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Respiratory > Asthma > Flashcards

Asthma Flashcards

1
Q

How many generations in the respiratory tree?

A

23

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2
Q

Which generations of the respiratory tree are the:
Large airways >2mm?
Small airways <2mm?

A 
Large = 0-7
Small = 8-23
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3
Q

At what generation does gas exchange begin?

A

Generation 17

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4
Q

What characterises asthma?

A

Allergic
Eosinophilic inflammation
Reversible

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5
Q 
What are the generations of the respiratory tree for:
Trachea?
Bronchi?
Bronchioles?
Terminal bronchioles?
Respiratory broonchioles?
Alveolar ducts?
Alveolar sacs?
A 
Trachea = 0 
Bronchi = 1
Bronchioles = 2-4
Terminal bronchioles = 5-16
Respiratory bronchioles = 17-19
Alveolar ducts =20-22
Alveolar sacs = 23
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6
Q

Asthma can be early or late onset?

A

True

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7
Q

Asthma can be atopic or non atopic?

A

True

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8
Q

Asthma can be extrinsic or intrinsic?

A

True

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9
Q

What is meant by extrinsic and intrinsic asthma?

A

Extrinsic- with an external trigger factor

Intrinsic- without an external trigger factor

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10
Q

What is in the asthma triangle?

A

Reversible airway obstruction
Airway inflammation
Airway hyperresponsiveness

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11
Q

What are the 3 stages to the dynamic evolution of asthma?

A

1) bronchoconstriction (brief symptoms)
2) chronic airway inflammation (exacerbations and airway hyperresponsiveness)
3) airway remoddeling (fixed airway obstruction due o collagen and scar tissue)

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12
Q

What are the hallmarks of remodelling in asthma?

A

1) Thickening of the basement membrane
2) Collagen deposition in the sub mucosa=> sub endothilial fibrosis)
3) Hypertrophy of smooth muscle cells
4) Epithilial damage exposing sensory nerve endings

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13
Q

Explain TH2 cytokine mediated inflammation?

A

1) Allergen present on airway epithilium
2) Allergen binds to TSLP
3) This complex is taken up by dendritic cells and translocates to a lymph node
4) Naive CD4+ T cells is activated and differentiates into a TH2 cell
5) TH2 cells activate B cells by binding to them and by the production of IL4
6) TH2 cells also release IL4 and IL13. TH2 cells and B cells leave the lymph node and enter the tissue
7) TH2 releases IL5 which acts as a chemotaxin to attract eosinophils
8) Eosinophils release histamine and CysLTs
9) B cells produce IgE which binds to mast cells causing then to release histamine. IgE also binds to basophils causing the release of LTD4
10) This causes the stimulation og goblet cells to produce mucus
11) MAst cells also secrete IL4 enhancing the TH2 response by positive feedback

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14
Q

Which cytokines are released by TH2 cells during an asthma attack?

A

IL4, IL13, IL5

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15
Q

What is the function of IL5?

A

To act as a chemotaxin to attract eosinophils

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16
Q

What do eosinophils release?

A

Histamine, CysLTs

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17
Q

What does IgE released by B cells bind to?

A

Mast cells and basophils

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18
Q

What do mast cells release?

A

Histamine and IL4 (which enhances the response)

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19
Q

What do basophils release?

A

LTD4

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20
Q

What histological changes can be seen due to eosinophillic asthma?

A 
Entropy and disorder. 
Desquamation 
Thickening of the basement membrane 
Inflammation of the lamina propria
Presence of eosinophils and inflammatory cells 
Mucus and epithilial plugging
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21
Q

Key symptoms in an asthma history

A 
Episodic 
Diurnal variability
Non productive cough and wheeze 
Trigger factors
Associated atopy
Family history 
Responsiveness to beta 2 agonist 
Blood eosinophilia >4%
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22
Q

How is air flow obstruction measured?

A

Spirometry

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23
Q

How is bronchial hyperresponsiveness measured?

A

Bronchial challenge testing

24
Q

How is air way inflammation measured?

A

Using a bronchoscope and obtaining a biopsy.

Very invasive and uncommon

25
Q

What would you expect the FEV1/FVC ratio to be in asthma?

A

<75%

26
Q

What would you expect the FVC to be in asthma?

A

Maintained

27
Q

What is neurogenic inflammation?

A

When sensory nerve endings are exposed and excited by allergens causing the release of inflammatory mediators- contributes to airway hyperresponsiveness

28
Q

What is airway hyperresponsiveness?

A

The combination of the hypersensitivity and hyper reactivity of bronchioles

29
Q

What type of hypersensitivity reaction is the immediate phase of an asthma attack and what does it involve?

A

Type 1

Involving bronchospasm and acute inflammation

30
Q

What type of hypersensitivity reaction is the delayed phase of an asthma attack and what does it involve?

A

Type 4

Bronchospasm and delayed inflammation

31
Q

When a non asthmatic is exposed to an allergen what immune response is generated?

A

Cell mediated immune response

Low levels of TH1 cells

32
Q

When an asthmatic is exposed to an allergen what immune response is generated?

A

Antibody mediated immune response

High levels of TH2 cells

33
Q

What classes of drug are releivers?

A

SABA
LABA
CysLT1 receptor antagonists

34
Q

What classes of drug are preventers?

A

Glucocorticoids (steroids)
Cromoglicerate
Monoclonal IgE antibodies

35
Q

What should preventative treatment be used?

A

If an individual has more than 2 episode of asthma in a week

36
Q

What is the one class of drug that can be both a preventer and releiver?

A

Methylxanthines

37
Q

Give 2 SABAs.

A

Salbutamol and Terbutaline

38
Q

How long does it take for a SABA to act and when does it reach its most effective concentration?

A

5 mins

30 mins

39
Q

Adverse effects of SABAs.

A

Beta agonist tremor, tachycardia, dysrythmia, hypokalemia

40
Q

Give 2 LABAs

A

Salmoterol and Formoterol

41
Q

When are LABAs most useful?

A

Noctural asthma as they act for 8 hours.

42
Q

What must be given with a LABA?

A

ICS

43
Q

Combination inhalers:
Symbicort?
Seratide?

A 
Symbicort= Budesonide and formoterol 
Seratide = Fluticasone and salmeterol
44
Q

LABAs used alone may worsen asthma. True or false?

A

True

45
Q

What is the action of CysLT1 receptor antagonists?

A

Act competitively at the CysLT1 receptor which results in smooth muscle relaxation

46
Q

Give 2 examples of CysLT1 receptor antagonists.

A

Montelukast and Zafirlukast

47
Q

How are CysLT1 receptor agonists administered?

A

Orally

48
Q

Give 2 examples of methylxanthines.

A

Aminophyline and theophylline

49
Q

What is the action of methylxanthines?

A

Inhibit mediator release from mast cells and increase mucus clearance
Also increase diaphragmatic contractility and reduce fatigue which may improve lung ventilation

50
Q

Why are methylxanthines not used so commonly?

A

Lots of drug interactions involving the cytokine P450
Narrow therapeutic index
Many unwanted side effects

51
Q

How are methyxanthines administered?

A

Orally

52
Q

How are glucorticiods administered?

A

Inhaled and orally

53
Q

What are the signs of a severe asthma attack?

A

1) Unable to talk in complete sentences
2) FEV1/FVC ratio <50%
3) Respiratory rate >25
4) Heart rate >110bpm

54
Q

What are the signs of a moderate asthma attack?

A

1) FEV1/FVC ratio <75%

2) increasing symptoms

55
Q

What are the signs of a life threatening asthma attack?

A

1) Silent Chest/ reduced breath sounds
2) FEV1/FVC ratio <33%
3) Poor respiratory effort
4) Altered consciousness

56
Q

How should acute asthma be treated?

A

1) Oxygen 60%
2) Salbutamol 5mg nebulised
3) Hydrocortisone 100mg IV
4) Ipratropium 0.5mg nebulised
5) Theophyline
6) Magnesium sulphate 1.2-2g IV over 20 minutes
7) Anaesthetist

Respiratory (26 decks)

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