Asthma

Question 1

Is airway obstruction is asthma reversible?

Answer 1

Yes

Question 2

What type of cytokines are activated by T helper cells in the bronchial mucosa of asthmatics?

Answer 2

Th2

Question 3

What do Th2 cytokines do?

Answer 3

Attract other inflammatory granulocytes to the musocal surface (eosinophils)
Promotes IgE synthesis and responsiveness (in some asthmatics)

Question 4

What is the immediate phase of an asthma attack caused by?

Answer 4

Spasm of bronchial smooth muscle

Question 5

What initiates the late phase of an asthma attack

Answer 5

Th2

Question 6

What do B2-adrenoceptor agonists do?

Answer 6

Dilate the bronchi by direct action on the b2-adrenoceptors of smooth muscle
They inhibit mediator release from eosinophils
They also increase mucous clearance by an action on cilia

Question 7

What are the side effects of B2-adrenoceptor agonists?

Answer 7

Tremor
Tachycardia
Cardiac dysthrhythmia

Question 8

What does theophylline do?

Answer 8

It inhibits phosphodiesterase and blocks adenosine receptors

Question 9

When is theophylline used?

Answer 9

IV in status asthmaticus

Oral add on to inhaled corticosteroids and LABAs

Question 10

What type of drug is theophylline?

Answer 10

Xanthine

Question 11

Monteleukast and Zafirlukast are types of which class of drug?

Answer 11

Cysteinyl leukotriene receptor antagonists

Question 12

What do Cysteinyl leukotriene receptor antagonists do?

Answer 12

Reduce acute reactions to aspirin in sensitive patients
Inhibit exercise-induced asthma
Decreases both early and late responses to an inhaled antigen.

Question 13

When is a Cysteinyl leukotriene receptor antagonist used?

Answer 13

It is 3rd line: Used as an add on to corticosteroids and LABAs

Question 14

Name a short(er) acting and a long(er) acting muscarinic receptor antagonist.

Answer 14

Ipratropium

Tiotropium

Question 15

What are glucocorticoids main action in asthma?

Answer 15

Anti-inflammatory action

Question 16

How do glucocotricoids work?

Answer 16

They decrease formation of cytokines in particular the Th2 cytokines

Question 17

What is the main glucocorticoid used in asthma treatment?

Answer 17

Beclometasone

Question 18

What are the side effects of glucocorticoids?

Answer 18

Oral candidiasis, sore throats, adrenal suppression

Question 19

What are the treatments given in severe acute asthma (status asthmaticus)?

Answer 19

Oxygen
Nebulised salbutamol
IV hydrocortisone
Oral prednisalone
Additional measures:
Nebulised ipratropium
IV salbutamol/aminophylline
antibiotics

Question 20

What changes does chronic asthma involve?

Answer 20

Increased smooth muscle mass
Accumulation of interstitial fluid
Increased mucous secretion
Epithelial damage

Question 21

List the order of drugs in the asthma guidelines.

Answer 21

(Identification + avoidance of triggers)
1. Occasional use of SABA
2. Low dose inhaled corticosteroid
(Add anti-histamine if reaction is to known allergen)
3. Love-moderate dose inhaled corticosteriod + LABA
4. High dose inhaled corticosteroids + Regular brochodilators + Leukotriene receptor antagonist or theophylline
5. Regular oral corticosteroids