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Pulmonary > Asthma > Flashcards

Asthma Flashcards

1
Q

What is asthma?

A

A chronic inflammatory pulmonary disorder that is characterized by reversible obstruction of the airways

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2
Q

What are airway morphological changes seen in asthma?

A 
mucus gland hypertrophy --> increased mucus
Edema (from microvascular leak)
Thickening of basement membrane
Epithelial damage
Inflammatory cell infiltration
Vascular dilation
Increased airway smooth muscle
Bronchoconstriction and bronchiol hyperresponsiveness
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3
Q

Wah tis the metacholine challenge test?

A

A test that is used to determine if the airways are hyperreactive. Increasing doses of methacholine (a potent bronchoconstrictor) are given and spirometry measurements are made after each dose.

People with airway hyperreactivity will show a reduction in FEV at lower doses than patients without airway hyperresponsiveness. May be used to help diagnose asthma when spirometry is nondiagnostic.

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4
Q

What is a postitive metacholine test?

A

Positive if FEV1 reduced ≥ 20%

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5
Q

How does [terminal] bronchial inflammation occur?

A

Overexpression of Th2-cells → inhalation of antigen results in production of cytokines (IL-3, IL-4, IL-5, IL-13) → activation of eosinophils and induction of cellular response (B-cell IgE production) → bronchial submucosal edema and smooth muscle contraction → bronchioles collapse

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6
Q

How does allergic asthma occur?

A

IgE-mediated type 1 hypersensitivity to a specific allergen –> characterized by mast cell degranulation and release of histamine after a prior phase of sensitization

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7
Q

Which helper cells are important for delated sensivity?

A

TH1

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8
Q

Which helper cells are important for allergic imflammation?

A

TH2

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9
Q

What is atopy?

A

A genetic predisposition to produce IgE after antigen exposure. This leads to a tendency toward developing hypersensitivity reactions, especially allergic rhinitis, eczema, and asthma (atopic triad).

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10
Q

What are risk factors for asthma?

A 
Maternal smoking
Atopy or family history of asthma/atopy
Males more often than females < 14 yrs (opposite when age > 14)
Pollution (NO2, ozone)
Obesity
Viral infections (?)
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11
Q

What are predictors of poor prognosis?

A 
persistent symptoms/ long duration 
high levels of hyperreactivity in childhood
decreased inhaled corticosteroid use
environmental smoke exposure
female sex
atopic history/ exposure
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12
Q

What are some triggers of asthma?

A

Viral respiratory tract infections (one of the most common stimuli, especially in children) [4]
Cold air
Physical exertion (exercise-induced asthma)
Medication: aspirin/NSAIDS (aspirin-induced asthma), beta-blockers
Stress
Cigarette smoke
Air pollution
Environmental allergens

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13
Q

What are cardinal symptoms of asthma?

A

Cough:

  • after exertion
  • breathing cold air
  • at night
  • after colds

Wheezing:

  • tightness
  • noisy breathing

Dyspnea:

  • intermittent
  • after exertion
  • at night
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14
Q

What is management for asthma?

A
  • environmental control and education
  • fast-acting bronchodilators (acute)

mild to severe:

  • inhaled corticosteroid or leucotriene receptor agonsit (LTRA)
  • add LABA (long-acting beta2-agonist) [for .12 yrs] OR increase ICS dose [for <11 yrs)
  • add LTRA [for 12 yrs older] or add LABA [under 12]
  • add prednisone (in addition to anti-IgE)
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15
Q

What effect does corticosteroid have on inflammatory cells?

A

decrease in numbers of cells and cytokines

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16
Q

What effect does corticosteroid have on strucutral cells?

A

epithelial cells: decrease cytokine mediators
endothelial: less leak
airway smooth muscle: increase in B2 receptors
Mucus gland: less secretion

17
Q

T or F: in ashtma patient there is a perception of reduced severity of their condition

A

T

18
Q

T or F:

A

Poorly controlled asthma has a more detrimental effect on growth than does long-term use of ICS!

19
Q

T or F: adding LABA is more effective than increasing dose of ICS

A

T
Adding salmeterol or formoterol to inhaled steroid therapy is more effective than just increasing the dose of the inhaled steroid

20
Q

When would you go for LTRA over ICS?

A

aspirin sensitive asthma
exercise induced asthma mild asthma
moderate-severe asthma with ICS side effects as a possible means to decrease ICS dosage

21
Q

Whats the effect of theophylline?

A

increased cyclic AMP levels:
–> smooth muscle
bronchodilation

–>eosinophils
decreased release of leukotrienes and cytotoxins
increased apoptosis

–> leukocytes
decreased cytokine release
decreased proliferation
increased T suppressor cells

22
Q

What is treatment for mild intermittent asthma?

A
  • no longer term control

- short-acting B2 agonist

23
Q

What is treatment for mild persistent asthma?

A
  • Daily Medication with some anti-inflammatory agent: ICS, LTRA, cromolyn [long-term]
  • Short Acting b-2 agonist [quick relief]
24
Q

What is treatment for moderate persistent asthma?

A
  • Daily Medication with an inhaled corticosteroid (ICS).
    Consider add-on therapies: LABA, LTRA
  • Short Acting b-2 agonist [quick relief]
25
Q

What is treatment for severe persistent asthma?

A
  • Daily Medication with an inhaled corticosteroid (ICS) + LABA, LTRA + theophylline
  • Short Acting b-2 agonist
26
Q

What is mild intermittent asthma?

A

Asthma is considered intermittent if without treatment any of the following are true:

  • Symptoms (difficulty breathing, wheezing, chest tightness, and coughing):
    Occur on fewer than 2 days a week.
    Do not interfere with normal activities.
  • Nighttime symptoms occur on fewer than 2 days a month.
  • PEF is normal when the person is not having an asthma attack. The results of these tests are 80% or more of the expected value and vary little (PEF varies less than 20%) from morning to afternoon.
27
Q

What is mild persistent asthma?

A
  • Symptoms occur on more than 2 days a week but do not occur every day.
  • Attacks interfere with daily activities.
  • Nighttime symptoms occur 3 to 4 times a month.
  • PEFs are 80% or more of the expected value and may vary a small amount (PEF varies 20% to 30%) from morning to afternoon.
28
Q

What is moderate persistent asthma?

A
  • Symptoms occur daily. Inhaled short-acting asthma medication is used every day.
  • Symptoms interfere with daily activities.
  • Nighttime symptoms occur more than 1 time a week, but do not happen every day.
  • PEFs tests are abnormal (more than 60% to less than 80% of the expected value), and PEF varies more than 30% from morning to afternoon.
29
Q

What is severe persistent asthma?

A
  • Symptoms:
    Occur throughout each day.
    Severely limit daily physical activities.
  • Nighttime symptoms occur often, sometimes every night.
  • Lung function tests are abnormal (60% or less of expected value), and PEF varies more than 30% from morning to afternoon.

Pulmonary (25 decks)

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