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RC Test 2 > B4.032 Asthma > Flashcards

B4.032 Asthma Flashcards

1
Q

what type of hypersensitivity is representative of asthma?

A

type 1 hypersensitivity

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2
Q

type 1 reactions

A

immediate hypersensitivity

involve IgE mediated release of histamine and other mediators from mast cells and basophils

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3
Q

type 2 reactions

A

cytotoxic hypersensitivity reactions

involve IgG or IgM antibodies bound to cell surface antigens, with subsequent complement fixation

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4
Q

type 3 reactions

A

immune complex reactions
involve circulating antigen-antibody immune complexes that deposit in postcapillary venules, with subsequent complement fixation

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5
Q

type 4 reactions

A

delayed hypersensitivity, cell mediated immunity

mediated by T cells rather than by antibodies

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6
Q

Arthus reaction

A

type 3 hypersensitivity
immune complex mediated hypersensitivity reaction that occurs following the intradermal injection of antigen in the presence of high level of circulating antibody
area become red and edematous in 4-12 hours

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7
Q

what cell line is increased in patients with an acute asthma exacerbation, severe asthma, or in smokers with asthma?

A

neutrophils

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8
Q

what is the definition of asthma?

A

chronic inflammatory disorder of the airways in which many cells and cellular elements play a role
often associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment

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9
Q

which cells and cellular elements play a particular role in asthma?

A

mast cells, eosinophils, neutrophils, T lymphocytes, macrophages, epithelial cells

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10
Q

what does the inflammation associated with asthma cause?

A

recurrent episodes of coughing, wheezing, breathlessness, and chest tightness

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11
Q

describe the pathogenesis of inflammation in asthma

A
  1. inhaled antigen activates mast cells/th2 cells in airway
  2. inflammatory mediators/cytokines
  3. bone marrow activation
  4. eosinophils migrate to area of allergic inflammation
  5. eos/ mast cells release inflammatory mediators
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12
Q

what is airway remodeling?

A

smooth muscle hypertrophy that occurs in airways over long periods of untreated symptoms
only partially reversible
associated with progressive loss of lung function

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13
Q

pathogenesis of asthma

A
  1. airways infiltrated with eosinophils and mononuclear cells
  2. vasodilation and microvascular leakage
  3. airway smooth muscle hypertrophy
  4. new vessel formation
  5. increased numbers of epithelial goblet cells
  6. deposits of interstitial collagen beneath the epithelium
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14
Q

discuss the risk factors for asthma

A

early in life, prevalence is higher in boys

at puberty, the sex ratio shifts and asthma appears primarily in women

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15
Q

what would cause wheezing in an infant?

A

in utero exposure to environmental tobacco smoke

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16
Q

what is the hygiene hypothesis?

A

allergic diseases and asthma may be characterized by a shift toward Th2 cytokine-like disease
airway inflammation may represent a loss of normal balance between Th1 and Th2 lymphocytes

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17
Q

Th1 lymphocytes

A

produce IL-2 and IFN-y

critical in cellular defense mechanisms in response to infection

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18
Q

Th2 lymphocytes

A

generate IL-4,5,6,9,13

mediate allergic inflammation

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19
Q

factors favoring a Th1 phenotype

A

presence of older siblings
early exposure to daycare
Tb, measles or hepatitis A infection
rural environment

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20
Q

factors favoring a Th2 phenotype

A

widespread use of antibiotics
western lifestyle
diet
sensitization to house-dust mites and cockroaches

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21
Q

are ICSs associated with less disease burden after discontinuation of therapy?

A

ICSs provide superior control and prevention of symptoms and exacerbations during treatment, but they DO NOT modify the underlying disease process

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22
Q

what is vocal chord dysfunction?

A

abnormal adduction of vocal chords during the respiratory cycle
often mimics persistent asthma

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23
Q

who commonly gets VCD

A

young females with psychiatric illnesses

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24
Q

what is an important feature in discriminating VCD

A

localization of airflow obstruction to the laryngeal pharynx

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25
Q

how might you detect a lesion given a flow volume loop?

A

flattened inspiratory loop = extrathoracic lesion

flattened expiratory loop = intrathoracic lesion

26
Q

extrathoracic lesions

A

vocal chord paralysis
subglottic stenosis
neoplasm
goiter

27
Q

intrathoracic lesions

A

tumor of lower trachea
tracheomalacia
strictures
Wegener’s granulomatosis or relapsing polychondritis

28
Q

fixed lesions

A

fixed neoplasm of central airway
vocal chord paralysis with fixed stenosis
fibrotic structure

29
Q

what is key in building a differential diagnosis including asthma?

A

medical history

30
Q

consider diagnosis of asthma if these things are present:

A

wheezing on expiration
history of cough (worse at night), recurrent wheeze, recurrent breathing issues, recurrent chest tightness
symptoms occur or worsen in the presence of exercise, viral infection, animals with fur, dust mites, mold, smoke, pollen, changes in weather, strong emotional expression, airborne chemicals, menstrual cycles

31
Q

what 2 features are present on the spirometry of an asthmatic

A

airflow obstruction

reversibility

32
Q

how is airflow obstruction shown

A

low FEV1

33
Q

what is reversibility

A

FEV1 improves with the administration of a bronchodilator

34
Q

additional studies after conducting medical history, physical exam, and spirometry

A

CXR
lung volumes and DLCO
diurnal peak expiratory flows
bronchoprovocation

35
Q

what is bronchoprovocation

A

give methylcholene to try to induce bronchoconstriction
assess airway hyper-responsiveness
not recommended if FEV1 <65% predicted
negative test rules out asthma

36
Q

what are the 4 primary goals in long term management of asthma

A
  1. reduce impairment
  2. reduce risk
  3. gain and maintain control
  4. monitor and follow-up
37
Q

are single steps to reduce exposure to allergens generally effective in preventing asthma?

A

when questions arise like this is answer is literally always no why do you even make these cards lauren

38
Q

what are the classifications of asthma severity

A
  1. intermittent
  2. mild persistent
  3. moderate persistent
  4. severe persistent
39
Q

describe intermittent asthma

A 
symptoms < 2 days per week
brief exacerbations
SABA use <2x per month
nighttime symptoms <2x per month
symptomatic with normal lung function between exacerbations
FEV1 and PEF > 80% predicted
PEF variability < 20%
40
Q

describe mild persistent asthma

A 
symptoms > 2 days per week but not daily
minor limitations
SABA > 2days/week but not daily, and not more than 1x on any day
nighttime asthma symptoms 3-4x/month
FEV1 and PEF > 80% predicted
PEF variability 20-30%
41
Q

describe moderate persistent asthma

A

daily symptoms
exacerbations >2x per week affect activity
nighttime asthma symptoms >1x per week but not nightly
daily use of SABA
FEV1 and PEF > 60% and <80% predicted
FEV1/FVC reduced 5%
PEF variability >30%

42
Q

describe severe persistent asthma

A 
continuous symptoms
frequent exacerbations
frequent nighttime symptoms
limited activity
FEV1 and PEF < 60% predicted
PEF variability >30%
43
Q

what med is often used in ED settings to treat severe asthma exacerbations?

A

ipratropium bromide + SABA

albuterol + atrovert

44
Q

what are SABA and LABA

A

short acting or long acting beta agonist

45
Q

what is important about ICS compliance?

A

if a patient is on an LABA, they must also be on an ICS

some people will be less compliant with ICS bc they cause side effects and are more expensive

46
Q

LABA examples

A

salmeterol

formoterol

47
Q

what is the target of new asthma therapies?

A

biological agents target IL-5 and eosinophil release

48
Q

treatment for intermittent asthma

A

SABA prn

49
Q

which steps are relevant for persistent asthma and require daily medication?

A

steps 2-6

50
Q

step 2 treatment

A

preferred: low dose ICS
alternative: cromolyn, LTRA, nedocromil, theophylline

51
Q

step 3 treatment

A

preferred: low dose ICS + LABA or medium dose ICS

52
Q

step 4 treatment

A

preferred: medium dose ICS + LABA

53
Q

step 5 treatment

A

preferred: high dose ICS + LABA

54
Q

step 6 treatment

A

preferred: high dose ICS + LABA + oral corticosteroid

55
Q

what should you do before advising a step up in treatment

A

check adherence, environmental control, and comorbid conditions

56
Q

when should you step down a treatment

A

well controlled at least 3 months

57
Q

quick relief medication for all patients

A

SABA as needed for symptoms

up to 3 treatments at 20 min intervals as needed

58
Q

what would suggest need for daily meds?

A

use of SABA >2 days per week for symptom relief

59
Q

what is immunomodulation?

A

adding a monoclonal antibody to IgE (omalizumab) as adjunctive therapy in step 5 or 6 care

60
Q

what is bronchial thermoplasty

A

radiofrequency ablation of airway smooth muscle tissue
tx has been shown to decrease mild exacerbations in patients with moderate to severe exacerbations
no effect in severe exacerbations
designed to decrease smooth muscle mass

RC Test 2 (17 decks)

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