Asthma

Question 1

Definition: A disease of the airways characterized by (3)

Answer 1

• Variable airflow obstruction
• Bronchial hyper-responsiveness
;Airway inflammation

Question 2

gold standard for diagnosis of occupational asthma

Answer 2

day to day variability with bad days while at work

Question 3

Reversibility

Answer 3

> 12% and 200mL

> 20% improvement post bronchodilators quite specific for asthma over COPD

nil reversibility - recent bronchodilator use, poorly controlled asthma (needs steroids first), normal baseline FEV1

Question 4

ABPA (allergic bronchopulmonary aspergilosis)

• characteristics
• treatment

Answer 4

• Chronic asthma, recurrent pulmonary infiltrates, bronchiectasis
• Finger in glove
• Very high total IgE >1000IU/mL)
• Evidence of Aspergillus sensitivity

Very steroid responsive
can try Itraconazole if not

Question 5

Eosinophilic granulomatosis with polyangiitis (EGPA)

Answer 5

• Necrotising vasculitis, granulomas, tissue eosinophilia

* Asthma + blood eosinophilia essential

Question 6

Samter’s triad

Answer 6

Asthma, aspirin intolerance + nasal polyps

Question 7

AERD - Aspirin Exacerbated Respiratory Disease

Answer 7

Samter’s triad
80% have reaction to ETOH drinks
give leukotrine antagonists - montelukast

Question 8

Allergic asthma elevated IgE - biologics

Answer 8

Omalizumab

Question 9

Eosinophiliac asthma

Answer 9

Mepolizumab benralizumab

Question 10

Omalizumab

MOA
Indications
ADR

Answer 10

mAb directed against IgE

Indication - maintenance of mod-severe allergic asthma in pts Rx with ICS and with raised serum IgE levels

ADR -thrombocytopenia, bleeding

Question 11

Mepolizumab

MOA
Indications
ADR

Answer 11

mAb that binds to IL 5 -life cycle of eosinophils is controlled by IL 5

Used in Eosinophilic Asthma

ADR - headache, flu like sx

Question 12

Benralizumab

MOA
Indications
ADR

Answer 12

Binds to IL5 receptor

Used in Eosinophilic Asthma

ADR - headache, flu like sx