PAHTOPHYS: Asthma Flashcards
What is asthma?
chronic inflammatory disorder of the airways, characterized by episodic, reversible bronchospasm resulting from exaggerated bronchoconstrictor response to various stimuli
What group has the highest death rate in asthma?
black race is associated with higher risk of asthma death
How is asthma classified at diagnosis?
Intermittent
Persistent
How is Intermittent asthma treated?
As needed albuterol
What drugs are added on if asthma is persistent?
Inhaled steroids (mild) LABAs (moderate) Leukotriene modifiers (severe)
What is the most common type of asthma? Who gets it?
Extrinsic asthma (IgE mediated response to environmental allergens) is common in children.
What is intrinsic asthma?
Adult-onset asthma triggered by respiratory infection and is NOT allergy mediated (skin antigen test is usually negative)
What types of drugs induce asthma?
Aspirin and NSAIDs (inhibit COX which shunts arachadonic acid metabolism toward leukotrienes)
What is first line therapy for drug-induced asthma?
Monteleukast
What is occupational asthma?
2-10% of adult onset asthma due to repeated exposure and sensitization to fumes, organic and chemical dusts, and gases at the workplace
What is exercise-induced asthma?
Asthma symptoms that occur usually immediately after exercise (5-10 minutes after)
What causes exercise-induced asthma?
cooling and mucosal drying of airways during exercise is thought to trigger mast cells to release histamine
How do you treat exercise-induced asthma?
Pre-treatment with cromolyn or beta-agonist
Slow warm up period
What may be a presentation of asthma that is not necessarily expected?
cough (due to irritants)
Why do people get nocturnal asthma?
decline in circulating catecholamines and cortisol
What is ABPA?
Allergic bronchopulmonary aspergillosis (asthma due to the fungi that leads to an IgE-mediated reaction)
What are diagnostic criteria of ABPA?
Poorly controlled asthma
Eosinophilia
IgE increased
How do you treat ABPA?
Prednisone (antifungals do not really help, need to wipe out eosinophils!)
What does aspergillosis fumigatus look like?
acute angle (looks like As)
What is airway hyper-responsiveness?
exaggerated bronchoconstrictive response by the airways to a variety of stimuli (that cause airflow obstruction)
What is the neural mechanism in asthmatics that is partially responsible for bronchospasm?
Elevated parasympathetic tone and reflex bronchosonstriction
What interleukin is relevent in asthma inflammation? COPD?
IL-5
IL-8 in COPD
During exacerbation, what cell type is most numerous in asthmatics? In COPD patients?
Asthma= neutrophilic
COPD= eosinophilic
(opposite of inflammation type!)
Why might viral tracheobronchitis be confused with asthma?
it leads to post-infectious bronchial hyperresponsiveness for up to 6 weeks
Death from asthma is usually related to what?
diffuse mucous plugging in the airways
Why do asthmatics have highest PEFR at 4pm and lowest at 4am?
decline of circulating catecholamines nd cortisol
What diurnal variation is considered diagnostic for asthma?
PEFR > 20% varied
True or false: methacholine challenge test has a high positive predictive value.
FALSE: it has a high negative predictive value (so it is good for RULING OUT asthma)
What asthma treatment should NOT be used?
primatene mist (epinephrine)
what asthma treatment has increased mortality association adn should be used cautiously?
LABAs
