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Week 210 - Asthma Flashcards

1
Q

Week 210 - Asthma: Give a definition of asthma.

A

• Chronic inflammatory disorder of the airways, characterised by airway hyper-sensitivity, with airway obstruction that is reversible, either with medication or spontaneously.

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2
Q

Week 210 - Asthma: What is the pathophysiology behind asthma?

A
  • Bronchial hyperreactivity, (in response to allergen) producing bronchial spasm.
  • Bronchial inflammation (eosinophilic)
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3
Q

Week 210 - Asthma: What are the symptoms of asthma?

A
  • Wheeze
  • Breathlessness
  • Cough
  • Chest tightness
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4
Q

Week 210 - Asthma: What are the signs of a severe asthma attack?

A
  • Tachycardia.
  • Hyperexpanded chest.
  • Severe dyspnoea with wheezing.
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5
Q

Week 210 - Asthma: What is the pattern of an obstructive airway disease on a spirometry? (FEV1, FVC, FEV1:FVC, PEFR)

A

FV1 - Reduced
FVC - Normal
FEV1:FVC - <70%
PEFR - Reduced

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6
Q

Week 210 - Asthma: What are the two main types of asthma, give an example of each.

A
  • Extrinsic - IgE mediated - Atopic, occupational.

* Intrinsic - Non-immune - Infection, cold, exercise, stress, irritants.

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7
Q

Week 210 - Asthma: Asthma which is responsive to specific allergens is which type?

A

• Extrinsic.

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8
Q

Week 210 - Asthma: What are the four classifications of asthma?

A
  • Stage 1 - Intermittent
  • Stage 2 - Mild persistent
  • Stage 3 - Moderate persistent
  • Stage 4 - Severe persistent
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9
Q

Week 210 - Asthma: Describe intermittent asthma in terms of symptoms, night-time symptoms and PEF:FEV1.

A
  • Symptoms - <1 time/week, asymptomatic between attacks.
  • Night-time - ≤2 times/month.
  • PEF:FEV1 - ≥80% predicted.
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10
Q

Week 210 - Asthma: Describe mild persistent asthma in terms of symptoms, night-time symptoms and PEF:FEV1.

A
  • Symptoms - ≥1/week but 2 times/month.

* PEF:FEV1 - ≥80% predicted.

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11
Q

Week 210 - Asthma: Describe moderate persistent asthma in terms of symptoms, night-time symptoms and PEF:FEV1.

A
  • Symptoms - Daily, use of B2-agonist daily, attacks effect activity.
  • Night-time symptoms - >1/week
  • PEF:FEV1 - >60% - <80%
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12
Q

Week 210 - Asthma: Describe severe persistent asthma in terms of symptoms, night-time symptoms and PEF:FEV1.

A
  • Symptoms - Continuous, limited physical activity.
  • Night-time symptoms - Frequent
  • PEF:FEV1 - <60%

(Only need one of these for the asthma to be classed as severe.)

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13
Q

Week 210 - Asthma: What is the primary prophylaxis of asthma?

A
  • Breastfeeding may be beneficial.

* Avoid smoking during pregnancy.

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14
Q

Week 210 - Asthma: What is the secondary prophylaxis of asthma?

A
  • Aeroallergen avoidance.

* Weight loss, in obese patients, to improve control.

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15
Q

Week 210 - Asthma: What are the two main medicine groups for pharmacological management of asthma?

A
  • Bronchodilators

* Anti-inflammatories.

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16
Q

Week 210 - Asthma: Give the types of bronchodilators and examples for each.

A
  • SABAs - Short-acting Beta2-agonists - Salbutamol, ventolin.
  • LABAs - Long-acting Beta2-agonists
  • Aminophylline
  • Magnesium (Severe acute asthma)
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17
Q

Week 210 - Asthma: Give examples of anti-inflammatories used in the treatment of asthma.

A
  • Inhaled corticosteroids.

* Leukotriene antagonists.

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18
Q

Week 210 - Asthma: Aside from a B2-agonist inhaler for prn, what medication should be added to those suffering from mild asthma?

A

• Low-dose inhaled corticosteroid.

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19
Q

Week 210 - Asthma: Aside from a B2-agonist inhaler for prn, what medication should be added to those suffering from moderate asthma?

A
  • Low-medium dose inhaled corticosteroid.

* LABA

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20
Q

Week 210 - Asthma: Aside from a B2-agonist inhaler for prn, what medication should be added to those suffering from severe asthma?

A 
• High dose inhaled corticosteroid.
• LABA
• If needed;
- Theophylline
- Leukotriene antagonist
- Oral corticosteroid
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21
Q

Week 210 - Asthma: What is the general population of asthma for intrinsic and extrinsic types?

A
  • Intrinsic - Typically occurs in later life.

* Extrinsic - The most common type of asthma in children and young adults.

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22
Q

Week 210 - Asthma: What is atopy?

A

• A genetic predisposition towards the development of immediate hypersensitivity towards common environmental allergens.

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23
Q

Week 210 - Asthma: What are the environmental risk factors for developing/antagonising asthma?

A
  • Smoking
  • Occupational
  • Polution
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24
Q

Week 210 - Asthma: CD4+ are which kind of cells?

A

• T-helper cells.

25
Q

Week 210 - Asthma: What is the difference between Th1 and Th2 cells?

A

• They differ based on the cytokines they produce.
• In terms of asthma;
- Th1 - non-atopic
- Th2 - pro-atopic, pro-asthma

26
Q

Week 210 - Asthma: Th1 cells are non-atopic, which cytokines do they produce?

A
  • IFN Gamma
  • IL2
  • IL10
  • TNF Alpha/beta
27
Q

Week 210 - Asthma: Th1 cells are pro-atopic, which cytokines do they produce?

A
  • IL3,4,5,6,13

* GM-CSF

28
Q

Week 210 - Asthma: Th2 cells are part of the hypersensitivity response in atopic-asthma. What are the three pathways they produce and which cytokines mediate each?

A
  • Activation of plasma cells > IgE - IL-13, 1L-4.
  • Recruitment of mast cells - IL-4, IL-5.
  • Recruitment of Eosinophils - IL-3, IL-6, GM-CSF
29
Q

Week 210 - Asthma: What are the major products of eosinophils?

A
  • Major basic protein - Epithelial damage, loss of tight junctions.
  • Eosinophil cation protein - Epithelial shredding.
  • Leukotriene - Smooth muscle contraction.
  • Cytokines
30
Q

Week 210 - Asthma: What the sensitivity mediators released by mast cells and what physiological effect do they have? (5)

A
  • Histmine - Bronchoconstriction, microvascular leakage, mucus secretion.
  • Prostaglandins - Bronchoconstriction
  • Leukotrienes - Bronchoconstriction
  • IL4/IL4 - Ig subclass switching in B-cells.
  • IL5 - Eosinophilic differentiation.
31
Q

Week 210 - Asthma: IgE production is stimulated by which cytokines?

A

IL-4, IL-13

32
Q

Week 210 - Asthma: Aside from eosinophils, plasma cells and mast cells, which other cells play an important role in hypersensitivity? Give a brief description for each. (3)

A
  • Dendritic cells - Found in respiratory epithelium, present antigen on MHCII class complexes to Th2 cells.
  • Epithelial cells - secrete inflammatory mediators (TSLP) which recruits dendritic cells.
  • Macrophages - Also able to express IgE, and can promote cytokines.
33
Q

Week 210 - Asthma: What occurs pathologically during the early phase response and late phase response of an asthmatic response?

A

• Early Phase;

  • IgE cross linking on mast cells.
  • Degranulation.
  • Bronchodilation within minutes.

• Late phase;

  • Influx of basophils, eosinophils, T-cells, lymphocytes, macrophages, dendritic cells.
  • Inflammation, further bronchoconstriction, epithelial damage.
34
Q

Week 210 - Asthma: What mediators are released by mast cells, immediately, minutes and hours in response to an allergen?

A
  • Immediate - Histamine, TNF-alpha, Heparin, Proteases.
  • Minutes - Leukotriene, protaglandins.
  • Hours - Cytokines (IL-4, IL-13) (leading to eosinophil recruitment)
35
Q

Week 210 - Asthma: What are the two actions of salbutamol?

A
  • Beta-2 agonist, promotes smooth muscle relaxation.

* Stabilises mast cells.

36
Q

Week 210 - Asthma: Omalizumab?

A

• Anti-IgE antibody.

37
Q

Week 210 - Asthma: What is Mepoluzimab?

A
  • Mono-clonal antibody for IL-5.

* Helps to reduce asthma symptoms by reducing eosinophil recruitment.

38
Q

Week 210 - Asthma: How can aspirin aggravate asthma?

A

• Inhibits cox-2, which has a role in the production of broncho-dilatory prostaglandins.

39
Q

Week 210 - Asthma: What is bronchiolitis?

A
  • Most common LRTI in infancy.
  • Viral infection during winter months, most commonly Respiratory Syncytial Virus.
  • Necrosis of the ciliated cells.
  • Leading to bronchiolar obstruction and hyperinflation.
40
Q

Week 210 - Asthma: What are the signs and symptoms of bronchiolitis?

A
  • Respiratory distress; tachypnoea, grunting, subcostal+intercostal recession, palpable liver edge, tracheal tug, nasal flaring.
  • Widespread fine crepitations.
  • Prolonged expiratory phase with wheezing.
  • Hypoxia
  • Fever in most.
41
Q

Week 210 - Asthma: An infant (<1) presents to clinic with a chronic cough +/- wheeze. What is the most likely clinical diagnosis?

A
  • Viral - Bronchioloitis, Recurrent URTI.
  • GORD
  • Transient-early wheeze.
42
Q

Week 210 - Asthma: A preschool child presents to clinic with chronic cough +/- wheeze. What is the most likely diagnosis?

A
  • Transient-early wheeze.
  • Recurrent viral URTIs
  • Asthma
  • Inhaled foreign body
  • Passive smoking
43
Q

Week 210 - Asthma: A schoolage/teenage child presents to clinic with chronic cough +/- wheeze. What is the most likely diagnosis?

A
  • Asthma

* Recurrent viral hepatitis

44
Q

Week 210 - Asthma: What asthma devices should be used in a preschool child?

A

• Metered-dose inhaler and spacer.

45
Q

Week 210 - Asthma: What asthma devices should be used for 6-12 years old?

A
  • Bronchodilator - MDI + spacer, Dry powder, breath accentuated.
  • Steroids - MDI + large spacer.
46
Q

Week 210 - Asthma: What is the main short term symptom of inhaled steroids?

A

• Candida

47
Q

Week 210 - Asthma: Give some examples of B2-agonists and describe their method of action.

A
  • Salbultamol, Terbutaline.
  • Increases cAMP resulting in bronchial smooth muscle relaxation.
  • Also inhibits release of inflammatory mediators and increases mucus clearance.
48
Q

Week 210 - Asthma: What is the mechanism of action of corticosteroids in the treatment of asthma?

A

• Reduces the amount of inflammatory cells and reduces vascular permeability.

49
Q

Week 210 - Asthma: What are the side effects of prolonged use of systemic corticosteroids?

A
  • Osteoporosis.
  • Increased susceptibility to infection.
  • Tendancy to hyperglycaemia
  • Easy bruising
  • Weight gain
  • Growth retardation
  • Mood changes
50
Q

Week 210 - Asthma: Give examples of inhaled corticosteroids and give the colour for the pump of each.

A
  • Beclometasone - Brown
  • Fluticasone - Red
  • Budesonide - Brown
51
Q

Week 210 - Asthma: How to SABAs last longer? Give examples.

A
  • There is a lipid side-chain, which prolongs the action of the Beta-2 receptor.
  • Salmeterol
  • Formoterol
52
Q

Week 210 - Asthma: Combination inhalers contain which two types of drug? What is the purpose of giving them combined?

A
  • LABA and a corticosteroid (E.g. Symbicort - Budesonide - formoterol.)
  • Guarantees that steroid is taken with LABA.
53
Q

Week 210 - Asthma: What is the symbicort smart regime?

A

Symbicort (Budesonide and Formoterol) for both prevention and relief.

54
Q

Week 210 - Asthma: What is the mechanism of action of leukotriene receptor antagonists?

A
  • Reduces bronchoconstriction.
  • Reduces eosinophils and basophils influx.
  • Reduces mucus and microvascular leakage.
55
Q

Week 210 - Asthma: Give some examples of Leukotriene receptor antagonists. What are the side effects?

A
  • Montelukast, Zafirlukast

* GI disturbances and headache.

56
Q

Week 210 - Asthma: What is the mechanism of action for Xanthines in the treatment of asthma. Give examples.

A
  • Inhibits the action of phosphodiesterase which prevents the conversion of cAMP into AMP, which aids bronchodilation.
  • Theophylline, aminophylline
57
Q

Week 210 - Asthma: What are the side-effects of theophylline?

A
  • Nausea and vomitting
  • Tachycardia
  • Convulsions
  • Coma
58
Q

Week 210 - Asthma: Name 3 conditions and 2 drugs that increase the half-life of theophylline.

A
  • Hepatic cirrhosis.
  • CHF
  • Acute pulmonary oedema.
  • Erythromycin
  • Fluconazole

Revision Cards (61 decks)

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