Week 3: Upper airway correlations: asthma and sleep apnea

Question 1

Aspirin exacerbated respiratory disease (AERD) and Samter’s traid

Answer 1

• Samter’s Triad: asthma, aspirin sensitivity, nasal polyposis
• AERD symptoms: nasal obstruction from polyps, allergic rhinitis, sneezing, chronic congestion, flushing of head and neck
• occurs within 1 hour of ingestion of NSAID, or certain food coloring

Question 2

Mechanism of AERD

Answer 2

-NSAID blockage of COX results in increased production of leukotrienes, leading to bronchoconstriction

Question 3

Multiple symptom asthma

Answer 3

• allergic rhinitis, chronic rhinosinusitis (patients tend to have chronic nasal symptoms and blockage)
• defined as patient with diagnosis of asthma, on chronic asthma medication, suffers from attacks of dyspnea, at least one of the following: recurrent wheezes, dyspnea at night, dyspnea with exertion and dyspnea in the cold
• multi-symptom asthma was more likely to be found in patient with more severe attachs fo asthma, especially those that had awakenings in the night

Question 4

Allergic rhinitis

Answer 4

• immune based, requires trigger
• itchy nose with nasal congestion, repetitive sneezing, clear watery rhinorrhea, irritated eyes with tearing and redness
• irritation of the throat, post nasal drip, cough

Question 5

Mechanisms of worsening asthma control

Answer 5

1. Obstruction of upper airway
   -congenital: choanal atresia-back of nasal passage blocked by tissue
   -deviation of nasal septum: creates turbulent air flow, blocks maxillary sinus opening into nasal passages
   -oral cavity: retrognathic mandible (small chin), macroglossia, tonsil and adenoid hypertrophy
2. Neuromechanical reflex bronchoconstriction
   -irritation at laryngeal mucosa results in increased lung resistance distally
   -afferent: superior laryngeal nerve
   -efferent: vagus nerve (M3 receptor on SM-bronchocontriction)
3. GERD
   ~60% of patients with OSA have GERD
   -increased trans-diaphragmatic pressure and decreased intrathoracic pressure during apnea spells increases amount of reflux
   -acid in mid esophagus with asthma is associated with increased airway resistance

Question 6

AHI index (apnea hypopnea index)

Answer 6

-hypopnea is reduced air flow, apnea is cessation of breathing
-AHI=(apneas+hyponeas)/sleep time x 60
AHI>30 serious severe sleep apnea
15-30 moderate sleep apnea
<5 normal

Question 7

allergic fungal sinusitis (AFS)

Answer 7

• fungal disease in patients who have competent immune systems
• allergic reaction to aerosolized environmental fungi

Question 8

chronic rhinosinusitis

Answer 8

• inflammation of mucosa of nose and paranasal sinuses of at least 12 weeks.
• characterized by having 2 of following: nasal congestion, mucus discharge from nose or post-nasal drip, decreased sense of smell, facial pain