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respiratory > asthma > Flashcards

asthma Flashcards

1
Q

symptoms

A
  • wheeze
  • chest tightness
  • cough
  • shortness of breath (worse at night)
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2
Q

when does it occur

A

between 3-5 years old

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3
Q

what are the 3 characteristics

A
  • airflow limitation
  • airway hyper-responsiveness
  • bronchial inflammation
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4
Q

is airflow limitation reversible

A

yes

may need treatment to do so

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5
Q

what is present in bronchial inflammation

A
  • T lymphocytes
  • mast cells
  • eosinophils m
  • oedema
  • smooth muscle hypertrophy
  • mucus plugging
  • epithelial damage
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6
Q

what is the skin prick test result

A

positive to common inhalant allergens such as dust mite, animal danders, pollens and fungi

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7
Q

what is childhood asthma often accompanied by

A

eczema

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8
Q

what can be a cause of late onset asthma

A

sensitisation to chemicals or biological products in the workplace

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9
Q

what can cause non-atopic asthma in middle age

A
  • sensitisation to occupation agents
  • intolerance to NSAIDs (aspirin)
  • prescription of beta-adrenoreceptor blockers
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10
Q

causes

A
  • grass pollen
  • domestic pets
  • rhinovirus
  • cold air
  • emotion
  • perfume
  • cigarette smoke
  • NSAIDs
  • Beta blockers
  • genetics
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11
Q

what does term atopy include

A

asthma and hayfever

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12
Q

atopic diseases are those that

A
  • run in families
  • skin reactions to common allergens
  • circulating allergen-specific antibodies (IgE)
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13
Q

what is elevated serum IgE linked to in asthma

A

airway hyper-responsiveness

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14
Q

what genes control cytokine production

A
  • IL-3
  • IL-4
  • IL-5
  • IL-9
  • IL-13

these affect mast cell development and eosinophils

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15
Q

what helper cells are involved in asthma

A

type 2 helper cells

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16
Q

how can airway hyper-responsiveness be demonstrated

A

ask patient to inhale gradually increasing concentrations of histamine or methacholine

aka bronchial provocation test

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17
Q

what would the bronchial provocation test be in asthmatic patient

A

they would respond to a very low dose of methacholine

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18
Q

what other conditions would react to methacholine

A
  • wheezing with viral infection
  • seasonal wheeze
  • allergic rhinitis
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19
Q

what increases the risk of developing some forms of occupational asthma

A

smoking

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20
Q

when do asthmatics usually wheeze

A

after prolonged exercise or inhalation of cold, dry air (air conditioning included)

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21
Q

what is exercise induced wheeze driven by

A

release of histamine, prostaglandins and leukotrienes from mast cells

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22
Q

what can asthmatics experience worsening of symptoms

A
  • exposure to tobacco smoke
  • car exhaust fumes
  • solvents
  • strong perfumes
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23
Q

what drugs implicate asthma

A

NSAIDs

particularly aspirin

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24
Q

what do NSAIDs inhibit

A

arachidonic acid metabolism via the cyclo-oxygenase (COX) pathway

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25
Q

what is there a reduction of in aspirin intolerant asthma

A

reduce production of PGE2

leads to overproduction of cysteinyl leukotrienes by eosinophils, mast cells and macrophages

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26
Q

COX-2 inhibitors trigger asthma attacks

true or false

A

false

only COX-1 do

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27
Q

what drug contraindicates asthma and should never be given to patient

A

beta blocker

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28
Q

what is the inflammatory component of asthma driven by

A

Th2 T lymphocytes

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29
Q

what response occurs when there is a decrease in sensitivity to corticosteroids

A

Th1 response with release of mediators such as TNF-alpha

30
Q

where is there an increase in mast cells in asthma

A
  • epithelium
  • smooth muscle
  • mucous glands
31
Q

what do mast cells release in asthma

A
  • histamine
  • tryptase
  • PGD2
  • cysteinyl leukotrienes

cause immediate asthmatic reaction

32
Q

where are eosinophils found in asthma

A

in bronchial wall and secretions

33
Q

how are eosinophils attracted to the airways

A

by cytokines:

  • IL-3
  • IL-5
  • GM-CSF
34
Q

what do eosinophils release when activated

A

LTC4

35
Q

what drug can decrease activation of eosinophils

A

corticosteroids

36
Q

epithelium changes

A
  • loss of ciliated columnar cells
37
Q

what is epithelium a major source of

A
  • mediators
  • cytokines
  • growth factors

these enhance inflammation and promote tissue remodelling

38
Q

what is a useful test for continuing inflammation

A

measurement of exhaled NO

39
Q

what is smooth muscle like

A

hyperplasia

40
Q

what happens to the smooth muscle

A
  • contracts more easily

- remains contracted

41
Q

what do smooth muscle secretes

A
  • cytokines
  • chemokines
  • growth factors
42
Q

what does acetycholine stimulate

A

M3

43
Q

symptoms

A
  • wheezing
  • SOB (episodic)
  • worse during night
  • cough
44
Q

what can be done for diagnosis

A
  • PEFR
  • spirometry
  • exercise test
  • CXR
  • skin prick
45
Q

how is PEFR done

A
  • measure on walking before bronchodilator use

- measure in bed after bronchodilator m

46
Q

what does PEFR show

A

the diurnal variability

47
Q

how does spirometry show ashtma

A

greater than 15% improvement in FEV1 following bronchodilator use

48
Q

what is used for diagnosis in children

A

exercise test

49
Q

how is exercise test done

A

run for 6 minutes on treadmill

50
Q

what can be seen on CXR

A
  • overinflation
51
Q

treatment for occasional symptoms not everyday

A

SABA

52
Q

treatment for daily symptoms

A

corticosteroid

53
Q

treatment for severe symptoms

A

corticosteroid + LABA

if not controlled add either leukotriene or theophylline

54
Q

treatment for severe symptoms that are uncontrolled on high dose corticosteroid

A

increase corticosteroid + LABA

+ leukotriene/theophylline

55
Q

treatment for severe symptoms with patient deteriorating

A

corticosteroid
+
prednisolone

56
Q

treatment for severe symptoms and continued deterioration on prednisolone

A

hospital admission

57
Q

example of SABA

A

salbutamol

58
Q

example of LABA

A

salmeterol

59
Q

example of corticosteroid

A

beclometasone
budesonide
fluticasone

60
Q

example of leukotriene

A

monelukast

zafirlukast

61
Q

when can drugs be reassessed

A

2-3 months after under control

62
Q

what do beta adrenoreceptor agonist do

A

affect B2 only

- relax the bronchial smooth muscle

63
Q

can LABAs be given on their own

A

no

64
Q

what are LABAs given with

A

corticosteroids

65
Q

what does sodium cromoglicate prevent

A

activation of many inflammatory cells, particularly mast cells, eosinophils and epithelial cells

66
Q

SE of inhaled corticosteroids

A
  • oral candidiasis
  • hoarseness
  • osteoporosis
67
Q

drug against IgE

A

omalizumab

68
Q

features of life threatening attack

A
  • silent chest
  • exhaustion
  • bradycardia
69
Q

drugs used for acute severe asthma

A
  • SABA
  • antimuscarinic
  • magnesium sulphate
  • hydrocortisone
  • predisolone
  • ventilation
70
Q

order of treatment for acute severe asthma

A
  1. oxygen
  2. salbutamol
  3. ipatropium
  4. hydrocortisone
  5. prednisolone
  6. magensium sulphate IV

respiratory (20 decks)

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