determine the presence of a reversible airways obstruction

• Offer In adults (aged 17 and over): Spirometry after inhaling short acting b2AR agonist.
Consider a BDR test in children and young people (aged 5 to 16) with obstructive spirometry
Positive result Improvement in FEV1 of 12% or more

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11
Q

peak flow variability

A

• Determine the presence of daily variability of air peak flow.

  • Monitor the peak flow for variability for 2-4 weeks.
  • exceeds 20% (and is at least 60 l/min) the diagnosis of asthma is strongly supported.
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12
Q

what is direct bronchial test?

A

-hyperresponsiveness/ hypersensitivity test

· Asthmatics usually demonstrate an excessive response to an inhaled dose of methacholine or histamine which causes little or no change in lung function in normal healthy individuals.
Graph shows Dose-response curves to inhaled methacholine in a healthy, mild-asthmatic, and severe-asthmatic subject, showing both the leftward shift of the curve (hypersensitivity) and steeper slope (hyperreactivity) that characterise BHR.

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13
Q

what is an immediate phase of an asthma attack

A
  • TRIGGER
  • mast cell spasmogen
    causes bronchospasm
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14
Q

what is delayed phase of an asthma attack

A
  • chemotaxins
  • activate inflammatory cells - monocytes, eosinophils which release leukotrienes, cytokines, eosinophil proteins
  • this causes bronchospasm - coughing and wheezing
  • increase in hypersensitivity and inflammation
  • causes mucus
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15
Q

primary preventions of asthma?

A
  • Multifaceted approach to avoid indoor asthma
    • Aeroallergen and food avoidance
    • Weight-loss interventions for overweight and obese adults and children with asthma
    • Microbial exposure and ‘hygiene hypothesis’
      Avoid Smoking and air pollution
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16
Q

secondary preventions of asthma

A
  • cleaning - dust
  • ventilation
  • breathing execerise program
  • family therapy with pharmacotherapy
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17
Q

is bronchodilator a reliever or preventer

A

reliver

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18
Q

what is the function of a bronchodilator

A
  • SABA
    only LABA in MART
  • fast control less than 7 mins
    -relieve asthmatic symptoms for asthmatic patients with infrequent, short-lived wheezed and normal function
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19
Q

what is the preventer/controller and what it is its function?

A

long acting bronchodilators and anti- inflammatory drugs
LABA (in combination with ICS)

  • inhaled and systemic corticosteroid
  • leukotriene receptor antagonists ( Inflammatory receptor antagonist)
  • long acting muscaranic receptor antagonist
  • theophylline
20
Q
  1. Why activate b2 adrenoreceptor agonist in the airway smooth muscle
A

Cause airway smooth muscle relaxation by cAMP-dependent (and independent) mechanisms.

21
Q

What happens when you give salbutamol/non adrenaline- smooth muscle relaxation?

A
  1. Salbutamol given
    1. Receptor g alpha s protein
    2. Activation of adenyl cyclase
    3. Production of cAMP
    4. Activation of pKA
      Causes smooth muscle
22
Q

Is salbutamol hydrophilic or hydrophobic and use ?

A

hydrophilic- enter binding site b2ar - reliever - acute asthma

23
Q

Give examples of long lasting b2 adrenoreceptors agonists

A

fometerol - lipophilic

salmeterol - lipophilic

24
Q

How does salbutamol, formoterol and salmeterol act and bind to the b2 adrenergic agonist?

A

fometrol - fast onset, long duration
sulbutamol - fast onset and short suration
salmeterol - slow onset and long duration

25
Q

When are long acting b2 adrenoreceptor agonist used?

A
  • Inhaled
    • Chronic asthma
    • MART - maintenance and redeliver therapy. - formoterol
    • Only used in combination with ICS (inhaled cortical steroid)
      This is because it is shown it can cause side effects, death, hospitalisation
26
Q

What are the advantages and disadvantages of using ICS on long lasting b2 adrenoreceptor.

A
  • A: allow reduction of corticosteroid dose.
    • A: Reduction of symptoms and improvement of lung function.
      D: risk increase of asthma exacerbation, hospitalisation, death
27
Q

What are the adverse effects of B2 adrenoreceptors?

A
  • Arrythmias, angina precipitation, palpitation, tachycardia
    • Peripheral vasodilation
    • Headache
    • Tremor (route/dose-related)
      Increased mortality/morbidity (LABA)
28
Q

What are some contradictions and caution of b2 adrenoreceptor agonist?

A
  • Cardiovascular diseases
    • Pregnancy
      Interactions with hypokalaemia
29
Q

What is corticosteroids?

A

Most effective anti-inflammatory therapy for asthma.

30
Q

What is trans-repression?

A
  • Mechanism of action
    • Switching off multiple activated inflammatory genes and decrease transcription of:
      ○ Cytokine
      ○ Chemokine
      ○ Inflammatory enzyme
      ○ Inflammatory receptors
      Others
31
Q

What us trans activation?

A
  • Mechanisms of action
    • Activate anti-inflammatory gene expression and increase transcription of
      ○ B2 adrenergic receptor
      ○ IL-1 receptor antagonist
      Others
32
Q

What is the effect od corticosteroids?

A
  • decrease in no of esinophil
    -decrease in cytokines
    -decrease in leukrotines
    -decrease in mast cells and macrophages
    -smc- b2ar increase
    endothelial cell leak
    mucus secretion drcreases
33
Q

How are corticosteroids given?

A

inhaled: - used as preventer drugs
- beclometasone dipropionate
- budesonide
- flucticasone propionate

oral : prednislone - acute and severe asthma

parental : hydrocortisone - life threatening acute asthma

34
Q

what are the side effects of corticosteriod

A
  • mortality/morbidity
  • hypertension
  • diabetics
  • vulnerability to infections
  • thinning of skin and easy bruising
  • osteoporosis
35
Q

function of leukotrines

A
  • increase mucus secretion
  • increase hypersensitivity
    -broncho constriction
    -plasma leak
    AHR
    easoniphil chemotaxis activation - decreased aptosis
36
Q

What is the mechanism of action of leukotriene receptor antagonist?

A
  • Block cysteinyl-leukotrienes receptors on bronchial tissue (and other cells) to reduce bronchoconstriction, mucus secretion , oedema, eosinophil migration.
    ○ Montelukast
    Zafirukast
37
Q

When do you give leukotriene receptor antagonist?

A

Oral asthma preventer NOT as reliever/rescue remedy.

38
Q

What is the mechanism of action of anticholinergic agent?

A
  • Antagonist of muscarinic acetylcholine receptors
    Blockage of M3 receptor reduces bronchoconstriction (promoting relaxation of the pulmonary smooth muscle and bronchodilation) and reduces mucus secretion.
39
Q

What is an example of anticholinergic agent?

A

Tiotropium bromide: long acting muscarinic antagonist (LAMA)

40
Q

What is the use of anticholinergic agent?

A
  • Recently improved for maintenance treatment of asthma
    ○ In combination with ICS and LABA
    Bigger role in the management of COPD
41
Q

What is the mechanism of action of theophylline?

A
  • Non selective phosphodiesterase inhibitor
    • Which increases cAMP
    • Non-selective antagonist at adenosine receptors
    • Activates histone deacetylases (HDACs)
    • Others unknown
    • Induces relaxation of smooth muscle of bronchial airways reducing airways obstruction and airway responsiveness
      Inhibits release of inflammatory mediators
42
Q

What is the use of theophylline?

A

-oral/parenteral, for chronic and acute asthma.
Very small therapeutic window as it is extensively metabolised by liver therefore serum levels must be monitored to avoid toxicity.

43
Q

What can alter theophylline levels?

A

-alcohol

44
Q

What are acute asthma management (attack) - pharmacological ?

A
  • Supplementary oxygen
    • High dose inhaled b2 agonist
      ○ Nebuliser
      ○ Intravenous
    • Steroids
      ○ Oral
      ○ Parental
    • Nebulised ipratropium bromide
      IV aminophylline
45
Q

What is the use of omalizumab?

A
  • Use subcutaneous injections every 4 weeks for severe persistent iGE mediated asthma.
    Effect is immediate - 12 week treatment is required.
46
Q

how does allergic inflammation occur

A

-igE antigens
attack mast cells
produce - histamine, leukotriene, prostaglandin, tryptase
causes asthma symptoms (allergic imflammation)

anti-ige -omalizumb

47
Q

anti-ige

A

-omalizumb

part 2c (18 decks)

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