bronchial asthma

Question 1

what is asthma?

Answer 1

chronic inflammatory disorder of the airways leading to reversible airway obstruction
hypersensitivity

Question 2

what is the clinical symptoms of asthma ?

Answer 2

wheezing
dyspnea
chest tightness
coughing in the early morning

Question 3

what is the aetiology of asthma

Answer 3

genetic

evironemnetal - allergens
indoor - mites , furred animals , cockroach
outdoor - pollen , fungi , told
viral infections

Question 4

pathogenesis of asthma

Answer 4

allergen is presented as an antigen on dendritic cells
CD4th cells release cytokines to bring eosinophils and plasma cells

the plasma cells secrete IgE

IgE binds to mast cell causing degranulation
mast cells release histamines , leukotrienes and prostaglandin D2

eosinophils release cytokines and leukotrienes

leading to contraction of smooth muscle
thickening of air way wall by edema - due to microvascular leakaage
mucus hypersecretion
basement membrane thickening

early phase - bonchoconstriction
mucus production
vasodilation
increased vascular permeability

late phase - leukocyte recruitemnet - eosinophils and t cells

inflamttion - mast cell activation 
edema
denudation of bronchial epithelium 
collagen deposition n basement membrane 
goblet cell hyeplasia 
smooth muscle thickening

Question 5

what are the classificiatons of asthma ?

Answer 5

atopic asthma - specific IgE
begins in childhood
triggered by environmental factors
skin test of antigen positive

non atopic - no specific IgE - caused by cold
inhaled airpollutants
drug induced - aspirin sensitive asthma

exercise induced

occupational - triggered by fumes , occurring after repeated exposure

cough variant

according to severity
intermittent - less than once a week symptoms , not more than twice a mont hsymptoms
FEV1 more than 80 percent
dev1 variability less than 20 percent

mild persistnat  symptoms more than twice a week 
night time symptoms 
3-4 times a month 
fev1 less than 80 percent 
but variability 20-30 percent 

moderate persistant 
symptom daily 
night time symptom more than 1 a week
fev1 60-80 percent 
variability more30 percent 

severe persisitant 
symptom continiously 
night time 7 times a week 
fev1 less than 60 percent 
variability 30 percent

Question 6

physical examination of asthma ?

Answer 6

wheezing
auscultation - expiratory crackles
silent lung - dampened breathing sounds
percussion - hyperresonant

Question 7

what is the symtom of a controlled asthma ?

Answer 7

normal breathing sound

Question 8

what is the symptoms of exacerbated asthma ?

Answer 8

episodic breathlessness 
whezing 
chest tightness
coughing 
allergic rhinitis

Question 9

diagnosis of asthma ?

Answer 9

spirometry - FEV1/fvc always less than 0.7

peak expiratory flow

bronchodilator test - in acute dyspnea apply bronchodilators
FEV1 more than 200ml from the initial value then positive for asthma or differential diagnosis
negative - demo not asthma

bronchoprovocation testing - The patient breathes in nebulized methacholine or histamine
The degree of narrowing can then be quantified by spirometry. People with pre-existing airway hyperreactivity, such as asthmatics, will react to lower doses of drug

measurement of allergic status skin test

measurement of specific IgE

blood gas analysis

x ray - hyperinflation , lowered diaphragm , distened intercostal spaces , barrel thorax

Question 10

what are the diagnostic challenges in asthma ?

Answer 10

children less than 5 years old
the elderly
occupational asthma

Question 11

how to differentiate asthma from copd in spirometry

Answer 11

in copd FVC is reduced and asthma fvc normal
should be 80 percent

FEV1 ratio reduced all the time
asthma only reduced during attacks
should be 80 percent

Question 12

what is the medications given to asthma

Answer 12

controllers - inhaled systemic glucocortocsteroids - beclomethasone
leukotreine modifiers - montelucast
long acting b2 agonist (form0etrol) combo with inhaled corticosteroids
sustained release theophylline (non specific phosphodiesterase inhibitor

relivers -
rapid short acting b2 agonist - salbutamol

inhlaed anticholinergic - atrovent (ipratropium)

short acting theophylline

Question 13

what are the inhaled glucocorticosteroids ?

Answer 13

beclomethasone -
aldecin - 50ug /kg
becotide pMDI - 50 ug

Question 14

what are the leyukotrine modifiers ?

Answer 14

cysLT1 anatgonist - montelucast

Question 15

what are the indications of leukotriene modifiers ?

Answer 15

patients with mild persistent asthma alternative

aspirin sensitive asthma

Question 16

what are the long standing B2agonist ?

Answer 16

salmeterol PMDI - 25ug

formeterol
oxis /turbuhaler - 4.5ug

Question 17

what is the asthma attack treatment at home ?

Answer 17

mild intermittent - short acting b2 agonsit

mild persistant -‘ ‘ inhaled low dose cortocosteroids

moderate persistent - ‘ ‘ LABA

severe persistent - ‘ ‘ high dose ics , laba

very severe persistent - ‘ ‘ ocs - oral corticosteroid

asthma control - 
if you are fully controlled you can take step down 
having no daytime symptoms 
no limitation in activties 
nocturnal symptoms
need for relievement 
lung function normal

partially controlled - day time symptoms twice a week
lung function less than 80 percent predicted
exacerbation one or more a year

uncontrolled - any of the three in controlled factors and exacerbation one in any week

acute severe asthma
high conc of 02 given
high dose of SABA
impeding rest failure -