Asthma Flashcards by Cristina Yang

anti-inflammatory cytokines;

may be deficient in asthma

IL-10 and IL-12

How well did you know this?

Not at all

Perfectly

anti-inflammatory cytokines;

may be deficient in asthma

IL-10 and IL-12

How well did you know this?

Not at all

Perfectly

upstream cytokine released from epithelial cells of asthmatics that orchestrates the release of chemokines that selectively attract TH2 cells

Thymic stromal lymphopoietin

How well did you know this?

Not at all

Perfectly

selectively attractant to eosinophils via CCR3 and is expressed by epithelial cells of asthmatics

Eotaxin

CCL11

How well did you know this?

Not at all

Perfectly

expressed by epithelial cells of asthmatics attract TH2 cells via CCR4

CCL17 (TARC) and CCL22 (MDC)

How well did you know this?

Not at all

Perfectly

expressed by epithelial cells of asthmatics attract TH2 cells via CCR4

CCL17 (TARC) and CCL22 (MDC)

How well did you know this?

Not at all

Perfectly

Proinflammatory transcription factors activated in asthmatic airways

nuclear factor-B (NF-B)

activator protein-1

How well did you know this?

Not at all

Perfectly

Proinflammatory transcription factors activated in asthmatic airways

nuclear factor-B (NF-B)

activator protein-1

How well did you know this?

Not at all

Perfectly

transcription factors regulate the expression of TH2 cytokines in T cells

nuclear factor of activated T cells

GATA-3

How well did you know this?

Not at all

Perfectly

transcription factors regulate the expression of TH2 cytokines in T cells

nuclear factor of activated T cells

GATA-3

How well did you know this?

Not at all

Perfectly

Bronchoconstrictor mediators released in asthma

Chemokines
Histamines
Leukotrienes
Prostaglandin D2

How well did you know this?

Not at all

Perfectly

physiologic abnormality of asthma:

Airway hyperresponsiveness

How well did you know this?

Not at all

Perfectly

Bronchoconstrictor mediators released in asthma

histamine, 
prostaglandin D2, 
Cysteinyl leukotrienes, 
cytokines, chemokines, 
growth factors, 
neutrotropins

How well did you know this?

Not at all

Perfectly

physiologic abnormality of asthma:

Airway hyperresponsiveness

How well did you know this?

Not at all

Perfectly

Mech for basement membrane thickening in asthmatic patients

subepithelial fibrosis

deposition of types III and V collagen

How well did you know this?

Not at all

Perfectly

Mech for basement membrane thickening in asthmatic patients

subepithelial fibrosis

deposition of types III and V collagen

How well did you know this?

Not at all

Perfectly

How epithelial damage may contribute to AHR

1) loss of its barrier function to allow penetration of allergens;
2) loss of enzymes (such as neutral endopeptidase) that degrade certain peptide inflammatory mediators;
3) loss of a relaxant factor (so called epithelial-derived relaxant factor);
4) exposure of sensory nerves

How well did you know this?

Not at all

Perfectly

How epithelial damage may contribute to AHR

How well did you know this?

Not at all

Perfectly

Mechanism involved in exercise induced asthma

hyperventilation
results in increased osmolality in airway lining fluid –> triggers mast cell mediator release –>
bronchoconstriction

How well did you know this?

Not at all

Perfectly

Mechanism involved in exercise induced asthma

hyperventilation
results in increased osmolality in airway lining fluid –> triggers mast cell mediator release –>
bronchoconstriction

How well did you know this?

Not at all

Perfectly

induce mucus hypersecretion in experimental models of asthma

IL-4

IL-13

How well did you know this?

Not at all

Perfectly

mechanism premenstrual worsening of asthma

fall in progesterone

How well did you know this?

Not at all

Perfectly

mechanism premenstrual worsening of asthma

fall in progesterone

How well did you know this?

Not at all

Perfectly

Mechanism of Exercise-induced asthma (EIA)

prior administration of B2-agonists and antileukotrienes

regular treatment with ICS

How well did you know this?

Not at all

Perfectly

Mechanism of Exercise-induced asthma (EIA)

> prior administration of B2-agonists and antileukotrienes | > regular treatment with ICS

may trigger asthma through the release of sulfur dioxide gas in the stomach

Metabisulfite (food preservative)

Increased ambient levels of ____ are associated with increased asthma symptoms

sulfur dioxide, ozone, and nitrogen oxides

reversible occupational asthma

If removed from exposure within the first 6 months of symptoms

PATHOPHYSIOLOGY | Limitation of airflow in asthma

bronchoconstriction, but airway edema, vascular congestion, and luminal occlusion with exudate

PATHOPHYSIOLOGY | lung hyperinflation, (air trapping) and increased residual volume in asthma

Early closure of peripheral airway

PATHOPHYSIOLOGY | lung hyperinflation, (air trapping) and increased residual volume in asthma

Early closure of peripheral airway

direct broncho constrictors Increased bronchoconstrictor responsiveness

histamine | methacholine

MOA of AHR with fog

mast cell activation

MOA of AHR with sulfur dioxide

cholinergic reflex

Diagnosis reversibility of airflow limitation in asthma

>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 (OCS) (prednisone or prednisolone 30-40 mg daily)

spirometry findings in asthma

reduced FEV1 FEV1/FVC ratio PEF

how to measure increased AHR

methacholine or histamine challenge with calculation of the provocative concentration that reduces FEV1 by 20% (PC20)

noninvasive test to measure eosinophilic airway inflammation; may be a test of compliance with therapy

Exhaled NO; | elevated levels of NO in asthma are reduced by ICS,

MOA ipratropium (anti-cholinergic)

prevent cholinergic nerve-induced bronchoconstriction and mucus secretion

MC adverse effect of ipratropium (anti-cholinergic)

dry mouth

MOA ipratropium (anti-cholinergic)

prevent cholinergic nerve-induced bronchoconstriction and mucus secretion

MC adverse effect of ipratropium (anti-cholinergic)

dry mouth

MOA theophylline

inhibition of phosphodiesterases in airway smooth-muscle (which increases cyclic AMP)

Other effects of B agonists helpful against asthma

inhibition of mast cell mediator release reduction in plasma exudation inhibition of sensory nerve activation

SABA duration of action

3-6 hours

soluble salt of theophylline previously used for the treatment of severe asthma

aminophylline | now replaced by LABA-- more effective and fewer side effects

soluble salt of theophylline previously used for the treatment of severe asthma

aminophylline | now replaced by LABA-- more effective and fewer side effects

Factors Affecting Clearance of Theophylline | Increased Clearance

Enzyme induction (rifampicin, phenobarbitone, ethanol) Smoking (tobacco, marijuana) High-protein, low-carbohydrate diet Barbecued meat Childhood (imagine a TB patient, alcoholic, with seizure) smoker drug addict barbecuing meat (for a high protein low carb lunch) for his child

Factors Affecting Clearance of Theophylline | Increased Clearance

Factors Affecting Clearance of Theophylline | Decreased Clearance

``` Congestive heart failure Liver disease Pneumonia Viral infection and vaccination High carbohydrate diet Old age ```

MOA ICS

switch off the transcription of multiple activated genes that encode inflammatory proteins such as cytokines, chemokines, adhesion molecules, and inflammatory enzymes

Local SE ICS

hoarseness (dysphonia) and oral candidiasis

MOA montelukast and zafirlukast | Antileukotrienes

block cys-LT1-receptors (activation of cys-LT1-receptors cause microvascular leakage, and increase eosinophilic inflammation --> bronchoconstriction)

MOA montelukast and zafirlukast | Antileukotrienes

block cys-LT1-receptors (activation of cys-LT1-receptors cause microvascular leakage, and increase eosinophilic inflammation --> bronchoconstriction)

MOA Cromolyn sodium and nedocromil sodium (cromones)

inhibit mast cell and sensory nerve activation

Steroid-Sparing Therapies used in asthma

``` Methotrexate cyclosporin A azathioprine gold IV gamma globulin ```

blocking antibody that neutralizes circulating IgE without binding to cell-bound IgE and, thus, inhibits IgE-mediated reactions

Omalimumab

duration trial of therapy to show objective benefit: Omalizumab

3 to 4-month

chronic asthma

ICS given twice daily

O2 asthma

face mask to achieve oxygen saturation of >90%

(approximately 5% of asthmatics) are difficult to control despite maximal inhaled therapy

refractory asthma

Rx refractory asthma

OCS

most effective therapy Brittle asthma

subcutaneous epinephrine,

Brittle asthma persistent pattern of variability and may require oral corticosteroids or, at times, continuous infusion of 2-agonists

type I brittle asthma

Brittle asthma normal or near-normal lung function but precipitous, unpredictable falls in lung function that may result in death

type 2 brittle asthma

Hx of OCS treatment impt before surgery

will have adrenal suppression and should be treated with an increased dose of OCS immediately prior to surgery

allergic pulmonary reaction to inhaled spores of Aspergillus fumigatus and, occasionally, other Aspergillus species.

Bronchopulmonary aspergillosis (BPA)

Rx Bronchopulmonary aspergillosis (BPA)

itraconazole

Direct bronchoconstrictors increased in asthma

Histamine | Methacholine

Define reversibility in asthma

>12% and 200 ml increase in fev1 15 mins after an inhaled short acting B2 agonist Or 2-4 wk trial of OCS

Non invasive test used to measure airway inflammation

FENO exhaled nitric oxide

Vasculities associated with wheezing

Churg strauss | Polyarteritis nodosa