Lecture 1

Question 1

Define asthma

Answer 1

Heterogenous disease
chronic airway inflammation

Question 2

What history of respiratory symptoms does asthma have

Answer 2

wheezing
shortness of breath
chest tightness
cough

Question 3

4 things causing people to have asthma

Answer 3

Narrowed airway
tightened muscles constricting airway
inflamed/thickened airway wall
mucous

Question 4

endogenous risk factors (6)

Answer 4

1. Genetic predispositon
2. Atopy (tendency to develop allergic reaction)
3. Airway hyperresponsiveness
4. Gender (males > women)
5. Obesity (in woman)
6. Early viral infections

Question 5

6 environmental risk factors

Answer 5

indoor allergens (mold)
outdoor allergens (pollen)
occupational sensitizers
smoking
respiratory infections
diet

Question 6

Mast Cells Function

Answer 6

-degranulation after exposure to allergens through an IgE dependent mechanism.
-results in the release of bronchoconstrictor mediators

Question 7

what are some bronchoconstrictor mediators

Answer 7

histamine, PG D2, leukotrienes, cytokines, growth factors, neutrophils

Question 8

Macrophages function

Answer 8

• Serve as scavengers engulfing and digesting bacteria and other foreign material
• can release cytokines which initiate a type of inflammatory response

Question 9

Dendritic cells

Answer 9

• specialized macrophage-like cells in the airway epithelium
• take up allergens, process them to peptides, and present them to T lymphocytes in the lymph nodes to stimulate production of th2 cells

Question 10

eosinophils function

Answer 10

• release proinflammatory mediators (leukotrienes, granule proteins), cytotoxic mediators, cytokines

Question 11

T lymphocytes

Answer 11

release of specific patterns of cytokines which result in the maintenance of eosinophils and mast cells in the airways

Question 12

asthmatic airways have more of which cells

Answer 12

TH2 cells! in regular individuals, TH1 and TH2 balance each other out

Question 13

Name the 5 inflammatory cells

Answer 13

Mast cells, macrophages, dendritic cells, eosinophils, T lymphocytes

Question 14

Name 5 structural cells

Answer 14

airway epithelial cells, airway smooth muscle cells, endothelial cells, fibroblasts and myofibroblasts, airway nerves

Question 15

what are structural cells

Answer 15

source of mediators that drive chronic inflammation in asthmatic individuals

Question 16

airway epithelial cells function

Answer 16

express inflammatory proteins, release cytokines, chemokines, and lipid mediators if physical activatioina

Question 17

airway smooth muscle cells

Answer 17

express similar inflammatory proteins as airway epithelial cells
show increased proliferation and growth in asthma

Question 18

endothelial cells function

Answer 18

recruit inflammatory cells from the circulation into the airway

Question 19

fibro and myofibroblasts

Answer 19

produce connective tissue components such as collagens and proteoglycans that are involved in airway remodelling

Question 20

airway nerves function

Answer 20

• activation of cholinergic nerves may cause bronchoconstriction and mucus secretion
• sensory nerves that may be sensitized by inflammatory stimuli can cause symptoms such as cough and chest tightness

Question 21

name 4 cellular mediators

Answer 21

chemokines, cysteinyl leukotrienes, cytokines, histamine, prostaglandin D2

Question 22

Chemokines function

Answer 22

recruitment of inflammatory cells into the airways

Question 23

cysteinyl leukotrienes

Answer 23

bronchoconstrictors and pro-inflammatory mediators

Question 24

cytokines

Answer 24

Orchestrate the inflammatory response in asthma

Question 25

histamine

Answer 25

released from mast cells and contribute to bronchoconstriction and to the inflammatory response

Question 26

prostaglandin D2

Answer 26

bronchoconstrictor involved in Th2 cell recruitment in the airways.

Question 27

3 steps of asthma process

Answer 27

1. allergen activates dendritic cells and mast cells 2. these cells release proinflammatory mediators which increase proliferation of TH2 and release chemical mediators 3. causes contraction of airway smooth muscle, bronchoconstriction, narrowing etc.

Question 28

how quick does early phase happen and what therapy is it amenable to

Answer 28

10-20 mins from exposure, bronchodilator therapy

Question 29

how quickly does late phase happen, amenable to

Answer 29

4-8 hours after initial reaction, inhaled corticosteroids therapy

Question 30

4 things contributing to airway narrowing

Answer 30

airway smooth muscle contraction, edema, thickening, mucous hypersecretion

Question 31

airway hyperresponsiveness 4 things

Answer 31

excessive contraction of airway smooth muscle, uncoupling of airway contraction, thickening of airway wall, sensory nerves

Question 32

symptoms of asthma are worse at _____ and ____

Answer 32

night and early morning

Question 33

decreased probability that symptoms are due to asthma if

Answer 33

- isolated cough with no other respiratory symptoms - chronic production of sputum - SOB associated with dizziness, light-headedness, or peripheral tingling - chest pain - exercise-induced dyspnea with noisy inspiration (stridor)

Question 34

most frequent physical finding for asthma

Answer 34

wheezing on auscultation, especially on forced expiration