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ICC1 > bronchial asthma part 1 > Flashcards

bronchial asthma part 1 Flashcards

1
Q

what is the definition of asthma ?

A

is a heterogenous disease ( with many phenotypes), which is variable

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2
Q

what is the difference between COPd and asthma ?

A

with COPD there is persistent symptoms along with airflow obstruction
whilst with asthma there are variable symptoms along with airflow limitations

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3
Q

what is the difference between a risk factor and a trigger ?

A

a risk factor causes pathological changes whilst a trigger would cause an acute attack

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4
Q

what is the pathophysiology in asthma patients?

A

airway hyper-responsiveness
hyper-reactivity to trigger
trigger normally not affect non asthmatics
bronchospasm

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5
Q

what is the clinical picture of asthma ?

A

have more than one symptom :

1- variable overtime and in intensity
2- often occur and worsen at night
3- often occur with viral infections
4- often triggered by exercise, cold air

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6
Q

when are we less likely to detect asthma?

A 
with an isolated cough 
chronic sputum production 
chest pain 
dyspnea with dizziness or paresthesia 
dyspnea with noisy inspiration ( stridor)
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7
Q

what are the physiological tests required to make a diagnosis of asthma ?

A

spirometry
peak expiratory flow meter
bronchial provocation tests

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8
Q

what is reversibility testing ?

A

performing a spirometry before and after medications

usually given a salbutamol dose of 200-400mg and then the FEV1 should increase by 200 ml and by 12%

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9
Q

what is the cutoff value for the FEV1/FVC ration in order to make a diagnosis of asthma ?

A

less than 80%

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10
Q

what is the daily diurnal variability ?

A

take the PEF value in the morning then PEF value in the afternoon , ( mean reading of 3) subtract values from each other divided by the mean x 100
a value exceeding 10% is diagnostic of bronchial asthma

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11
Q

what is the purpose of the bronchial challenge test ?

A

detect airway hyper sensitivity

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12
Q

how is the bronchial challenge test performed ?

A

by measuring FEV1 pre and post inhalation of histamine or metacholine

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13
Q

what is the value for diagnosis of asthma using the bronchial challenge test ?

A

fall in FEV1 by 20% or more

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14
Q

what other tests can help in the diagnosis of asthma ?

A

increased fractioned expired nitric oxide in breath
increased blood or sputum eosinophils

increased blood/eosinophils in sputum

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15
Q

what are the general available treatment options for bronchial asthma ?

A

anti inflammatory ( ICS, OCSS, LTRA)
bronchodilators ( b2 agonist, anti-muscarinic)
other treatments ( biologic, azithromycin, bronchial thermoplasty )

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16
Q

how must ICS be used with asthma patients ?

A

used as a reliever in acute attacks and a controller for long term
used alone or combined with SABA, LABA, LAMA or LTRA

and must be given in stepwise doses : low, intermediate and high

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17
Q

what are the side effects of ICS ?

A

oral candidiasis, hoarseness of voice
risk of pneumonia with high dose

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18
Q

what is the method of administration with OCS ?

A

oral or intravenous

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19
Q

when are OCS usually used ?

A

in exacerbations and not in regular treatments

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20
Q

what are the side effects of OCS ?

A

immunosuppression: risk of infection
muscle weakness
gastritis/ peptic ulcer
hypertension, hyperglycemia, edema
osteoporosis
addisonian crisis

Addisonian crisis

21
Q

how are leukotriene receptor antagonists administered ?

A

oral or iv not by inhalation

22
Q

what is an example of a LTRA and when can leukotriene receptor agonists be used ?

A

montelukast
with patients intolerant to ICS side effects
allergic rhinitis/sinusitis

23
Q

what precautions must be taken with leukotriene receptor agonists ?

A

neuropsychiatric problems

24
Q

what drugs should be avoided with asthma patients ?

A

aminophylline and theophylline (methylxanthine)

25
Q

what are the treatment options for difficult to treat asthma ?

A

biological treatment
macrolide
bronchial thermoplasty

26
Q

what are the different asthma phenotypes ?

A 
early-onset asthma 
late-onset asthma 
exersice induced asthma 
aspirin induced asthma 
occupational asthma 
asthma-copd overlap syndrome
27
Q

what is the triad of aspirin induced asthma ?

A

rhinitis
sinusitis
asthma

28
Q

when can magnesium sulfate be used ?

A

in exacerbations only

29
Q

what are the biological treatments that can be used ?

A

anti IgE omalizumab
anti-il5/5r - reslizumab
anti il4/4r Duplimab

30
Q

how do we asses inflammation phenotype in severe asthma ?

A

by looking at
sputum eosinophils > 2%
and/or FeNO> 20ppb
and/or blood eosinophils >150

31
Q

if there is evidence of Th2 inflammation what treatment regimen should be opted for ?

A

there is ? biological
azithromycin
High OCS

no th2 inflamm ? LAMA , azithromycin, bronchial thermoplasty

32
Q

how should the reversibility testing be done for the diagnosis of bronchial asthma ?

A

measure FEV1
then give salbutamol 200-400 mcg
wait 10 -15 minutes
an increase in 12% and 200ml is diagnostic for asthma

33
Q

what is the most common method of administration of bronchodilators ?

A

inhalation

34
Q

what are examples of b2 agonists ?

A

SABA - salbutamol
LABA -formoterol
Ultra-long lasting -indacaterol

35
Q

what are the side effects of b2 agonists ?

A

tachycardia
arrhythmia
hypokalemia
tremors
anxiety

36
Q

what is the method of administration of antimuscarinics ?

A

given by inhalation only

37
Q

what are examples of antimuscarinic bronchodilators ?

A

SAMA - ipratropium bromide
LAMA - tiotropium bromide

38
Q

what are the side effects of antimuscarinics ?

A

dry mouth
bitter/metallic taste
poor systemic absorption

39
Q

what iis the dose for magnesium sulphate ?

A

single dose of 2gm infusion over 20 minutes

40
Q

what are the side effects of using aminophylline and theophylline in asthmatic patients ?

A

gastritis
arrhythmia
convulsion

41
Q

when is it called severe asthma ?

A

not controlled on any of the previous treatments despite avoiding risk factors and controlling co-morrbidities

42
Q

what can be used for severe asthma ?

A

1- biologic treatment : anti IgE
anti IL4
Anti IL5
2- azithromycin
3- bronchial thermoplasty

43
Q

early onset asthma is responsive to ?

A

steroids

44
Q

late onst asthma iss responsiive to ?

A

LTRA and macrolides

45
Q

what is useful when dealing with exersice induced asthma ?

A

prophylactic ICS-formeterol

46
Q

what should be avoided in aspirin iinduced asthma ?

A

Aspirin aw NSAIDs

47
Q

what should be given in aspirin induced asthma ?

A

LTRA

48
Q

what should be given in asthma-COPD overlap syndrome ?

A

ICS + (LAMA and or LABA )

ICC1 (50 decks)

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