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Pulmonology > Lecture 10: Asthma > Flashcards

Lecture 10: Asthma Flashcards

1
Q

Define asthma

A

An inflammatory process that leads to hyperresponsive airways and reversible airway obstruction

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2
Q

Causes of airflow obstruction (7 parts)

A

Bronchoconstriction, mucus plugging, bronchial wall edema, inflammatory infiltrate, airway remodeling (fibrosis), SM hypertrophy, uncoupling elastic recoil forces

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3
Q

Asthma represents an intra or extrathoracic obstruction. What does this mean for flow limitation during inspiration and expiration?

A

Intrathoracic: flow is decreased during expiration

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4
Q

How do we define obstruction (FEV1 / FVC)

A

FEV1 / FVC ratio of less than 0.7

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5
Q

Can you normalize obstruction with a bronchodilator in asthma?

A

Yes, you can completely normalize the FEV1 / FVC ratio

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6
Q

What is air trapping?

A

As aspect of asthma in which the alveolus cannot release air, leading to expanded alveolus

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7
Q

What does air trapping cause (in terms of RV/VC)?

A

Residual volume is greater, vital capacity is lower proportionally to TLC (which is fixed)

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8
Q

V/Q in asthma

A

Hypoxemia from V/Q mismatch (some airways more affected than others)

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9
Q

Mild asthma attack vs severe (in terms of PCO2)

A

PCO2 falls as functioning units can remove CO2; severe attacks can cause a rise in PCO2

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10
Q

Why does asthma increase pulsus paradoxus?

A

Large swings in intrapleural pressure due to battling increased pulmonary resistance increases pulsus paradoxus

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11
Q

Describe allergic asthma

A

Asthma exacerbated by exposure to various allergens

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12
Q

Allergic asthma pathophysiology (be sure to identify two phases)

A

An initial allergen causes an increase in Th2 CD4 cells, which release TH2 cytokines; re-exposure leads to IgE cross-linking on mast cells and histamine dumping + leukotrience production (early phase) –> bronchoconstriction and perpetuated inflammation via major basic protein (late phase)

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13
Q

Hygiene hypothesis

A

Exposure to infections early in life –> development of Th1-mediated response (protective immunity) and down regulation of Th2-mediated immune response (allergic diseases)

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14
Q

Th2 Cytokines

A

IL-4 –> B cells to synthesize IgE; IL-5 –> eosinophil maturation; IL-9 –> mast cell recruitment; IL-13 –> airway hyperresponsivneess and mucous secretion

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15
Q

Exercise-induced asthma pathophysiology

A

Exercise can provoke bronchoconstriction via cooling of air leading to fluid accumulation

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16
Q

Describe aspirin-exacerbated respiratory disease

A

Inhibition of cyclooxygenase pathway can shift pathway to production of bronchoconstrictor leukotrienes

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17
Q

Airway remodeling leads to…

A

Persistent airflow obstruction

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18
Q

Describe some features of airway remodeling (5)

A

Increase SM mass, increased mucous glands, inflammatory cells persist (ongoing inflammation), fibrosis/collagen deposition, elastolysis

19
Q

Symptoms of asthma

A

Cough, dyspnea, wheezing, chest tightness

20
Q

Signs of asthma

A

Wheezing, prolonged expiratory phase

21
Q

Why would you have no wheezing with severe asthma?

A

If asthma is so bad there is no airflow

22
Q

What is status asthmaticus?

A

Severe asthma attack refractory to treatment w/ bronchodilators that may require assisted ventilation

23
Q

What can be used during bronchoprovocation test?

A

Methacholine (stimulates SM receptors), mannitol (mast cell mediators), exercise, eucapnic voluntair hyperpnea

24
Q

If you give methacholine or mannitol, what do you measure?

A

PC20: conc of provacative med needed to cause fall in FEV1 by 20% (lower conc, higher chance of asthma)

25
Q

How does eucapnic voluntair hyperpnea work?

A

Fast breathing causes cooling, which can lead to asthma attack

26
Q

Asthma treatment (3)

A

Bronchodilators, anti-inflammatory agents, targeted therapy

27
Q

Bronchodilators

A

Sympathomimetics, anticholinergics

28
Q

Sympathomimetics should have what specificity? What is the chemical mediator?

A

Beta-2; cAMP –> SM relaxation

29
Q

What are some beta-2 agonists used to treat asthma and time course

A

Short: albuterol, Long: salmeterol, formoterol

30
Q

How do anticholinergics treat asthma? What are some drugs (4)?

A

Decrease bronchoconstrictor tone; ipratropium (short acting, M1, M2, M3), tioropium (long acting, blocks M1 and M3), umeclidinium/aclidinium (long acting, M3)

31
Q

Why can’t all anticholinergics be used to treat asthma?

A

Some do not cross into respiratory tract (scopolamine) and some cross BB barrier (atropine)

32
Q

How do methylxanthines work?

A

Block adenosine receptors, inhibit PDE, which leads to inhibited degredation of cAMP (more cAMP = SM relaxation)

33
Q

What are two methylxanthines? Are they used? Why?

A

Theophylline, aminophylline; NEVER USED; bad SEs (N, D, arrhythmias)

34
Q

Corticosteroides do what? How are they delivered?

A

Decrease airway inflammation through various mechanisms; inhaled to deliver drugs locally (want LOW bioavailability)

35
Q

What are some corticosteroids (note acute and chronic)

A

Belcomethoasone, fluticasone, mometasone; attacks: prednisone

36
Q

Largely, leukotrienes cause..

A

Bronchoconstriction

37
Q

What are medications that work on the leukotriene pathway?

A

Receptor antagonists: montelukast, zafirlukast, pranlukast; 5-LO inhibitor: zileuton

38
Q

What is omalizumab?

A

Recombinant humaized monoclonal IgG that binds IgE –> down regulation of IgE receptor on mast cells/basophils; “heavier” medication

39
Q

How does histamine lead to asthma?

A

Increased SM contraction, mucus production, etc…

40
Q

Antihistamine drugs

A

H1 blockers; Fist generation: diphenhydramine, hydroxyzine (cause significant sedation because cross BBB); Second generation: ioratadine, fexofenadine, cetirizine

41
Q

Does asthma respond to antihistamines?

A

No, not really

42
Q

What is bronchial thermoplasty?

A

Treatment for very sever asthma that reduces hypertrophic bronchial SM

43
Q

Asthma exacerbation meds

A

Short acting bronchodilators (albuterol + ipratropium)

44
Q

Asthma controller meds

A

Inhaled corticosteroid (2x a day), longer acting sympathomimetic/anticholinergic medication

Pulmonology (21 decks)

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