Asthma

Question 1

Major risk factor for asthma?

Answer 1

Atopy

Question 2

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?

Answer 2

Hygiene hypothesis

Question 3

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

Answer 3

Occupational asthma

Question 4

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

Answer 4

Obesity (body mass index >30 kg/m2)

Question 5

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

Answer 5

Acetaminophen (Paracetamol)

Question 6

Most common allergens to trigger asthma?

Answer 6

Dermatophagoides species

Question 7

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

Answer 7

Intrinsic asthma

Question 8

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

Answer 8

Thunderstorm asthma

Question 9

Most common viral triggers of acute severe exacerbations

Answer 9

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

Question 10

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

Answer 10

ACEI

Question 11

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

Answer 11

Beta blockers

Question 12

Which beta blockers should be avoided in asthma?

Answer 12

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

Question 13

Antiplatelet that may worsen asthma in some patients?

Answer 13

Aspirin

Question 14

How is EIA best prevented?

Answer 14

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

Question 15

When does EIA start and end typically?

Answer 15

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

Question 16

What type of weather triggers EIA?

Answer 16

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

Question 17

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

Answer 17

Metabisulfite

Question 18

How can premenstrual worsening of asthma be improved?

Answer 18

Treat with high doses of progesterone or GnRH

Question 19

Why is GERD common in asthmatic patients?

Answer 19

GERD is usually increased by bronchodilators

Question 20

Common pathologic finding in fatal asthma?

Answer 20

Occlusion of airway by mucus plugs

Question 21

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

Answer 21

Subepithelial collagen deposition

Question 22

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

Answer 22

Eosinophilic bronchitis

Question 23

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

Answer 23

True

Question 24

Characteristic physiologic abnormality of bronchial asthma?

Answer 24

Airway hyperresponsiveness

Question 25

Infiltration of __ is a characteristic feature of asthmatic airways.

Answer 25

Eosinophils

Question 26

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

Answer 26

Neutrophils

Question 27

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

Answer 27

Thymus stimulated lymphopoeitin (TSLP)

Question 28

Expected spirometry findings in asthma?

Answer 28

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

Question 29

Examples of direct bronchoconstrictors which contract | airway smooth muscle

Answer 29

Histamine, methacholine

Question 30

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

Answer 30

Allergens, exercise, irritant dusts, sulfur dioxide

Question 31

Prodromal symptoms that precede an attack?

Answer 31

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

Question 32

Reversibility in spirometry is demonstrated as:

Answer 32

>12% and 200-mL increase in FEV1 | 15 min after an inhaled short-acting β2-agonist

Question 33

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

Answer 33

Measurements of PEF twice daily

Question 34

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

Answer 34

FENO

Question 35

Examples and duration of action of SABA

Answer 35

Albuterol, terbutaline, 3-6 hours

Question 36

Examples and duration of action of LABA

Answer 36

Salmeterol, Formoterol, >12 hours

Question 37

Most common side effects of Beta 2 agonists?

Answer 37

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

Question 38

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

Answer 38

Anticholinergics (Ipratropium, Tiotropium)

Question 39

Most common side effects of anticholinergics?

Answer 39

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

Question 40

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

Answer 40

Theophylline

Question 41

MOA of Theophylline

Answer 41

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

Question 42

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

Answer 42

IV Aminophylline

Question 43

Most common SE of theophylline

Answer 43

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

Question 44

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

Answer 44

adenosine A1-receptor antagonism

Question 45

Examples of drugs that block CYP450 causing elevated levels of theophylline

Answer 45

Erythromycin, Allopurinol

Question 46

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

Answer 46

ICS

Question 47

Local SE of ICS?

Answer 47

hoarseness (dysphonia) and oral candidiasis

Question 48

How to reduce SE of ICS?

Answer 48

use of a large volume spacer device

Question 49

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

Answer 49

30–45 mg once daily for 5–10 days

Question 50

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

Answer 50

Antileukotrienes (Montelukast)

Question 51

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

Answer 51

Cromolyn sodium

Question 52

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

Answer 52

Omalizumab

Question 53

Most common reason for poor control of asthma

Answer 53

Non compliance with maintenance medications

Question 54

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

Answer 54

Corticosteroid resistant asthma

Question 55

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

Answer 55

Type 1

Question 56

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

Answer 56

Type 2

Question 57

Most effective therapy of Brittle Asthma?

Answer 57

SC epinephrine

Question 58

T/F All COX inhibitors should be avoided

Answer 58

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

Question 59

Medications safe for asthma in pregnancy?

Answer 59

SIT | SABA ICS Theophylline

Question 60

Rule of thirds in asthma in pregnancy?

Answer 60

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

Question 61

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

Answer 61

False