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PULMONOLOGY > Chapter 281 - Asthma > Flashcards

Chapter 281 - Asthma Flashcards

1
Q

Prevalence of asthma in adults

A

10-12%

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2
Q

Prevalence of asthma in children

A

15%

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3
Q

Increasing prevalence of asthma in developing countries is due to

A

increased urbanization

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4
Q

Most patients with Asthma in affluent countries are due to

A

Atopy

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5
Q

Peak age of Asthma

A

3 years old

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6
Q

Prevalence of asthma according to sex

A

Children: 2:1
Adults: 1:1

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7
Q

The severity of asthma does not vary significantly within a given patient

A

True

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8
Q

Major risk factors for asthma deaths

A
  1. poorly controlled disease with frequent use of bronchodilator inhalers
  2. lack of or poor compliance with ICS therapy
  3. previous admissions to hospital with near-fatal asthma.
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9
Q

These are environmental factors which worsen asthma in a patient with established asthma

A

Triggers

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10
Q

Major risk factor for Asthma

A

Atopy

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11
Q

Allergic rhinitis is found in how many percent of asthmatic patients

A

> 80%

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12
Q

How many percent of the population in affluent countries are atopic

A

40-50%

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13
Q

Most common allergen to trigger asthma

A

Dermatophagoides pteronyssinus

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14
Q

Severity of Asthma is genetically determined

A

true

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15
Q

Most consistent finding in gene polymorphism of which chromosome

A

chromosome 5q

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16
Q

Th2 cells in asthma secrete these interleukins which are associated with atopy

A

IL-4
IL-5
IL-9
IL-13

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17
Q

Novel genes associated with Asthma but their function in disease pathogenesis is not yet clear

A

ADAM 33
DPP 10
ORMDL3

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18
Q

genetic polymorphism associated with reduced response to B2 agonists

A

Arg-Gly-16 variant in the B2 receptor

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19
Q

Epigenetic mechanisms associated

A

DNA methylation

Histone modification

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20
Q

Virus implicated in the development of asthma

A

RSV

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21
Q

What is the Hygiene hypothesis

A

Lack of infections in early childhood: preserves Th2

exposure to infectionsL shift to protective Th1

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22
Q

Infection with which intestinal parasite is associated with a reduced risk of asthma

A

Hookworm

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23
Q

Dietary factors associated with an increased risk of asthma

A

Low in antioxidants (Vit C, Vit A, Mg, Se, omega 3 PUFA)

High in Na and Omega 6 PUFA

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24
Q

Air pollutants triggering asthma symptoms

A

Diesel
Ozone
Sulfur dioxide

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25
Q

Rigorous allergen avoidance have shown reduced risk of asthma development

A

False

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26
Q

Which domestic pet has been associated with allergic sensitization

A

Cats

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27
Q

Which chemicals lead to sensitization independent of atopy

A

Toluene diisocyanate

Trimellitic anhydride

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28
Q

Asthma occurs more frequently in obese which which BMI?

A

> 30

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29
Q

Other factors implicated in asthma etiology

A 
Low birth weight
Low maternal age
Duration of breastfeeding
Prematurity
Inactivity
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30
Q

How many percent of asthmatic patients have negative skin tests to common inhalant allergens and normal serum concentration of IgE

A

10%

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31
Q

Characteristic of Intrinsic asthma

A 
non atopic
adult onset
aspirin sensitive
nasal polyps
more severe, persistent asthma
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32
Q

pollens usually trigger allergic rhinitis than asthma.But when disrupted, pollen grains may be released and can trigger what kind of asthma

A

Thunderstorm asthma

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33
Q

Most common triggers of acute severe exacerbation of asthma

A

URTI by rhinovirus, RSV, coronavirus

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34
Q

Mechanism of beta blockers causing asthma exacerbation

A

increased cholinergic bronchoconstriction

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35
Q

All beta blockers would be avoided including selective and topical BB

A

True

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36
Q

ACE-I induced cough is no more frequent in asthmatics than in non asthmatics

A

true

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37
Q

Mechanism of asthma in Exercise

A

Hyperventilation, resulting in increased osmolality, triggering mast cell release

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38
Q

Exercise induced asthma occurs when?

A

begins AFTER exercise has ended and recovers SPONTANEOUSLY within 30 mins

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39
Q

Sports commonly associated with asthma

A

cross country running in cold weather
overland skiing
ice hockey

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40
Q

EIA is best prevented how?

A

regular treatment with ICS

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41
Q

Mechanism of asthma in cold air and hyperventilation

A

increased osmolality triggering mast cell release

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42
Q

Food additive that may trigger asthma through the release of sulfur dioxide gas in the stomach

A

metabisulfite

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43
Q

How many months should a person be removed from he work exposure before complete recover in occupational asthma

A

within the first 6 months

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44
Q

Mechanism of premestrual worsening of asthma

A

fall in progesterone

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45
Q

Mechanism of stress induced asthmas

A

bronchoconstriction through cholinergic reflex

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46
Q

Degree of inflammation is poorly related to disease severity

A

true

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47
Q

Characteristic finding in Remodeling

A

thickening of the basement membrane due to subepithelial collagen deposition

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48
Q

Pathology of asthma is remarkably uniform in different phenotypes of asthma

A

true

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49
Q

Physiologic abnormality of asthma

A

airway hyperresponsiveness

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50
Q

Indistinguishable pattern of inflammation seen in intrinsic asthma

A

Neutrophilic pattern

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51
Q

Characteristic feature of asthmatic airways

A

Eosinophilic infiltration

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52
Q

Interleukin associated with eosinophilic inflammation

A

IL-5

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53
Q

Interleukin associated with increased IgE formation

A

Il-4 and 13

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54
Q

Major sources of mediators that drives chronic inflammation in asthmatic airways

A

Structural cells– epithelial cells, fibroblasts, airway smooth muscle cells

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55
Q

Th2 cytokines that mediate allergic inflammation

A

IL-4
IL-5
IL-9
IL-13

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56
Q

Th2 cytokines that amplify the inflammatory response and play a role n a more severe disease

A

TNF-a

IL-1B

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57
Q

Anti-inflammatory cytokines that are deficient in asthma

A

IL-10

IL-12

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58
Q

Oxidative stress in asthma is provided by the increased concentration of which product ?

A

8-isoprostane

59
Q

Increased oxidative stress is related to disease severity, it may amplify the inflam- matory response, and may reduce responsiveness to corticosteroids.

A

true

60
Q

Diagnostic test used in the diagnosis and monitoring of asthmatic inflammation

A

Fractional excretion of NO

61
Q

How does Epithelial damage contribute to AHR?

A
  1. loss of its barrier function
  2. loss of enzymes inflammatory mediators
  3. loss of a relaxant factor
  4. exposure of sensory nerves
62
Q

Subepthelial fibrosis n th basement membrane is associated with deposition of which collagen types

A

III and V

63
Q

Which interleukin is associated with with increased number of goblet cells contributing to mucus hypersecretion

A

IL-13

64
Q

Characteristic structural changes in asthma

A
  1. increased airway smooth muscle
  2. fibrosis
  3. angiogenesis
  4. mucus hyperplasia
65
Q

Direct bronchoconstrictors

A

histamine

methacholine

66
Q

Most triggers for asthma symptoms appear to act INDIRECTLY

A

True

includes allergens, exercise,, hyperventilation, fog, irritant dusts, sulfur dioxide

67
Q

Prodromal symptoms of an asthma attack

A
  1. itching under the chin
  2. discomfort between the scapulae
  3. inexplicable fear (impending doom)
68
Q

Airflow limitation in simple spirometry shows what findngs

A

reduced FEV1
reduced FEV1/FVC ratio
reduced peak expiratory flow

69
Q

How is reversibility demonstrated in asthma

A

> 12% AND 200-mL increase in FEV1 15 min after an inhaled SABA (albuterol 400 μg) or after a 2–4 week trial of OCS (prednisone or prednisolone 30–40 mg daily)

70
Q

What does the Flow volume loops show

A

reduced peak flow

reduced maximum expiratory flow

71
Q

Whole body plethysmography show which findings (although rarely necessary)

A

increased airway resistance
increased total lung capacity
increased residual volume

72
Q

increased AHR is normally mea- sured by methacholine or histamine challenge with calculation of the provocative concentration that reduces FEV1 by how much?

A

20%

73
Q

FEV1/FVC ratio diagnostic of asthma and copd

A

<70%

74
Q

Typical appearance of the flow volume loop indicating a widespread airflow obstruction

A

scalloped appearance

75
Q

CXR in asthma

A

normal

but may show hyperinflated lungs in more severe patients

76
Q

noninvasive test to measure eosinophilic airway inflammation and may be useful in demonstrating compliance with ICS therapy

A

FeNO

77
Q

How many percent of COPD patients have features of asthma ?

A

15%

78
Q

Bronchodilator therapies in asthma

A

B2 agonists
Anticholinergics
Theophylline

79
Q

Aims of asthma therapy

A
  • Minimal chronic symptoms, including nocturnal
  • Minimal exacerbations
  • No emergency visits
  • Minimal use of a required β2-agonist
  • No limitations on activities, including exercise
  • Peak expiratory flow circadian variation <20%
  • (Near) normal PEF
  • Minimal adverse effects
80
Q

Mode of action of B2 agonists

A
  1. relax airway smooth muscles
  2. inhibition of mast cell release
  3. reduction in plasma exudation
  4. inhibition of sensory nerve activation
81
Q

Duration of action of LABA (salmeterol and formoterol)

A

12 h

82
Q

LABA given on a once a day dosing

A

Indacaterol
Olodaterol
Vilanterol

83
Q

How is bronchodilator tolerance by mast cells reduced?

A

concomitant administration of ICS

84
Q

muscarinic receptor antagonists are less effective than B2 agonists

A

True

they inhibit only the cholinergic reflex component of bronchoconstriction, whereas β2-agonists prevent all bronchoconstrictor mechanisms

85
Q

Side effects of antimuscarinics

A

dry mouth
urinary retention
glaucoma

86
Q

Bronchodilator which acts by inhibiting the phosphodiesterase in airway smooth muscles

A

Theophylline

87
Q

anti-inflammatory effect of theophylline is mediated through which mechanism?

A

activation of HDAC2

88
Q

Theophylline level associated with an additional bronchodilator effect in severe asthma

A

10-20 mg/L

89
Q

Theophylline level associated with additive effects to ICS in severe asthma

A

5-10 mg/L

90
Q

Side effects of theophylline are rarely observed at plasma concentrations of what?

A

<10 mg/L

91
Q

Most effective anti-inflammatory agent in asthma therapy

A

ICS

reduces inflammatory cell numbers, eosinophils, activated T lymphocytes, surface mast cells

92
Q

Increases/Decreases clearance of theophylline

Rifampicin

A

Increase

93
Q

Increases/Decreases clearance of theophylline

Phenobarbitone

A

increase

94
Q

Increases/Decreases clearance of theophylline

Ethanol

A

Increase

95
Q

Increases/Decreases clearance of theophylline

Smoking

A

Increase

96
Q

Increases/Decreases clearance of theophylline

High protein, low carbohydrate diet

A

increase

97
Q

Increases/Decreases clearance of theophylline

Barbecued meat

A

increase

98
Q

Increases/Decreases clearance of theophylline

Childhood

A

increase

99
Q

Decreases clearance of theophylline

A 
cimetidine
erythromycin
ciprofloxacin
allopurinol,
zafirlukast
Congestive heart failure
Liver disease
Pneumonia
Viral infection and vaccination
High carbohydrate diet
Old age
100
Q

Side effects of ICS

A

hoarseness and oral candidiasis

101
Q

How many percent of asthma patients may require maintenance treatment with OCS

A

1%

102
Q

asthma therapy that blocks activation of cys-LT1-receptors which causes microvascular leakage and increase eosinophilic inflammation

A

Antileukotrienes

103
Q

Asthma therapy that inhibits mast cell and sensory nerve activation therefore effective in blocking trigger induced asthma such as EIA and allergen/sulfure dioxide induced symptoms

A

Cromones

104
Q

Methotrexate, cyclosporin A, azathioprine, gold, and IV gamma globulin have all been used as steroid-sparing therapies, but none of these treatments has any long-term benefit

A

True

105
Q

blocking antibody that neutralizes cir- culating IgE without binding to cell-bound IgE and, thus, inhibits IgE-mediated reactions

A

omalizumab

SQ every 2-4 weeks

106
Q

Drugs that block IL-5

A

mepolizumab

reslizumab

107
Q

Drug that blocks the IL-5 receptor

A

Benralizumab

108
Q

Nonpharmacologic treatments, including hypnosis, acupuncture, chiropraxis, breathing control, yoga, and speleotherapy lacks efficacy

A

true

109
Q

bronchoscopic treatment using thermal energy to ablate airway smooth muscle which reduce exacerbations and improve asthma control in patients not controlled on maximal inhaler therapy

A

Bronchial thermoplasty

110
Q

drug that blocks against the common receptor for IL-4 and IL-13 (IL-4Ra) showing promise in reducing exacerbations and improving asthma control

A

Dupilumab

111
Q

Partly controlled asthma

A 
daytime symptoms >2x/wk
any limitation of activities
any nocturnal sx/awakening
need for reliever >2x/wk
FEV1 <80% predicted
112
Q

How many features are needed for uncontrolled asthma

A

3 or more

113
Q

in acute severe asthma, what is the goal oxygen saturation?

A

> 90%

114
Q

treatment of acute severe asthma

A 
high doses SABA neb/MDI
IV B2 agonists
Anticholinergics neb/IV
MgSO4 IV/neb
Prophylactic intubation
Antibiotics NOT routine unless there are signs of pneumonia
115
Q

How many percent of patients are refractory to treatment despite animal inhaled therapy

A

5%

116
Q

most common reason for poor asthma control

A

poor adherence with ICS

117
Q

Corticosteroid resistant asthma is defined as?

A

failure to respond to a high dose of oral prednisone/ prednisolone (40 mg once daily over 2 weeks)

118
Q

Asthma showing a persistent pattern of variability and may require OCS or, at times, continuous infusion of β2-agonists

A

type 1 brittle asthma

119
Q

asthma showing a generally normal or near-normal lung function but precipitous, unpredictable falls in lung function that may result in death

A

type 2 brittle asthma

120
Q

Treatment of choice for type 2 brittle asthma

A

epinephrine SQ

121
Q

Phenotype of asthma prided by perennial rhinitis and nasal polyps in non atopic patients with a late onset of the disease

A

Aspirin-sensitive asthma

122
Q

In aspirin-sensitive asthma, All nonselective COX inhibitors should be avoided, but selective COX2 inhibitors are safe

A

true

123
Q

Patterns of asthma during pregnancy

A

1/3 improve
1/3 deteriorate
1/3 unchanged

124
Q

Drugs allowed during pregnancy

A

ICS
SABA
Theophylline

125
Q

In asthma in pregnancy, prednisone is preferred over prednisolone

A

true

126
Q

how many percent of asthmatics smoke?

A

20%

127
Q

Which can affect the response to antileukotrienes?

A

Repeats of an Sp1 recognition sequence in the promoter region if 5-Lipoxygenase

128
Q

Which bacteria have been implicated in the mechanism of severe asthma development?

A

Mycoplasma and Chlamydophila

129
Q

How many percent of young adults are affected by occupational asthma

A

10%

130
Q

Acetaminophen consumption in childhood increases risk of developing asthma through which mechanism?

A

Increased oxidative stress

131
Q

Which cytokine released from epithelial cells in asthmatic patients instructs dendritic cells to release chemokines that attract Th2 cells into the airways ?

A

Thymic stromal lymphopoietin

132
Q

Which chemokine is selectively attractant to eosinophils vis CCR3

A

Eotaxin

133
Q

Which chemokines attract Th2 cells via CCR4

A

CCL17 (TAR )

CCL22(MDC)

134
Q

How is the diurnal variation in air flow obstruction confirmed?

A

PEF twice daily

135
Q

Increased AHR is measured by methacholine or histamine challenge with calculation of the provocative concentration that reduces FEV1 by how much?

A

20%

136
Q

What test is done to demonstrate post exercise bronchoconstriction if there is a predominant history of EIA?

A

Exercise testing

137
Q

Upper airway obstruction is a differential diagnosis of BA that is confirmed how?

A

Flow volume loop showing reduction in inspiratory and expiratory flow.

138
Q

Theophylline at high concentrations cause cardiac arrhyrhmias, epileptic seizures, death through which mechanism

A

Adenosine A1-receptor antagonism

139
Q

How is hoarseness and oral candidiasis reduced in patients using ICS

A

Use of a large volume spacer device

140
Q

Intranuscular triamcinolone acetonide is a depot preparation used in NON COMPLIANT patients but what is the major problem with this therapy?

A

Proximal myopathy

141
Q

Incidence of steroid resistant asthma

A

<1 in 1000 patients

142
Q

4 mechanisms of corticosteroid resistant asthma

A
  • increase in GR-B
  • Abnormal pattern of histone acetylation
  • defect in Il-10 production
  • reduction in HDAC2 activity
143
Q

Proportion of asthmatics who become worse with aspirin and other COX inhibitors

A

1-5%

144
Q

Which set of patients require a boost of OCS prior to surgery?

A

patients with FEV1 <80%

PULMONOLOGY (10 decks)

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