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Asthma Flashcards

1
Q

Major risk factor for asthma. (Harrison’s 19th edition, pp 1669)

A

Atopy

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2
Q

Spirometry findings in asthma. (Harrison’s 19th edition, pp 1675)

A

Confirms airflow limitation

Reduced FEV1, FEV1/FVC ratio and PEF

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3
Q

Reversibility in spirometry. (Harrison’s 19th edition, pp 1675)

A

> 12% and 200mL increase in FEV1 15 mins after an inhaled SABA
OR
2-4 week trial of OCS (prednisone or prednisolone 30-40mg daily)

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4
Q

Confirms the diurnal variations in airflow obstruction in asthma. (Harrison’s 19th edition, pp 1675)

A

Measurements of PEF twice daily

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5
Q

Parameters/components use in assessing severity and control of asthma. (Harrison’s 19th edition, pp 1679).

A 
Daytime symptoms
Limitation of activities
Nocturnal symptoms or awakening
Need for reliever or rescue treatment
Lung function (PEF or FEV1)
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6
Q

Controlled asthma. (Harrison’s 19th edition, pp 1679)

A 
No (< or = 2/week) daytime symptoms
No limitation of activities 
No nocturnal symptoms or awakening
No (< or = 2/week) Need for reliever or rescue treatment
Normal lung function (PEF or FEV1)
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7
Q

Partly controlled asthma. (Harrison’s 19th edition, pp 1679)

A

> 2/week daytime symptoms
Any limitation of activities
Any nocturnal symptoms or awakening
2/week need for reliever or rescue treatment
< 80% predicted or personal best lung function (PEF or FEV1)

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8
Q

Uncontrolled asthma. (Harrison’s 19th edition, pp 1679)

A

Three or more features of partly controlled

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9
Q

Intermittent asthma.

A

< or = 2 days per week daytime symptoms
< or = 2 times per month nocturnal symptoms or awakening
< or = 2 days per week need for reliever or rescue treatment
No limitation of activities
Normal FEV1 between exacerbations; FEV1 > 80%

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10
Q

Mild persistent asthma.

A

> 2 days per week daytime symptoms
3-4 times per month nocturnal symptoms or awakening
2 days per week need for reliever or rescue treatment
Minor limitation of activities
FEV1 >/= 80% of predicted; FEV1/FVC normal

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11
Q

Moderate persistent asthma.

A

daily daytime symptoms
once per week nocturnal symptoms or awakening
daily need for reliever or rescue treatment
some limitation of activities
80%> FEV1 > 60% of predicted; FEV1/FVC reduced to 5%

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12
Q

Severe persistent asthma.

A

Throughout the day symptoms
Often 7 times per week nocturnal symptoms or awakening
Several times per day need for reliever or rescue treatment
Extremely limited activities
FEV1 < 60% of predicted; FEV1/FVC reduced to > 5%

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13
Q

Treatment for mild intermittent asthma. (Harrison’s 19th edition, pp 1679)

A

Short acting B2-agonist, as needed

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14
Q

Treatment for mild persistent asthma. (Harrison’s 19th edition, pp 1679)

A

Short acting B2-agonist, as needed

+ low dose ICS

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15
Q

Treatment for moderate persistent asthma. (Harrison’s 19th edition, pp 1679)

A

Short acting B2-agonist, as needed
+ low dose ICS
+ long acting B2-agonist

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16
Q

Treatment for severe persistent asthma. (Harrison’s 19th edition, pp 1679)

A

Short acting B2-agonist, as needed
+ High dose ICS
+ long acting B2-agonist

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17
Q

Treatment for very severe persistent asthma. (Harrison’s 19th edition, pp 1679)

A

Short acting B2-agonist, as needed
+ High dose ICS
+ long acting B2-agonist
+ OCS

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18
Q

Most common reason for poor control of asthma. (Harrison’s 19th edition, pp 1679)

A

Noncompliance to medication, particularly ICS

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19
Q

Most effective controllers of asthma. (Harrison’s 19th edition, pp 1677)

A

Inhaled corticosteroids

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20
Q

The characteristic structural changes of airway remodeling in asthma. (Harrison’s 19th edition, pp 1675)

A

Increased airway smooth muscle
Fibrosis
Angiogenesis
Mucus hyperplasia

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21
Q

The characteristic physiologic abnormality of asthma. (Harrison’s 19th edition, pp 1675)

A

Airway hyperresponsiveness

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22
Q

The pathologic changes in asthma are found in?. (Harrison’s 19th edition, pp 1672)

A

In all airways

do not extend to the lung parenchyma

23
Q

Pathology in asthma. (Harrison’s 19th edition, pp 1671-1672)

A
  • Activation on eosinophils, T-lymphocytes and mast cells
  • Thickening of the basement membrane due to subepithelial collagen deposition
  • Shed/friable epithelium with reduced attachments to airway walls and increase number in lumen
  • Thickened and edematous airway
  • occlusion of the airway lumen by mucus plug
  • Vasodilation and angiogenesis
24
Q

Describes as the excessive bronchoconstrictor response to multiple inhaled triggers that would have no effect on normal airways. (Harrison’s 19th edition, pp 1675)

A

Airway hyperresponsiveness

25
Q

The degree of inflammation is _____ related to disease severity of asthma. (Harrison’s 19th edition, pp 1671)

26
Q

In asthma, the inflammation in the respiratory mucosa is from the _____ to ______, but with predominance in the ________. (Harrison’s 19th edition, pp 1672)

A

Trachea, terminal bronchioles, bronchi

27
Q

Clinical features of severe asthma. (Harrison’s 19th edition, pp 1679)

A

Increasing chest tightness, wheezing, and dyspnea that are often not or poorly relieved by their usual reliever inhaler

28
Q

It maybe present in acute severe asthma but this is rarely a useful clinical sign. (Harrison’s 19th edition, pp 1679)

A

Pulsus paradoxus

29
Q

Additional clinical features in severe exacerbation. (Harrison’s 19th edition, pp 1679)

A

Unable to complete sentences and cyanotic.

chest tightness, wheezing and dyspnea

30
Q

These should never be given or not be used routinely in acute severe asthma. (Harrison’s 19th edition, pp 1679)

A

Antibiotics (unless there are signs of pneumonia)

Sedatives (may depress ventilation)

31
Q

Mainstay of treatment in acute severe asthma. (Harrison’s 19th edition, pp 1679)

A

High doses of SABA

32
Q

This has been shown to be effective when added to B2-agonists for treatment of acute severe asthma. (Harrison’s 19th edition, pp 1679)

A

Magnesium sulfate

33
Q

Maybe effective in patients with acute severe asthma that who are refractory to inhaled therapies. (Harrison’s 19th edition, pp 1679)

A

Slow infusion of aminophylline

34
Q

This may be indicated for patients with impending respiratory failure. (Harrison’s 19th edition, pp 1679)

A

Prophylactic intubation

35
Q

Intubated patients due to respiratory failure may benefit from this drug if they have not responded to conventional bronchodilator. (Harrison’s 19th edition, pp 1679)

36
Q

Bronchodilator effect of theophylline. (Harrison’s 19th edition, pp 1677)

A

Due to inhibition of phosphodiesterases in airway smooth-muscle cells which increases cyclic cAMP

37
Q

Mechanism of action of Anticholinergics (Ipatropium and tiotropium). (Harrison’s 19th edition, pp 1676)

A

Prevent cholinergic nerve-induced bronchoconstriction and increases mucus secretion

38
Q

Used intravenously for the treatment of acute severe asthma. (Harrison’s 19th edition, pp 1679)

A

Corticosteroids

39
Q

Mechanism of action of Beta-2agonist on airways. (Harrison’s 19th edition, pp 1676)

A

Relax airway smooth-muscle

40
Q

Non bronchodilator effects of Beta-2 agonists. (Harrison’s 19th edition, pp 1676)

A

Inhibition of mast cell mediator release
Reduction in plasma exudation
Inhibition of sensory nerve activation

41
Q

Anti-inflammatory effect of Beta-2 agonists. (Harrison’s 19th edition, pp 1676)

A

No effects on inflammatory cells

No reduction in airway hyperresponsiveness

42
Q

Mechanism of action of Beta-2agonist on airways. (Harrison’s 19th edition, pp 1676)

A

Relax airway smooth-muscle

43
Q

Non bronchodilator effects of Beta-2 agonists. (Harrison’s 19th edition, pp 1676)

A

Inhibition of mast cell mediator release
Reduction in plasma exudation
Inhibition of sensory nerve activation

44
Q

Anti-inflammatory effect of Beta-2 agonists. (Harrison’s 19th edition, pp 1676)

A

No effects on inflammatory cells

No reduction in airway hyperresponsiveness

45
Q

Short-acting B2-agonists. (Harrison’s 19th edition, pp 1676)

A

Albuterol

Terbutaline

46
Q

Long-acting B2-agonists. (Harrison’s 19th edition, pp 1676)

A

Salmeterol

Formeterol

47
Q

Most common side effect of Anticholinergics. (Harrison’s 19th edition, pp 1677)

48
Q

Most common side effects of B2-agonists. (Harrison’s 19th edition, pp 1676)

A

Muscle tremor

Palpitations

49
Q

Approximately how many of asthmatic patients who are pregnant improve during the course of pregnancy? (Harrison’s 19th edition, pp 1680)

A

1/3

1/3 deteriorate, 1/3 unchanged

50
Q

Drugs that are safe to use for asthmatic patients who are pregnant. (Harrison’s 19th edition, pp 1680)

A

SABA
ICS
Theophylline
Prednisone

51
Q

Rationale on using prednisone over of prednisolone for asthmatic patients who are pregnant. (Harrison’s 19th edition, pp 1680)

A

Prednisone cannot be converted to active prednisolone by fetal liver, thus protecting the fetus from systemic effects.

52
Q

Drugs that are safe to use for asthmatic patients who are breast-feeding. (Harrison’s 19th edition, pp 1680)

A

SABA
ICS
Theophylline
Prednisone

53
Q

In acute severe asthma, this should be given by face mask to achieve oxygen saturation of > 90%. (Harrison’s 19th edition, pp 1680)

A

High concentration of oxygen

Pulmonology (16 decks)

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