Asthma and sleep apnea

Question 1

Atopy

Answer 1

• Refers to the allergic conditions that cluster in families and include hay fever (allergic rhinitis), asthma, eczema
• Characteristics: early age onset, high IgE levels, Ag specific, higher FEV1, associated w/ mild arthritis

Question 2

Non atopic asthma

Answer 2

• Have decreased lung function, more uncontrolled asthma
• More severe rhinitis
• Show higher sputum neutrophils

Question 3

Aspirin exacerbated respiratory disease (AERD)

Answer 3

• Accounts for 20% of asthmatics, triggered by NSAIDs
• Classic triad: asthma, aspirin sensitivity, nasal polyposis
• Sx begin 1 hr after NSAID ingestion
• Mechanism: AERD does not involve IgE mediated reactions, but is due to increased production and release of leukotrienes which cause bronchoconstriction
• NSAIDs that block COX cause the arachidonic acid to be shunted to LOX and increase LT synthesis, along w/ histamine release

Question 4

Multisymptom asthma

Answer 4

• Associated diseases of multi symptom asthma include hay fever, chronic rhinosinusitis and includes one of the following: recurrent wheezes, dyspnea at night, dyspnea on exertion, or dyspnea in the cold
• To have multiSx asthma these conditions must be met, plus the pt must have chronic asthma on meds who still suffers from attacks

Question 5

Allergic rhinitis

Answer 5

• Seasonal Sx associated w/ nose, often triggered by inhaled allergens (dust, pollen, etc) that cause histamine release from mast cells
• Results from sensitization due to previous exposures (type 1 hypersensitivity- Th2)

Question 6

Worsening asthma control 1

Answer 6

• Anatomic obstruction (congenital or acquired) including deviation of nasal septum
• Others: retrognathic mandible, macrogloassia, tonsil/adenoid hypertophy, vocal cord paralysis, polyps, cysts, infections of the larynx
• Neuromechanical bronchoconstriction reflex: mechanical irritation of the laryngeal mucosa results in increased lung resistance distally
• Superior laryngeal nerve is afferent limb, vagus nerve is efferent limb

Question 7

Worsening asthma control 2

Answer 7

• Repeated stimulation of the neural receptors during heavy snoring and OSA may stimulate bronchoconstriction (nocturnal asthma)
• GERD: present in 60% of OSA pts, due to increased transdiaphragmatic pressure (to breath more deeply) and decreased intrathoracic pressure during apnea spells
• Net effect is increased refluxate which can trigger the receptors in the larynx and cause nocturnal asthma
• Important to Rx the GERD in pts w/ nocturnal asthma

Question 8

Obstructive sleep apnea (OSA)

Answer 8

• Repeated episodes of upper airway collapse/occlusion during sleep, where breathing stops for more than 10 seconds
• Apnea: lack of breathing vs hypopnea: reduced airflow
• AHI (apnea hypopnea index) will be elevated (>5)
• AHI is calculated by taking the total number of apneas plus the total number of hypopneas and dividing it by the total sleep minutes

Question 9

Chronic rhinosinusitis (CRS)

Answer 9

• Inflammatory condition that affects the entire respiratory tract
• Known to be a fungal disease, but occurs in pts who have competent immune systems
• Characterized by inflammation of nose and paranasal sinuses of at least 12 wks duration
• There are bacterial infections along w/ the fungal component