Asthma And COPD Flashcards
Causes of airway narrowing in asthma exacerbation
Contraction smooth muscle
Mucus plugs in lumen
Thickening / edema of bronchial mucosa
Cellular infiltration
Most easily reversible cause of asthmatic airway obstruction
Contraction of smooth muscle (edema / infiltration is covered with sustained anti-inflammatories)
Short term control of asthma is achieved with
Relaxation of airway smooth muscle with
B agonists
Sometimes can use Theophylline (methylxanthine) or antimuscarinics
Long term control of asthma most effectively achieved with
Anti-inflammatory agent like ICS
Or:
LTRA (leukotrine pathway antagonist)
Cromolyn or Nedocromil (mast cell de granulation inhibitor)
Omalizumab (monoclonal Ab targeted against IgE)
Bronchoconstriction in asthma can be IgE mediated or non IgE mediated. Name a few of non IgE mediated reasons
ASA
cold air
Exercise
Name 3 inflammatory cells involved in pathophysiology of airway inflammation
Lymphocytes Mast cells Eosinophils Neutrophils Macrophages Dendritic cells Airway smooth muscle
Name 3 inflammatory mediators involved in asthma
Chemokines Cytokines Cysteinylleukotriens Nitric oxide IgE
Name 6 comorbidities and complicating factors of asthma
Allergies Viral or bacterial infections Nonselective B blockers Air pollution ASA/ NSAID sensitivity Food sensitivity GERD OSA OBesity Stress/ depression
Step 1 Asthma Tx
SABA PRN
Step 2 asthma TX (0-4 years)
Preferred: low-dose ICS
Alternatives:
Cromolyn
LRTA (Singulair)
Step 2 asthma Tx (5-11 years)
Preferred: Low-dose ICS Alternative: Cromolyn/Nedocromil LRTA theophylline
Step 2 asthma Tx (12 + years)
Preferred: Low-dose ICS Alternative: Theophylline Cromolyn, Nedocromil LRTA
Clinical presentation of asthma
Reversible bronchoconstriction
SOB
chest tightness
Wheeze
Eosinophilic or lymphocytic inflammation of bronchial mucosa
“Remodeling” of bronchial mucosa (hyperplasia)
Step 3 Asthma Tx (12+ years)
Preferred: Low-dose ICS & LABA OR MED-dose ICS Alternatives: Low-dose ICS & THeophylline; Low-dose ICS & LRTA Low-dose ICS & Zileuton (also an LRTA)
Step 4 asthma Tx (0-4 years)
Preferred: MED-dose ICS &
Either LABA or Singulair
Step 4 asthma Tx (5-11 years)
Preferred: MED-dose ICS & LABA Alternatives: MED-dose ICS & LTRA; MED-dose ICS & theophylline
Step 5 asthma tx (0-4 years)
Preferred:
HIGH DOSE ICS &
EITHER
LABA OR SINGULAIR
Step 5 asthma Tx (5-11 years)
Preferred: HIGH DOSE ICS & LABA alternatives: HIGH DOSE ICS & theophylline; HIGH DOSE ICS & LRTA
Step 5 Asthma Tx (12 + years)
Preferred:
HIGH DOSE ICS & LABA
alternatives:
Consider Omalizumab for pets with allergies
Step 6 asthma Tx (0-4 years)
HIGH DOSE ICS & LABA
Or HIGH DOSE ICS & Singulair
AND
ORAL STEROIDS
Step 6 Asthma Tx (5-11 years)
HIGH DOSE ICS & LABA & ORAL STEROID
Alternatives:
HIGH DOSE ICS & theophylline & oral steroid;
HIGH DOSE ICS & LRTA & oral steroid
Step 6 Asthma Tx (12+ years)
HIGH-DOSE ICS & LABA & ORAL STEROID
AND
Consider Omalizumab for pts with allergies