Asthma + Asbestos Flashcards
What is severe asthma?
Patients with asthma that remains uncontrolled despite (a) treatment with high dose inhaled glucocorticoids + LABA + leukotriene modifier or theophylline OR
(b) treatment with oral corticosteroids for at least half of the previous year
It is all about CONTROL rather than lung function
Asthma Control
Daytime symptoms, night time symptoms, limitations of activities and need for reliever
GOOD Control ALL of - Daytime symptoms <2 days/week - Need for reliever <2 days /week - No limitations of activities - No symptoms during night or on waking
Partial Control: 1 or 2 of
Poor Control: 3 or more
- Daytime symptoms >2 days/week
- Need for reliever >2 days/week
- Any limitations of activities
- Any symptoms during night or on waking
Which viruses causes significant bronchospasm
RSV
Influenza
Causes of triggers of asthma
- Smoking
- Medications, eg: beta blockers
- Dust mites
- Thunderstorms
- Canola
- GORD
Causes of triggers of asthma
- Smoking
- Medications, eg: beta blockers
- Dust mites
- Thunderstorms
- Canola
- GORD
Effect of tiotropium in severe asthma
Has been shown to increase lung function and time to first exacerbation in severe asthma
What are treatments for severe asthma
- HIgh dose ICS/LABA combination +
- Tiotropium
- Macrolide
- Leukotriene modifier - normally used for aspirin induced
Biologics for available for asthma
Omalizumab: anti IgE, binds to Fc receptor of free IgE
Mepolizumab: anti IL-5 - binds to circulating IL-5
Benzaliuzumab: IL-5 receptor, binds to IL-5 receptor resulting in lysis of eosinophils
Dupilimab: IL4
Which of the following asbestos related lung diseases requires the most significant and prolonged exposure?
- Pleural plaques
- Asbestosis
- Asbestos related pleural disease
- Lung cancer
- Mesothelioma
- Asbestosis
Asbestos latency period
Asbestos latency period is LONG between exposure and development of asbestos related lung disease (often 30-40yrs)
Type of Asbestos: crocidolite (blue), chrysolite (white), amosite (brown/grey)
Blue more likely to cause mesothelioma
Types of asbestos related lung disease
(1) Pleural plaques
- look near contours of lung and diaphragm
- Benign, non-pre-malignant and asymptomatic
- Doesn’t affect lung function
- Important as marker of asbestos exposure
(2) Asbestos related pleural disease
- Diffuse pleural disease
- >25% circumference showing pleural disease
- Can cause symptoms if enough circumference (eg: >70-80%) is involved to cause restrictive disease
- Benign and non-pre malignant
- Does not predispose to mesothelioma
- ROUNDED atelectasis
(3) Asbestosis
- Interstitial lung disease secondary to asbestosis
- Predominantly upper lobe and then affect all lobes in contrast to IPF (lower lobes)
- Temporal heterogeneity
(4) Mesothelioma
- Present with pleural effusion and chest wall pain (dull ache that keeps them awake at night) - neural invasion in the nerve endings in the pleura and chest wall that causes this pain
- Prolonged asbestos exposure but can also occur with minimal exposure
- CXR + CT chest
- Diagnostic: VATS lung biopsy of PLEURA
Pleural aspiration will not be diagnostic
- Tx: pemetrexed
(5) Lung cancer
Non small cell
Squamous
Asthma vs COPD
First Line Management
Asthma: ICS
COPD: LABA/LAMA
