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PHA 223 > asthma -greame > Flashcards

asthma -greame Flashcards

1
Q

what is asthma?

A

Chronic inflammatory disease affecting airways of the lung

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2
Q

what are the symptoms of asthma?

A

Variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms

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3
Q

what causes asthma?

A

Caused by combination of genetic and environmental factors

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4
Q

what was the old classification of asthma?

A 
Intrinsic Asthma
•Caused by factors within the body
•‘Non-allergic’ asthma
•Skin-prick negative, triggered by cold, exercise, etc
•Adult onset
Extrinsic Asthma
•Caused by inhaling foreign substances
•‘Allergic’ asthma
•Skin-prick test positive to known allergens e.g. dust mite, pollen, etc
•Childhood onset
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5
Q

what are the asthma associated conditions?

A

COPD/ GERD/ Physiological conditions /other atopic or allergic disorders

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6
Q

what do COPD and asthma have in common?

A

overlap of symptoms

Both feature immunologically driven lung pathology

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7
Q

what is GERD?

A

Digestive disorder that affects the sphincter of the lower oesophagus which does not close completely, allowing some semi-digested food and gastric acid to be pushed back up into the oesophagus.

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8
Q

what are the consequences of GERD?

A

Heart burn and cough

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9
Q

what are the two putative mechanisms in GERD?

A
  • GERD-associate stomach contents may enter lung leading to irritation, tissue damage and progression to asthma
  • Asthma-associated pressure changes in the thoracic cavity may inhibit sphincter closing and lead to GERD
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10
Q

why is a physiological dysfunction associated with asthma?

A

Bi-directional reciprocal incidence in longitudinal studies (those with asthma more like to develop psychological dysfunction but also vice-versa)

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11
Q

what other allergic disorders do people with asthma tend to have?

A

just under half of asthma patients have allergic rhinitus / ezcema

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12
Q

what are the common triggers of asthma?

A 
Dust mites
•Pollen
•Cockroach urine
•Animal dander
•Mould
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13
Q

do paracetamol/ acetaminophen trigger asthma?

A

no- it was thought that was was being treated was what showed typical asthma symptoms

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14
Q

what happens in sensitisation?

A
  • Antigen can penetrate epithelial layer= dendritic cell maturation
  • Resting are ighly phagocytotic can capture through epithelium
  • Dendritic cells will mature in response- and process these antigens
  • These antigens will be presented on mhc cell to naieve t cells in local lymph nodes
  • Recognize and active t cells on these lymph nodes
  • Clonal expansion producing daughter of cells
  • In an atopic individual may skewe towards a th2/ t helper 2 response
  • They can then interact B cells to drive production of IGE
  • These b cells will diffeernciate into
  • They can bind to mast cells to FC receptor
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15
Q

what are the two respiratory system zones?

A

conducting zone (nose to the bronchioles) •respiratory zone (from the alveolar duct to the alveoli where gas exchange takes place)

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16
Q

how does the lung changes in response to mediators?

A

Asthma is primarily involved in the bronchial tree
•Contain smooth muscle and elastic fibres
•Changes based on contraction and relaxation of smooth muscle due to •inflammatory mediators
•Bronchoconstrictors
•bronchodilators

17
Q

what is the airwaves hyperresponsiveness?

A

Excessive contractile response of airway smooth muscle in asthma

18
Q

what does little provocation in an asthmatic induce?

A

inordinate bronchoconstriction

•airflow obstruction

19
Q

how does it cause bronchoconstriction and airflow obstruction?

A

Vagal tone (inadequate relaxation)
•Extracellular calcium
•Smooth muscle mass
•Histamine secretion

20
Q

what is lung compliace?

A

is the willingness for the lungs to distend, while elastance is the ability of the lungs to return to their resting position

21
Q

what is the difference between a normal and a healthy blood vessel?

A

In healthy individual we have alarge lumen- thin wall of bronchile- thin layer of epithelia cells. Mucous and smooth muscle
Obstructed airway- smooth muscle thicker, inc mucous production and significant decrease in the lumen diameter- significant impact with a smaller lumen to transport gases

22
Q

what is the clinical adage associated with asthma?

A

‘all that is asthma does not wheeze and all that wheezes is not asthma’

23
Q

what is the typcial presentation of asthma?

A
  • Child or adult with a range of spontaneous respiratory symptoms
  • Including recurrent cough and nocturnal awakening
  • Symptoms triggered by external stimuli, such as allergens, viral infections, exercise and cold air.
24
Q

what is the new improved asthma diagnosis?

A

look for - Extra dimensions of airway inflammation

25
Q

what is Fractional Exhaled Nitric Oxide (FeNO) and what does it measure?

A

Provides a measure of eosinophilic inflammation of the lungs
•≥35 ppb as a positive test in children
•≥40 ppb as a positive test in adults.

26
Q

what is a positive test for spirometry ?

A

FEV1/FVC ratio of less than 70% indicative of obstructive airway disease

27
Q

what is a positive test in the peak expiratory flow rate?

A

variation of more than 20%

28
Q

what are the challenge tests?

A

lung reactivity:
•Challenge test of airway reactivity
•Increasing dose of •Methacholin•Histamine•mannitol
•Lung function measured by spirometry•20% change diagnostically significant
other tests- blood tests and ski n prick tests

29
Q

what are bronchodilators used for?

A

Used for symptom relief in asthma but have no effect on the underlying inflammatory process

30
Q

how do Inhaled beta2-adrenergic agonists work? symptom relief

A

Relax smooth muscle by increasing the concentration of cyclic AMP and by opening potassium channels

31
Q

what is emergency bronchodilators you would give?

A

adrenaline/epinephrine

32
Q

what are Corticosteroids used for?

A

powerful pylotrophic inflamatory drugs
High doses of oral corticosteroids would control almost every asthmatic patient
•Serious systemic side effects limit the dose that can be given over long periods

33
Q

what is an Anti-IgE Antibody and how does it work?

A

Omalizumab- it is an ANTI IGE anti-tbody- bind to immunoglobin e in the circulation

  • Have their IGE bound- no longer free to bind to receptors on mast cells
  • No longer sensitized- decrease in the release of sol mediationrs
34
Q

what is hyposensitisation?

A

restore tolerance to these allergens-administer allergen in a diff way than inhaled- fed into them under a rapidly escalating dose controlled

PHA 223 (42 decks)

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