Asthma

Question 1

Status asthmaticus=

Answer 1

acute severe life threatening asthma

Question 2

chronic asthma can =>

Answer 2

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

Question 3

hypersensitivity in asthma definition

Answer 3

less stimulation required to make FEV1 fall

Question 4

hyper-reactivity in asthma definition

Answer 4

increased fall in FEV1 at same concn of stimulant

Question 5

hypersensitivity reactions in asthma=

Answer 5

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

Question 6

Th0 predominantly mature to____ in asthma

Answer 6

Th2 => cytokine envnt

Question 7

Asthma is obstructive/restrictive?

Answer 7

Obstructive

Question 8

Extrinsic asthma=

Answer 8

has an identifiable external trigger

Question 9

Intrinsic asthma=

Answer 9

non-identifiable external trigger

Question 10

Inflammation in asthma is caused by

Answer 10

eosinophils

Question 11

How do Th2 cells activate B cells in asthma?

Answer 11

bind to them and release IL-2

Question 12

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

Answer 12

IgE

Question 13

Th2 produce these so mast cells develop FcE receptors in asthma

Answer 13

IL4 and 13

Question 14

Th2 produce__ activates eosinophils in asthma

Answer 14

IL5 (then IgE binds and they express FcE)

Question 15

Function of FcE receptor

Answer 15

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

Question 16

degranulation of mast cells in asthma releases

Answer 16

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

Question 17

Asthma relievers

Answer 17

bronchodilators: SABA, LABA, CysLT1 receptor antagonists

Question 18

Asthma reliever and a preventer

Answer 18

Methylxanthines

Question 19

Asthma controllers/preventers

Answer 19

decrease inflammation: corticosteroids, cromoglicate, monoclonal IgE

Question 20

Asthma step up treatment

Answer 20

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

Question 21

SABA egs

Answer 21

salbutamol and terbutaline

Question 22

SABA effects

Answer 22

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

Question 23

LABA egs

Answer 23

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

Question 24

CysLT1 receptor aantagonist egs

Answer 24

montelukast zafirlukast PO

Question 25

methylxanthine egs.

Answer 25

theophylline aminophylline PO for sustained release

Question 26

CysLT1 receptor ant. function

Answer 26

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

Question 27

methylxanthine mechanism

Answer 27

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

Question 28

corticosteroids in asthma eg.

Answer 28

beclometasone, budesonide, fluticasone

Question 29

adverse effects of steroids in asthma

Answer 29

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

Question 30

Management of severe asthma attack | OSHITMAN

Answer 30

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

Question 31

Cromoglicates in asthma... expand

Answer 31

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

Question 32

Monoclonal IgE in asthma

Answer 32

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

Question 33

Oral steroid for acute asthma attacks eg

Answer 33

prednisolone

Question 34

Effects on inflammatory cells of ICS

Answer 34

``` 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 ```

Question 35

Effects on structural cells of ICS

Answer 35

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

Question 36

side effects of ICS

Answer 36

oral candidiasis, dysphonia

Question 37

Triad of asthma problems

Answer 37

airway inflammation airway hyperresponsiveness reversible airway obstruction

Question 38

Histogram of progressed asthma shows

Answer 38

messy -lots of eosinophils in mucosa and endothelium | desquamation of endothelium

Question 39

Asthma mediators that are drug targets

Answer 39

histamine, Lt4, Th2 cytokines, IL5, IgE

Question 40

Asthma potential triggers

Answer 40

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

Question 41

In asthma FVC and TLCO are ___

Answer 41

preserved

Question 42

Gas exchange in asthma is ___

Answer 42

normal