bronchial asthma part 1 Flashcards
what is the definition of asthma ?
is a heterogenous disease ( with many phenotypes), which is variable
what is the difference between COPd and asthma ?
with COPD there is persistent symptoms along with airflow obstruction
whilst with asthma there are variable symptoms along with airflow limitations
what is the difference between a risk factor and a trigger ?
a risk factor causes pathological changes whilst a trigger would cause an acute attack
what is the pathophysiology in asthma patients?
airway hyper-responsiveness
hyper-reactivity to trigger
trigger normally not affect non asthmatics
bronchospasm
what is the clinical picture of asthma ?
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
when are we less likely to detect asthma?
with an isolated cough chronic sputum production chest pain dyspnea with dizziness or paresthesia dyspnea with noisy inspiration ( stridor)
what are the physiological tests required to make a diagnosis of asthma ?
spirometry
peak expiratory flow meter
bronchial provocation tests
what is reversibility testing ?
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%
what is the cutoff value for the FEV1/FVC ration in order to make a diagnosis of asthma ?
less than 80%
what is the daily diurnal variability ?
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
what is the purpose of the bronchial challenge test ?
detect airway hyper sensitivity
how is the bronchial challenge test performed ?
by measuring FEV1 pre and post inhalation of histamine or metacholine
what is the value for diagnosis of asthma using the bronchial challenge test ?
fall in FEV1 by 20% or more
what other tests can help in the diagnosis of asthma ?
increased fractioned expired nitric oxide in breath
increased blood or sputum eosinophils
increased blood/eosinophils in sputum
what are the general available treatment options for bronchial asthma ?
anti inflammatory ( ICS, OCSS, LTRA)
bronchodilators ( b2 agonist, anti-muscarinic)
other treatments ( biologic, azithromycin, bronchial thermoplasty )
how must ICS be used with asthma patients ?
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
what are the side effects of ICS ?
oral candidiasis, hoarseness of voice
risk of pneumonia with high dose
what is the method of administration with OCS ?
oral or intravenous
when are OCS usually used ?
in exacerbations and not in regular treatments
what are the side effects of OCS ?
immunosuppression: risk of infection
muscle weakness
gastritis/ peptic ulcer
hypertension, hyperglycemia, edema
osteoporosis
addisonian crisis
Addisonian crisis
how are leukotriene receptor antagonists administered ?
oral or iv not by inhalation
what is an example of a LTRA and when can leukotriene receptor agonists be used ?
montelukast
with patients intolerant to ICS side effects
allergic rhinitis/sinusitis
what precautions must be taken with leukotriene receptor agonists ?
neuropsychiatric problems
what drugs should be avoided with asthma patients ?
aminophylline and theophylline (methylxanthine)
what are the treatment options for difficult to treat asthma ?
biological treatment
macrolide
bronchial thermoplasty
what are the different asthma phenotypes ?
early-onset asthma late-onset asthma exersice induced asthma aspirin induced asthma occupational asthma asthma-copd overlap syndrome
what is the triad of aspirin induced asthma ?
rhinitis
sinusitis
asthma
when can magnesium sulfate be used ?
in exacerbations only
what are the biological treatments that can be used ?
anti IgE omalizumab
anti-il5/5r - reslizumab
anti il4/4r Duplimab
how do we asses inflammation phenotype in severe asthma ?
by looking at
sputum eosinophils > 2%
and/or FeNO> 20ppb
and/or blood eosinophils >150
if there is evidence of Th2 inflammation what treatment regimen should be opted for ?
there is ? biological
azithromycin
High OCS
no th2 inflamm ? LAMA , azithromycin, bronchial thermoplasty
how should the reversibility testing be done for the diagnosis of bronchial asthma ?
measure FEV1
then give salbutamol 200-400 mcg
wait 10 -15 minutes
an increase in 12% and 200ml is diagnostic for asthma
what is the most common method of administration of bronchodilators ?
inhalation
what are examples of b2 agonists ?
SABA - salbutamol
LABA -formoterol
Ultra-long lasting -indacaterol
what are the side effects of b2 agonists ?
tachycardia
arrhythmia
hypokalemia
tremors
anxiety
what is the method of administration of antimuscarinics ?
given by inhalation only
what are examples of antimuscarinic bronchodilators ?
SAMA - ipratropium bromide
LAMA - tiotropium bromide
what are the side effects of antimuscarinics ?
dry mouth
bitter/metallic taste
poor systemic absorption
what iis the dose for magnesium sulphate ?
single dose of 2gm infusion over 20 minutes
what are the side effects of using aminophylline and theophylline in asthmatic patients ?
gastritis
arrhythmia
convulsion
when is it called severe asthma ?
not controlled on any of the previous treatments despite avoiding risk factors and controlling co-morrbidities
what can be used for severe asthma ?
1- biologic treatment : anti IgE
anti IL4
Anti IL5
2- azithromycin
3- bronchial thermoplasty
early onset asthma is responsive to ?
steroids
late onst asthma iss responsiive to ?
LTRA and macrolides
what is useful when dealing with exersice induced asthma ?
prophylactic ICS-formeterol
what should be avoided in aspirin iinduced asthma ?
Aspirin aw NSAIDs
what should be given in aspirin induced asthma ?
LTRA
what should be given in asthma-COPD overlap syndrome ?
ICS + (LAMA and or LABA )
