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Asthma Facts Flashcards

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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
What is an AQHI (Air Quality Health Index) of 1-3 mean?
Low-Good
26
What is an AQHI of 4-6 mean?
Moderate-Consider rescheduling
27
What is an AQHI of 7-10 mean?
High-Reschedule
28
What is an AQHI of 10+ mean?
Very High- Avoid
29
What are non allergic inhaled irritants?
smoke, strong odours (perfumes), particulates (chalk dust, talcum powder), fumes (cleaning products, paints etc), exhaust, ozone
30
What are the medications that can trigger asthma symptoms?
1. ASA 2. NSAIDS 3. Beta Blockers
31
What % of adult asthmatics will have an acute worsening of asthma symptoms after ingesting NSAIDs?
5-10%
32
Occupational asthma...
Occurs primarily in adults Causes 10-15% of asthma Common in farming, painting, cleaning & plastic manufacturing
33
What is Rhinitis?
Inflammation of the mucous membrane inside the nose
34
What is rhinosinusitis?
Inflammation of the sinuses & nasal cavity
35
How does GERD affect asthma?
Airway responsiveness or aspiration-induced inflammation
36
How does asthma affect GERD?
Beta agonists & methylxanthines (theophylline) can impair function of the lower esophageal sphincter
37
What % of children with atopic dermatitis will develop allergic rhinitis and/or asthma?
40-60%
38
What is Exercise Induced Bronchoconstriction?
Narrowing of airways following vigorous exercise
39
What is the mechanism behind EIB?
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
What % of the general population have EIB?
10%
41
What % of asthmatics have EIB?
90%
42
Diagnosis of EIB
FEV1 reduced by 10% or more from pre-exercise
43
What % of asthmatic women have worsening symptoms during menstration?
20-40%
44
Why does asthma have an effect on pregnancy?
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
What is the occurrence of worsening asthma symptoms during pregnancy?
1/3 of pregnancies have worsening symptoms, 1/3 stay under control, 1/3 have less symptoms
46
What is work exacerbated asthma?
Asthma made worse by triggers at work
47
What is occupational asthma?
New asthma diagnosis induced at work
48
What is RADS?
Reactive airway dysfunction syndrome- acute onset of asthma after single high irritant exposure
49
Examples of work place asthma irritants
Platinum, isocyanates, chromium, cobalt
50
Asthma Symptoms
1. Cough 2. Wheeze 3. SOB 4. Reduced activity 5. Past family hx 6. Therapeutic trials with low does ICS
51
Asthma Physical Exam
Expiratory wheeze on auscultation, hyper-expansion of thorax, increase nasal secretions, nasal polyps, atopic dermatitis
52
Asthma Spirometry
Reversibility of obstruction shown by an improvement of FEV1 with bronchodilator by 12% and 200 mls
53
What is diurnal variation in PEF in Well Controlled Asthma?
<10-15%
54
What is diurnal variation in PEF in uncontrolled asthma?
8-10%
55
What is the green zone?
``` 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
What is the yellow zone?
``` 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
What is the red zone?
``` PEF <60% Reliever lasts 2-3 hours or less Continuous asthma symptoms Wheezing all the time Severe SOB "ASTHMA ATTACK" ```
58
What medication is used to treat allergic asthma?
ICS first then Omalizumab (Xolair) lowers IgE levels
59
What is indirect challenge testing?
Exercise or Cold air challenge | >10-15% decrease is FEV1 post exercise
60
What is a positive methacholine challenge test?
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
What is considered a positive skin prick test?
Wheal diameters > or = 3 mm
62
What does an Asthma Control Test result of > or = to 20 mean?
Well controlled asthma
63
ACT result of 16-15?
Not well controlled asthma
64
ACT result of < or equal to 15
Poorly controlled asthma
65
What does a ACQ-5 Questionnaire score below 0.75 mean?
Well controlled asthma
66
ACQ-5 score above 1.50
Inadequately controlled asthma
67
ACQ-5 score between 0.76-1.49
Indeterminate
68
What is a normal sputum eosinophil count?
Less than 2-3%
69
What is the Pediatric Respiratory Assessment Measure? (PRAM)
Assessment of acute severity 0-3 Mild 4-7 Moderate 8-12 severe (uses o2 saturation, suprasternal retractions, air entry & wheezing)
70
What is the Pediatric Respiratory Assessment Measure? (PRAM)
Assessment of acute severity 0-3 Mild 4-7 Moderate 8-12 severe (looks at o2 saturation, suprasternal retractions, air entry & wheezing)
71
What was the GOAL study?
Gaining Optimal Asthma Control study
72
What were the outcomes of the GOAL study ?
The study demonstrated ICS/LABA therapy is superior to ICS monotherapy for achieving control
73
Asthma Exacerbation Treatment
Oxygen, SABA, SAMA, Systemic steroids, ICS | Epinephrine & Theophiline, Magnesium sulfate IV (not routine)
74
Prednisone dosage for Asthma Exacerbation
Adult: 50 mg/day for 7 days Child: 1 mg/kg for 3-5 days
75
What are the long term side effects of high does ICS?
Bruising, adrenal suppression, decreased bone density, increase risk of TB
76
What are side effects of OCS-prednisone?
Osteoporosis, arterial HTN, diabetes, bruising, muscle weakness, weight gain

Asthma (1 decks)

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