Asthma and Sinusitis

Question 1

Canadian Thoracic Society definition of Asthma

Answer 1

An inflammatory disorder of the airways characterized by paroxysmal or persistent symptoms such as dyspnea, chest tightness, wheezing, sputum production and cough, associated with variable airflow limitation and airway hyper-responsiveness to endogenous or exogenous stimuli.

Question 2

Susceptibility genes thought to include those for which immune cells?

Answer 2

Th1 and Th2
IgE
IL-3, 4, 5, 9, 13
Granulocyte-monocyte colony-stimulating factor
TNF-alpha

Question 3

What is the effect of early childhood exposure to bacterial and viral infections and endotoxins on the developing immune system?

Answer 3

Th1 suppresses Th2

Th1 induces tolerance

Question 4

What is the effect of cleaner environments, and antibiotics on the developing immune system?

Answer 4

Th2

• proallergic
• proinflammatory
• IgE and eosinophils

Question 5

In a 12-month period, what percentage of people with asthma will have an asthma attack?

Answer 5

56%

Leading cause of absenteeism from school and the third leading cause of work loss

Question 6

What # Canadians currently diagnosed with asthma?

Answer 6

3 million

Question 7

What is the immune pathway (pathophys) of asthma? Starting with APC

Answer 7

APC -> T helper cell -> Th2…

Th2, eosinophils, mast cells, neutrophils all form an inflammatory infiltrate

Increases reaction to allergens, infections, irritants, etc.

Question 8

How is adult-onset asthma different from childhood onset?

Answer 8

Asthma that starts in adulthood often non-atopic, more severe and associated with a faster decline in lung function.

Less known about prevalence and associated factors.

Question 9

What are various types of asthma?

Answer 9

Allergic (60%)
Non-allergic (viral infxns, tobacco smoke)
Exercise-induced
Cough variant
Occupational
Medication induced (Aspirin + other NSAIDs)
Nocturnal
Glucocorticoid resistant

Question 10

How do you make a diagnosis of asthma?

Answer 10

Based on clinical evaluation and pulmonary function testing

Spirometry
Flow-volume loops
Provocative testing (methacholine challenge)
Diffusing capacity for CO2 (DDx COPD)
Chest x-ray
Allergy testing

Question 11

relative CI to spirometry?

Answer 11

FVC may raise intracranial, intra-thoracic, and intra-abdominal pressures

• recent eye, thoracic or abdominal surgery
• recent MI, uncontrolled hypertension
• pneumothorax
• acute disorders affecting test performance (vomiting, nausea, vertigo)

Question 12

Common allergic triggers for asthma?

Answer 12

mold
animal dander
pollen
cockroaches
dust mites

Question 13

Common non-allergic triggers for asthma?

Answer 13

Drugs (ASA, b-blockers)
Chemicals (sulfites), fumes, odours
Respiratory viral infection
weather
strenuous physical exercise
tobacco smoke
air pollution

Question 14

Connection between estrogen and asthma susceptibility?

Answer 14

Clinically observed differences in airway reactivity and asthma exacerbations in women at different life stages suggest a role for sex steroids in modulating airway function. Targets and MOA still being explored.

ERs found on:
nasal mucosa cells
lung cells
mast cells
others 

Estrogen may promote bronchodilation.

During natural menstrual cycles, increases in estrogen levels were associated with decreased exhaled NO levels, whereas increases in progesterone levels were associated with increased eNO levels and skin-prick test wheal size. These effects not observed among women using OCP.

Asthma symptoms alleviated in female patients taking hormonal OCs.