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Supporting Life > Hypersensitivity and Asthma > Flashcards

Hypersensitivity and Asthma Flashcards

1
Q

Type I

A

Immediate. Anaphylaxis, allergy and atopy

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2
Q

Type II

A

Antibody mediated. Complement and recruitment

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3
Q

Type III

A

Immune complexes - pathology determined by which tissues they are deposited in
Ab-Ag interaction but soluble complexes not cleared
Complement, neutrophils and macrophages

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4
Q

Type IV

A

Cell mediated (delayed response: 24-48 hours)
CD4 ->Th1, 2 and 17 activated -> cytokines
CD8 response

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5
Q

Which type of asthma responds well to ICS?

A

Allergic asthma

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6
Q

Which type of asthma is eosinophilic?

A

Allergic asthma

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7
Q

Which cells are contained in non-allergic asthma sputum?

A

Neutrophils/Eosinophils/neither

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8
Q

Does non-allergic asthma respond well to ICS?

A

Less so than allergic

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9
Q

Diagnosis of asthma:

A

Skin prick wheal > 3mm
IgE > 100 IU/ml
Tryptase levels (transient over 24-48 hours)
Radio-allergo sorbent test; BAT; MAT

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10
Q

Leukotrienes from which inflammatory cell cause vasodilation, bronchoconstriction and inflammation?

A

Basophil

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11
Q

Which interleukin causes eosinophil degranulation?

A

IL-5

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12
Q

Which interleukin causes mucus production?

A

IL-13

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13
Q

Degranulation of which inflammatory cell causes bronchoconstriction and inflammation?

A

Eosinophil

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14
Q

What are the airway symptoms of asthma?

A

Wheezing, SOB, rhinitis, sneezing, runny nose

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15
Q

What are the eye symptoms of asthma?

A

Conjunctivitis

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16
Q

What are the skin symptoms of asthma?

A

Atopic dermatitis

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17
Q

What are the gut symptoms of asthma?

A

Food allergy

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18
Q

Which type of asthma tends to present later and to which demographic?

A

Non-allergic, women

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19
Q

What are the symptoms of long-standing asthma?

A

Fixed airflow limitation and airway remodelling

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20
Q

What makes up inflammatory infiltrate?

A

Recruitment, Th2 cells, mast cells and eosinophils

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21
Q

Histology of asthma:

A

Leaky epithelium, reticular BM thickening, airway SM thickening, submucosal gland hypertrophy

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22
Q

Key features of asthma!

A

Irreversible airway narrowing, constant bronchoconstriction to random stimuli, mucosal inflammation and airway remodelling

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23
Q

Which type II hypersensitivity condition is characterised by Abs against the TSH receptor?

A

Grave’s disease

24
Q

Which type II hypersensitivity condition is characterised by Abs against the Ach receptor?

A

Myasthenia gravis

25
Q

Which type is late-onset asthma?

A

Type IV

26
Q

Which type is early onset asthma?

A

Type I

27
Q

What does reduction in FEV1 mean?

A

Lower volume of air can be expelled in the first second

28
Q

If an asthma patient is using their accessory muscles what is their status?

A

Sever exacerbation

29
Q

What is the immediate treatment for an acute asthma exacerbation?

A

SABA: 4-10 puffs pMDI + spacer (every 20 mins for an hour)
Prednisolone: 1 mg/kg adults; 1-2 mg/kg children

30
Q

What are the target O2 sats for an acute asthma exacerbation?

A

90-95%

31
Q

What is the urgent treatment for a severe acute asthma exacerbation? (6 drugs)

A 
SABA (nebuliser)
Ipratropium bromide
O2
Systemic corticosteroid
IV Magnesium
High dose ICS
32
Q

What are the features of a life-threatening asthma exacerbation?

A

Drowsy, confused or silent chest

33
Q

Clinical features of a mild/moderate asthma exacerbation:

A

Raised RR
PR: 100-120 bpm
O2: 90-95%
PEF > 50% predicted/ best

34
Q

Clinical features of a severe asthma exacerbation:

A

RR > 30
PR > 120 bpm
O2 < 90%
PEF lower than/equal to 50% predicted/best

35
Q

Discharge from acute exacerbation criteria:

A

SABA not needed, PEF > 60-80% predicted/best, O2 > 94% on room air + resources at home

36
Q

Stage 1 treatment =

A

SABA (< twice a month with no night waking/exacerbations)

37
Q

Stage 2 treatment =

A

Low does ICS and SABA as needed

38
Q

Stage 3 treatment =

A

Low dose ICS and LABA

39
Q

Stage 4 treatment =

A

Medium-high ICS and LABA

40
Q

Stage 5 treatment =

A

Refer for additional treatment of monoclonal Abs

41
Q

Formaterol, salmeterol and volanterol are all examples of what?

A

LABA

42
Q

SABA and LABAs are examples of?

A

Selective beta-2 adrenoreceptor agonists (bronchodilators)

43
Q

Name short and long acting anticholinergic/muscarinic receptor antagonists: (also bronchodilators in addition to -BAs)

A

Ipratropium (short)

Tiotropium , umeclodinium (long)

44
Q

What added effect does Tiotropium have over other bronchodilators?

A

Attenuates IL-13 induced goblet cell hyperplasia and reduces mucus secretion

45
Q

What is the only licensed once daily inhaler drug combination?

A

Futicasone furoate and vilanterol

46
Q

What do ICSs suppress?

A

Th2 ‘type 2’ airway inflammation and eosinophilia

47
Q

Which ICS has a long action?

A

Futicasone Furoate (FF)

48
Q

Which treatment is used for AERD asthma?

A

LTRA - Montelukast (once daily, oral)

49
Q

What are the side effects of prednisolone?

A

Obesity, diabetes, cataracts, reflux, glaucoma, osteoporosis, skin disease, psychological conditions

50
Q

Which monoclonal antibody drugs target IL-5?

A

Mepolizumab, Reslizumab and Benralizumab

51
Q

Which monoclonal antibody drug targets IgE?

A

Omalizumab

52
Q

What action to biologics against IgE and IL-5 share?

A

Stop the activation of eosinophils

53
Q

What is the most common cause of exacerbations?

Can be normalised by omalizumab

A

Viral infection

54
Q

Anti - IL-4R biologic?

A

Dupilumab (stops Th2 activation of B cells)

55
Q

Anti - TSLP biologic?

A

Tezepelumab (reduces IL-13,5 release)

56
Q

CRTH2 antagonist biologic?

A

Fevipiprant (reduces IL-13,5 release)

Supporting Life (14 decks)

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