Asthma-Tal Flashcards
Definition of Asthma
Chronic inflammatory disorder/disease of airways characteriwzed by acute airflow limitation and airway hyperresponsiveness. Airway obstruction with hyperactivity.
Early response of asthma
Cough and wheezing within minute. Controlled by beta receptors.
Late response of asthma
6-8 hours after exposure, a worse decline. more troublesome, cough and wheezing and trouble sleeping at night. Edema, hypersecretion of mucus, airway hyperactivity. Prevented by corticosteroids.
Role of cysteinyl leukotrienes
Bronchoconstrictor/bronchospastic and proinflammatory agent.
What inflammatory differentiation process results in less allergies (hint: T-helpers)?
More allergens push differentiation into Th1 rather than Th2 causing IgE suppression.
Exercise challenge test for asthma
Measure percent fall for a 6 minute run at 6 km/h at 6% incline. For children with cough variant asthma to see if lung function diminishes.
Name some triggers of asthma
Cold air, chemicals, pollutants, smoke, aspirin and other beta blockers, other infection, allergens (pollen, feathers, cats, etc), milk if allergic.
What percentage of children wheeze before age 4?
25%. They are also more prone to be hospitalized.
What are the criteria for transient early wheezing?
At age 6 not wheezing but wheezed before age 3. 20% of children. Usually had small airways and grew out of it.
What are the criteria for persistent wheezing?
14% of children. Wheezing at age 6 from before age 3. Family history.
What are the criteria for late onset wheezing?
Have a wheeze at age 6 but weren’t wheezing at age 3. Usually have family history. 15% of asthmatics.
How many persistent wheezers continue wheezing after age 13?
15%
Factors predicting persistent asthma
Family history, atopy (positive skin tests, eczema, rhinitis), allergen exposure, viral infection, males>females as infants but reversed as adults, smoking, severity in childhood.
When is peak flow highest and lowest in asthmatics?
4am is lowest, 4pm is highest funciton. Same as normal people but lower.
How does the FEV1 curve change in an asthmatic?
Lower slope, so will be much lower after one second.
What are the two types of treatment for asthma?
Bronchospasm relievers: beta-2 agonists (SABA-albuterol/salbutamol, terbutalin, Ipratropium bromide, Formoterol), Long term block of inflammation: Corticosteroids (inhaled, leukotriene modifiers-rarely), Combined inhaler (SABA with theophylline and LABA-if used alone increase mortality)
What are the indicators of total control?
No symptoms, no rescue SABA, >80% PEF every morning, no nighttime awakenings, no exacerbations, no emergency visits, no adverse events to change therapy. Sustained at least 7/8 weeks.
What is Omalizumab?
Anti IgE recombinant DNA-derived humanized monoclonal antibody that selectively binds to human IgE. Injection every 2 weeks costs $1000, rarely used.
GINA guidelines for levels of asthma control
Goal to maintain clinical control. Once you reach it you can step down.
What is the time course for improvement of parameters of asthma under steroid treatment?
No night symptoms within days. Improved FEV1 within weeks, morning PEFand discontinuation of SABA after months and improved AHR after years. If discontinued, within weeks same as placebo.
What is the main concerning side effect of steroids?
Height difference, but after 2 years of treatment 1.1cm difference but if steroids are discontinued will catch up and only 0.3cm difference after a year.
What is Monelukast
Blocks the effects of CysLTs (leukotrienes), reduces inflammation the corticosteroids do not so used in conjuction.
Use of symbicort (Budesonide/formoterol)
Either total control by higher doses twice a day or lower doses and supplementary doses as needed with symptoms.
What percentage of drugs end up in the lungs with an MDI alone vs a spacer vs Qvar?
11%, 21%, 50%
What is HFA BDP/ Qvar?
More gentle, smaller particles, over 50% gets into lungs.
