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Phase 1b - Cardiovascular & Respiratory Medicine > Asthma & Respiratory Immunology > Flashcards

Asthma & Respiratory Immunology Flashcards

1
Q

Outline the epidemiology of asthma.

A
  • 5.4 million people in the UK currently receiving treatment for asthma
  • 1.1 million children affected (approx. 3 in every class)
  • On average, 3 people die of an asthma attack every day in the UK
  • NHS spends approx. £1billion annually treating asthma
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2
Q

What are the risk factors of asthmas (3)?

A
  • Genetic susceptibility
  • Allergies / Allergic diseases
  • Environmental exposures
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3
Q

Outline the aetiology of asthma.

A
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4
Q

How would a patient with suspected asthma present (5)?

A
  • Wheeze +/- Dry cough +/- Dyspnoea
  • Persistent symptoms + episodes (attacks) – precipitated by exertion, colds, allergen exposure
  • Atopy / allergen sensitisation
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5
Q

Outline the pathophysiology of asthma.

A
  1. Airway eosinophilia
  2. Airway inflammation / narrowing on baseline
  3. Reversible airway obstruction
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6
Q

How would one diagnose suspected asthma (6)?

A
  • Clinical assessment:
    • History & examination
    • Assess / confirm wheeze when acutely unwell (doctor diagnosed wheeze)
  • Objective tests:
    • FBC
    • Airway obstruction on spirometry - FEV1/FVC ratio < 0.7 (adults), < 0.8 (children)
    • Reversible airway obstruction - Bronchodilator reversibility > 12%
    • Exhaled nitric oxide (FeNO) >35ppb (children), > 40ppb (adults) – in a treatment naïve patient
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7
Q

What airway obstruction on spirometry would confirm asthma on an adult?

A

FEV1/FVC ratio < 0.7

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8
Q

What airway obstruction on spirometry would confirm asthma on a child?

A

FEV1/FVC ratio < 0.8

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9
Q

What reversible airway obstruction would confirm asthma?

A
  • Bronchodilator reversibility >12%
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10
Q

What Exhaled nitric oxide (FeNO) would confirm asthma on an adult?

Fraction of exhaled nitric oxide (FeNO): a non-invasive biomarker of airway (type-2) inflammation

A

More than 40ppb

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11
Q

What Exhaled nitric oxide (FeNO) would confirm asthma on a child?

Fraction of exhaled nitric oxide (FeNO): a non-invasive biomarker of airway (type-2) inflammation

A

More than 35ppb

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12
Q

Fraction of exhaled nitric oxide (FeNO): a non-invasive biomarker of airway (type-2) inflammation. How does Type 2 inflammation relate to asthma?

A
  • Type 2 inflammation lead to eosinophilia
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13
Q

What FBC abnormality would one expect in a patient with asthma?

A

Blood eosinophil count: >300 cells/mcl
* Eosinophilia

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14
Q

Why would one need an need an FBC or more than one non-invasive biomarkers to diagnose asthma?

A
  • A single non-invasive biomarker does not reflect airway eosinophilic inflammation
Korevaar DA Lancet Respir Med 2015;3:290-300
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15
Q

What are the management principles of asthma (3)?

A
  • Reduce airway eosinophilic inflammation
  • Acute symptomatic relief
  • Severe asthma - steroid sparing therapies
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16
Q

How does one manage asthma (reduce airway eosinophilic inflammation) (2)?

A
  • Inhaled corticosteroids (ICS)
  • Leukotriene receptor antagonists
17
Q

How does one manage asthma (acute symptomatic relief) (2)?

A
  • Beta-2 agonists (smooth muscle relaxation)
  • Anticholinergic therapies (smooth muscle relaxation)
18
Q

How does one manage asthma (severe asthma) (3)?

A
  • Biologic targeted to IgE
    • Anti-IgE antibody (Omalizumab)
  • Biologics targeted to airway eosinophils
    • Anti-interleukin-5 antibody
    • Anti-interleukin-5 receptor antibody
19
Q

When is the use of omalizumab (anti-IgE antibody) recommended?

A
  • Severe, persistent allergic (IgE mediated) asthma in patients > 6 years who need continuous or frequent treatment with oral corticosteroids
    • 4 or more courses in the previous year

Patient needs to have documented compliance bcs omalizumab is VERY expensive

20
Q

What determines the dosage of omalizumab (anti-IgE antibody)?

A

Dosing based on:
* Total serum IgE (30-1500 IU/ml)
* Weight

Administered every 2-4 weeks subcutaneously

21
Q

When is mepolizumab (anti-IL-5-antibody) recommended?

A

For severe eosinophilic asthma
* Blood eosinophils >300 cells/mcl in the last 12 months
* At least 4 exacerbations requiring oral steroids in the last 12 months
* Licenced for adults and children > 6 years

THEN

Trial for 12 months – 50% reduction in attacks, then continue

IL-5 regulates growth, recruitment, activation and eosinophil survival
22
Q

Outline the pathogenesis of an acute asthma attack.

A

Phase 1b - Cardiovascular & Respiratory Medicine (21 decks)

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