Asthma

Question 1

What is asthma?

Answer 1

A chronic inflammatory disorder marked by VARIABILITY IN AIR FLOW OBSTRUCTION that is often reversible, either spontaneously or with treatment.

Question 2

What is GINA?

Answer 2

The global initiative for asthma which aims to reduce asthma morbidity and mortality and improve management of asthma. They have created guidelines for treating asthma.

Question 3

What are the anatomic alterations seen in the lungs associated with asthma?

Answer 3

Bronchospasm, thick bronchial secretions, mucus plugging, hyperinflation, atelectasis caused by mucus plugging, and bronchial wall inflammation.

Question 4

What may happen if an asthma patient is not properly managed?

Answer 4

The chronic inflammatory state contributes to airway remodeling (i.e. fibrosis of the airways)

Question 5

Who first recognized asthma and when?

Answer 5

Hippocrates about 2000 years ago.

Question 6

Where in the world is asthma most prevalent and what could be a reason why?

Answer 6

Western, developed countries. We are potentially too clean and not exposing our children to allergens that would normally strengthen their immune system.

Question 7

What are the two types of asthma?

Answer 7

Intrinsic- reaction caused by host factor; Extrinsic- reaction caused by external factors such as an allergen or other environmental factor.

Question 8

Does the type of asthma affect the treatment?

Answer 8

No, they are treated the same and are often both present in the same patient.

Question 9

What type of reaction is extrinsic asthma?

Answer 9

Type 1 hypersensitivity (immediate)

Question 10

Describe the immunologic mechanism of extrinsic asthma.

Answer 10

An antigen interacts with peripheral lymphoid tissue which produces IgE antibodies which attach to mast cells and sensitize them. In a future encounter with the same antigen, the sensitized mast cells will now release inflammatory mediators such as NCF, ENF-A, HISTAMINE, PROSTAGLANDINS, LEUKOTRIENES. These cause smooth muscle constriction, mucus hypersecretion, dilation of blood vessels, and tissue edema.

Question 11

What branch of the nervous system is activated during an asthma attack?

Answer 11

The parasympathetic, particularly in bronchial airways which leads to bronchoconstriction, vasodilation, and mucus hypersecretion

Question 12

What are delayed reactions (4-24 hours after exposure) typically mediated by?

Answer 12

Basophils

Question 13

What are immediate reactions mediated by?

Answer 13

Eosinophils

Question 14

What changes in vital signs would we see during an asthma attack?

Answer 14

Increased RR, HR, and BP, use of accessory muscles, pursed-lip breathing, substernal intercostal retractions, cyanosis, barrel chest, cough and sputum production, pulsus paradoxus.

Question 15

Which tests are used in the diagnosis and monitoring of asthma?

Answer 15

Spirometry/PFT, peak expiratory flow, responsiveness to methacholine, histamine, mannitol, or exercise challenge, and positive skin tests with allergens or measurement of specific IgE in serum

Question 16

What PFT findings might we observe in asthma?

Answer 16

Pre and post bronchodilator numbers with >12% improvement and/or >200mls in FEV1

Question 17

What clinical features indicate intermittent asthma?

Answer 17

Symptoms less than once a week, brief exacerbations, nocturnal symptoms less than twice per month, FEV1 >80% predicted, FEV1 variability <20%

Question 18

What clinical features indicate mild persistent asthma?

Answer 18

Symptoms more than once a week but less than once a day, exacerbations affecting activity and sleep, nocturnal symptoms more than twice per month, FEV1 >80% predicted, FEV1 variability 20-30%

Question 19

What clinical features indicate moderate persistent asthma?

Answer 19

Symptoms daily, exacerbations affect activity and sleep, nocturnal symptoms more than once a week, daily use of SABA, FEV1 60-80% predicted, FEV1 variability >30%

Question 20

What clinical features indicate severe persistent asthma?

Answer 20

Symptoms daily, frequent nocturnal symptoms, limitation of physical activities, FEV1 <60%, FEV1 variability >30%

Question 21

What are the stages of an asthmatic episode?

Answer 21

Mild to moderate- respiratory alkalosis because of hyperventilation; severe- respiratory acidosis as patients lose strength and energy and begin to hypoventilate (respiratory failure)

Question 22

What are some laboratory tests and procedures used to help diagnose asmtha?

Answer 22

Sputum examination for eosinophils, charcot-leyden crystals, and casts of mucus from small airways (Kirschman spirals) and IgE levels

Question 23

What are some radiologic findings associated with asthma?

Answer 23

Barrel chest, dark lung fields, depressed or flattened diaphragms.

Question 24

What are GINA’s five components of asthma care?

Answer 24

1. Develop patient/doctor partnership
2. Identify and reduce exposure to risk factors
3. Assess, treat, and monitor asthma
4. Manage asthma exacerbations
5. Special considerations in managing asthma

Question 25

Which classes of drugs are used to treat asthma?

Answer 25

Bronchodilators, anticholinergics, corticosteroids, anti-Leukotrienes, and immune modulation.

Question 26

Which bronchodilators are often used for asthma?

Question 27

Which anticholinergics are often used for asthma?

Question 28

What kinds of corticosteroids are used in asthma?

Answer 28

Flovent and Pulmicort are inhaled corticosteroids, Prednisone is a short-course oral steroid.

Question 29

How do corticosteroids help treat asthma?

Answer 29

They reduce activation of inflammatory cells by reducing transcription factors which reduces the production of cytokines. They also increase the expression of B2 receptors.

Question 30

What do anti-Leukotrienes do to help treat asthma and what is an example of one?

Answer 30

They block the receptor sites for leukotrienes which are responsible for bronchoconstriction, microvascular leakage, eosinophilic recruitment and infiltration of the airway. Monteleukast is one drug that is used.

Question 31

How does immune modulation improve asthma?

Answer 31

It targets different cytokines or pathways. Omalizumab is often used.