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HPIM 19th Pulmo > Asthma > Flashcards

Asthma Flashcards

1
Q

Pathophysiologic abnormality of asthma

A

Airway hyperresponsiveness

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2
Q

Major risk factor for asthma

A

Atopy

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3
Q

Seen in 80% of asthmatic patients

A

Allergic rhinitis

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4
Q

Sensitizing allergens

A

Proteins with protease activity

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5
Q

Independent risk factor for women with asthma

A

Obesity

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6
Q

Late-onset asthma with concomitant nasal polyps

A

Intrinsic asthma

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7
Q

Activated by inhaled allergens that release inflammatory mediators

A

IgE in mast cells

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8
Q

MCC of perennial allergens

A

Dermatophagoides
Animal dander proteins
Cockroaches

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9
Q

MCC of seasonal allergens

A

Grass pollen
Ragweed
Tree pollen
Fungal spores

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10
Q

MC trigger of acute severe exacerbations

A

Viral URTI

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11
Q

Common trigger of asthma particularly in children

A

Exercise

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12
Q

Mechanism of EIA

A

Hyperventilation leading to increased osmolality of airway fluids

ABG: respi acid

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13
Q

Prevention of EIA

A

B2 agonists and antileukotrienes prior to exercise

Best prevention: regular treatment with ICS

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14
Q

Recommended for patients with aspirin-induced asthma

A

Salicylate-free diet

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15
Q

2 types of asthma

A

Allergic asthma

Idiosyncratic/Intrinsic

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16
Q

Allergic Asthma

A

(+) personal and/or family hx of allergic diseases

(+) wheal and flare skin reactions to ID injections

Inc level of serum IgE

(+) Response to provocation test

17
Q

Intrinsic Asthma

A

Adult-onset, non atopic, MORE SEVERE and persistent

(-) Personal and/or Fam Hx of allergy

(-) skin tests

(+) Nasal polyps

(+) Aspirin-sensitivity

N serum IgE but may have Inc IgE in airways due to staph enterotoxins

18
Q

Characteristic histo finding

A

Thickening of the BM due to subepithelial collagen deposition

19
Q

Pathology of asthma

A

Uniform regardless of type, changes do not extend to the lung parenchyma

20
Q

Characteristic of asthmatic airways

A

Eosinophil infiltration

21
Q

Phenotype predominant in asthmatics

A

TH2 (releases IL5 inc IgE formation)

22
Q

Major target cells of ICS

A

Epithelial cells

23
Q

Pro inflammatory cytokines associated with more severe disease

A

TNF a, IL 1B

24
Q

Mechanisms of AHR from epithelial damage

A

Loss of barrier function allowing penetration of allergens

Loss of enzymes degrading inflammatory mediators

Loss of relaxant factor

Exposure of sensory nerves

25
Q

Structural changes in the airways that may lead to irreversible narrowing

A

Inc airway smooth muscle

Fibrosis

Angiogenesis

Mucus Hyperplasia

26
Q

Confirms airflow limitation in asthma

A

Spirometry

Decreased FEV1, FEV1/FVC, PEF

27
Q

Reversibility of spirometry in asthma

A

> 12% and 200mL INCREASE in FEV1 15 mins after and inhaled short-acting B2-agonist

(in some, 2-4 week trial of pred or prednisolone 30-40mg daily)

28
Q

Test for airway responsiveness

A

AHR: induced by methacholine or histamine challenge calculating the provocative concentration that reduces FEV1 by 20% (PC20)

29
Q

Three classes of bronchodilators

A

B2-adrenergic agonists
Anticholinergics
Theophylline

30
Q

MOA of bronchodilators

A

Reverse bronchoconstriction, relaxation of airway smooth muscle

31
Q

Most effective bronchodilators

A

B2 agonists

32
Q

Duration of action of SABAs

Albuterol, Terbutaline

A

3-6 hours

As PRN meds

33
Q

Duration of LABAs

Salmeterol, Formoterol

A

Over 12 hours, given BID

*never given in the absence of ICS

34
Q

MC AE of B2 agonists

A

Muscle tremor and palpitations

35
Q

Prevent cholinergic nerve-induced bronchoconstriction and mucus secretion

A

Anti-cholinergics (ipratropium, tiptropium)

*used only as add-on bronchodilators not controlled by LABA + ICS

36
Q

MC reason for refractory asthma

A

Noncompliance

HPIM 19th Pulmo (11 decks)

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