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Respiratory Diseases Overview > Asthma > Flashcards

Asthma Flashcards

1
Q

define asthma

A

chronic inflammatory condition of the airways

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2
Q

three main characteristics of asthma

A
  • airflow limitation
  • airway hyper responsiveness to various stimuli
  • bronchial inflammation with T lymphocytes, mast cells and eosinophils
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3
Q

main causes/ triggers of asthma

A
  • environmental exposure
  • viral infections
  • cold air
  • emotion
  • irritant dusts
  • drugs
  • genetic factors
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4
Q

examples of environmental stimulants that can cause an asthma attack

A
  • grass pollen
  • pets
  • pollution
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5
Q

examples of viral infections that can cause an asthma attack

A
  • rhinovirus
  • parainfluenza virus
  • RSV
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6
Q

examples of irritant dusts that can induce an asthma attack

A
  • perfume
  • cigarette smoke
  • airborne dust
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7
Q

examples of drugs that can induce an asthma attack

A
  • NSAIDs (aspirin, ibuprofen and indometacin)

- beta blockers (propranolol)

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8
Q

how does NSAIDs induce asthma?

A

inhibit the COX pathway so production of thromboxane and some anti-inflammatory prostaglandins is decreased leading to over-production of pro-inflammatory leukotrienes

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9
Q

how does the beta blocker propranolol lead to an asthma attack?

A

block the effects of adrenaline on beta2-adrenoceptors on smooth muscle causing bronchoconstriction

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10
Q

what is the exercise induced wheeze driven by?

A

release of histamine, prostaglandins and leukotrienes from mast cells

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11
Q

what causes pathological changes in chronic asthma?

A

inflammatory cells affecting the bronchioles

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12
Q

pathological changes in chronic asthma

A
  • smooth muscle hypertrophy and hyperplasia
  • leakage of interstitial fluid
  • increased mucous secretion
  • epithelial damage making the bronchi more sensitive as nerve endings are exposed
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13
Q

what do the pathological changes in chronic asthma cause?

A

narrowing of the diameter of the lumen, constricting the airways

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14
Q

characteristic spirometry in asthma

A
  • reduced FEV1

- reduced FEV1/FVC ratio

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15
Q

characteristics peak expiratory flow rate (PEFR) in asthma

A

decreased

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16
Q

two stages in the asthmatic reaction when an allergen is inhaled

A
  1. immediate

2. delayed/ late-phase

17
Q

describe the immediate reaction

A

airflow restriction and bronchoconstriction within minutes of contact with allergen

18
Q

when does the delayed/late-phase of the asthma attack often occur

A

6 hours after inhalation of the allergen

19
Q

in the delayed/late-phase what inflammatory mediators are released

A
  1. mast cells (histamine, PGD2 and cysteinyl leukotrienes)
  2. eosinophils (IL-3, IL-5 and LTC4)
  3. dendritic cells and lymphocytes (Th2 response)
20
Q

describe the Th2 response in asthmatic individuals (what cells do the T helper lymphocytes activate)

A
  • mast cells via IL-3, IL-4, IL-9 and IL-13
  • eosinophils via IL-3 and IL-5
  • IgE
21
Q

what happens if the allergen is introduced into a healthy individual?

A
  • allergen is phagocytosed by an antigen-presenting cell (dendritic, mast, macrophage) and ingested
  • Th1 response (IgG and macrophages)
22
Q

clinical features of asthma

A
  • wheeze
  • episodic SOB (worse at night due to more cytokine release at night)
  • non-productive cough (nocturnal cough in young children)
  • chest tightness
23
Q

signs in asthma

A
  • tachypnoea
  • wheeze
  • hyperinflated chest
  • hyper resonated percussion note
  • high RR and pulse and inability to complete sentences (in acute)
  • cyanosis (severe acute)
24
Q

investigations for asthma

A
  • peak flow
  • spirometry
  • skin prick test
25
Q

results of peak flow in asthma

A

reduced

26
Q

results of spirometry in asthma

A

reduced FEV1
normal FVC
reduced FEV1/FVC

27
Q

how to improve the spirometry result?

A

beta agonist

28
Q

chronic treatment for asthma

A
  • SABA
  • SABA + ICS
  • SABA + ICS (beclomethasone) + LRTA (montelukast)
  • SABA + ICS + LABA +/- LRTA
  • SABA + MART (LABA+ICS) +/-LRTA
  • increase dose of MART
  • refer
29
Q

acute treatment for asthma

A
  • oxygen in non-rebreathing bag
  • nebulised salbutamol 5mg
  • hydrocortisone (steroid) 100mg IV or oral (or prednisolone 40-50mg PO)
  • ipratropium bromide 0.5mg nebulised with oxygen

Respiratory Diseases Overview (18 decks)

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