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JazRespiratory > Asthma > Flashcards

Asthma Flashcards

1
Q

Status asthmaticus=

A

acute severe life threatening asthma

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2
Q

chronic asthma can =>

A

hypertrophy/plasia of SM, interstitial oedema, increased secretion and accumulation of mucus, sub-endothelial fibrosis, epithelial damage

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3
Q

hypersensitivity in asthma definition

A

less stimulation required to make FEV1 fall

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4
Q

hyper-reactivity in asthma definition

A

increased fall in FEV1 at same concn of stimulant

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5
Q

hypersensitivity reactions in asthma=

A

immediate phase: Type 1 - bronchospasm mainly (+acute inflam) delayed: Type 4 - bronchospasm and delayed inflam

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6
Q

Th0 predominantly mature to____ in asthma

A

Th2 => cytokine envnt

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7
Q

Asthma is obstructive/restrictive?

A

Obstructive

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8
Q

Extrinsic asthma=

A

has an identifiable external trigger

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9
Q

Intrinsic asthma=

A

non-identifiable external trigger

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10
Q

Inflammation in asthma is caused by

A

eosinophils

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11
Q

How do Th2 cells activate B cells in asthma?

A

bind to them and release IL-2

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12
Q

In asthma, when B cells have matured into plasma cells they secrete…

A

IgE

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13
Q

Th2 produce these so mast cells develop FcE receptors in asthma

A

IL4 and 13

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14
Q

Th2 produce__ activates eosinophils in asthma

A

IL5 (then IgE binds and they express FcE)

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15
Q

Function of FcE receptor

A

IgE receptors - when it binds causes degranulation of mast and eosinophils

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16
Q

degranulation of mast cells in asthma releases

A

histamine, leukotrienes (LTC4 and LTD4) = spasmogens, chemotaxins and chemokines (LTB4 PAF and PGD2) attract eosinophils => inflam

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17
Q

Asthma relievers

A

bronchodilators: SABA, LABA, CysLT1 receptor antagonists

18
Q

Asthma reliever and a preventer

A

Methylxanthines

19
Q

Asthma controllers/preventers

A

decrease inflammation: corticosteroids, cromoglicate, monoclonal IgE

20
Q

Asthma step up treatment

A

SABA -> +ICS -> +LABA then increase ICS then stop LABA and increase ICS then try different -> increase ICS and add 4th drug -> oral glucocorticoid and specialist

21
Q

SABA egs

A

salbutamol and terbutaline

22
Q

SABA effects

A

B2 receptor = bronchodilation; increased mucus clearance and decreased mediator release from mast cells and monocytes

23
Q

LABA egs

A

salmeterol and formoterol - for nocturnal asthma - must co-admin with glucocorticoid so arent desensitised to LABAs

24
Q

CysLT1 receptor aantagonist egs

A

montelukast zafirlukast PO

25
Q

methylxanthine egs.

A

theophylline aminophylline PO for sustained release

26
Q

CysLT1 receptor ant. function

A

block receptor for cysLTs (C4, D4, E4) released from inflammatory cells which cause bronchospasm, inflam, mucus secretion and oedema.

27
Q

methylxanthine mechanism

A

Inhibits PDE => bronchodilation; inhibits mediator release from mast cells => increased mucus clearance, diaphragmatic contractility and reduces fatigue

28
Q

corticosteroids in asthma eg.

A

beclometasone, budesonide, fluticasone

29
Q

adverse effects of steroids in asthma

A

dysphonia (hoarse and weak voice) oropharyngeal candidiasis (thrush)

30
Q

Management of severe asthma attack

OSHITMAN

A

Oxygen (100% non rebreather), Salbutamol (nebulised back to back), hydrocortisol IV (or prednisolone), ipratropium (nebulised hrly), theophylline IV, magnesium, anaesthetist

31
Q

Cromoglicates in asthma… expand

A

eg. Sodium cromoglicate; prophylaxis ; decrease sensitivity of sensory C fibres the trigger reflex bronchospasm; reduces cytokine release

32
Q

Monoclonal IgE in asthma

A

eg. omalizumab - prevent FcE receptor binding - stops mast cell degranulation

33
Q

Oral steroid for acute asthma attacks eg

A

prednisolone

34
Q

Effects on inflammatory cells of ICS

A 
B cells no Ig production
Eosinophils - apop
T cells - decrease cytokines and apop
dendritics - apop
mast cells - apop , decreased Fce expression
macro.s - decreased cytokines
35
Q

Effects on structural cells of ICS

A

epithelial - decrease production cytokines and mediators
endothelials - less leakage(oedema)
Goblet - less mucus
ASM - less cytokine, increase b2 receptor sens to s/laba

36
Q

side effects of ICS

A

oral candidiasis, dysphonia

37
Q

Triad of asthma problems

A

airway inflammation
airway hyperresponsiveness
reversible airway obstruction

38
Q

Histogram of progressed asthma shows

A

messy -lots of eosinophils in mucosa and endothelium

desquamation of endothelium

39
Q

Asthma mediators that are drug targets

A

histamine, Lt4, Th2 cytokines, IL5, IgE

40
Q

Asthma potential triggers

A

allergy, exercise, virus, smoke, cold, chemicals, drugs (NSAIDs and beta-blockers)

41
Q

In asthma FVC and TLCO are ___

A

preserved

42
Q

Gas exchange in asthma is ___

A

normal

JazRespiratory (18 decks)

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