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Pulmonology > Asthma > Flashcards

Asthma Flashcards

1
Q

____ is the most common chronic disease associated with significant morbidity and mortality,

A

Asthma

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2
Q

____ is a hallmark of asthma.

A

Airway hyperresponsiveness

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3
Q

A major therapeutic objective in asthma is to decrease the degree of ____

A

airway hyperresponsiveness.

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4
Q

Most asthmatics have evidence of chronic inflammation in the airways. Most commonly, this inflammation is ___ in nature.

A

eosinophilic

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5
Q

In some patients, ___ inflammation may be predominant, especially in those with more severe asthma.

A

neutrophilic

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6
Q

_____ is an immune response involving the innate and adaptive arms of the immune system to promote barrier immunity on mucosal surfaces.

A

Type 2 inflammation

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7
Q

It is called Type 2 because it is associated with the type 2 subset of _____, which produce the cytokines interleukin (IL)____

A

CD4+ T-helper cells
4, IL-5, and IL-13.

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8
Q

IL?
Promotes B-cell isotype switching to IgE production.
IgE binding to mast cells and basophils triggers allergen sensitivity.

A

IL4

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9
Q

IL?
Regulates eosinophil formation, recruitment, and survival.

A

IL5

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10
Q

IL13

Induces airway hyperresponsiveness, mucus hypersecretion, and goblet cell metaplasia.

A
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11
Q

May occur alongside type 2 inflammation or independently

A

Non Type 2 Inflammation

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12
Q

This type of inflammation is more commonly seen in severe asthma that has not responded to the common anti-inflammatory therapies, such as corticosteroids, that usually suppress type 2 inflammation

A

Neutrophilic inflammation

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13
Q

Non type 2 inflammation is also commonly seen in ____

A

reactive airway dysfunction syndrome

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14
Q

____are the major cytokines associated with type 2 inflammation.

A

IL-4, IL-5, and IL-13

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15
Q

____ have been implicated in non–type 2 inflammation.

A

IL-6, IL-17, tumor necrosis factor α (TNF-α), IL-1β, and IL-8

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16
Q

It is produced by epithelial cells, especially in response to IL-13, and by stimulated inflammatory cells including eosinophils, mast cells, and neutrophils.

A

NO

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17
Q

___ Also implicated in type 2 inflammation

A

IL-9

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18
Q

The cysteinyl leukotrienes (leukotrienes _____ ) are produced by eosinophils and mast cells.

A

C4 , D4 , and E4

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19
Q

Prostaglandin D 2(PGD 2 ) is produced by ___

A

mast cells.

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20
Q

___ has a strong genetic predisposition

A

Asthma

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21
Q

The most consistently identified igenes include

A

ORMDL3/ GSDMB (in the 17q21 chromosomal region), ADAM33, DPP-10, TSLP, IL-12, IL-33, ST2, HLA-DQB1, HLA-DQB2, TLR1, and IL6R. I

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22
Q

Genetic polymorphisms linked to differential therapeutic responses:

____: Affects response to β-agonists
.
Variants in ____: Impacts corticosteroid response.

A

β-receptor variant (Arg16Gly in ADRB2)

glucocorticoid-induced transcript 1 gene

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23
Q

____and ____exposure are associated with increased childhood asthma.

A

Maternal smoking
secondhand smoke

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24
Q

Childhood secondhand smoke exposure increased asthma risk ___

A

twofold

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25
Q

Active smoking is estimated to increase the incidence of asthma by up to ___ in adolescents and young adults.

A

fourfold

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26
Q

Incidence and frequency of ____ infections in children are associated with development of asthma

A

human rhinovirus
respiratory syncytial virus

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27
Q

The evidence is not yet definitive, but ____insufficiency may increase asthma risk in the progeny and supplementation may decrease such risk

A

vitamin D

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28
Q

Use of ___and ____in pregnancy has been associated with an increased risk of asthma in children

A

H 2 blockers

proton pump inhibitors

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29
Q

___ and ___ have been associated with increased risk of asthma in the progeny.

A

Preeclampsia
prematurity

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30
Q

Babies born by ____are at higher risk for asthma.

A

cesarean section

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31
Q

A subset of women develop asthma around ___. Such asthma tends to involve ___

A

menopause
non–type 2 mechanisms

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32
Q

A solitary exposure to a high concentration of irritant agents that rapidly (usually within hours) produces bronchospasm and bronchial hyperactivity is known as ___

A

RADS

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33
Q

So-called allergic bronchopulmonary aspergillosis (ABPA) is characterized by a ______ response to aspergillus with IgE >1000 IU/mL, eosinophils >500/μL, positive skin test to Aspergillus, and specific IgE and IgG antibodies to Aspergillus.

A

type 2 airway inflammatory

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34
Q

The presence of ____ predicts poor quality of life and is an independent predictor of asthma exacerbations.

A

gastroesophageal reflux disease (GERD)

35
Q

____ is rare in children, and its presence in adults with asthma should raise suspicions of aspirin-exacerbated respiratory disease (see “Special Considerations”).

A

Nasal polyposis

36
Q

Reversibility is defined as a ___increase in the FEV 1 and an absolute increase of ___ mL at least 15 min after administration of a β2 -agonist or after several weeks of corticosteroid therapy.

A

≥12%
≥200

37
Q

Diurnal peak flow variability of____has also been proposed as an indicator of reversible airways disease, but it is less reliable due to difficulties with quality control and variability of home assessments.

A

> 20%

38
Q

Provocative Test:
____, a cholinergic agonist, inhaled in increasing concentrations is most commonly used.

A

Methacholine

39
Q

A provocative dose producing a ____drop in FEV 1 (PD 20 ) is calculated, with a value ≤400 μg indicative of airway reactivity.

A

20%

40
Q

Challenge with exercise and/or cold, dry air can be performed, with a positive response recorded if there is a____ drop in FEV 1from baseline

A

≥10%

41
Q

____ in exhaled breath is an approximate indicator of eosinophilic inflammation in the airways.

A

Fraction of exhaled nitric oxide (FeNO)

42
Q

Elevated levels (____ ppb) in untreated patients are indicative of eosinophilic inflammation.

A

> 35–40

43
Q

Levels ____ ppb in patients with severe asthma on moderate- to high-dose ICS indicate either poor adherence or persistent type 2 inflammation despite therapy.

A

> 20–25

44
Q

Albuterol: Bronchodilation begins within ____of inhalation, and effects generally last ____

A

3–5 min
4–6 h

45
Q

____ has a quick onset comparable to the short-acting β2-agonists.

A

Formoterol

46
Q

In contrast to their use in chronic obstructive pulmonary disease (COPD), LABAs are not recommended for use as monotherapy in the treatment of asthma. Their use in asthma is generally restricted to use in combination with an ICS. T/F

A
47
Q

Dry mouth may occur. At higher doses and in the elderly, acute glaucoma and urinary retention have been reported.

A

LAMA

48
Q

Represents a cornerstone of asthma treatment.

A

ICS

49
Q

____reduce airway hyperresponsiveness, improve airway function, prevent asthma exacerbations, and improve asthma symptoms.

A

Corticosteroids

50
Q

Pneumocystis pneumonia prophylaxis should be administered for those maintained on a daily prednisone dose of ____

A

≥20 mg

51
Q

______ are effective in preventing exercise-induced bronchoconstriction without the tachyphylactic effects that occur with regular use of LABA

A

Leukotriene modifiers

52
Q

prevents the binding of IgE to mast cells and basophils.

A

Omalizumab

53
Q

It is generally used in patients not responsive to moderate- to high-dose ICS/LABA. It reduces exacerbations by 25–50% and can reduce asthma symptoms but has minimal effect on lung function.

A

Omalizumab

54
Q

In patients who are not on chronic OCSs, these drugs are less effective in those with eosinophil counts <300/μL.

A

IL-5 Active Drugs

55
Q

____ reduces exacerbations by ≥50%, decreases symptoms, and may produce more of an effect on FEV 1 than anti–IL-5 drugs. It gradually reduces FeNO and IgE levels. Paradoxically, circulating eosinophil counts may initially temporarily increase. Most effects are seen by ____ of therapy.

A

Dupilumab

3–6 months

56
Q

The cornerstone of preferred therapy is the intensification of _____ in conjunction with the use of a LABA to achieve greater control at lower ICS doses.

A

ICS therapy

57
Q

_____ be used as the reliever in all steps of asthma severity, including intermittent asthma

A

ICS/formoterol

58
Q

Exercise-induced airway narrowing in elite athletes may be related to ____.

A

direct epithelial injury

59
Q

Poor asthma control, especially exacerbations, is associated with ____

A

poor fetal outcomes.

60
Q

Chronic use of OCS has been associated with :___

A

neonatal adrenal insufficiency, preeclampsia, low birth weight, and a slight increase in the frequency of cleft palate.

61
Q

A 45-year-old patient with known asthma presents with frequent nocturnal symptoms and increased use of short-acting β2-agonists (SABAs). Which of the following is the most appropriate next step in management?

A. Increase SABA dose.
B. Add a long-acting β2-agonist (LABA) as monotherapy.
C. Add inhaled corticosteroid (ICS).
D. Prescribe montelukast only.

A

C

62
Q

A 34-year-old patient has a 15-year history of asthma with poor control despite using high-dose ICS/LABA. Peripheral blood eosinophils are 450/μL. Which biologic agent is most appropriate for this patient?

A. Omalizumab
B. Dupilumab
C. Mepolizumab
D. Zafirlukast

A

C

Mepolizumab targets IL-5, reducing eosinophils and is indicated for severe eosinophilic asthma. Omalizumab targets IgE, and dupilumab targets IL-4/13 receptors, useful when eosinophils are not elevated. Zafirlukast is a leukotriene receptor antagonist.

63
Q

In patients with aspirin-exacerbated respiratory disease (AERD), which of the following is true regarding management?

A. Avoid acetaminophen and use only cyclooxygenase-1 inhibitors.
B. Use leukotriene modifiers.
C. Use PGF2-α for obstetric management.
D. Aspirin desensitization is contraindicated.

A

B

Leukotriene modifiers are first-line treatment in AERD. Aspirin desensitization can be considered when needed. Acetaminophen is generally safe. PGF2-α should be avoided due to bronchoconstriction risk.

64
Q

A 67-year-old with a history of asthma presents with worsening symptoms. PFTs reveal FEV₁/FVC <70% and reduced FEV₁ with minimal reversibility after bronchodilators. Which condition should be considered in addition to asthma?

A. Chronic bronchitis
B. Asthma-COPD overlap
C. Sarcoidosis
D. Bronchiectasis

A

B. Asthma-COPD overlap.
Explanation: Asthma-COPD overlap is suspected when patients with asthma have persistent airflow limitation and minimal bronchodilator reversibility. Smoking history and reduced FEV₁/FVC support this diagnosis.

65
Q

Which adverse effect is most commonly associated with montelukast use in asthma management?

A. Hypokalemia
B. Depression and suicidal ideation
C. Hyperglycemia
D. Cardiac arrhythmias

A

B

66
Q

Which of the following correctly describes the diagnostic threshold for airway hyperresponsiveness using a methacholine challenge test?

A. PD₂₀ ≤400 μg
B. FEV₁/FVC <60%
C. PEF variability >30%
D. FEV₁ decrease of ≥30% after exercise

A

A. PD₂₀ ≤400 μg.

Methacholine challenge test measures airway hyperresponsiveness. A PD₂₀ ≤400 μg indicates significant reactivity, supporting an asthma diagnosis.

67
Q

In a pregnant patient with asthma, which medication is considered safest based on available data?

A. Omalizumab
B. Budesonide
C. Zileuton
D. Benralizumab

A

B

There is extensive experience suggesting the safety of inhaled albuterol, beclomethasone, budesonide, and fluticasone, with reassuring information on formoterol and salmeterol in pregnancy

68
Q

Which of the following findings in an asthma patient in respiratory distress should raise concern for impending respiratory failure?

A. Persistent hypoxemia
B. Hyperventilation with low Pco₂
C. Normal or near-normal Pco₂
D. Wheezing on expiration

A

C

Normal or near-normal Pco 2 in a patient with asthma in respiratory distress should raise concerns of impending respiratory failure and need for mechanical ventilation.

69
Q

What is the preferred reliever medication for step 1 asthma management according to GINA guidelines?

A. SABA
B. ICS/LABA (formoterol)
C. ICS only
D. LTRA

A

B

70
Q

Which cell type is most commonly associated with chronic inflammation in asthma?
A. Neutrophils
B. Basophils
C. Eosinophils
D. T cells

A

C

71
Q

Which airway component is primarily responsible for mucus hypersecretion in asthma?
A. Goblet cell metaplasia
B. Ciliated epithelial cells
C. Type II pneumocytes
D. Basal cells

A

A

72
Q

Which cytokine primarily regulates eosinophil production and survival in asthma?
A. IL-4
B. IL-13
C. IL-5
D. TNF-α

A

C

73
Q

Which cytokine promotes IgE production and B-cell isotype switching in asthma?
A. IL-5
B. IL-13
C. IL-4
D. IFN-γ

A

C

74
Q

What is the primary function of IL-13 in type 2 inflammation?
A. Recruitment of neutrophils
B. Induction of airway hyperresponsiveness and mucus hypersecretion
C. Suppression of T-helper cells
D. Stimulation of IL-6 production

A

B

75
Q

Which cytokine is directly involved in the induction of airway hyperresponsiveness, mucus hypersecretion, and goblet cell metaplasia in asthma?
A. IL-4
B. IL-5
C. IL-13
D. IL-6

A

C

76
Q

Which fatty acid mediator is produced by eosinophils and mast cells, causing potent bronchoconstriction, mucus secretion, and airway inflammation?
A. Prostaglandin D₂ (PGD₂)
B. Leukotriene B₄ (LTB₄)
C. Cysteinyl leukotrienes (LTC₄, LTD₄, LTE₄)
D. Lipoxins

A

C

77
Q

What is the role of nitric oxide (NO) in asthma pathophysiology?
A. It suppresses airway inflammation by reducing oxidative stress.
B. It relaxes airway smooth muscle, decreasing airway tone.
C. It promotes mucus hypersecretion and smooth muscle proliferation.
D. It inhibits eosinophil recruitment in asthma.

A

C

78
Q

Which cytokines are primarily involved in type 2 inflammation and have been successfully targeted by asthma therapies?
A. IL-4, IL-5, and IL-13
B. IL-8, IL-6, and TNF-α
C. IL-17, IL-1β, and IFN-γ
D. TSLP, IL-25, and IL-33

A

A

79
Q

What is the primary effect of reactive oxygen species (ROS) in asthma pathophysiology?
A. Airway relaxation and improved mucus clearance
B. Suppression of eosinophil activity
C. Smooth muscle contraction and epithelial damage
D. Inhibition of cytokine production

A

C

80
Q

In asthma evaluation, what result on a methacholine challenge test confirms airway hyperresponsiveness?
A. PD₂₀ ≤ 200 μg
B. PD₂₀ ≤ 400 μg
C. FEV₁/FVC >80% after methacholine
D. Increase in FEV₁ ≥12%

A

B

81
Q

Which biomarker can be measured in exhaled breath to assess eosinophilic inflammation in asthma?
A. Exhaled carbon monoxide
B. Serum IgE
C. Exhaled nitric oxide (FeNO)
D. Arterial blood gas (ABG)

A

C

82
Q

What is the most common reason for persistent asthma symptoms despite appropriate medication?
A. Poor inhaler technique
B. Underlying bronchiectasis
C. Pulmonary embolism
D. Lung cancer

A

A

83
Q

Which of the following best supports the diagnosis of asthma based on pulmonary function testing (PFT)?
A. FEV₁/FVC ratio >80% after bronchodilator use
B. Decrease in FEV₁ by 10% after exercise
C. Increase in FEV₁ ≥12% and ≥200 mL after bronchodilator use
D. Normal FEV₁/FVC ratio with reduced total lung capacity

A

C

84
Q
A

Pulmonology (11 decks)

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