Asthma Flashcards
How can we divide asthma?
It can be divided into:
- Atopic asthma (Allergic). Also known as extrinsic
asthma where it is triggered by the environment. Here
the inflammation is mediated by systemic IgE
production. - Non-atopic asthma (Non-allergic). Can call this intrinsic
asthma, which is far less common. Here the
inflammation and constriction of the airway is not
caused by an allergen. The inflammation is mediated
by local IgE production.
It can also be divided into to immune-response T2 and non-T2 asthma
What are the histological changes in asthma?
Airflow obstruction (Smooth muscle constriction and increase mucus production)
Bronchial Hyperresponsiveness (Due to histamine release)
Inflammation (Due to increase in neutrophils and other immune cells.)
Name the typical symptoms of ashtma.
Dyspnea
Cough. Often more worsen at night, with exercise or on exposure to triggers/irritants such as cold air, allergens and smoke.
Wheezing
Chest tightness
How does spirometry look in ashtma?
Decrease in FEV1 (<80%)
Decrease or normal FVC
Tiffno index <70%
Bronchodilator test:
- >12% imporvment of FEV1 or >200 ml.
If spirometry dosent give us good result or patient not able to do it, what is an alternative?
Bronchoprovocation test with methacholine (muscarinic agonist) which induce bronchoconstriction.
Patient with asthma are hyperresponsive to this test and with low dose there will be changes in FEV1.
- A possitive test is when there is >20% reduction in
FEV1 with a dose of 8mg/ml or less
Why is it important to know severity of ashtma?
If you understand the severity it help you know what type of treament approch needed for these patients.
Name the criteria for mild intermittent asthma
Symptoms - ≤ 2 days/week
Night time symptoms - Rare
FEV1 - >80%
Name the criteria for mild persistant asthma
Symptoms - >2 days/week
Night time symptoms - 3-4 times / month
FEV1 - >80%
Name the criteria for moderate persistent asthma
Symptoms - Daily
Night time symptoms - 1-2 times / week
FEV1 - 60-80%
Name the criteria for severe persistent asthma
Symptoms - Throughout the day
Night time symptoms - Often (most nights)
FEV1 - <60
How would you treat patient with mild intermittent asthma.
Known as Step 1 treatment (GINA)
Controller therapy:
- AS NEEDED ICS + formoterol (LABA)
- Budesonide-formoterol 1 inhalation
- Effect in 3-5 min. Last around 12 h
- Alternative is ICS whenever SABA is taken.
Reliever therapy:
- ICS + formoterol, as above
- SABA
How would you treat patient with mild persistant asthma?
Known as Step 2 treatment (GINA)
Controller therapy:
- Daily low dose ICS or as needed Low-dose
glucocorticoid together with formoterol (LABA).
- Budesonide-formoterol 1 inhalation
- Effect in 3-5 min. Last around 12 h
Reliever therapy:
- Leukotriene modifying drugs (LTRA) and low dose ICS
whenever SABA is taken
How would you treat patient with moderate persistent asthma?
Known as Step 3 treatment (GINA)
Controller therapy:
- Low-doses of an inhaled glucocorticoid + LABA
(Salmeterol or Formoterol)
- Alternative: Medium dose of ICS
How would you treat patient with severe persistent asthma?
Known as Step 4 treatment (GINA)
Controller therapy: Preferred - Medium dose ICS + LABA Alternative - High dose ICS and add on of tiotropium or LTRA if needed.
Known as Step 5 treatment (GINA)
- Used if symptoms are not controlled and
exacerbations present with step 4 treatment.
Controller therapy:
Preferred
- High dose ICS + LABA where we can do add-on
therapy:
- Tiotropium (Age have to be >6y)
- Anti-IgE: Omalizumab (anti-Ig-E): Patients with
severe allergic asthma
- Anti-IL5/5R: Benralizumab, Mepolizumab
- Anti-IL4R: Dupilumab
Alternative
Add low dose of oral corticosteroids, but remember side effects!
What would you give patient as a reliever therapy?
As needed Budesonide-formoterol
OR
As needed SABA. (Salbutamol/albuterol or levalbuterol)
