Asthma Flashcards
IL responsible for neutrophilic asthma, also present in adipose tissue
IL-17
Diagnosis of asthma
Mostly clinical!
Reduced FEV1/FVC
10% increase in FEV1 or FVC (bronchodilator response)
Can have diurnal peak flow variability>20% in adults
Direct bronchoprovocation tests and cut off
- Mathacholine challenge
- Histamine challenge
> 20% change in FEV1
Has great negative predictive value in symptomatic patients
Choosing direct or indirect bronchoprovocation test and their advantages
Indirect: more specific; correlates better with airway inflammation, best choice when exercise bronchospasm is in question
Direct: good negative predictive value if patient is symptomatic
Indirect bronchoprovocation tests and cut offs
- Mannitol
- Eucapnic hyperventilation
FEV1 >15% change
- Exercise testing: >10% change and 200 ml
Which IL is FeNO testing correlative with and what is the cut off for it to be positive
IL-13
Also correlates with eosinophils and exacerbations
> 50 ppb
Benefit of LAMA as an add on to ICS/LABA in asthma
small increase in lung function
NO clinical benefit in sx or QOL
Modest reduction in exacerbation compared to ICS+LABA
Indications for Leukotriene modifiers (2)
Aspirin exacerbated disease
Exercise induced bronchoconstriction
Black box warning for leukotriene inhibitors
SI/mental health
Benefit of ICS+Formoterol AIR therapy vs. scheduled ICS or SABA prn
- Decrease exacerbations by 40-60%
- Decreased steroid exposure
When to start maintenance therapy: “persistent”
Step 2:
Night awakening 2-3x/mo (Step 3)
OR daily sx >2-3 days/week (Step 2)
Step 3:
FEV 60-80%
night sx more than 1x a week
Severe asthma definition
Step 4-5; FEV <60%
Use of corticosteroids >50% of the previous year
Remains uncontrolled despite therapy
Omalizumab target & indications
IgE lvl 30-700
Max weight 60-90kg depending on IgE level
3 biologics indicated for nasal polyposis
Omalizumab
Mepolizumab
Dupilumab
3 anti IL-5 and how they differ
Mepolizumab: indication for EGPA, Hypereosinophilic sd, nasal polyps
Benralizumab: targets RECEPTORS
Reslizumab: IV, weight base, only clinic administration
Dupilumab target
IL-4 receptor (shared by IL-4 and IL-13)
What does IL-13 do
Increase IgE
Increase mucus
Affect airway epithelium
Which biologics are indicated for corticosteroid-dependent asthma
dupilumab
benralizumab
mepolizumab
When should we use Tezepelumab
low T2 asthma
Though more effective with high eos
Benefit of azithromycin in asthma
when used 500mg 3x/week –> reduction in
1. exacerbation frequency
2. QOL
Definition of ASA exacerbated respiratory disease (3 criteria)
- asthma
- chronic rhinosinusitis with nasal polyposis
- ASA sensitivity
Treatment of ASA exacerbated respiratory disease
leukotriene modifiers
ASA avoidance if able
How does controlling GERD help with Asthma
- Improves Peak flow
- QOL
- Decreases exacerbations
How to diagnose occupational asthma
specific exposure inhalation test
PFT
What genes are associated with early onset asthma
Chromosomes 17q21
Genes ORMDL3
GSMDB
Abs Eos count cut off to qualify for Mepolizumab
> 150
Absolute eos count cut off for Reslizumab
> 150
Dx of hereditary angioedema
Type I: Low ag and functional C1 esterase
Type II: normal Ag, low C1 inhibitor function
Tx of hereditary angioedema and C1 inhibitor deficiency
SQ Icatibant (bradykinin receptor antagonist) - no more than 3 doses in 24h period q6h
Lanadelumab: mAb inhibitor of plasma kallikrein
When is allergen immunotherapy safe to start
when someone has controlled asthma
in smoker, decreased FVC and FEV1 with normal ratio, think dx of ____
PRISM (presereved ratio impaired spirometry)
Those with dx of PRISm have high risk of ____
COPD
and mortality risk, greater respiratory sx and reduced exercise capacity compared to those with normal lung function
Influenza vaccine benefit in COPD
frequency of exacerbation
NOT mortality
Most common site of bronchial atresia
LUL apicoposterior segment
Management of dupilumab-associated hypereosinophilia
usually lasts 16-20 weeks, will persist after 6 mo
Stop dupi if >5000 AEC or end-organ dysfunction
Should you step down or use LAMA in pregnancy
no!
LAMA is contraindicated
Indication for bronchothermoplasty
2 episodes requiring corticosteroids in the past year, FEV1 has to be >60%
Benefit and logistics of bronchothermoplasty
decrease in severe exacerbations
decrease in ED visits
decrease in days off from work/school
3 treatments
likely to have asthma exacerbations in the immediate post-op period 6wk
