Asthma

Question 1

what are the two components of asthma?

Answer 1

1) increase tone of bronchial smooth muscle

2) inflammation and edema of the airways

Question 2

what drug can make asthma worse? Or induce it?

Answer 2

methacholine

Question 3

what is intermittent asthma?

Answer 3

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

Question 4

What is mild persistent asthma?

Answer 4

1) more than 2 symptoms/week
2) more than 2 nights of sleepnessness/ MONTH
3) PEF is less than or equal to 80%

Question 5

what is moderate persistent asthma?

Answer 5

1) daily symptoms
2) more than 1 nights of sleepnessness/ WEEK
3) PEF is between 61 and 80%

Question 6

what is severe persistent asthma?

Answer 6

1) constant symptoms
2) frequent nights of sleepnessness
3) PEF is less or equal to 60%

Question 7

asthma control criteria: daytime symptoms

Answer 7

less than 4 days/week

Question 8

asthma control criteria: night-time symptoms

Answer 8

less than 1 night/week

Question 9

asthma control criteria: physical activity

Answer 9

normal

Question 10

asthma control criteria: exacerabations

Answer 10

mild, infrequent

Question 11

asthma control criteria: absence from school/work due to asthma

Answer 11

none

Question 12

asthma control criteria: need for fast-acting beta2 agonist

Answer 12

less than 4 doses/week

Question 13

asthma control criteria: FEV1 or PEF

Answer 13

more than or equal to 90% personal best

Question 14

asthma control criteria: PEF diurnal variation

Answer 14

less than 10-15%

Question 15

asthma control criteria: sputum eosinophils

Answer 15

less than 2-3%

Question 16

long term control medications for asthma

Answer 16

• corticosteroids
• leukotriene inhibitors
• mast cell stabilizers
• long acting beta agonists
• methylxanthines
• immunomodulators = monoclonal antibody prevents IgE binding to mast cells (allergic with severe obstruction)

Question 17

acute medications (rescue or reliever)

Answer 17

• short/fast acting beta agonists
• anti-cholinergics
• oral corticosteroids

Question 18

treatment for mild intermittent asthma

Answer 18

fast-acting beta agonist

Question 19

treatment for mild persistent asthma

Answer 19

low dose inhaled corticosteroids

Question 20

treatment for moderate persistent asthma

Answer 20

• add long acting beta agonist

- second option, leukotriene antagonist

Question 21

treatment for severe persistent asthma

Answer 21

• higher dose inhaled corticosteroids
• long acting beta agonists
• leukotriene antagonists

Question 22

what are non-invasive methods to measure airway inflammation?

Answer 22

• sputum eosinophils

- exhaled NO

Question 23

what medications for asthma have been tried but are NOT recommended?

Answer 23

• methotrexate
• gold
• azathioprine
• monoclonal antibodies to IL-5 and IL-12
• cyclosporine
• IVIG
• colchicine

Question 24

how do we control a patient’s asthma?

Answer 24

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

Question 25

what are potential targets to treat asthma?

Answer 25

• submucosa
• SM
• BVs
• lamina propria
• epithelium
• mucus