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Pulmonology > Asthma > Flashcards

Asthma Flashcards

1
Q

Major risk factor for asthma?

A

Atopy

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2
Q

Lack of infections in early childhood preserves the TH2 cell bias at birth, whereas exposure to infections and endotoxin results in a shift toward a predominant protective TH1 immune response?

A

Hygiene hypothesis

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3
Q

May be suspected when symptoms of asthma improve during weekends and holidays

A

Occupational asthma

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4
Q

Independent risk factor for asthma, particularly in women, but the mechanisms are thus far unknown

A

Obesity (body mass index >30 kg/m2)

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5
Q

Consumption of this drug in childhood, which may be linked to increased oxidative stress, predisposes to asthma development

A

Acetaminophen (Paracetamol)

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6
Q

Most common allergens to trigger asthma?

A

Dermatophagoides species

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7
Q

Minority have negative skin tests to common inhalant allergens and normal serum concentrations of IgE. These patients usually show later onset of disease (adult-onset), commonly have concomitant nasal polyps, and may be asa sensitive

A

Intrinsic asthma

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8
Q

Pollen grains are disrupted and the particles that may be released can trigger severe asthma exacerbations

A

Thunderstorm asthma

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9
Q

Most common viral triggers of acute severe exacerbations

A

Upper respiratory tract virus infections such as rhinovirus, respiratory syncytial virus, and coronavirus

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10
Q

Inhibit breakdown of kinins, which are bronchoconstrictors; however, they rarely worsen asthma

A

ACEI

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11
Q

Commonly acutely worsen asthma, and their use may be fatal. The mechanisms are not clear, but are likely mediated through increased cholinergic bronchoconstriction

A

Beta blockers

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12
Q

Which beta blockers should be avoided in asthma?

A

All beta blockers, even selective beta 2 blockers or topical application (e.g., timolol eye drops)

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13
Q

Antiplatelet that may worsen asthma in some patients?

A

Aspirin

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14
Q

How is EIA best prevented?

A

Regular treatment with ICS, which reduce population of surface mast cells

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15
Q

When does EIA start and end typically?

A

Exercise-induced asthma (EIA) typically begins after exercise has ended and resolves spontaneously within about 30 min

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16
Q

What type of weather triggers EIA?

A

EIA is worse in cold, dry climates than in hot, humid conditions. It is, therefore, more common in sports activities such as cross-country running in cold weather, overland skiing, and ice hockey than in swimming

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17
Q

Food preservative that trigger asthma through the release of sulfur dioxide gas in the stomach.

A

Metabisulfite

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18
Q

How can premenstrual worsening of asthma be improved?

A

Treat with high doses of progesterone or GnRH

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19
Q

Why is GERD common in asthmatic patients?

A

GERD is usually increased by bronchodilators

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20
Q

Common pathologic finding in fatal asthma?

A

Occlusion of airway by mucus plugs

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21
Q

Characteristic finding of asthma is thickening of the basement membrane due to

A

Subepithelial collagen deposition

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22
Q

Thickening of basement membrane in asthma is also found in what condition?

A

Eosinophilic bronchitis

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23
Q

T/F These pathologic changes in asthma are found in all airways, but do not extend to the lung parenchyma

A

True

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24
Q

Characteristic physiologic abnormality of bronchial asthma?

A

Airway hyperresponsiveness

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25
Q

Infiltration of __ is a characteristic feature of asthmatic airways.

A

Eosinophils

26
Q

Increased numbers of __ are found in sputum and airways of some patients with severe asthma and during exacerbations

A

Neutrophils

27
Q

Upstream cytokine released from epithelial cells of asthmatics that orchestrates the release of chemokines that selectively attract TH2 cells.

A

Thymus stimulated lymphopoeitin (TSLP)

28
Q

Expected spirometry findings in asthma?

A

reduction in forced
expiratory volume in 1 second (FEV1), FEV1/forced vital capacity
(FVC) ratio, and peak expiratory flow (PEF)

29
Q

Examples of direct bronchoconstrictors which contract

airway smooth muscle

A

Histamine, methacholine

30
Q

Examples of indirect stimuli, which release bronchoconstrictors from mast cells or activate sensory nerves

A

Allergens, exercise, irritant dusts, sulfur dioxide

31
Q

Prodromal symptoms that precede an attack?

A

itching under the chin, discomfort
between the scapulae, or inexplicable fear (impending
doom)

32
Q

Reversibility in spirometry is demonstrated as:

A

> 12% and 200-mL increase in FEV1

15 min after an inhaled short-acting β2-agonist

33
Q

What tests can be done to confirm the diurnal variations in airflow obstruction?

A

Measurements of PEF twice daily

34
Q

Noninvasive test to measure airway inflammation. The typically elevated levels in asthma are reduced by ICS, so this may be a test of compliance with therapy

A

FENO

35
Q

Examples and duration of action of SABA

A

Albuterol, terbutaline, 3-6 hours

36
Q

Examples and duration of action of LABA

A

Salmeterol, Formoterol, >12 hours

37
Q

Most common side effects of Beta 2 agonists?

A

Muscle tremors, palpitations (but not a problem during inhalational route), commonly seen in the elderly
Mild hypokalemia

38
Q

Less effective than beta 2 agonists in asthma therapy because they inhibit only the cholinergic reflex component of bronchoconstriction

A

Anticholinergics (Ipratropium, Tiotropium)

39
Q

Most common side effects of anticholinergics?

A

Dry mouth (most common), in elderly patients, urinary retention and glaucoma

40
Q

Reduce corticosteroid insensitivity in severe asthma by activates the key nuclear enzyme histone deacetylase-2 (HDAC2)

A

Theophylline

41
Q

MOA of Theophylline

A

Inhibition of phosphodiesterases in airway smooth-muscle cells, which increases cyclic AMP

42
Q

Theophylline occasionally used (via slow IV infusion) in patients with severe
exacerbations that are refractory to SABA

A

IV Aminophylline

43
Q

Most common SE of theophylline

A

nausea, vomiting,and headaches and are due to phosphodiesterase inhibition

44
Q

Diuresis and palpitations may also occur, and at high concentrations,
cardiac arrhythmias, epileptic seizures, and death may occur
due to:

A

adenosine A1-receptor antagonism

45
Q

Examples of drugs that block CYP450 causing elevated levels of theophylline

A

Erythromycin, Allopurinol

46
Q

most effective anti-inflammatory agents
used in asthma therapy, reducing inflammatory cell numbers and
their activation in the airways.

A

ICS

47
Q

Local SE of ICS?

A

hoarseness (dysphonia) and oral candidiasis

48
Q

How to reduce SE of ICS?

A

use of a large volume spacer device

49
Q

Dose of course of OCS (usually prednisone or prednisolone) used to treat acute exacerbations of asthma; no tapering of the dose is needed.

A

30–45 mg once daily for 5–10 days

50
Q

Block cys-LT1-receptors and provide modest clinical benefit in asthma

A

Antileukotrienes (Montelukast)

51
Q

controller drugs that appear to inhibit mast cell and sensory nerve
activation and are, therefore, effective in blocking trigger-induced
asthma such as EIA and allergen- and sulfur dioxide–induced
symptoms

A

Cromolyn sodium

52
Q

blocking antibody that neutralizes circulating
IgE without binding to cell-bound IgE and, thus, inhibits
IgE-mediated reaction

A

Omalizumab

53
Q

Most common reason for poor control of asthma

A

Non compliance with maintenance medications

54
Q

failure to respond to a high dose of oral prednisone/prednisolone
(40 mg once daily over 2 weeks), ideally with a 2-week run

A

Corticosteroid resistant asthma

55
Q

Type of Brittle Asthma show a persistent pattern of
variability and may require oral corticosteroids or, at times, continuous
infusion of β2-agonists

A

Type 1

56
Q

generally normal or near-normal lung function but precipitous, unpredictable
falls in lung function that may result in death

A

Type 2

57
Q

Most effective therapy of Brittle Asthma?

A

SC epinephrine

58
Q

T/F All COX inhibitors should be avoided

A

False selective COX2
inhibitors are safe to use when an anti-inflammatory analgesic is
needed

59
Q

Medications safe for asthma in pregnancy?

A

SIT

SABA ICS Theophylline

60
Q

Rule of thirds in asthma in pregnancy?

A

1/3 improve, 1/3 worsen, 1/3 unchanged

61
Q

T/F Breastfeeding is contraindicated when taking asthma meds during pregnancy

A

False

Pulmonology (1 decks)

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