Asthma: Definition, diagnosis, evaluation and management Flashcards
What are the two main categories of obstructive lung diseases?
- COPD
- Asthma
Asthma is a … rather than a …
Asthma is a syndrome rather than a disease. It is a complex, multifactorial condition with different phenotypes that vary with age.
Asthma arises from…
complex interaction between a genetic predisposition and environmental exposures. Note that there are many genes involved in asthma and there is no specific genetic testing in clinic.
Asthma is…
a a chronic inflammatory disease of the airways.
What are the 3 main characteristics of asthma?
People with asthma have variable degrees of airway obstruction, airway inflammation and bronchial hyper-responsiveness.
What accounts for 90% of asthma costs?
Poor asthma control (60% of asthmatics)
Asthma is a “barrier diease”. Explain.
Rhe epithelium is a “barrier” that covers the airways. People with asthma have an epithelium which reacts differently to a variety of factors than normal people, triggering an inflammatory response (it gets more inflamed due to cold, allergy, infections, oxidative stress).
What is the role of interleukin 4,5 and 13 in asthma? Why are they important?
There are now important treatments targeting these interleukins.
Which type of lymphocyte is steroid sensitive?
Th2: lymphocytes -
Which pathway is not steroid sensitive?
?
What happens to airways smooth muscle in asthma?
Hypertrophy and hyperplasia of smooth muscle, which leads to an excess in the layer of airway smooth muscle and excess bronchoconstriction (smaller radius of the airway, which increases resistance to airflow).
Younger asthmatics are….
Older asthmatics…
Younger asthmatics respond better to steroid treatments than older people…?
What are symptoms of asthma?
- recurrent episodes of wheezing
- troublesome cough, especially at night
- coughing or wheezing after exercise
- counghing, wheezing or chest tightness after exposiure to airborne allergens and pollutants
- prolonged cough or wheeze following a respiratory infections
What factors trigger asthma (or worsen symptoms in people with asthma)?
- respiratory tract infections
- allergens
- pollutants
- medications
- physical factors
- physiological factors
How do we score asthma?
Using an ACQ5 asthma control questionnaire
How is asthma diagnosed and monitored?
- Hisotry and patterns of syptoms
- Symptom scoring (ACQ5 questionnaire)
- Measurement of lung function (spirometry)
- Measurement of inflamatory status of the airways
- FeNO
How is FEV1 different in people with asthma?
Decreased with asthma (may increase or even return to normal with treatment)
What criteria determine significant reversibility in airflow after bronchodilator administration?
- Improvement of FEV1 of at least 12% and at least 200 mL within 30 minutes after administration of bronchodilator
- Improvement i % predicted FEV1>or=10% after administration of bronchodilator
How do you measure airway responsiveness?
Give a very small dose of methacholine which….
What are the 5 items of the ACQ5 questionnaire?
- Night awakenings
- Severity of morning symptoms
- Limitation of activity
- Shortness of breath
- Wheezing
How does the ACQ5 questionnaire work?
Airway inflammation can also be measured by doing sputum induction with hypertonic saline. How does this work?
Airway inflammation can also be measured by measuring nitric oxide. How?
In patients without asthma: low FeNO
In patients with asthma: high FeNO
What are the goals of long-term management in asthma?
- Achieve and maintain control of symptoms
- Maintain normal activity levels, including exercise
- Maintain pulmonary function as close to normal levels as possible
- Prevent asthma exacerbations
- Avoid adverse effects from asthma medications
- Prevent asthma mortality
What is considered to constitute acceptable control of asthma in Canada?
How can asthma be effectively controlled and managed?
Pharmacologically:
Non-pharmacologically:
What types of medications are used to treat asthma?
Rescue medications (‘ols’ and ‘iums’): short-acting bronchodilator agents (SABA)
Controller medications : long-acting bronchodilator (LABD)
Inhaled corticosteroids (ICS) (‘ides’ and ‘ones’)
ICS-LABA Combination therapy) (‘one’ combined with ‘ol’, ‘ide’ combined with ‘ol’)
Review stepwise approach to treating asthma…
What reduces the rate of mortality in asthma?
Asthma mortality rate is reduced with each additional cartridge of inhaled corticosteroids (ICS) during the preceding year.
Asthma mortality rate is reduced during the 3 months following stopping the treatment.
Reduction in asthma exacerbation with the use of ICS is often dose-dependent. What type of doses are more effective?
Higher ICS doses are more effective than lower doses.
Asthma is difficult to treat in what % of asthmatic population?
5-10% of asthmatic population
Asthma that is difficult to reat characteristics
- increased use of asthma medicaton
- 15x ER use
- 20x hospital admission
- increased absenteeism
Wat is associated with severe asthma and poor response to therapy?
female gender, obesity and smoking
Why could asthma still remain uncontrolled despite high dose therapy?
- incorrect diagnosis
- non-adherence to therapy
- hidden allergens/sensitizers
- severe sinus infections
- hidden triggers (e.g. in workplace)
- co-morbidities
What are 2 treatments for severe asthma?
- Prednisone
- Monoclonal antibodies
Why do physicians use prednisone as a last resort?
It has many dangerous side effects when used frequently or long duration:
- weak bones
- weak muscles
- cataracts
- glaucoma
- diabetes
What is one of the key goals of asthma doctors?
Keeping patients OFF oral steroids by ensuring they use their inhalers consistently and ?.
