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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
how might you detect a lesion given a flow volume loop?
flattened inspiratory loop = extrathoracic lesion | flattened expiratory loop = intrathoracic lesion
26
extrathoracic lesions
vocal chord paralysis subglottic stenosis neoplasm goiter
27
intrathoracic lesions
tumor of lower trachea tracheomalacia strictures Wegener's granulomatosis or relapsing polychondritis
28
fixed lesions
fixed neoplasm of central airway vocal chord paralysis with fixed stenosis fibrotic structure
29
what is key in building a differential diagnosis including asthma?
medical history
30
consider diagnosis of asthma if these things are present:
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
what 2 features are present on the spirometry of an asthmatic
airflow obstruction | reversibility
32
how is airflow obstruction shown
low FEV1
33
what is reversibility
FEV1 improves with the administration of a bronchodilator
34
additional studies after conducting medical history, physical exam, and spirometry
CXR lung volumes and DLCO diurnal peak expiratory flows bronchoprovocation
35
what is bronchoprovocation
give methylcholene to try to induce bronchoconstriction assess airway hyper-responsiveness not recommended if FEV1 <65% predicted negative test rules out asthma
36
what are the 4 primary goals in long term management of asthma
1. reduce impairment 2. reduce risk 3. gain and maintain control 4. monitor and follow-up
37
are single steps to reduce exposure to allergens generally effective in preventing asthma?
when questions arise like this is answer is literally always no why do you even make these cards lauren
38
what are the classifications of asthma severity
1. intermittent 2. mild persistent 3. moderate persistent 4. severe persistent
39
describe intermittent asthma
``` 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
describe mild persistent asthma
``` 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
describe moderate persistent asthma
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
describe severe persistent asthma
``` continuous symptoms frequent exacerbations frequent nighttime symptoms limited activity FEV1 and PEF < 60% predicted PEF variability >30% ```
43
what med is often used in ED settings to treat severe asthma exacerbations?
ipratropium bromide + SABA | albuterol + atrovert
44
what are SABA and LABA
short acting or long acting beta agonist
45
what is important about ICS compliance?
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
LABA examples
salmeterol | formoterol
47
what is the target of new asthma therapies?
biological agents target IL-5 and eosinophil release
48
treatment for intermittent asthma
SABA prn
49
which steps are relevant for persistent asthma and require daily medication?
steps 2-6
50
step 2 treatment
preferred: low dose ICS alternative: cromolyn, LTRA, nedocromil, theophylline
51
step 3 treatment
preferred: low dose ICS + LABA or medium dose ICS
52
step 4 treatment
preferred: medium dose ICS + LABA
53
step 5 treatment
preferred: high dose ICS + LABA
54
step 6 treatment
preferred: high dose ICS + LABA + oral corticosteroid
55
what should you do before advising a step up in treatment
check adherence, environmental control, and comorbid conditions
56
when should you step down a treatment
well controlled at least 3 months
57
quick relief medication for all patients
SABA as needed for symptoms | up to 3 treatments at 20 min intervals as needed
58
what would suggest need for daily meds?
use of SABA >2 days per week for symptom relief
59
what is immunomodulation?
adding a monoclonal antibody to IgE (omalizumab) as adjunctive therapy in step 5 or 6 care
60
what is bronchial thermoplasty
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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