Asthma

Question 1

What is asthma?

Answer 1

Chronic Inflammatory lung disease with:

• Cough, Dyspnea, chest tightness, wheezing associated with a drigger
• airway narrowing that’s reversible
• increased airway responsiveness to a variety of stimuli

Question 2

What are the risk factors for asthma?

Answer 2

Atopy
Indoor allergen exposure 
Rhinitis
Occupational Exposures
Pollution
Resp infections 
Smoke exposure
Obesity
Early menarche
Maternal Age
Meds

Question 3

What demographic has a worse outcome in adult asthma?

Answer 3

Young African American Men

Question 4

What is the pathogenesis of Asthma?

Answer 4

Combination of inflammation and cellular infiltration

Inflamm. paralells the degree of bronchial hyper-responsiveness

^TH2 lymphocytes release cytokines(IL3, 4, 5 and GM-CSF)

^Sensitized mast cells release CK and effect eos. chemotaxis

^Eos release ECP, Neurotoxin, and peroxidase

Question 5

What are the 3 components to inflammation in Asthma?

Answer 5

Infiltration of the airway with eosinophils and lymphocytes

Airway wall cells are upregulated to a proinflammatory state

Alterations in non-cellular components of the airway wall

Question 6

What indoor allergens are risk factors for developing asthma?

Answer 6

House Dust mites
Animal proteins (dogs/cats)
Cockroach antigen
Alternaria Mold

Question 7

Which inflammatory mediators are involved in asthma?

Answer 7

Histamine
Leukotrienes
Kallekrein
Platelet activation factor

Question 8

What are the components of Airway obstruction in Asthma?

Answer 8

Inflammation
SM contraction and hypertrophy
Mucus Gland hypersecretion and mucus plugging
Airway Remodeling

Question 9

What are common Asthma Triggers?

Answer 9

Viral Infections
Exercise in cold, dry air
Weather Changes(humidity, barometric pressure)
Smoking
Drugs (ASA, NSAIDS, B-Blockers)
Pollution and Occ. Exposre  
Allergens

Question 10

What are the cardinal symptoms of Asthma?

Answer 10

Cough (after exertion, cold air, at night, after colds, paroxysmal)
Wheezing (tightness, noisy breathing)
Dyspnia (Esp if Intermittent or Variable, after exertion, At night)

Question 11

What is seen on physical exam in Asthma?

Answer 11

Tachypnia
Dec intensity of breath sounds
Tachycardia
Accessory muscle use
Wheezing (not diagnostic)

Question 12

What is the prodedure for Bronchoprovocation test?

Answer 12

Increasing concentrations of Methacholine shows stepwise decrease in FEV-1
Asthmatics react to relatively low concentration

Question 13

What are Pitfalls to Bronchoprovoction testing?

Answer 13

False pos- following infection
False pos- on meds
Not Diagnostic Of asthma Alone

Question 14

How is asthma severity classified?

Answer 14

Days with Symptoms
Nocturnal symptoms
Peak flow rates
PFR variability

Question 15

What are the Goals of Asthma therapy?

Answer 15

Freedom from frequent or troublesome symptoms
Minimal need for Short acting Beta-Antagonists
Optomization of lung function
Maint of normal dialy activities
Satisfaction with asthma care

Question 16

What are the components of Asthma Tx?

Answer 16

Monitoring of symptoms and lung function
Pt and Fam Ed
Control of Envt Factors and comorbid conditions
Pharm Therapy

Question 17

What are the Asthma Meds?

Answer 17

Rapid and long acting Beta antagonists
Anticholinergics
Theophylline
Leukotriene modifiers
Inhaled Corticosteroids (get out of trouble)
Systemic Corticosteroids (worst cases)
Omalizumab $ (IgE blocking drug)

Question 18

What beta Agonists are used in Asthma?

Answer 18

Albuterol
Levalbuterol
Pirbuterol
When severe combo with Ipratropium

Question 19

How are inhaled Steroids used in asthma?

Answer 19

Used for long term care after asthma is under control

Question 20

When do you add an anti-inflammatory in asthma therapy?

Answer 20

After step 1 of treatment

Question 21

What drugs are used for acute asthma exacerbation?

Answer 21

Short Acting Inhaled beta agonists 
O2
Systemic Stroids
Mg Sulfate 
Heliox