Asthma Flashcards
what are the two components of asthma?
1) increase tone of bronchial smooth muscle
2) inflammation and edema of the airways
what drug can make asthma worse? Or induce it?
methacholine
what is intermittent asthma?
1) less than or equal to 2 symptoms/week
2) less than or equal to 2 nights of sleepnessness/ MONTH
3) PEF is less than or equal to 80% predicted
What is mild persistent asthma?
1) more than 2 symptoms/week
2) more than 2 nights of sleepnessness/ MONTH
3) PEF is less than or equal to 80%
what is moderate persistent asthma?
1) daily symptoms
2) more than 1 nights of sleepnessness/ WEEK
3) PEF is between 61 and 80%
what is severe persistent asthma?
1) constant symptoms
2) frequent nights of sleepnessness
3) PEF is less or equal to 60%
asthma control criteria: daytime symptoms
less than 4 days/week
asthma control criteria: night-time symptoms
less than 1 night/week
asthma control criteria: physical activity
normal
asthma control criteria: exacerabations
mild, infrequent
asthma control criteria: absence from school/work due to asthma
none
asthma control criteria: need for fast-acting beta2 agonist
less than 4 doses/week
asthma control criteria: FEV1 or PEF
more than or equal to 90% personal best
asthma control criteria: PEF diurnal variation
less than 10-15%
asthma control criteria: sputum eosinophils
less than 2-3%
long term control medications for asthma
- corticosteroids
- leukotriene inhibitors
- mast cell stabilizers
- long acting beta agonists
- methylxanthines
- immunomodulators = monoclonal antibody prevents IgE binding to mast cells (allergic with severe obstruction)
acute medications (rescue or reliever)
- short/fast acting beta agonists
- anti-cholinergics
- oral corticosteroids
treatment for mild intermittent asthma
fast-acting beta agonist
treatment for mild persistent asthma
low dose inhaled corticosteroids
treatment for moderate persistent asthma
- add long acting beta agonist
- second option, leukotriene antagonist
treatment for severe persistent asthma
- higher dose inhaled corticosteroids
- long acting beta agonists
- leukotriene antagonists
what are non-invasive methods to measure airway inflammation?
- sputum eosinophils
- exhaled NO
what medications for asthma have been tried but are NOT recommended?
- methotrexate
- gold
- azathioprine
- monoclonal antibodies to IL-5 and IL-12
- cyclosporine
- IVIG
- colchicine
how do we control a patient’s asthma?
1) reduce airway SM tone
=beta-adrenergic stimulation
= anti-cholinergic treatment
2) decrease airway edema
= steroids
=leukotriene antagonists
=mast cell stabilizers
3) reduce precipitating factors
=sinusitis
=GERD
=allergens
what are potential targets to treat asthma?
- submucosa
- SM
- BVs
- lamina propria
- epithelium
- mucus
