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Pulmonology > Asthma - Muthiah > Flashcards

Asthma - Muthiah Flashcards

1
Q

what is a treatment modality, comparable to the lower barometric pressure experienced at elevation, that is used in the ICU for patients having acute severe bronchospasm

A

give them Helium oxygen mixture - makes the air less dense, eases the work of breathing, allows the physician to work on correcting inflammation and spasm (probably not on test, he liked it though)

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2
Q

what is the clinical definition of asthma

A

chronic INFLAMMATORY disorder of the airways, characterized by EPISODIC REVERSIBLE (reversible in early stages) bronchospasm resulting from an exaggerated bronchoconstrictor response to various stimuli

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3
Q

airway inflammation in asthma contributes to what (another buzzword) - which results in what other symptoms

A

airway inflammation contributes to airway hyperresponsiveness, airflow limitation, respiratory symptoms, and disease chronicity

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4
Q

what occurs in some patients with asthma, regarding persistent changes in airway structure? - give name and examples

A

airway remodeling - in some pts, persistent changes in airway structure occur, including sub-basement fibrosis, mucus hypersecretion, injury to epithelial cells, smooth muscle hypertrophy, and angiogenesis

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5
Q

why does airway remodeling happen? what is the end result?

A

it is a result of these inflammatory attacks happening many times, to where some of the changes get left behind permanently - results in narrowing of airway lumen

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6
Q

what is the prevalence of asthma?

A

2-7 %

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7
Q

what percentage of children will “outgrow” their asthma into adulthood? why?

A

30-50%
may have to do with increasing the size of airways (diameter) and something to do with maturing your exposure to allergens, becoming less hypersensitive over time

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8
Q

what race is associated with higher risk of asthma death (must know - exam)

A

black - may have to do w/ genetic factors

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9
Q

does asthma have a preference for affected population? sex race age etc

A

no - asthma is equal opportunity employer

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10
Q

what is the trend in asthma prevalence rates recently? and what epidemic associated with

A

rates have been steadily increasing

may be associated with obesity epidemic (keep this in mind)

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11
Q

what is the trend in asthma related death rates since 2000?

A

they have decreased - possibly due to Advair, the combined long acting B agonist and corticosteroid in one inhaler

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12
Q

compare extrinsic v intrinsic asthma

A

extrinsic - atopic, allergic, we know what is causing it

intrinsic - idiosyncratic, non-allergic, we do not know what is causing it

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13
Q

what drugs are associated with drug induced asthma

A

ASA, NSAIDs

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14
Q

what is cough variant asthma? How is it diagnosed?

A

diagnosed through therapy trial - do not know what is causing pt’s cough, treat w/ bronchodilator, cough goes away, call it cough variant asthma

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15
Q

what is the rare form of Asthma that is important for step

A

Allergic Bronchopulmonary Aspergillosis - ABPA

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16
Q

What are the two classifications of asthma at dx?

A

intermittent or persistent

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17
Q

what are the 3 classifications of asthma at follow up

A

controlled, partially controlled, uncontrolled

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18
Q

what is the only treatment for intermittent asthma? what is this medication type called?

A

albuterol - rescue therapy - use as needed

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19
Q

what is the treatment plan for persistent mild asthma?

A

inhaled steroids - for inflammation

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20
Q

treatment plan for persistent moderate asthma (2)

A

inhaled steroids + long acting beta agonist

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21
Q

tx plan for persistent severe asthma (3)

A

inhaled steroids + long acting beta agonists + leukotriene modifiers

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22
Q

what is the black box warning assoc w/ LABA

A

LABA are assoc w/ increased mortality - use cautiously

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23
Q

extrinsic asthma - what inflammatory mediators associated? what about pt history?

A

IgE mediated - eosinophils too

there will be a family history

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24
Q

for pts w/ extrinsic asthma, what things do they need to avoid?

A

house dust mites, cockroaches, pets, mold

25
Q

intrinsic asthma - what will you not see?

A

serum IgE is NOT elevated and they do not have eosinophilia

26
Q

drug induced asthma - ASA, NSAIDS - what triad do you see?

A

1) asthma
2) aspirin sensitivity
3) nasal polyps

27
Q

what is pathogenesis of drug induced asthma?

A

arachidonic acid can either go through the cyclooygenase pathway or lipoxygenase pathway/ admin of NSAID will block COX, shunt more AA down leukotriene path. leukotrienes are potent bronchoconstrictors - this will precipitate the attack

28
Q

why is the pathogenesis of drug induced asthma important from treatment perspective?

A

these patients work really well when you start them on leukotriene receptor antagonists - don’t have to give steroids and B agonists

29
Q

what is typical presenting history of occupational asthma?

A

pt has asthma every weeknight evening. on weekends they feel better. they go on vacation and the asthma goes away entirely

30
Q

(good, good, to know) - in exercise induced bronchospasm, when does the bronchospasm occur? pathogenesis?

A

immediately AFTER exercise (5-10 min after)
patho - it is due to cooling and mucosal drying of airways during exercise - thought to trigger mast cells to release histamine

31
Q

what are two treatments (concurrent) for exercise induced bronchospasm

A

1) pre-treat w/ B-agonist

2) slow warm up period

32
Q

REDBOX (test) - what is the cause of nocturnal asthma

A

common between midnight and 8AM - due to decline of circulating catecholamines (bronchodilator) and cortisol (anti-inflammatory)

33
Q

what is type of hypersensitivity and mediator in allergic bronchopulmonary aspergillosis (ABPA)

A

astham due to specific fungi, aspergillus fumigatus

IgE mediated reaction and type III IgE mediated response

34
Q

what are 4 main criteria for ABPA dx?

1) symptoms
2) antigen test
3) CBC value
4) another level of something in the blood

A

1) poorly controlled asthma
2) A. fumigatus positive skin antigen test
3) significant Eosinophilia (huge)
4) IgE greater than 1000ng/mL (this is also huge)

35
Q

what is mainstay of tx for ABPA

A

prednisone

36
Q

what are some other criteria for dx of ABPA (probably not test, but still seems impt)

A

1) proximal bronchiectasis
2) fleeting chest infiltrates
3) peripheral eosinophilia w/ chest infiltrates

37
Q

recall the general pathophysiology for asthma

A

airway hyperresonpsiveness due to inflammation, epithelial injury, neural mechanism (too much vagal tone) - all this leads to airflow obstruction

38
Q

what mediator do we use to modulate each of the following? (this is must know)

1) eosinophils
2) mast cells
3) Eosinophilic Cationic Protein (ECP)
4) Histamine
5) leukotrienes
6) IgE
7) vagal afferent and efferent
8) IL-5

A

1) steroids
2) Cromolyn
3) (not sure)
4) H1 blockers
5) LTRAs
6) Omalizumab
7) Anticholinergics
8) Mepolizumab

39
Q

what crystal is associated with asthma?

A

Charcot-Leyden Crystals

40
Q

what happens to the epithelium in asthma?

A

disruption - loss of ciliated cells to complete denudation of epithelium
increased permeability to inhaled allergens promotes hyperresponsiveness
increased mucous and resp secretions

41
Q

nerual mechanisms - what autonomic tone predominates in asthma? how do we treat

A

elevated parasympathetic tone (vagal tone - thus bronchoconstriction) - anticholinergics attenuate this - cause bronchodilation

42
Q

memorize - compare asthma and COPD w/ onset

A

asthma - younger age

COPD - older age

43
Q

memorize - compare asthma and COPD w/ type of inflammation

A

asthma - eosinophilic

COPD - neutrophilic

44
Q

memorize - compare asthma and COPD w/ relevant lymphocytes

A

asthma - CD-4

COPD - CD-8

45
Q

memorize - compare asthma and COPD w/ relevant interleukins

A

asthma - IL-5

COPD - IL-8

46
Q

memorize - compare asthma and COPD w/ allergy history

A

asthma - usually present

COP - not usual

47
Q

memorize - compare asthma and COPD w/ reversibility of bronchospasm

A

asthma - usually present

COPD - variable, and limited

48
Q

memorize - compare asthma and COPD w/ what predominates during exacerbation
(MUST KNOW)

A

asthma - neutrophils
COPD - eosinophils
(note the diff from initial type of inflammation)

49
Q

what symptoms clue you in to dx of asthma

A

SOB or wheezing that is seasonal/after exposure to allergens etc

50
Q

what does death from asthma usually result from

A

diffuse mucous plugging of airways

51
Q

asthma diagnostic tests -PFTs - FEV1 and FEV1/FVC

A

reduction of FEV1, FEV1/FVC - this reverse with bronchodilators

52
Q

MUST KNOW - reversibility criteria

A

12% improvement AND 200cc increase in FEV1 and/or FVC

53
Q

what is the lung volume status of asthma during attack

A

hyperinflated

54
Q

REDBOX (exam) - what is the clinical utility of the Methacholine Challenge test?

A

it has a high negative predictive value - use it to rule out asthma (a positive result on methacholine test is much less useful than a negative one)

55
Q

what is one random trigger of asthma?

A

GERD - even acid refluxed into part of esophagus is enough to trigger bronchospasm (b/c of common embryological origin or something)

56
Q

what medication should you not use for asthma?

A

Primatene Mist - epinephrine, should not use

57
Q

asthma medications, what are the 2 relievers? (need to know)

A

1) short acting Beta 2 agonists

2) short acting Anticholingergics

58
Q

asthma meds - what are the 7 controllers? (need to know)

A

1) inhaled corticosteroids
2) inhaled LABA
3) LAMA
4) leukotriene modifiers
5) systemic steroids
6) Anti IgE
7) Anti IL-5

Pulmonology (31 decks)

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