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PULMO: BRONCHIAL ASTHMA Flashcards

1
Q

The rising prevalence of asthma in developing countries is associated with?

A

INCREASED URBANIZATION

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2
Q

Most patients with asthma in affluent countries are ATOPIC, with allergic sensitization to the…

A

HOUSE DURST MITE (DERMATOPHAGOIDES PTERONYSSINUS) and other environmental allergens, such as animal fur and pollens.

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3
Q

Peak age of asthma presentation

A

THREE YEARS OLD

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4
Q

TRUE OR FALSE.

In childhood, twice as many males as females are asthmatic, but by adulthood the sex ratio has equalized.

A

TRUE

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5
Q

TRUE OR FALSE.

Adults with asthma, including those with persistent symptoms during adulthood, RARELY become permanently asymptomatic.

A

TRUE

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6
Q

TRUE OR FALSE.

The severity of asthma DOES NOT vary significantly within a given patient.

A

TRUE.

Those with mild asthma RARELY progress to a more severe disease, whereas those with SEVERE asthma usually have SEVERE disease at the onset.

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7
Q

Deaths from asthma are relatively UNCOMMON.

A rise in asthma mortality seen in several countries during the 1960s was associated with…

A

INCREASED USE OF SABA (AS RESCUE THERAPY).

But there is now compelling evidence that the more widespread use of inhaled corticosteroids (ICS) in patients with persistent asthma is responsible for the decrease in mortality.

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8
Q

Three major risk factors for ASTHMA DEATHS

A
  1. Poorly controlled disease with frequent use of bronchodilators
  2. Lack of or poor compliance with ICS therapy
  3. Previous admissions to hospital with near-fatal asthma
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9
Q

RISK FACTORS AND TRIGGERS INVOLVED IN ASTHMA

A
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10
Q

SIX ENDOGENOUS RISK FACTORS IN ASTHMA

A 
GAGO EE!
Genetic predisposition 
Atopy
Gender
Obesity

Ethnicity
Early viral infections

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11
Q

NINE ENVIRONMENTAL RISK FACTORS IN ASTHMA

A

O, PRADA DIO!

Occupational sensitizers

Passive Smoking
Respiratory infections
Air pollution (diesel particulates, nitrogen oxides)
Dampness and mold exposure
Acetaminophen (Paracetamol)

Diet
Indoor allergens
Outdoor allergens

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12
Q

Major risk factor for asthma

A

ATOPY

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13
Q

Patients with asthma commonly suffer from OTHER ATOPIC DISEASES, particularly…

A 
ALLERGIC RHINITIS (found in >80%)
ATOPIC DERMATITIS (eczema)
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14
Q

The allergens that lead to sensitization (of atopic individuals) are usually…

A

PROTEINS THAT HAVE PROTEASE ACTIVITY.

The most common allergens are derived from house dust mites, cat and dog fur, cockroaches (in inner cities), grass and tree pollens, and rodents (in lab workers).

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15
Q

TRUE OR FALSE

There is a high degrees of concordance for asthma in identical twins.

A

TRUE

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16
Q

The most consistent findings of genetic predisposition in asthma have been associations with…

A

POLYMORPHISMS OF GENES ON CHROMOSOME 5q, including the T helper cells (TH2) IL 4/5/9/13 - associated with Atopy.

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17
Q

Virus infection in infancy implicated in the development of asthma

A

RESPIRATORY SYNCYTIAL VIRUS

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18
Q

Living in a damp house with exposure to ________________ is now recognized to be a risk factor.

A

MOLD SPORES

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19
Q

TRUE OR FALSE.
The observation that allergic sensitization and asthma were LESS COMMON in children with older siblings suggested that LOWER LEVELS OF INFECTION MAY BE A FACTOR in affluent societies that INCREASES the risk of asthma.

A

TRUE

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20
Q

What does the HYGIENE HYPOTHESIS propose?

A

LACK OF INFECTIONS in early childhood PRESERVES THE TH2 CELL BIAS AT BIRTH, whereas exposure to infections and endorphin results in a shift toward a PREDOMINANT PROTECTIVE TH1 IMMUNE EXPOSURE.

-Children brought up on farms or intestinal parasitisim may also be associated with a reduced risk of asthma.

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21
Q

Low consumption of the following is associated with an INCREASED RISK of asthma

A
  1. Low vitamin C, A, D
  2. Low magnesium
  3. Low selenium
  4. Low omega 3 polyunsaturated fats (fish oil)
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22
Q

High consumption of the following is associated with an INCREASED RISK of asthma

A
  1. High sodium

2. High omega 6 polyunsaturated fats

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23
Q

An independent risk factor for asthma particularly in women.

A

OBESITY

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24
Q

There is increasing evidence that exposure to road traffic pollution is associated with increased asthma symptoms, with the main culprits being….

A

DIESEL PARTICULATES

NITROGEN DIOXIDE

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25
Q

Indoor air pollution is also important with exposure to ___________________ from cooking stoves and exposure to passive cigarette smoke.

A

NITROGEN OXIDES

26
Q

TRUE OR FALSE

Rigorous allergen avoidance has not shown any evidence for a reduced risk of developing asthma.

27
Q

TRUE OR FALSE
The increase in house dust mites in centrally heated poorly ventilated homes with fitted carpets has been implicated in the increasing prevalence of asthma in affluent countries.

28
Q

TRUE OR FALSE

Early exposure to CATS in the home MAY BE PROTECTIVE through the induction of TOLERANCE.

29
Q

This type of asthma is suspected when symptoms improve during weekends and holidays.

A

OCCUPATIONAL ASTHMA

30
Q

Occupational asthma may affect up to___ of young adults.

31
Q

TRUE OR FALSE

Asthma occurs MORE FREQUENTLY in OBESE PEOPLE (>30 kg/m2)

A

TRUE.

It may also be linked to the PRO-INFLAMMATORY ADIPOKINES and reduced anti-inflammatory ADIPOKINES thatvare released from fat cells.

32
Q

FIVE other factors implicated in the etiology of asthma

A
  1. LOWER MATERNAL AGE
  2. DURATION OF BREASTFEEDING
  3. PREMATURITY AND LOW BIRTH WEIGHT
  4. INACTIVITY
  5. ACETAMINOPHEN (PARACETAMOL) CONSUMPTION IN CHILDHOOD (linked to oxidative stress)
33
Q

Characteristics of NON-ATOPIC or INTRINSIC ASTHMA

A
  1. Usually show later onset of disease (adult-onset)
  2. Commonly have concomitant nasal polyps
  3. May be aspirin-sensitive
  4. Usually have more severe, persistent asthma
  5. Immunopathology in bronchial biopsies and Sputum appears to be identical in atopic asthma
  6. Staphylococcus enterotoxins (superantigens) have been implicated
  7. Type 2 innate lymphoid cells (ILC2) may drive the eosinophilic inflammation
34
Q

11 asthma triggers

A
  1. Allergens
  2. Virus infections
  3. Pharmacological interventions
  4. Exercise
  5. Physical factors
  6. Food and diet
  7. Air pollution
  8. Occupational factors
  9. Hormones
  10. Gastroesophageal reflux
  11. Stress
35
Q

The MOST COMMOM ALLERGENS to trigger asthma

A

DERMATOPHAGOIDES SPECIES

Environmental exposure leads to low-grade Chronic symptoms that are perennial

36
Q

What is THUNDERSTORM ASTHMA?

A

POLLENS usually cause allergic rhinitis than asthma

But in thunderstorms, pollen grains are disrupted and the particles that may be released can trigger severe asthma exacerbation (thunderstorm asthma)

37
Q

THREE most common VIRAL triggers of asthma

A

URTI

  1. Rhino virus
  2. Respiratory syncytial virus
  3. Corona virus

Mechanisms:
Increase in airway inflammation with increased numbers of eosinophils and neutrophils

REDUCED production of TYPE I INTERFERONS by epithelial cells resulting in greater susceptibility

38
Q

TRUE OR FALSE

Beta adrenergic blockers commonly acutely worsen asthma. All beta-blockers need to be avoided.

A

TRUE. Even selective Beta, Beta 2 blockers, or topical application (eg timolol eye drops).

39
Q

TRUE OR FALSE.

ACEi are theoretically detrimental for asthma.

A

TRUE. ACEi inhibit breakdown of kinins, which are bronchoconstrictors. However they rarely worsen asthma.

40
Q

EXERCISE-INDUCED ASTHMA mechanism

A

Linked to hyperventilation

Results in increased osmolality in airway lining fluid

Triggers mast cell mediator release resulting in bronchoconstriction

41
Q

EIA characteristics

A
  1. Begins AFTER exercise has ended
  2. Recovers spontaneously within about 30 minutes
  3. Worse in cold, dry climates (more common in sports such as cross-country running, overland skiing, and ice hockey than in swimming)
42
Q

How can exercise-induced asthma be prevented?

A

PRIOR ADMINISTRATION OF BETA AGONISTS and ANTILEUKOTRIENES

43
Q

How to BEST PREVENT EIA?

A

REGULAR TREAMENT WITH ICS

Reduces the population of surface mast cells

44
Q

Physical factors that trigger asthma

A
  1. Cold air
  2. Hyperventilation
  3. Laughter
45
Q

Food additives that may trigger asthma

A

METABISULFITE (food preservative, through release of sulfur dioxide gas in stomach)

TARTRAZINE (yellow food coloring agent)

46
Q

Air pollution that triggers asthma

A

Sulfur dioxide
Ozone
Diesel particulates
Nitrogen oxides

47
Q

Occupational Asthma characteristics

A

Associated with symptoms at work
Relief of symptoms on weekends and holidays

If removed from exposure within the first 6 months of symptoms, there is USUALLY complete recovery

48
Q

Why is there pre menstrual worsening of asthma?

A

Fall in progesterone in severe cases

49
Q

Other hormones that can worsen asthma

A

Thyrotoxicosis

Hypothyroidism

50
Q

Why is GERD common in asthmatic patients?

A

Increased by bronchodilators

51
Q

How do psychological factors induce bronchoconstriction?

A

Through cholinergic pathways

52
Q

Main pathophysiology of asthma

A

CHRONIC INFLAMMATION OF THE MUCOSA OF THE LOWER AIRWAYS.

53
Q

Airway mucosa in autopsy of asthmatics reveals…

A

Infiltration with:

Activated eosinophils, T lymphocytes, Mucosal mast cells

54
Q

TRUE OR FALSE

The degree of inflammation is POORLY RELATED to disease severity

55
Q

Characteristic finding of airway REMODELING in asthma

A

THICKENING OF THE BASEMENT MEMBRANE DUE TO SUBEPITHELIAL COLLAGEN DEPOSITION

56
Q

Description of mucous plug seen in airway lumen of fatal asthma

A

MUCOUS PLUG

  • MUCOUS GLYCOPROTEINS from goblet cells
  • PLASMA PROTEINS from leaky bronchial vessels
57
Q

TRUE OR FALSE

There is also vasodilation and angiogenesis

58
Q

TRUE OR FALSE

The pathology of asthma is remarkably uniform in different phenotypes of asthma

A

TRUE

  • The pathologic changes are found in all airways but to not extend to the lung parenchyma
  • Peripheral airway inflammation is found particularly in patients with severe asthma
  • Patchy airways = uneven narrowing of airways
59
Q

Airway inflammation in asthma is predominantly in…

A

Bronchi (cartilaginous airways)

60
Q

PHYSIOLOGIC ABNORMALITY IN ASTHMA

A 
AIRWAY HYPERRESPONSIVENESS (AHR)
-Correlated with variable airflow Obstruction

Some patients with severe asthma show a neutrophilic pattern of inflammation that is less sensitive to corticosteroids

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