Asthma

Question 1

T or F. Making the air less dense helps with asthma

Answer 1

T. Add heliux (Helium and Oxygen mixture)

Question 2

Define asthma

Answer 2

chronic inflammatory disorder of the airways, characterized by episodic, reversible bronchospasm

Question 3

What cells play the biggest roles in asthma? Acute exacerbations?

Answer 3

mast cells, eosinophils, and T-lymphocytes AND

neutrophils in acute exacerbations

Question 4

What is a methacolein challenge test?

Answer 4

asking a patient to inhale methacolein (a muscarinic agonist) to test airway hyperresponsive-ness

Question 5

What are some persistent changes in airway structures seen in some asthmatics?

Answer 5

• sub-basement fibrosis
• mucus hyper-secretion
• injury to epithelium
• smooth muscle hypertrophy
• angiogenesis

aka airway remodeling (can also happen in COPD)

Question 6

T or F. Airway remodeling is not reversible

Answer 6

T. Smooth muscle contraction can be reversed but not fibrosis

Question 7

30-50% of children with asthma will outgrow their childhood asthma in adulthood. How?

Answer 7

good management and airways grow with age

Question 8

Overall incidence of asthma is more common in ____.

Answer 8

Women and black race!, but pediatric more in boys

Question 9

What is extrinsic asthma?

Answer 9

triggered type 1 hypersensitivity

Question 10

What drugs can induce asthma?

Answer 10

• Aspirin

- NSAIDS

Question 11

T or F. Leptin levels are elevated in asthmatics

Answer 11

T. Makes you obese

Question 12

Classification of Asthma at diagnosis

Answer 12

Intermittent or Persistent

Question 13

Classification of Asthma at follow-up

Answer 13

Controlled
Partially controlled
Uncontrolled

Question 14

Treatment of Intermittent Asthma

Answer 14

As needed Albuterol

Question 15

Treatment of Mild Persistent Asthma

Answer 15

Inhaled steroids

Question 16

Treatment of Moderate Persistent Asthma

Answer 16

Inhaled steroids + LABA

Question 17

Treatment of Severe Persistent Asthma

Answer 17

Inhaled steroids + LABA + Leukotriene modifiers

Question 18

LABA are associated with increased mortality

Answer 18

Use cautiously

Question 19

Describe intrinsic asthma

Answer 19

• Triggered my respiratory infection in adulthood
• Serum IgE not elevated and no family history
• Skin antigen test negative

Question 20

What is the triad for drug-induced asthma?

Answer 20

• asthma
• aspirin sensitivity (flushing, angioedema, urticaria)
• Nasla polyps

Question 21

How do leukotriene affect bronchial smooth muscle?

Answer 21

contraction

Question 22

How does aspirin cause bronchospasm?

Answer 22

Aspirin blocks the production of prostaglandins from arachidonic acid, potentiating the production of leukotrienes

Question 23

Ho do corticosteroids help in asthma?

Answer 23

block production of phospholipid A2

Question 24

When do asthma symptoms occur in exercise-induced bronchospasm?

Answer 24

immediately after (peaks around 5-10 minutes after)

Question 25

What triggers exercise-induced bronchospasm?

Answer 25

cooling and mucosal drying of airways during exercise triggers mast cells to release histamine

Question 26

What are some agents used to decrease mast cell degranulation?

Answer 26

inhaled corticosteroids, **chromolyn-sodium, and LABA**

Question 27

T or F. A slow warm up period of exercise helps in exercise-induced bronchospasm

Answer 27

T.

Question 28

What causes nocturnal asthma?

Answer 28

decline of circulating catecholamines and cortisol

Question 29

What is needed to diagnose ABPA?

Answer 29

- poorly controlled asthma - eosinophilia - A. fumigatus positive skin test, IgG Ab - IgE > 1000ng/ml - proximal bronchiectasis - **fleeting chest infiltrates

Question 30

How is ABPA treated?

Answer 30

Prednisone (aspergillus is everywhere)

Question 31

Pathophysiology of Asthma

Answer 31

airway hyper-responsiveness, inflammation, etc.

Question 32

What is a major anaphylatoxin that mediates asthma?

Answer 32

IL-5

Question 33

How to target eosinophils in asthma?

Answer 33

steroids

Question 34

How to target mast cells in asthma?

Answer 34

cromolyn

Question 35

How to target histamine in asthma?

Answer 35

H1 blockers

Question 36

How to target leukotrienes in asthma?

Answer 36

LTRAs

Question 37

How to target IgE in asthma?

Answer 37

Omalizumab

Question 38

How to target IL-5 in asthma?

Answer 38

Mepolizumab (new)

Question 39

T or F. Asthma patients elevated parasympathetic tone

Answer 39

T.

Question 40

Difference in age of onset in asthma vs COPD

Answer 40

asthma younger

Question 41

Difference in main inflammatory cell in asthma vs COPD

Answer 41

asthma- eosinophil | COPD-neotrphil

Question 42

Relevant lymphocytes in asthma vs COPD

Answer 42

asthma- CD4 | COPD- CD8

Question 43

Relevant inteleukins in asthma vs COPD

Answer 43

asthma- IL-5 | COPD- IL-8

Question 44

Difference in main EXACERBATION cell in asthma vs COPD

Answer 44

asthma- neutrophil | COPD- eosinophil

Question 45

Asthma may be exacerbated by___

Answer 45

GERD, URI, exercise, allergens

Question 46

Ddx of asthma?

Answer 46

Viral tracheobronchitis may cause post-infectious bronchial hyper-responsiveness for up to 6 weeks

Question 47

Death from asthma is typically due to what?

Answer 47

diffuse mucus plugging of airways

Question 48

What is a Peak Flow Meter?

Answer 48

diagnostic tool for asthma (more than 20% variability = airway hyper-reactivity= diagnostic for asthma)

Question 49

When is the highest PEFR in the day?

Answer 49

4pm (and lowest at 4 am due to decline in circulating catecholamines)

Question 50

How do lung volumes in asthmatics compare to normal people?

Answer 50

hyperinflation elevated RV, FRC, RV/TLV, TLV

Question 51

What is PC20?

Answer 51

What concentration of methacholine will decreased FEV1 by 20+%

Question 52

T or F. Methacholine has a high NEGATIVE predictive value

Answer 52

T. Negative result= highly unlikely they have asthma

Question 53

What are some hormonal triggers of asthma?

Answer 53

menses, hyperthyroidism, pregnancy, stress

Question 54

What are asthma rescue medications?

Answer 54

SABA (albuterol) and SA anticholingerics (Ipratropium)

Question 55

What is a common cause of asthma bronchospasm?

Answer 55

GERD (can also cause chronic cough)

Question 56

Causes of chronic cough in non-smokers?

Answer 56

- Allergies - GERD - Asthma - ACEI cough (more rare)

Question 57

What is 'chronic' cough defined as?

Answer 57

8+ weeks

Question 58

What is an advantage of LEVObuterol in asthma rescue?

Answer 58

less tendency to cause tachycardia

Question 59

Sequence of asthma controllers?

Answer 59

``` 1st- ICS 2nd- LABA 3rd- LTRA 4th- LAMA 5th- Omalizumab ```

Question 60

How can you differentiate between asthma and hypersensitivity pneumonitis?

Answer 60

patients with asthma will complain of SOB and wheezing and hypersensitivity pneumonitis will complain of SOB and dry cough (not an airway disease-interstitial)