Asthma Flashcards
T or F. Making the air less dense helps with asthma
T. Add heliux (Helium and Oxygen mixture)
Define asthma
chronic inflammatory disorder of the airways, characterized by episodic, reversible bronchospasm
What cells play the biggest roles in asthma? Acute exacerbations?
mast cells, eosinophils, and T-lymphocytes AND
neutrophils in acute exacerbations
What is a methacolein challenge test?
asking a patient to inhale methacolein (a muscarinic agonist) to test airway hyperresponsive-ness
What are some persistent changes in airway structures seen in some asthmatics?
- sub-basement fibrosis
- mucus hyper-secretion
- injury to epithelium
- smooth muscle hypertrophy
- angiogenesis
aka airway remodeling (can also happen in COPD)
T or F. Airway remodeling is not reversible
T. Smooth muscle contraction can be reversed but not fibrosis
30-50% of children with asthma will outgrow their childhood asthma in adulthood. How?
good management and airways grow with age
Overall incidence of asthma is more common in ____.
Women and black race!, but pediatric more in boys
What is extrinsic asthma?
triggered type 1 hypersensitivity
What drugs can induce asthma?
- Aspirin
- NSAIDS
T or F. Leptin levels are elevated in asthmatics
T. Makes you obese
Classification of Asthma at diagnosis
Intermittent or Persistent
Classification of Asthma at follow-up
Controlled
Partially controlled
Uncontrolled
Treatment of Intermittent Asthma
As needed Albuterol
Treatment of Mild Persistent Asthma
Inhaled steroids
Treatment of Moderate Persistent Asthma
Inhaled steroids + LABA
Treatment of Severe Persistent Asthma
Inhaled steroids + LABA + Leukotriene modifiers
LABA are associated with increased mortality
Use cautiously
Describe intrinsic asthma
- Triggered my respiratory infection in adulthood
- Serum IgE not elevated and no family history
- Skin antigen test negative
What is the triad for drug-induced asthma?
- asthma
- aspirin sensitivity (flushing, angioedema, urticaria)
- Nasla polyps
How do leukotriene affect bronchial smooth muscle?
contraction
How does aspirin cause bronchospasm?
Aspirin blocks the production of prostaglandins from arachidonic acid, potentiating the production of leukotrienes
Ho do corticosteroids help in asthma?
block production of phospholipid A2
When do asthma symptoms occur in exercise-induced bronchospasm?
immediately after (peaks around 5-10 minutes after)
What triggers exercise-induced bronchospasm?
cooling and mucosal drying of airways during exercise triggers mast cells to release histamine
What are some agents used to decrease mast cell degranulation?
inhaled corticosteroids, chromolyn-sodium, and LABA
T or F. A slow warm up period of exercise helps in exercise-induced bronchospasm
T.
What causes nocturnal asthma?
decline of circulating catecholamines and cortisol
What is needed to diagnose ABPA?
- poorly controlled asthma
- eosinophilia
- A. fumigatus positive skin test, IgG Ab
- IgE > 1000ng/ml
- proximal bronchiectasis
- **fleeting chest infiltrates
How is ABPA treated?
Prednisone (aspergillus is everywhere)
Pathophysiology of Asthma
airway hyper-responsiveness, inflammation, etc.
What is a major anaphylatoxin that mediates asthma?
IL-5
How to target eosinophils in asthma?
steroids
How to target mast cells in asthma?
cromolyn
How to target histamine in asthma?
H1 blockers
How to target leukotrienes in asthma?
LTRAs
How to target IgE in asthma?
Omalizumab
How to target IL-5 in asthma?
Mepolizumab (new)
T or F. Asthma patients elevated parasympathetic tone
T.
Difference in age of onset in asthma vs COPD
asthma younger
Difference in main inflammatory cell in asthma vs COPD
asthma- eosinophil
COPD-neotrphil
Relevant lymphocytes in asthma vs COPD
asthma- CD4
COPD- CD8
Relevant inteleukins in asthma vs COPD
asthma- IL-5
COPD- IL-8
Difference in main EXACERBATION cell in asthma vs COPD
asthma- neutrophil
COPD- eosinophil
Asthma may be exacerbated by___
GERD, URI, exercise, allergens
Ddx of asthma?
Viral tracheobronchitis may cause post-infectious bronchial hyper-responsiveness for up to 6 weeks
Death from asthma is typically due to what?
diffuse mucus plugging of airways
What is a Peak Flow Meter?
diagnostic tool for asthma (more than 20% variability = airway hyper-reactivity= diagnostic for asthma)
When is the highest PEFR in the day?
4pm (and lowest at 4 am due to decline in circulating catecholamines)
How do lung volumes in asthmatics compare to normal people?
hyperinflation elevated RV, FRC, RV/TLV, TLV
What is PC20?
What concentration of methacholine will decreased FEV1 by 20+%
T or F. Methacholine has a high NEGATIVE predictive value
T. Negative result= highly unlikely they have asthma
What are some hormonal triggers of asthma?
menses, hyperthyroidism, pregnancy, stress
What are asthma rescue medications?
SABA (albuterol) and SA anticholingerics (Ipratropium)
What is a common cause of asthma bronchospasm?
GERD (can also cause chronic cough)
Causes of chronic cough in non-smokers?
- Allergies
- GERD
- Asthma
- ACEI cough (more rare)
What is ‘chronic’ cough defined as?
8+ weeks
What is an advantage of LEVObuterol in asthma rescue?
less tendency to cause tachycardia
Sequence of asthma controllers?
1st- ICS 2nd- LABA 3rd- LTRA 4th- LAMA 5th- Omalizumab
How can you differentiate between asthma and hypersensitivity pneumonitis?
patients with asthma will complain of SOB and wheezing and hypersensitivity pneumonitis will complain of SOB and dry cough (not an airway disease-interstitial)
