Module 3- Adult asthma

Question 1

Asthma Pathognomonic

Answer 1

common findings are airway inflammatory cell infiltration with eosinophils, neutrophils, lymphocytes- TCELLs, goblet cell hyperplasia, plugging of small airway with mucus, collagen deposition beneath the basement membrane, bronchial smooth muscle hypertrophy, airway edema, mast cell activation, denudation of epithelium

Question 2

Asthma Pathophysiology

Answer 2

Heterogeneous but divided into T2 high and T2 low

Question 3

Allergic Asthma

Answer 3

childhood, and associated with eczema, allergic rhinitis, or food allergy
inhaled allergens may cause symptoms immediately or 4-6 hours after allergen exposure
T2- high endotype
reducing exposure reduces findings and symptoms

Question 4

Common allergens

Answer 4

house dust mites, cockroaches, car dander and seasonal pollens

Question 5

T2 High endotype

Answer 5

allergic asthma, Late-onset, aspirin/NSAID associated respiratory disease

Question 6

T2 Low endotype

Answer 6

Non allergic asthma- Marked by neutrophils and inflammation and variable response to standard therapies

Question 7

Asthma with persistent airflow limitation

Answer 7

due to airway remodeling

Question 8

asthma with obesity

Answer 8

prominent respiratory symptoms on obese patients with little airway inflammation

Question 9

nonspecific precipitants of asthma

Answer 9

upper respiratory tract infection, rhinosinututus, postnasal drips, aspiration, gastroesophageal reflux, changes in the weather, stress and exercise

Question 10

Exercise- induced bronchoconstriction

Answer 10

begins during exercise or 3 min within 3 minutes after it ends, peaks within 10-15 minutes then resolves by 60 minutes

Question 11

cough variant asthma

Answer 11

main symptom is cough rather than wheezing

Question 12

Signs and symptoms of asthma

Answer 12

episodic wheezing, shortness of breath, chest tightness, and cough
often worst at nigh or morning,
prolong expiratory phase during normal breathing
chest examination btw exacerbation is normal during severe exacerbation airflow may be too limited to produce wheezing

Question 13

Lab findings with asthma

Answer 13

ABG- normal with mild but severe hypoxemia develops but returns to normal

Question 14

Pulmonary function testing

Answer 14

Spirometry, bronchoprovocation testing, Peak expiratory flow

Question 15

spirometry

Answer 15

forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC
Before and after the administration of short acting bronchodilator test if reversible- increase of 12% or more and 200 ml FEV1 or FVC suggest asthma

Question 16

Bronchoprovocation Testing

Answer 16

inhaled histamine or methacholine can help when spirometry test is negative, not recommended if FEV1 is less than 65%, Positive test is when FEV1 is 20% or more

Question 17

Peak expiratory flow (PEF)

Answer 17

Handheld meters are devices designed as personal monitoring tools, quantify asthma severity and control
PEF values vary with age, height, and sex and are poorly standardized

Question 18

Assessing control and severity of asthma

Answer 18

past 4 weeks
frequency of symptoms- days per week
awakening from sleep
frequency of SABA reliever use
severity is based of off level of control

Question 19

Severe & uncontrolled asthma

Answer 19

assess inhaler technique, medication adherence, comorbities, after addressing theses if patient remains on step 4-5, referral to pulmonary or asthma

Question 20

Inhaled corticosteroids
ICS

Answer 20

essential controller medication
as needed or Daily
Low-Medium- high doses
after symptom control for 3 months lower dose
mouth washing after to decrease systemic absorption and local side effects

Question 21

SE of ICS

Answer 21

Local- cough, dysphonia, oropharyngeal candidiasis
systemic effects- adrenal suppression, osteoporosis, skin thinning, easily bruising, cataracts

Question 22

Beta-adrenergic agonists

Answer 22

Short acting and Long
No one better than the other

Question 23

SABA

Answer 23

relaxing smooth muscles with rapid onset, repetitive administration produces incremental bronchodilation- 1-2 usually sufficient for mild to moderate
Severe 6-12 puff Q30-60mins

Question 24

LABA

Answer 24

Bronchodilation for up to 12 hours
salmetrerol formoterol
not to be used as mono-therapy
often used in combination with ICS

Question 25

Systemic Corticosteroids

Answer 25

primary treatment for mod to severe asthma exacerbations for patients who don’t respond to SABA, early administration is key- patients with mod-severe asthma should have prescription for home

Question 26

Systemic Corticosteroid dosing

Answer 26

Burst therapy- 0.5-1mg/kg/day up to 60mg in 1-3 doses for 3-7 days
long term administration require vit d and calcium supplements to prevent bone mineral loss

Question 27

Anticholinergics

Answer 27

reverse vaguely medicated bronchospasm but not allergen or exercise induced bronchospasm
decreases mucous gland hyper-secretion
short and long acting- SAMA- LAMA

Question 28

SAMA

Answer 28

Ipratropium bromide- can be added to SABA
less effective than SABA but used if pt are intolerance to SABA or bronchospasm due to beta-blocker medications

Question 29

LAMA

Answer 29

cornerstone treatment of COPD, used with medium dose ICS and salmeteral improves lung function

Question 30

Leukotriene modifiers

Answer 30

decreases leukotrienes, alternatives for ICS

Question 31

phosphodiesterase inhibitor

Answer 31

theophylline- mild bronchodilation, effective in nocturnal asthma,
narrow therapeutic window

Question 32

Mediator Inhibitors

Answer 32

cromolyn sodium and nedocromil- long term control for mild persistent or exercise-induced asthma

Question 33

Monoclonal antibody agents

Answer 33

pulmonologist or allergist to give
omalizumab, eslizumab, Dupilumab

Question 34

Vaccine for asthma

Answer 34

PNA vaccine and annul flu vaccine