Asthma-Tal

Question 1

Definition of Asthma

Answer 1

Chronic inflammatory disorder/disease of airways characteriwzed by acute airflow limitation and airway hyperresponsiveness. Airway obstruction with hyperactivity.

Question 2

Early response of asthma

Answer 2

Cough and wheezing within minute. Controlled by beta receptors.

Question 3

Late response of asthma

Answer 3

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.

Question 4

Role of cysteinyl leukotrienes

Answer 4

Bronchoconstrictor/bronchospastic and proinflammatory agent.

Question 5

What inflammatory differentiation process results in less allergies (hint: T-helpers)?

Answer 5

More allergens push differentiation into Th1 rather than Th2 causing IgE suppression.

Question 6

Exercise challenge test for asthma

Answer 6

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.

Question 7

Name some triggers of asthma

Answer 7

Cold air, chemicals, pollutants, smoke, aspirin and other beta blockers, other infection, allergens (pollen, feathers, cats, etc), milk if allergic.

Question 8

What percentage of children wheeze before age 4?

Answer 8

25%. They are also more prone to be hospitalized.

Question 9

What are the criteria for transient early wheezing?

Answer 9

At age 6 not wheezing but wheezed before age 3. 20% of children. Usually had small airways and grew out of it.

Question 10

What are the criteria for persistent wheezing?

Answer 10

14% of children. Wheezing at age 6 from before age 3. Family history.

Question 11

What are the criteria for late onset wheezing?

Answer 11

Have a wheeze at age 6 but weren’t wheezing at age 3. Usually have family history. 15% of asthmatics.

Question 12

How many persistent wheezers continue wheezing after age 13?

Answer 12

15%

Question 13

Factors predicting persistent asthma

Answer 13

Family history, atopy (positive skin tests, eczema, rhinitis), allergen exposure, viral infection, males>females as infants but reversed as adults, smoking, severity in childhood.

Question 14

When is peak flow highest and lowest in asthmatics?

Answer 14

4am is lowest, 4pm is highest funciton. Same as normal people but lower.

Question 15

How does the FEV1 curve change in an asthmatic?

Answer 15

Lower slope, so will be much lower after one second.

Question 16

What are the two types of treatment for asthma?

Answer 16

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)

Question 17

What are the indicators of total control?

Answer 17

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.

Question 18

What is Omalizumab?

Answer 18

Anti IgE recombinant DNA-derived humanized monoclonal antibody that selectively binds to human IgE. Injection every 2 weeks costs $1000, rarely used.

Question 19

GINA guidelines for levels of asthma control

Answer 19

Goal to maintain clinical control. Once you reach it you can step down.

Question 20

What is the time course for improvement of parameters of asthma under steroid treatment?

Answer 20

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.

Question 21

What is the main concerning side effect of steroids?

Answer 21

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.

Question 22

What is Monelukast

Answer 22

Blocks the effects of CysLTs (leukotrienes), reduces inflammation the corticosteroids do not so used in conjuction.

Question 23

Use of symbicort (Budesonide/formoterol)

Answer 23

Either total control by higher doses twice a day or lower doses and supplementary doses as needed with symptoms.

Question 24

What percentage of drugs end up in the lungs with an MDI alone vs a spacer vs Qvar?

Answer 24

11%, 21%, 50%

Question 25

What is HFA BDP/ Qvar?

Answer 25

More gentle, smaller particles, over 50% gets into lungs.