Asthma Flashcards
Name 5 chemokines involved in Th2 inflammation. (IgE isn’t a chemokine)
- IL-3
- IL-4
- IL-13
- IL-25
- TSLP
What does IL-5 do in the Th2 inflammation pathway?
Differentiation & maturation of eosinophils
What does IL-13 do in the Th2 inflammation pathway?
recruitment of eosinophils into airway
What does IL-4 do in the Th2 inflammation pathway?
production of IgE by B-Cells (i.e., class switching)
What does IgE do in the Th2 inflammation pathway?
activates mast cells & basophils to produce leukotrines and recruit / activate eosinophils.
What two commonly used asthma medication classes lower FeNO? Which one does not have an affect?
- ICS and Anti-IL-13 lower it.
- Anti-IL-5 has no effect.
What is the difference between exercise-induced asthma and exercise-induced bronchospasm?
- EIA patients only have symptoms when exercising.
- Exercise-induced bronchospasm is something that happens to patients with baseline asthma.
Diagnostic test for aspirin-exacerbated respiratory disease (AERD)?
Urine leukotrines after placebo/aspirin adminstration.
What disease is this?
- Nasal polyps
- Difficult to control asthma (OCS-dependent)
- Negative FHx and skin allergy testing
- 40s-50s female
- Angio-edema and GI symptoms
AERD (Aspirin-Exacerbated Respiratory Disease)
What four questions assess asthma control over the last 4 weeks?
(GINA 2020)
- Daytime symptoms more than 2/week?
- Any night awakenings due to asthma?
- SABA reliever needed more than 2/week?
- Any activity limitation due to asthma?
Well controlled = none
Partly controlled = 1-2 of these
Poorly controlled = 3+ of these
What is asthma step 1 treatment?
As-needed low-dose ICS / Formoterol
What is asthma step 2 treatment?
Daily low-dose ICS
-Alternative: daily LTRA
What is asthma step 3 treatment?
Daily low-dose ICS / LABA
- Alternative: medium dose ICS
- Alternative: Low-dose ICS + LTRA
What is asthma step 4 treatment?
Daily medium dose ICS / LABA
Add on tiotroprium or LTRA
-Alternative: High-dose ICS
What is asthma step 5 treatment?
Daily high dose ICS / LABA
Add on tiotroprium or biologic
-Alternative: add on low-dose OCS
Target range for theophylline?
8-12
In what organ is theophylline metabolized?
Liver
What is the ATS / ERS definition of severe asthma?
- High-dose ICS + another agent
- or-
- Needs prednisone >50% of last year.
What asthma biologic blocks IgE?
Omalizumab (Xolair)
What two asthma biologics blocks IL-5?
Mepolizumab (Nucala)
Reslizumab (Cinquair)
What asthma biologic blocks IL-5R?
Benralizumab (Fasenra)
What asthma biologic blocks IL-4R?
Dupalimumab (Dupixent)
What asthma biologic blocks TSLP?
Tezepelumab (no trade name yet, not yet approved)
What is the primary outcome of bronchial thermoplasty?
Decrease smooth muscle thickness and exacerbations.
For Th2-low asthma patients, what specific therapy may help?
Azithromycin decreases exacerbations (AMAZES trial)