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Respiratory Conditions (JBR) > Asthma > Flashcards

Asthma Flashcards

1
Q

What is asthma?

A

Recurrent episodes of dyspnoea, cough, and wheeze caused by reversible airway obstruction.

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2
Q

Which factors contribute to airway narrowing in asthma? (3)

A

Bronchial muscle contraction
Mucosal swelling/inflammation
Increased mucous production

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3
Q

Approximately what percentage of the population has asthma? How is incidence changing?

A

5-10%

Incidence is increasing

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4
Q

What are the symptoms of asthma?

A

Intermittent dyspnoea, wheeze, cough (?nocturnal)

Diurnal variation of symptoms (morning & nighttime dips)

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5
Q

What are the clinical signs of asthma?

A 
Tachypnoeic 
Audible wheeze
Difficulty breathing 
Tight chest 
Triggers
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6
Q

What is asthma associated with?

A

Atopy (Rihinitis, Conjunctivitis, Eczema)

FHx

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7
Q

Is asthma an obstructive or restrictive airway disease?

A

Obstructive

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8
Q

What kind of inflammation usually occurs in asthma?

A

Eosinophilic

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9
Q

How does dynamic asthma develop (3 steps)?

A

Bronchoconstriction
Chronic Airway Inflammation
Airway remodelling

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10
Q

What changes occur during asthma-induced airway remodelling? (6)

A 
Thickening of basement membrane
Collagen deposition in submucosa
Accumulation of interstitial fluid 
Increased mucous secretion
Epithelial damage (expose sensory nerve endings) 
Sub-endothelial fibrosis
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11
Q

What is the asthma triad?

A

Airway Inflammation
Airway hyper-responsiveness
Reversible airway obstruction

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12
Q

What is the asthma cascade (4 steps)?

A
  1. Genetic predisposition and triggers (virus/allergen/chemical/nutrition)
  2. Eosinophilic inflammation
  3. Mediators: TH2 cytokines - IgE/antibody mediated
  4. Hyper-reactivity (twitchy smooth muscle)
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13
Q

What is the treatment of asthma targeted at genetic predisposition and triggers?

A

Avoidance

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14
Q

What is the treatment of asthma targeted at eosinophilic inflammation?

A

Anti-inflammatory: corticosteroid or cromone

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15
Q

Wha tis the treatment of asthma targeted at mediators (TH2 cytokines & IgE etc.)?

A

Anti-leukotriene
Anti-histamine
Anti-IgE
Anti-IL-5

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16
Q

What is the treatment of asthma targeted at hyper-reactivity (twitchy smooth muscle)?

A

Beta-2-agonist (adrenaline endogenous)

Muscarinic Antagonist

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17
Q

Which medications can induce asthma-like symptoms?

A

NSAIDs

Beta-Blockers

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18
Q

Which type of hypersensitivity causes bronchospasm and acute inflammation (early phase)?

A

Type I hypersensitivity

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19
Q

Which type of hypersensitivity causes bronchospasm and delayed inflammation (late phase)?

A

Type IV hypersensitivity

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20
Q

Outline how an allergen causes B cells to mature to IgE secreting plasma cells? (in allergic asthma)

A 
Antigen presents
Endothelium 
Processed allergen 
T-CD4+ 
TH0
TH2 + monocytes
Cytokine environment 
TH2 binds to B cells (activate) + IL-4 production
B cells mature to IgE secreting P cells
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21
Q

TH2 also produces IL-5. What does this lead to in allergic asthma?

A

Eosinophils differentiate and activate
Mast cells express IgE receptors in response to IL-4 and IL-13 released
Calcium entry into mast cells evokes release of granules containing histamine and release of leukotrienes
Leads to ASM contraction and release of substances that tract cells causing inflammation.

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22
Q

Which investigations would be performed to diagnose asthma?

A 
Hx and examination
Peak flow rate (diurnal variation) 
FEV1/FVC <75%
FVC normal 
>15% reversibility to salbutamol
Provocation test
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23
Q

How does a provocation test work to diagnose asthma?

A

Expose to exercise or spasmogens such as histamine or metacholine to provoke bronchospasm

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24
Q

What is the 1st step in asthma treatment? (mild intermittent asthma)

A

SABA

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25
Q

What would be added to a SABA if it is needed more than once a day?

A

Inhaled corticosteroid (ICS)

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26
Q

If control with a SABA and ICS is inadequate; what would be added?

A

LABA

27
Q

If control with a SABA, ICS and LABA is not good; what do you do?

A

Increase dose of ICS

28
Q

What do you do if there is no response to LABA?

A

Stop LABA

Increase dose of ICS

29
Q

If control is still inadequate despite trying a LABA and increasing the dose of the ICS; what do you do`

A

Try CysLT1 receptor antagonist, oral b2-agonist or theophylline

30
Q

If control is still inadequate despite increased ICS dose and having tried an oral beta-2 agonist / CysLT1 receptor / theophylline; what do you do?

A

Increase ICS and add a 4th drug (oral beta-2-agonist / CystLT1 antagonist / theophylline)

31
Q

What is the last step if asthma treatment is still inadequate despite a 4-drug regimen?

A

Introduce oral glucocosteroid

Refer to specialist

32
Q

What is the emergency treatment regimen for an acute asthma attack?

A 
Oxygen (>60%through non-rebreather)
Salbutamol (nebuliser, back to back)
Hydrocortisone IV or prednisolone PO 
Ipratroprium bromide nebuliser hourly
Theophylline or aminophylline IV 
Magnesium &amp; 
Call an Anaesthetist
33
Q

What is the mechanism behind a SABA like salbutamol or terbutaline?

A

Initiates chain of reactions that causes ATP to be converted to cAMP leading to relaxation of ASM

34
Q

How is a SABA administered?

A

Metred dose or dry-powder device (less systemic effects)
Oral (children)
IV (emergency)

35
Q

What is the effect of a SABA?

A

Rapidly relaxes ASM
Increase mucous clearance
Decrease mediator release from mast cells and monocytes

36
Q

What is the most common side effect of a SABA?

A

Fine tremor

37
Q

What are rare side-effects of SABAs?

A

Tachycardia
Dysrhythmia
Hypokalaemia

38
Q

What are examples of LABAs?

A

Salmeterol

Formoterol

39
Q

What are key points for the use of LABAs?

A

Not recommended for acute relief
Good in nocturnal asthma
MUST be co-administered with a glucocorticoid (not used as mono therapy)

40
Q

What are examples of CysLT1 receptor antagonists?

A

Montelukast

Zafirlukast

41
Q

What is the mechanism behind CysLT1 receptor antagonists?

A

Act competitively against Cys LTs (like LTC4, LTD4 and LTE4) that come from mast and inflammatory cells that cause contraciton, mucous and oedema

42
Q

CysLT1 receptor antagonists are effective against ______ and ______ induced asthma. It is not indicated for?

A

Exercise
Antigen
Acute severe asthma

43
Q

How is a CysLT1 receptor antagonist administered?

A

Oral route

44
Q

What are side-effects of CystLT1 receptor antagonists?

A

GI upset

Headache

45
Q

What are examples of methylxanthines?

A

Theophylline

Aminophylline

46
Q

Methylxanthines have an uncertain mechanism of action but they act to inhibit?

A

Isoforms of PDE that inactivate cAMP and cGMP (relax ASM)

47
Q

How are methylxanthines administered?

A

Oral route

48
Q

What is a disadvantage of methylxanthines?

A

Narrow therapeutic window

49
Q

What are the side effects of methylxanthines?

A 
Dysrhythmia 
Seizure
Hypotension
Nausea
Vomiting 
Abdominal discomfort 
Headache
Drug interactions involving CYP450s
50
Q

What are examples of corticosteroids?

A

Cortisol (hydrocortisone)

Prednisolone

51
Q

What is the mechanism of corticosteroids?

A

Regulate inflammatory and immune response

52
Q

What is the mechanism of mineralocorticoids such as aldosterone?

A

Regulate retention of salt and water by the kidney

53
Q

What are examples of glucocorticoids?

A

Beclomethasone
Budesonide
Fluticasone

54
Q

What is the mechanism of glucocorticoids?

A

Reduce number of TH2 cells in inflammatory response

Lower levels of eosinophils, cytokines, mast cells, macrophages

55
Q

What are side effects of glucocovrticosteroids?

A 
Dysphonia (hoarse/weak voice) 
Oral candidiasis (thrush)
56
Q

Which drug may be used in combination with inhaled steroids to reduce systemic effects?

A

Prednisolone

57
Q

What is an example of a cromone?

A

Sodium cromoglicate

58
Q

How and when is a cromone administered?

A

Prophylactically

Inhalation

59
Q

In which patient group are cromones more effective?

A

Kids and young adults

60
Q

Cromones act to …?

A

Stabilise mast cells

61
Q

What is an example of a monoclonal antibody against IgE?

A

Omalizumab

62
Q

What is the action of Omalizumab?

A

Supresses mast cell response to allergen by binding IgE

63
Q

Which drug binds to IL-5 to control severe eosinophilia?

A

Mepolizumab

Respiratory Conditions (JBR) (26 decks)

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