Asthma Flashcards
Most pts with asthma are allergic to
house dust mite
Dermatophagoides pteronyssinus
Age of presentation of asthma
any age
Peak age of presentation of asthma
3 years
Drugs that can trigger asthma
aspirin
beta blockers
Allergic rhinitis is present in _________ % of atopic patients
80
Intrinsic asthma
non atopic
adult onset
aspirin sensitivity
nasal polyps
When to suspect occupational asthma?
When symptoms improve during weekends
Characteristic pathological finding in BA?
Thickening of subepithelial basement membrane
Causes of subepithelial basement membrane thickening in bronchioles?
Asthma
Eosinophilic bronchitis
Inflammatory changes are predominant in which airway in asthma
cartilaginous(bronchi)
beta blockers and asthma
avoid all beta blockers
selective and topical too
EIA clinical presentation
begins after exercise has ended, and recovers spontaneously within about 30 minutes
Hormonal factors associated with asthma
Thyrotoxicosis and hypothyroidism can both worsen athma
low progesterone can worsen asthma
GERD and asthma
common in asthmatic patients as it is increased by bronchodilators
ventilatory failure in asthma
Very uncommon
prodromal symptoms before asthma attack
itching of chin
discomfort between scapula
impending doom
Reversibility
> 12% and 200-mL increase in FEV1 15 minutes after an inhaled short-acting 2-agonist or in some patients by a 2 to 4 week trial of oral corticosteroids
role of allergen challenge in asthma
occupational asthma
methacholine or histamine challenge
reduction of FEV1 by 20%
role of methacholine challenge test
DD of chronic cough
Normal PFT
Shadowing in x ray in asthma patients
pneumonia
eosinophilic infiltrates in patients with bronchopulmonary aspergillosis
Difference between cardiac asthma and BA
basal crackles in cardiac asthma
causes of wheeze
foreign body obstruction BA cardiac asthma eosinophilic pneumonia churg strauss PAN
Difference between COPD and asthma
symptoms show less variability
never completely remit
show much less (or no) reversibility to bronchodilators
Duration of action of SABA
3-6 hours
SABAs
albuterol
terbutaline
LABAs
salmeterol
formoterol
duration of action of LABAs
12 hours
Most common adverse effect of beta agonists
muscle tremor
palpitations
Muscle tremor and palpitation due to beta agonists are commonly seen in
elderly
tolerance to beta agonist therapy
rapid in mast cells
no tolerance for airway dilatation
anticholinergic therapy in acute severe asthma
used only after beta agonists as they have a slower onset of action
Most common adverse effect of anticholinergic therapy
dry mouth
adverse effect of anticholinergic therapy in elderly patients
urinary retention
glaucoma
anti inflammatory action of theophylline is due to
activation of histone deacytelase 2
MOA of theophylline
Phosphodiesterase inhibitor
role of aminophylline in asthma
severe exacerbations that are refractory to SABAs
Most common side effects of theophylline
Nausea
vomiting
headache
adverse effects of theophylline occur at plasma concentrations above
10mg/L
adverse effects of theophylline
nausea,vomiting headache diuresis palpitations arrythmias seizures
arrythmias and seizures due to theophylline is the result of
adenosine A1 receptor antagonism
side effects of ICS
hoarsness
oral candidiasis
how to prevent local side effects of ICS
use of large spacer
OCS Rx in asthma
prednisone or prednisolone 35-40mg od for 5 to 10 days
no tapering needed
key side effect of intramuscular triamcinolone in asthma
proximal myopathy
steroid side effects
osteoporosis hypertension diabetes easy bruising GI ulceration cataract truncal obesity depression proximal myopathy
cromones
cromolyn sodium
nedocromil
role of cromones in asthma
trigger induced asthma like EIA,SO2,
Frequency of omalizumab injection
every 2-4 weeks
Use of reliever medication more than ________ times/week indicates need for controller therapy
3
marker of impending respiratory failure in Acute severe asthma
normal or raised PCO2
O2 sat target in Acute severe asthma
> 90%
Indication for intubation in acute severe asthma
impending respiratory failure
Causes of refractory asthma
non compliance chlamydia/mycoplasma beta blockers,aspirin hypo/hyperthyroidism premenstrual worsening rhinosinusitis
OCS of choice in pregnant patients
prednisone
as it is not converted to prednisolone by fetal liver
safe antiasthmatic medications
SABA
ICS
Theophylline
