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Asthma > Asthma Facts > Flashcards

Asthma Facts Flashcards

1
Q

How many Canadians have asthma?

A

8.4% (3.8 Million) Higher chance in children & females

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2
Q

How many asthmatics have their symptoms under control?

A

1/3

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3
Q

Asthma is:

A

A chronic condition
Recurring respiratory symptoms
Associated with chronic inflammation
Airway hyperresponsiveness that is normally reversable

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4
Q

What are the risk factors for hospitalization due to asthma?

A
  1. Hospital admission in the last 2 years
  2. > 8puffs of rescue medication in past 24hrs
  3. Lower socioeconomic status
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5
Q

What are some factors that affect QoL for asthmatic children?

A
  1. Sleeping difficulties
  2. Severity of attacks
  3. School absenteeism
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6
Q

What is the natural history of asthma?

A

Genetic disposition & Environmental exposure leads to TH2 cell response leading to Chronic inflammation & Airway remodeling that leads to Symptom Complex

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7
Q

What are the two main factors of transient wheeze in children less than 2?

A

RSV & Maternal smoking

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8
Q

How many URTI per year do children 5 and under get?

A

6-8

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9
Q

Asthmatic Airways

A

airway remodeling due to activation of the EMTU (epithelial-mesenchymal trophic unit) reduces responsiveness, increase in immune cells (mast cells, eosinophils, T-helper 2 cells)

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10
Q

Atopy

A

is the tendency to produce an exaggerated IgE immune response. (Allergic response)

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11
Q

Factors favouring TH1 phenotype

A
  1. Rural Environment
  2. Older Siblings
  3. Daycare
  4. TB, Measles, or Hep A infection
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12
Q

Factors favouring TH2 phenotype

A
  1. Antibiotic use
  2. Western lifestyle & diet
  3. Sensitization to house dust mites, cockroaches
  4. Urban environment
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13
Q

What is the hygiene hypothesis?

A

When we are born our immune system is skewed towards TH2 cytokine generation. With exposure to environmental stimuli such as infections, will activate TH1 to bring the relationship between them back to a balance. If children are not exposed to stimuli then it is thought that it promotes IgE antibodies (made from TH2 cells) to key allergens thus increasing the risk of asthma.

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14
Q

Prevalence of Asthma

A

As children males > females, as adults Females>Males

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15
Q

What happens with airway remodeling?

A

thickening of walls, increase smooth muscle mass, mucus hypersecretion leading to mucus plugs, increase # & size of blood vessels which can compress adjacent airways
- decreased response to treatment over time, occurs early in asthmatic airways, is the main reason why airway function may not be reversible over time.

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16
Q

Asthma & Eosinophils

A

Increased eosinophils in sputum, blood, bronchoalveolar lavage tissue and airway tissue

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17
Q

Asthma & Mast Cells

A

Increase mast cells = increased hyperresponsiveness

(mast cells release histamine, lukotrienes, prostaglandin D2) Roles in exercise induced asthma

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18
Q

Asthmas & Lymphocytes

A

Increase in T lymphocytes which releases cytokines which increases eosinophilic inflammation which increases IgE (produced by B lympocytes) which causes airway hyperresponsiveness

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19
Q

Inflammatory Mediators involved in athma

A
  1. Chemokines
  2. Cytokines
  3. Cysteinyl leukotrienes
  4. Histamine
  5. Nitric oxide
  6. Prostaglandin D2
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20
Q

What mediator, if inhibited will improve lung function and asthma symptoms?

A

Cysteinyl leukotrienes

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21
Q

What % of children who wheeze experience wheezing in adolescence?

A

60%

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22
Q

Aeroallergens that cause asthma are:

A
  1. Perennial Aeroallergens: Dander, urine, feces, saliva from animals, dust mites, cockroach, molds
  2. Seasonal Aeroallergens: <10um in size trees, grasses, weeds
  3. Smoke (Cig & Cannabis)
  4. Viruses (Rhinovirus, coronavirus, influenza, parainfluenza, RSV, Adenovirus & metapneumovirus
  5. Bacteria (S. pneumoniae, S. aures, M. catarrhalis,
    H. influenzae/parainfluenzae
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23
Q

What is an aeroallergen?

A

Airborne substance that results in IgE mediated allergic response

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24
Q

What is an IgE mediated allergic response?

A

TH2 recruitment, Mast cell activation, eosinophil influx

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25
Q

What is an AQHI (Air Quality Health Index) of 1-3 mean?

A

Low-Good

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26
Q

What is an AQHI of 4-6 mean?

A

Moderate-Consider rescheduling

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27
Q

What is an AQHI of 7-10 mean?

A

High-Reschedule

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28
Q

What is an AQHI of 10+ mean?

A

Very High- Avoid

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29
Q

What are non allergic inhaled irritants?

A

smoke, strong odours (perfumes), particulates (chalk dust, talcum powder), fumes (cleaning products, paints etc), exhaust, ozone

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30
Q

What are the medications that can trigger asthma symptoms?

A
  1. ASA
  2. NSAIDS
  3. Beta Blockers
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31
Q

What % of adult asthmatics will have an acute worsening of asthma symptoms after ingesting NSAIDs?

A

5-10%

32
Q

Occupational asthma…

A

Occurs primarily in adults
Causes 10-15% of asthma
Common in farming, painting, cleaning & plastic manufacturing

33
Q

What is Rhinitis?

A

Inflammation of the mucous membrane inside the nose

34
Q

What is rhinosinusitis?

A

Inflammation of the sinuses & nasal cavity

35
Q

How does GERD affect asthma?

A

Airway responsiveness or aspiration-induced inflammation

36
Q

How does asthma affect GERD?

A

Beta agonists & methylxanthines (theophylline) can impair function of the lower esophageal sphincter

37
Q

What % of children with atopic dermatitis will develop allergic rhinitis and/or asthma?

A

40-60%

38
Q

What is Exercise Induced Bronchoconstriction?

A

Narrowing of airways following vigorous exercise

39
Q

What is the mechanism behind EIB?

A

increased RR leads to increase water loss leads to increased airway osmolarity that leads to mast cell degranulation that leads to release of inflammatory mediators (histamine etc) which results in bronchoconstriction

40
Q

What % of the general population have EIB?

A

10%

41
Q

What % of asthmatics have EIB?

A

90%

42
Q

Diagnosis of EIB

A

FEV1 reduced by 10% or more from pre-exercise

43
Q

What % of asthmatic women have worsening symptoms during menstration?

A

20-40%

44
Q

Why does asthma have an effect on pregnancy?

A

Diaphragm rises 4 cm
Diameter of thoracic cage increases by 2 cm
Thoracic circumference increase by 6 cm
Reduced ERV & RV (Term 17-25% reduction in FRC)
20% increase in Oxygen consumption &15% increase is metabolic rate therefore 40-50% increase in MV

45
Q

What is the occurrence of worsening asthma symptoms during pregnancy?

A

1/3 of pregnancies have worsening symptoms, 1/3 stay under control, 1/3 have less symptoms

46
Q

What is work exacerbated asthma?

A

Asthma made worse by triggers at work

47
Q

What is occupational asthma?

A

New asthma diagnosis induced at work

48
Q

What is RADS?

A

Reactive airway dysfunction syndrome- acute onset of asthma after single high irritant exposure

49
Q

Examples of work place asthma irritants

A

Platinum, isocyanates, chromium, cobalt

50
Q

Asthma Symptoms

A
  1. Cough
  2. Wheeze
  3. SOB
  4. Reduced activity
  5. Past family hx
  6. Therapeutic trials with low does ICS
51
Q

Asthma Physical Exam

A

Expiratory wheeze on auscultation, hyper-expansion of thorax, increase nasal secretions, nasal polyps, atopic dermatitis

52
Q

Asthma Spirometry

A

Reversibility of obstruction shown by an improvement of FEV1 with bronchodilator by 12% and 200 mls

53
Q

What is diurnal variation in PEF in Well Controlled Asthma?

A

<10-15%

54
Q

What is diurnal variation in PEF in uncontrolled asthma?

A

8-10%

55
Q

What is the green zone?

A 
PEF 80-100%
Reliever no more than 3 times per week
Symptoms no more than 3 times per week
Can do normal physical activity/sports
Night asthma symptoms less than 1 night/week
No missed work/school
56
Q

What is the yellow zone?

A 
PEF 60-80%
Reliever more than 3 times per week
Symptoms more than 3 times per week
Physical activity is limited
Night asthma symptoms more than 1 night/week
57
Q

What is the red zone?

A 
PEF <60%
Reliever lasts 2-3 hours or less
Continuous asthma symptoms
Wheezing all the time
Severe SOB
"ASTHMA ATTACK"
58
Q

What medication is used to treat allergic asthma?

A

ICS first then Omalizumab (Xolair) lowers IgE levels

59
Q

What is indirect challenge testing?

A

Exercise or Cold air challenge

>10-15% decrease is FEV1 post exercise

60
Q

What is a positive methacholine challenge test?

A

PC20 <4mg/mL
Dose of methacholine <4mg/mL induces a 20% reduction in FEV1
PC20 4-16 is borderline
PC20> 16mg/mL is negative

61
Q

What is considered a positive skin prick test?

A

Wheal diameters > or = 3 mm

62
Q

What does an Asthma Control Test result of > or = to 20 mean?

A

Well controlled asthma

63
Q

ACT result of 16-15?

A

Not well controlled asthma

64
Q

ACT result of < or equal to 15

A

Poorly controlled asthma

65
Q

What does a ACQ-5 Questionnaire score below 0.75 mean?

A

Well controlled asthma

66
Q

ACQ-5 score above 1.50

A

Inadequately controlled asthma

67
Q

ACQ-5 score between 0.76-1.49

A

Indeterminate

68
Q

What is a normal sputum eosinophil count?

A

Less than 2-3%

69
Q

What is the Pediatric Respiratory Assessment Measure? (PRAM)

A

Assessment of acute severity
0-3 Mild 4-7 Moderate 8-12 severe
(uses o2 saturation, suprasternal retractions, air entry & wheezing)

70
Q

What is the Pediatric Respiratory Assessment Measure? (PRAM)

A

Assessment of acute severity
0-3 Mild 4-7 Moderate 8-12 severe
(looks at o2 saturation, suprasternal retractions, air entry & wheezing)

71
Q

What was the GOAL study?

A

Gaining Optimal Asthma Control study

72
Q

What were the outcomes of the GOAL study ?

A

The study demonstrated ICS/LABA therapy is superior to ICS monotherapy for achieving control

73
Q

Asthma Exacerbation Treatment

A

Oxygen, SABA, SAMA, Systemic steroids, ICS

Epinephrine & Theophiline, Magnesium sulfate IV (not routine)

74
Q

Prednisone dosage for Asthma Exacerbation

A

Adult: 50 mg/day for 7 days
Child: 1 mg/kg for 3-5 days

75
Q

What are the long term side effects of high does ICS?

A

Bruising, adrenal suppression, decreased bone density, increase risk of TB

76
Q

What are side effects of OCS-prednisone?

A

Osteoporosis, arterial HTN, diabetes, bruising, muscle weakness, weight gain

Asthma (1 decks)

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