Asthma

Question 1

Treatment of mild intermittent asthma

Answer 1

PRN inhaled corticosteroids

Same exacerbation rate, QOL, and FEV1 as daily ICS

Question 2

Treatment of mild persistent asthma

Answer 2

Daily preventative inhaled corticosteroids

Reduced hospitalisations, and severe exacerbations and increased symptom free days and FEV1 compared to PRN ICS

Question 3

Treatment of moderate persistent asthma

Answer 3

LABA and low dose ICS

Question 4

What is the optimal dose of ICS?

Answer 4

600ug/day of fluticasone

LOW DOSE BETTER THAN HIGH DOSE

Question 5

Side effects of ICS?

Answer 5

Bruising
Cataracts
OP
Dysphonia
Oral thrush

Question 6

Epitopes of asthma

Answer 6

Abnormal airway smooth muscle and inflammation

Atopic asthma = eosinophic asthma –> Th2 inflammation = steroid responsive and no airway hyper-responsiveness

Non-eosinophilic asthma –> Th1 response –> neutrophils and IL-17 –> chronic bronchitis and mucous gland hypertrophy = steroid resistant

Question 7

What is Omalizumab?

Answer 7

A humunized recombinant mAb –> forms complexes with free IgE –> prevents binding to mast cells –> prevents activation and degranulation of mast cells

Reduces frequency of exacerbations
Lowers doses of ICS

Question 8

What is Lebrikizumab?

Answer 8

Anti IL-13 antibody

Improves FEV1

Question 9

What are Mepolizumab and Reslizumab?

Answer 9

Anti IL-5 antibodies

Reduce exacerbations and improve FEV and symptom control and QOL

Benralizumab = Blocks IL-5 receptor –> also induces eosinophil apoptosis

Question 10

What is Dupilumab?

Answer 10

Anti IL-4 antibody
Blocks IL-4 and IL-13 signalling

Improves FEV-1 and reduces exacerbations

Question 11

Signs of poor prognosis for asthma?

Answer 11

History of hospitalisations esp. ICU

No asthma management plan