Asthma

Question 1

Prevalence

Asthma can present at any age with a peak age of……….

Answer 1

3 yrs

Question 2

Male/Female ratio

Answer 2

In childhood: M/F=2/1
With a trend toward greater prevalence in women in adulthood.

Question 3

Adults with asthma, including those with onset during adulthood

Answer 3

rarely become permanently asymptomatic

Question 4

Use of………… is responsible for the decrease in mortality in recent years.

Answer 4

ICSs

Question 5

Major risk factors for asthma deaths are:

Answer 5

-Poorly controlled disease with frequent use of bronchodilator inhalers
-Lack of corticosteroid therapy
-Previous admissions to the hospital with near-fatal asthma.

Question 6

Phathology of asthma

Answer 6

Mucus production
Epithelial shedding
Neuronal proliferation
Airway edema
Cellular proliferation
SM construction

Question 7

Inflammatory cells in asthma

Answer 7

Most commonly eosinophilic inflamation
In some patients with severe asthma , neutrophilic inflammation is predominant

Question 8

Airway smooth muscle cells can produce

Answer 8

chemokines and cytokines.

Question 9

Is more commonly seen in severe asthma Has not responded to the common anti-inflammatory therapies such as corticosteroids,

Answer 9

Non -type 2 asthma

Question 10

Tobacco

Answer 10

Maternal smoking & second hand smoke exposure Increased childhood asthma (2 fold)

Active smoking in adolesc. & Adults Inc.4 fold

Question 11

Air pollution

Answer 11

CO & NO2 and marginal effect of SO2

Question 12

associated with development of asthma

Answer 12

in children(Rhinovirus & RSV)

prior Mycoplasma Pneum.

Question 13

Occupational Exposure

2 types of exposures are:

Answer 13

1- Immunologic stimulus:
Latency period between exposure & symptoms
A-High molecular weight : Proteins-Flour
B-Low molecular weight : Formaldehyde - Diisocyanate
2-Irritative stimulus
Known as RADS(Reactive Airways dysfunction syndrome)

Question 14

At obesity

Answer 14

Adipokines & IL6 thought to play a pathobiologic role.

Question 15

Medications

Answer 15

(H2 blockers & Proton pump Inhibitors & Acetaminophen) in pregnancy , risk on the child

Question 16

ABPA

In air , soil , organic matter

Answer 16

2% of patients with asthma may have IgE mediated sensitization to colonozation of the airway by fungi.(Aspergillus Fumigatus)=ABPA

-Type 2 airway inflammatory response
-IgE>1000IU/ml
-Eosinophil>500/microlit
-Positive skin test to A.F.
-Mucous plug
-Central bronchiectasis

Question 17

ABG

Answer 17

HCO3-
Pco2
Po2
Sat o2

Question 18

Endogenous developmental risk factors

Answer 18

More prevalent among boys than girls.
-Atopy is more prevalent among boys
-Reduced airway size among boys
•Difference receding by age 20.
•More prevalent among women by age 40.
•Develop asthma around menopause.

Question 19

Reactive airways dysfunction syndrome (RADS)

Answer 19

High concentration irritant exposure cause Bronchospasm (whitin hours) .

Oxidizing & Reducing aerosolized agents cause Epithelial injury & Neutrophilia

Question 20

………….can cause asthma for 4-6 weeks

But maybe 🤔 permanent

Answer 20

Upper respiratory tract virus infections.

•Neutrophilic or eosinophilic inflammation.

Question 21

Exercise is a common trigger , particularly in children.

Answer 21

The mechanism is Hyperventilation which causes increased osmolality in airway lining fluids & triggers mast cell mediator release resulting in bronchoconstriction

EIA is worse in cold, dry climates.

Question 22

Autonomic innervation of lungs

Answer 22

Sym………beta………muscle relaxation ………bronchodilation

Parasym………muscarin………muscle contraction ………bronchoconstriction

Question 23

Pregnancy can worsen asthma in……… of patients.

Answer 23

1/3

Question 24

Most patients with Gastro-esophageal Reflux …………therapy fails to reduce asthma symptoms in most patients.

Answer 24

Anti-reflux