Asthma, D Kinder DSA Flashcards
What are the 3 distinct components of asthma
1- recurrent airway obstruction: resolves spontaneously or with Tx
2- Airway hyper-responsiveness: exaggerated bronchoconstriction in response to stimuli with little or no effect on non-asthmatic patients
3- airway inflammation
What cahracterizes mild asthma
edema and hyperemia of the mucosa plus mucosal infiltration with mast cells, eos and lymphocytes
what characterizes moderate asthma
chemokines, eotaxin, RANTES, macrophage inflammatory protein 1alpha, IL8 with sm m constriction
what characterizes severe asthma
hypertrophy and hyperplasia of airway glands and smooth muscle lead to severe airway thickening
airway obstruction in asthma is a combination of what
constricion of sm mm
thickening of epithelium
liquids in airways
What are triggers for asthma
atopy, allergy, cold air, smoking, pollution, climate changes, emotion, medications, occupational, food
What are the asthma chemical mediators
ACH
histamine
leukotrienes
NO
Describe how Ach contributes to asthma
released from intrapulmonary motor nn to stimulate M3 causing airway smooth mm constriction
describe how histamine contributes to asthma
released from mast cells- minor role
describe how leukotrienes and lipoxins contribute to asthma
derived by the lipoxygenation of AA released from target cell membrane phospholipids during cellular activation
describe how NO contributes to asthma
produced by airway epithelial cells and by inflammatory cells found in the asthmatic lung. High levels found during asthma attack
What is key in Hx that points towards asthma
dyspnea, cough, wheezing, anxiety
exercise induced, aspirin ingestion, extrinsic allergen induced
inability to sleep
tapid changes in temperature leading to attack
What is Ddx for asthma
COPD, CHF, pneumothorax, pulmonary embolism, large airway obstruction, vocal cord dysfunction
describe mild intermittent asthma
symptoms present for <2 nigh/mo
describe mild persistent asthma
symptoms present for >2days/week 2nights/mo
describe moderate persistent asthma
symptoms present daily or >once/night
describe severe persistent asthma
Sx are continual during the day and frequent at night
what do vital signs look like during asthma attack
tachypnea with RR 25-40, tachycardia and pulsus paradoxus
what are ominous signs of sthma
inability to speak or drink, fatigue, drowsiness, confusion and cyanosis
What does ABG look like in asthma
hypocapnea, if PaCO2 normalizes during severe attack may indicate impending respiratory failure
what will CBC show with asthma
eosinophilia and elevated IgE
What will CXR look like in asthma
normal, hyperinflation
sometimes severe hace have pneumothorax or pneumomediastinum
What does EKG look like with asthma attack
sinus tachy, RAD sometimes with RBBB, P pulmonale, ST-T changes in severe attack
what is Tx for intermittent asthma
no daily medication
short acting beta 2 agonist
Tx for mild persistent asthma
short acting beta 2 agonist as needed
inhaled corticosteroid
alternate Tx with mast cell stabilizer, leukotriene R antagonist or theophylline
What is Tx for moderate persistent asthma
SABA as needed
low to medium dose inhaled corticosteroid
LABA
Tx for severe persistent asthma
SABA
high dose corticosteroid and LABA
if persistent 2mg/kg/day prednisone
what gene has been traced to asthma
locus on chrom 17q21 for ORMDL3 which encodes ER TM proteins
What occurs in response to the inflammatory mediators released in asthma
deposition of type III and V collagen below true BM
what are the most potent contractile agonists for airway smooth m
LTC4 and LTD4
what drives RR in asthma attack
stimulation of intrapulmonary R with subsequent effects on central resp centers
how can asthma cause hyperventilation with low arterial PCO2
decrease in the ventilation to perfusion ratio
pulse paradoxus of 15 mmHg indictes how severe of asthma attack
moderate
PErcussion of thorax during asthma attck would present how
hyperresonance with loss of normal diaphragmatic movement
diminished tactile fremitus
rales heard during PE of asthma patient suggest what
raise suspicion of alternative Dx like localized infection or heart failure
At onset of asthma attack what type acid base may be present
pure respiratory alkalemia
a normal PaCO2 in asthma patient is concern because what
mechanical load on resp system is greater than can be sustained by ventilatory muscles
What blood serum [ ] could be elevated during severe asthma attcks
aminofransferase, lactac dehydrogenase, muscle creatinine kinase, ornitine transcarbamylase and ADH
What is an easy way to Dx asthma
SOB with elevated FENO
What is Mepolizumab
monoclonal Ab directed against IL5
What is Samters triad
patient with asthma who takes ASA and develops chronic rhinosinusitis, nasal polyps and severe bronchial asthma
