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Phase 2a Respiratory > Asthma > Flashcards

Asthma Flashcards

1
Q

What is happening to the incidence of asthma?

A

It is increasing

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2
Q

What is happening to the incidence of asthma?

A

It is increasing

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3
Q

What are the two main classifications of asthma?

A

Eosinophilic and non-eosinophilic

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4
Q

What is Eosinophilic asthma split into?

A

Intrinsic and extrinsic asthma

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5
Q

What is intrinsic asthma?

A

Rare + adult presentation

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6
Q

Who is commonly affected by extrinsic asthma?

A

Children - but adult presentation can occur (occupation)

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7
Q

What is extrinsic asthma associated with?

A

Atopy

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8
Q

What atopic conditions might someone with asthma have a PMHx or FHx of?

A

allergic rhinitis (hayfever), atopic eczema (atopic dermatitis)

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9
Q

What is asthma described as?

A

A chronic condition of the airways - reversible airways obstruction

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10
Q

How does asthma differ from COPD?

A

Reversible

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11
Q

What are the 3 features seen in asthma pathology?

A

Airway narrowing, Airway hyper-responsiveness (to Ag), airway remodelling

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12
Q

What are the 3 pathological features that cause airway narrowing?

A

Bronchoconstriction (SM contraction), mucosal swelling + inflammation (mucosal oedema), and ^ mucous production

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13
Q

What is airway hyper-responsiveness?

A

An abnormal response to an inhaled Ag causing unnecessary effects

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14
Q

What are the 3 features that occur in airway remodelling in asthma?

A

^ no. of goblet cells (metaplasia - loss of columnar cells), airway SM hypertrophy/hyperplasia and thickened BM (by collagen deposition)

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15
Q

What is Gell and Coomb’s classification for?

A

classifying pathological reactions into hypersensitivity reactions

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16
Q

What type of hypersensitivity reaction is atopic asthma?

A

Type 1 (IgE mediated)

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17
Q

What type of hypersensitivity reaction is occupational asthma?

A

Type 3 (according to Kim Suvana)

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18
Q

What occurs immunologically in asthma to cause bronchoconstriction and the other pathological features?

A

An APC presents allergen to a naive T cell –> activation –> Th2 cell –> releases IL-4 + 13 which activates a B cell –> releases IgE –> Mast cell degranulation

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19
Q

What type of T cell is involved in the asthma pathophysiology?

A

Th2

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20
Q

Does Th2 also activate Mast cells directly?

A

Yes (releases IL-4 + IL-9)

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21
Q

What is released in mast cell degranulation?

A

Histamine + Leukotrienes

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22
Q

What is the effect of histamine?

A

^ vascular permeability (oedema), goblet mucus ^ secretion, SM contraction

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23
Q

What is the effect of Leukotrienes?

A

potent bronchoconstrictors

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24
Q

What are the symptoms of asthma?

A

Wheeze, tight chest, dry cough, SOB

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25
Q

What is special about asthma symptoms?

A

Diurnal variation (worse at night + early morning)

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26
Q

Why might there be diurnal variation?

A

^ in mast cells at night

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27
Q

When are the signs of asthma seen?

A

During an asthma attack

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28
Q

What signs can be seen during an asthma attack?

A

Hyperinflated chest, bilateral expiratory wheeze, ^ RR, ^ HR, cyanotic, ^ use of expiratory muscles, nostril flaring, tachypnoea

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29
Q

What might happen t a person during an asthma attack?

A

Not be able to talk

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30
Q

What might trigger the symptoms of asthma?

A

Occupation, cold, exercise, emotion/stress, infections, drugs (NSAIDs + beta blockers)

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31
Q

What is the feature of occupational asthma?

A

Symptoms improve when away from work

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32
Q

What should you ask in a Hx from a patient with asthma?

A

Triggers (cold, pets, allergies, drugs?), hx/FHx of atopy, diurnal variation, smoking status, frequency of symptoms, triggers at work? occupation?

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33
Q

What 4 investigations might you decide to carry out on someone with suspected asthma?

A

PEFR, Spirometry, histamine + methacholine challenge, skin prick test

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34
Q

What would you see in spirometry for someone with asthma?

A

Airways obstruction: FEV1/FVC

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35
Q

What would you see in PEFR for someone with asthma?

A

Decreased (as ^ time to exhale air) + diurnal variation

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36
Q

What would you see in histamine/methacoline challenge in someone with asthma?

A

Hyper-responsive airways

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37
Q

What would you see in skin prick test in someone with asthma?

A

Atopy

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38
Q

What is the conservative management for someone with asthma?

A

Education (ensure good inhalor technique, ACTION plan, regular PEFR monitoring), avoid precipitating factors, smoking cessation, influenza vaccine

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39
Q

What is the first step in the management of chronic asthma? What PEFR is this?

A

SABA (salbutamol)

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40
Q

What is the second step in the management of chronic asthma?

A

Add an inhaled corticosteroid (beclamethasone)

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41
Q

Give an example of an inhaled corticosteroid

A

Beclamethasone

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42
Q

What is the 3rd step in the management of chronic asthma?

A

Add a LABA (salmeterol)

43
Q

What might you consider if SABA, ICS and LABA isn’t working?

A

increase the dose of the ICS or add a LTRA (leukotriene receptor antagonist)

44
Q

Give an example of a leukotriene receptor antagonist

A

Montelukast

45
Q

What might you consider if LTRA doesn’t work in controlling asthma symptoms?

A

Oral prednisolone + refer to asthma clinic

46
Q

What PEFR value indicates the use of oral prednisolone + referral to asthma clinic?

A

PEFR

47
Q

When do you move from step 1-2 in the management of chronic asthma?

A

PEFR

48
Q

What PEFR value indicates that an asthma patient should be admitted to hospital?

A
49
Q

When should you review the treatment plan for asthma?

A

Every 3months

50
Q

What mAb can you consider in severe asthma cases?

A

Omalizumab (IgE receptor antagonist)

51
Q

What is the advantage of inhaled corticosteroids over oral corticosteroids?

A

Less systemic affects

52
Q

What is a SE of inhaled corticosteroids?

A

Oral thrush (candidiasis)

53
Q

What is the treatment steps for someone suffering an acute asthma attack?

A

Salbutamol + oral corticosteroid –> salbutamol inhaler –> O2 therapy + IV salbutamol …etc

54
Q

What are the two main classifications of asthma?

A

Eosinophilic and non-eosinophilic

55
Q

What is Eosinophilic asthma split into?

A

Intrinsic and extrinsic asthma

56
Q

What is intrinsic asthma?

A

Rare + adult presentation

57
Q

Who is commonly affected by extrinsic asthma?

A

Children - but adult presentation can occur (occupation)

58
Q

What is extrinsic asthma associated with?

A

Atopy

59
Q

What atopic conditions might someone with asthma have a PMHx or FHx of?

A

allergic rhinitis (hayfever), atopic eczema (atopic dermatitis)

60
Q

What is asthma described as?

A

A chronic condition of the airways - reversible airways obstruction

61
Q

How does asthma differ from COPD?

A

Reversible

62
Q

What are the 3 features seen in asthma pathology?

A

Airway narrowing, Airway hyper-responsiveness (to Ag), airway remodelling

63
Q

What are the 3 pathological features that cause airway narrowing?

A

Bronchoconstriction (SM contraction), mucosal swelling + inflammation (mucosal oedema), and ^ mucous production

64
Q

What is airway hyper-responsiveness?

A

An abnormal response to an inhaled Ag causing unnecessary effects

65
Q

What are the 3 features that occur in airway remodelling in asthma?

A

^ no. of goblet cells (metaplasia - loss of columnar cells), airway SM hypertrophy/hyperplasia and thickened BM (by collagen deposition)

66
Q

What is Gell and Coomb’s classification for?

A

classifying pathological reactions into hypersensitivity reactions

67
Q

What type of hypersensitivity reaction is atopic asthma?

A

Type 1 (IgE mediated)

68
Q

What type of hypersensitivity reaction is occupational asthma?

A

Type 3 (according to Kim Suvana)

69
Q

What occurs immunologically in asthma to cause bronchoconstriction and the other pathological features?

A

An APC presents allergen to a naive T cell –> activation –> Th2 cell –> releases IL-4 + 13 which activates a B cell –> releases IgE –> Mast cell degranulation

70
Q

What type of T cell is involved in the asthma pathophysiology?

A

Th2

71
Q

Does Th2 also activate Mast cells directly?

A

Yes (releases IL-4 + IL-9)

72
Q

What is released in mast cell degranulation?

A

Histamine + Leukotrienes

73
Q

What is the effect of histamine?

A

^ vascular permeability (oedema), goblet mucus ^ secretion, SM contraction

74
Q

What is the effect of Leukotrienes?

A

potent bronchoconstrictors

75
Q

What are the symptoms of asthma?

A

Wheeze, tight chest, dry cough, SOB

76
Q

What is special about asthma symptoms?

A

Diurnal variation (worse at night + early morning)

77
Q

Why might there be diurnal variation?

A

^ in mast cells at night

78
Q

When are the signs of asthma seen?

A

During an asthma attack

79
Q

What signs can be seen during an asthma attack?

A

Hyperinflated chest, bilateral expiratory wheeze, ^ RR, ^ HR, cyanotic, ^ use of expiratory muscles, nostril flaring, tachypnoea

80
Q

What might happen t a person during an asthma attack?

A

Not be able to talk

81
Q

What might trigger the symptoms of asthma?

A

Occupation, cold, exercise, emotion/stress, infections, drugs (NSAIDs + beta blockers)

82
Q

What is the feature of occupational asthma?

A

Symptoms improve when away from work

83
Q

What should you ask in a Hx from a patient with asthma?

A

Triggers (cold, pets, allergies, drugs?), hx/FHx of atopy, diurnal variation, smoking status, frequency of symptoms, triggers at work? occupation?

84
Q

What 4 investigations might you decide to carry out on someone with suspected asthma?

A

PEFR, Spirometry, histamine + methacholine challenge, skin prick test

85
Q

What would you see in spirometry for someone with asthma?

A

Airways obstruction: FEV1/FVC

86
Q

What would you see in PEFR for someone with asthma?

A

Decreased (as ^ time to exhale air) + diurnal variation

87
Q

What would you see in histamine/methacoline challenge in someone with asthma?

A

Hyper-responsive airways

88
Q

What would you see in skin prick test in someone with asthma?

A

Atopy

89
Q

What is the conservative management for someone with asthma?

A

Education (ensure good inhalor technique, ACTION plan, regular PEFR monitoring), avoid precipitating factors, smoking cessation, influenza vaccine

90
Q

What is the first step in the management of chronic asthma? What PEFR is this?

A

SABA (salbutamol)

91
Q

What is the second step in the management of chronic asthma?

A

Add an inhaled corticosteroid (beclamethasone)

92
Q

Give an example of an inhaled corticosteroid

A

Beclamethasone

93
Q

What is the 3rd step in the management of chronic asthma?

A

Add a LABA (salmeterol)

94
Q

What might you consider if SABA, ICS and LABA isn’t working?

A

increase the dose of the ICS or add a LTRA (leukotriene receptor antagonist)

95
Q

Give an example of a leukotriene receptor antagonist

A

Montelukast

96
Q

What might you consider if LTRA doesn’t work in controlling asthma symptoms?

A

Oral prednisolone + refer to asthma clinic

97
Q

What PEFR value indicates the use of oral prednisolone + referral to asthma clinic?

A

PEFR

98
Q

When do you move from step 1-2 in the management of chronic asthma?

A

PEFR

99
Q

What PEFR value indicates that an asthma patient should be admitted to hospital?

A
100
Q

When should you review the treatment plan for asthma?

A

Every 3months

101
Q

What mAb can you consider in severe asthma cases?

A

Omalizumab (IgE receptor antagonist)

102
Q

What is the advantage of inhaled corticosteroids over oral corticosteroids?

A

Less systemic affects

103
Q

What is a SE of inhaled corticosteroids?

A

Oral thrush (candidiasis)

104
Q

What is the treatment steps for someone suffering an acute asthma attack?

A

Salbutamol + oral corticosteroid –> salbutamol inhaler –> O2 therapy + IV salbutamol …etc

Phase 2a Respiratory (11 decks)

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