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BRS Year 2 > CVR asthma and respiratory immunology > Flashcards

CVR asthma and respiratory immunology Flashcards

1
Q

cardinal features of asthma (4)

A
  1. wheeze
  2. atopy
  3. reversible airflow obstruction
  4. airway inflammation
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2
Q

what do you test for to confirm asthma diagnosis? (3)

A
  1. atopy
  2. reversible airflow obstruction
  3. airway inflammation -> eosinophilia and type 2 - lymphocytes
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3
Q

way to check for reversible lung obstruction

A

lung function tests

e.g. spirometry (obtain flow volume loop from this)

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4
Q

what does allergic reaction cause in the airway? (2)

A
  1. airway remodelling

2. inflammation

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5
Q

which layers are affected in the airway during allergic asthma?

A

all of them

(bronchial epithelium, matrix, smooth muscle)

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6
Q

why do only some people who have allergies have asthma?

A

genetic susceptibility

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7
Q

what genes are more prevalent in asthma?

A

IL-33 gene

GSDMB

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8
Q

What is type 2 immunity?

A

the adaptive response to allergen exposure in atopic individuals`

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9
Q

what are the antigen-presenting cells in the lung?

A

dendritic cells

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10
Q

what do dendritic cells carry antigens via in the type 2 immune response?

A 
MHC class II
-> go to lymph nodes, causes TH0 cells to turn in to TH2 cells
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11
Q

what ILs are secreted by Th2 cells in the type 2 immune allergic response?

A

4,5, 13

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12
Q

what does IL-5 promote?

A

eosinophil recruitment and prolonged survival

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13
Q

what does IL-4 promote?

A

b cell secretion of IgE

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14
Q

what does IL-13 promote?

A

mucous secretion

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15
Q

what does activated IgE bind?

A

mast cells

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16
Q

what do mast cells release when they degranulate?

A

GFs, cytokines, chemokines

-> histamines, nicotinoids, type II mediators

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17
Q

diagnostic test for allergic sensitisation

A
  1. bloods for specific IgE antibodies

2. skin prick test (wheel and flare if allergic)

18
Q

what can be exhaled in a breath test, when someone in asthmatic?

A

nitric oxide

-> elevated = supportive of diagnosis

19
Q

what can FeNO have a role in aiding?

A
  1. asthma diagnosis
  2. predicting steroid responsiveness
  3. assessing adherence to inhaled corticosteroids (should be low if compliant)
20
Q

NICE asthma diagnosis guidelines

A

clinical: history and examination, assess/confirm wheeze when acutely unwell

Spirometry: FEV1/FVC ratio: <0.7
Reversibility of airway obstruction: bronchodilator reversibility >=12%
Exhaled nitric oxide > 35ppb (kids), >40 (adults)

21
Q

aim of asthma treatments (2) and example of how to manage asthma (1)

A
  1. reduce airway eosinophilic inflammation
  2. acute symptomatic relief
  3. severe asthma = steroid-sparing therapies
22
Q

how to reduce airway eosinophilic inflammation

A
  1. inhaled corticosteroids

2. leukotriene receptor antagonists

23
Q

how to provide acute symptomatic relief (2)

A
  1. beta-2agonists

2. anticholinergic therapies

24
Q

examples of steroid-sparing therapies

A
  1. biologic targeted to IgE (anti-IgE AB)

2. Biologic targeted to airway eosinophils (anti-IL5-AB, anti-IL5receptor- AB)

25
Q

how to corticosteroids reduce eosinophil count?

A

promoting apoptosis

26
Q

what do corticosteroids do to type 2 mediators?

A

reduce them

27
Q

what do corticosteroids do to mast cells in asthma?

A

reduce their number

28
Q

what is the most important aspect of asthma management?

A

adherence to inhaled corticosteroids

29
Q

facets of asthma management (3)

A
  1. optimal device technique
  2. clear asthma management plan
  3. adherence to inhaled corticosteroids
30
Q

what must patients, even with mild asthma, always be prescribed?

A

a preventor

-> never just give as-required bronchodilators, always start with anti-inflammatory therapy

31
Q

what do you do if patient doesn’t response to inhaled corticosteroids and/or LTRA?

A

refer to a specialist

-> same for children

32
Q

how do beta-2 agonists help with asthma?

A

stimulate the beta-2 receptors in the airway, found on muscle: allows muscle to relax.

33
Q

what change in environment can cause an asthma attack?

A
  • suddenly cold

- allergen presence

34
Q

what is reduced in patient with asthma caused by infection?

A

reduced anti-viral response

- IFN alpha, beta and lamda(?) reduced

35
Q

name of anti-IgE AB used?

A

omalizumab

36
Q

criteria to be given omalizumab?

A

severe, persistent allergic mediated asthma in patients aged >= 6 years. Require frequent or continuous treatment with oral corticosteroids

37
Q

how is dose of omalizumab decided? (2)

A

weight and serum IgE

38
Q

how is omalizumab given?

A

2-4 weekly s/c injection

39
Q

what is mepolizumab?

A

anti-IL5-antibody

40
Q

who is given mepolizumab?

A

people with severe eosinophilic asthma

- suitable for adults and kids >=6yrs

41
Q

how does IL-5 work?

A

regulates growth, recruitment, activation and eosinophil survival

BRS Year 2 (110 decks)

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