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Pulm > Lec 10 Asthma > Flashcards

Lec 10 Asthma Flashcards

1
Q

Which pts most prevalently have asthma?

A

mostly children/young adults

low SES more at risk

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2
Q

What is radial traction?

A

idea that as you inhale –> pull airway and increase cross sectional area of airway

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3
Q

What happens to pleural pressure with inspiration?

A

decreases = bigger airway

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4
Q

Is ashtma obstructive or restrictive?

A

obstructive

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5
Q

What is intrathoracic vs extrathoracic obstruction?

A

intrathoracic: expiratory airway flow limitation; have wheeze on expiration

extrathoracic = wheezing on inspiration

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6
Q

What happens with asthma on pulm function test? what if you give bronchodilator?

A

FEV1/FVC < 07 or lower limit of normal

have scooped out look on pulm function graph

with bronchodilator have normalization of FEV1/FVC or FEV1 increase by 200 mL

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7
Q

What is peak expiratory flow?

A

if tubes have high resistance = can’t have flow as big

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8
Q

What is air trapping? What does this mean to lung volumes

A

increase resistance to expiration –> less flow out –> more air left in alveoli

= same TLC but bigger residual volume and smaller vital capacity

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9
Q

What happens to gas exchange in asthma?

A
  • increased airway resistance not evenly distributed

will have some degree of hypoxemia from V/Q mismtach

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10
Q

What happens to gas exchagne in mild vs severe asthma attack?

A

mild = pCO2 falls b/c other alveoli able to participate in gas exchange = primary respiratory alkalosis

severe = pCO2 rises b/c can’t ventilate properly; exacerbated by respiratory muscle fatigue

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11
Q

What is pulsus paradoxus?

A

systemic atrial P falls by < 10 during inspiration

can be caused by large swings in pleural pressure by asthma

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12
Q

How does asthma cause pulus paradoxus

A

negative intrathoracic P in inspiration –> increase blood return to RV –> septal bulging and decrease LV preload

increase LV afterload b/c of negative intrathoracic P

in expiration –> reversal

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13
Q

What is allergic asthma?

A
  • have underlying allergies, eczema, elevated IgE
  • exacerbated by exposure to allergens
  • family history of asthma or allergies
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14
Q

What is mech of allergic asthma

A
  • allergen inhaled
  • TH2 response –> eosinophils –> IgE
  • IgE cross-links on mast cells at re-challenge –> increase vascular permeability, bronchoconstriction, inflammatory cell recruitment, etc
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15
Q

What is pathology of asthma?

A
  • cellular infiltrates and edema within bronchial wall
  • epithelial damage
  • smooth muscle layer hypertrophy
  • increase mucous glands
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16
Q

What is hygiene hypothesis?

A
  • if exposure to microbes earlier in life –> TH1 mediated immune response down regulated TH2 response
  • if lack of exposure to microbes early in life –> overactive TH2 mediated immune response
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17
Q

What is action of each of the following TH2 cytokines?

IL4

  • IL-5
  • IL-9
  • IL-13
A
  • IL4 directs B cells to synthesizes IgE
  • IL-5 essential for eosinophil maturation
  • IL-9 mediates mast cell recruitment and function
  • IL-13 causes airway hyperresponsiveness and mucous hypersecretion
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18
Q

What happens in exercise induced asthma?

A

pathogenesis involves cooling of airway = breathing and hyperventilating –> dry cold air enters –> dries mucosa
–> bronchoconstriction

provokes bronchoconstriction in pt with hyperreactive airways

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19
Q

What is aspirin-exacerbated respiratory disease?

A
  • involved arachidonic acid path

- inhibit cyclooxygenase path –> produce bronchoconstrictor leukotrienes

20
Q

What is samter’s triad for aspirin exacerbated respiratory disease?

A
  • asthma
  • aspirin/NSAID sensitivity
  • nasal polyposis
21
Q

What kind of remodelling with asthma

A
  • increase smooth muscle mass
  • inflammatory cell persistence
  • muscle gland increase
22
Q

What are symptoms of asthma?

A
  • cough, dyspnea, wheezing, chest tightness
23
Q

What do you see on physical exam with asthma?

A

wheezing, prolonged expiratory phase

or may have no wheezing if not in midst of asthma attack or because no flow

24
Q

What is status asthmaticus?

A

severe asthma attack
doesnt respond to bronchodilators
may require assisted ventilation

25
Q

What are the 2 substances administered in bronchoprovocation tests? what do you test?

A
  • methacholine
  • mannitol

give the substance then measure PC20 = provocative concentration for a fall in FEV1 by 20% with methacholine

normal PC20 < 8 for asthmatics

26
Q

What is methacholine?

A
  • derivative of ACh

directly stimulates airway smooth muscle receptors

27
Q

What is manniotol?

A

increases osmolarity of airway surface and causes realease of mast cell mdiators

28
Q

How do you diagnose asthma?

A

no features really unique and universal

29
Q

What is treatment for asthma?

A
  • bronchodilators
  • anti-inflammatory agnets
  • targeted therapy
30
Q

What is action of sympathomimetics in asthma?

A

activate B receptor –> increase cAMP –> airway smooth muscle relaxation + inhibition of chemical mediator release from mast cells

B2 specific preferred to avoid adverse cardiac effects of B1

31
Q

What are examples of sympathomimetics used in asthma?

step1

A

albuterol = short acting 3 hrs

salmetrerol, formoterol = long action, for prophylaxis

32
Q

What is action of anticholinergics in asthma? 2 examples?

A
  • decrease bronchoconstrictor cholinergic tone to airways
ipratropium = lasts 6 hrs; blocks M1, M2, M3
tiotropium = lasts 24 hrs; blocks M1, M3
33
Q

What is action of methylxanthines in asthma? 2 examples? down sides?

A
  • inhibit phosphodiesterase which degrades cAMP –> increase cAMP –> bronchodilation
  • inhibits adenosine receptors
  • may be antiinflammatory
theophylline = oral
aminophylline = IV or PO

down sides = many side effects –> nausea, diarrhea, arrhythmias, CNS excitation

34
Q

What is action of corticosteroids in asthma treatment?

step1

A

inhibit synthesis of cytokines; inactivate NF-kB the transcription factor that induces production of TNF-alpha

1st line therapy for chronic asthma

35
Q

What are the 2 main corticosteroids used in chronic asthma?

A
  • beclomethasone

- fluticasone

36
Q

What is use of predinosine in asthma?

A

used for acute asthma attacks then tapered off

37
Q

What is action of montelukast/zafirlukast?

step1

A

both antileukotrienes
block leukotriene receptors

good for aspirin induced asthma

38
Q

What is action of zileuton?

step1

A

an antileukotriene

inhibits 5-lipoxygenase pathway
blocks conversino of arachidonic acid to leukotrienes

39
Q

What is action of omalizumab in astham?

A
  • monoclonal IgE antibody
    binds mostly unboudn serum IgE and blocks bindg to FceRI

used in allergic asthma resistant to inhaled steroids and long acting B2 agonists

40
Q

What is action of antihistamines in asthma?

A
  • block H1 receptor which mediates: bronchila smooth muscle contraction, increased nasal mucus production, vasodilation, increased vascular permeability etc
41
Q

What are the 2 first gen H1 blockers? downside?

A

diphenhydramin and hydroxyzine

cause significant sedation b/c easily cross BBB

42
Q

What are the three 2nd gen H1 blockers?

A
  • loratadine, fexofenadine, certirizine

lipophobic so don’t have the bad CNS effects

43
Q

What is action of IL-4

A
  • IL4 directs B cells to synthesizes IgE
44
Q

What is action of IL-5

A
  • IL-5 essential for eosinophil maturation
45
Q

What is action of IL-9

A
  • IL-9 mediates mast cell recruitment and function
46
Q

What is action of IL-13

A
  • IL-13 causes airway hyperresponsiveness and mucous hypersecretion

Pulm (24 decks)

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