Asthma

Question 1

Describe the most important risk factor for asthma?

Answer 1

Atopy: state of having IgE antibodies to specific allergens

Question 2

Higher ____ levels, family history, and greater number of _____ increases risk of asthma?

Answer 2

IgE and allergens

Question 3

Name things that can increase risk of asthma?

Answer 3

Dust mites, alternaria mold, cockroach allergens, cat and dog dander, smoking, excessive hygiene, obesity, environmental factors

Question 4

3 reversible causes of asthma and size of airways it takes place in?

Answer 4

Airway hypersensitivity, obstruction, inflammation.

Question 5

When an allergen is encountered, T-helper cells release cytokines, which cause these to travel to airways?

Answer 5

Basophils, eosinophils, mast cells, leukocytes

Question 6

Inflammation damages structural integrity and can result in this?

Answer 6

Long term remodeling of airway leading to resistance to future treatments.

Question 7

These are released from mast cells when antigens are crossed linked with IgE?

Answer 7

Histamine, prostaglandin D2, and leukotriene C4. TNF alpha which causes bronchoconstriction

Question 8

Eosinophils release these inflammatory mediators?

Answer 8

Major basic proteins- bronchoconstriction. Leukotrienes- bronchoconstriction and mucus

Question 9

Three symptoms of astham?

Answer 9

Cough, wheezing, dyspnea

Question 10

“Poor perceivers” of this usually require more emergent care?

Answer 10

Dyspnea

Question 11

This sign may disappear during sever exacerbations and has a prolonged expiratory phase I

Answer 11

Wheezing

Question 12

Name high risk patients?

Answer 12

Previous admission or intubation for asthma, 2 or more hospitalizations over 12 months, 3 or more ED visits over 12 months, hospitalized in previous 30 days for asthma, >2 rescue inhalers per month, “poor perceivers”, 2 or more PO steroids rx last 12 months.

Question 13

Treatment of exercise induced bronchoconstriction?

Answer 13

rescue inhaler 10 mins prior to excercise

Question 14

NSAIDs inhibit ______ and increase release of _______ causing bronchoconstriction?

Answer 14

cyclooxygenase adn leukotriene

Question 15

Samter’s triad or ASA triad?

Answer 15

Asthma, ASA sensitivity, nasal polyps

Question 16

Vital signs of astham?

Answer 16

Tachypnea, tachycardia, fever. RR >40 severe obstruction

Question 17

Make sure to observe these 3 things during physical examination

Answer 17

Mentation, posture, breathing

Question 18

Examples of obstructive disease?

Answer 18

Asthma, chronic bronchitis, bronchiactasis, emphysema

Question 19

Examples of restrictive diseases?

Answer 19

Restriction of chest wall with healthy lungs (obesity, neuromuscular disorders), Acute or chronic restrictive disorders (ARDS, Pneumoconiosis, interstitial fibrosis, sarcoidosis)

Question 20

PFTs measure

Answer 20

Lung volume, airflow, airway reactivity

Question 21

FVC

Answer 21

Forced vital capacity: total volume of gas that can be exhaled after a full inspiration. Decreased in restrictive and obstructive disorders

Question 22

FEV1

Answer 22

Forced expiratory volume: volume of gas forcefully exhaled in 1 second after taking full inspiration. reflects resistance in large and medium airways

Question 23

Most sensitive indicator of small airway disease

Answer 23

FEF (forced expiratory flow) 25-75%

Question 24

This test result is seen on PFT when an asthmatic uses a SABA and repeats the test?

Answer 24

FEV1 is increased by 12%

Question 25

This test is performed when asthma is in question but there is a normal PFT?

Answer 25

Methacholine challenge test. Should see decrease in FEV1

Question 26

What would indicated poor control on asthma control test (ACT)?

Answer 26

= 19

Question 27

Stepwise approach for managing asthma?

Answer 27

1. SABA 2. low dose ICS 3. low dose ICS + LABA or M dose ICS 4. M dose ICS + LABA 5. H dose ICS + LABA and consider omalizumab 6. h dose ICS + LABA + oral cortico and consider omalizumab

Question 28

B2 agonist effect? Short acting agents?

Answer 28

Bronchodilation and smooth muscle relaxation. Albuterol (90mcg) and levalbuterol (45mcg)

Question 29

Side effects of SABA?

Answer 29

Tachycardia and tremors

Question 30

LABA

Answer 30

Salmeterol and Formoterol. NOT used as rescue inhalor or as monotherapy!

Question 31

ICS actions?

Answer 31

Suppress and reduce inflammation, decrease symptoms and exascerbations, reduce hyperreactivity of airways, improve lung function

Question 32

ICS: metered dose inhalers (MDI)

Answer 32

Ciclesonide (80, 160mcg) Fluticasone propionate (44, 110,220 mcg) beclomethasone dipropionate (40, 80mcg)

Question 33

ICS: powder formulations

Answer 33

Mometasone furoate (110, 220mcg) Fluticasone propionate (50, 100, 250 mcg) budesonide (90,180mcg)

Question 34

ICS-nebulized

Answer 34

Budesonide (0.25mg/2mL, 0.5mg/2mL, 1mg/2mL)

Question 35

Anticholinergics

Answer 35

Ipratropium- short acting, titotropium- long acting

Question 36

These medications can be used in mild persistent asthma, or as adjunct to other treatments, but not as effective as ICS or LABAs?

Answer 36

Leukotriene modifiers: montelukast, zafirlukast, pranlukast, zileuton

Question 37

Phosphodiesterase inhibitor that posseses anti-inflammatory activity but must be monitored because of toxicity?

Answer 37

Theophylline

Question 38

Patients on Omalizumab must meet these characteristics?

Answer 38

Over the age of 12, moderate to severe asthma, not controlled on H dose ICS, total serum IgE 30-700, demonstrated allergic skin test sensitivity